Conjugated Estrogens Dosage

Usual Adult Dose for Osteoporosis

0.3 mg to 1.25 mg orally once a day.

Long-term therapy (for more than 5 years) is generally necessary in order to obtain substantive benefits in reducing the risk of bone fracture. Maximal benefits are obtained if estrogen therapy is initiated as soon after menopause as possible. The optimal duration of therapy has not been definitively determined.

In addition to hormonal therapy, adequate calcium intake is important for postmenopausal women who require treatment or prevention of osteoporosis. The average diet of older American women contains 400 to 600 mg of calcium per day. 1500 mg per day has been suggested as optimal intake. If dietary intake is insufficient to achieve 1500 mg per day, dietary supplementation may be useful in women who have no contraindication to calcium supplementation.

When used solely for the prevention of postmenopausal osteoporosis, approved non-estrogen treatments should carefully be considered, and estrogen and combined estrogen-progestin products should only be considered for women with significant risk of osteoporosis that outweighs the risks of the drug.

Usual Adult Dose for Postmenopausal Symptoms

0.3 mg to 1.25 mg orally once a day.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms should be limited. Treatment for one to five years is generally sufficient. However, long-term therapy (for the treatment/prophylaxis of osteoporosis and for risk reduction of cardiovascular disease) may be considered during the time in which the patient is being treated for postmenopausal symptoms.

Because of the potential increased risks of cardiovascular events, breast cancer and venous thromboembolic events, use should be limited to the shortest duration consistent with treatment goals and risks for the individual woman, and should be periodically reevaluated. When used solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.

Usual Adult Dose for Atrophic Urethritis

1/2 to 1 applicatorful (2 to 4 g) vaginally once a day.

-or-

0.3 mg to 1.25 mg orally once a day.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms like atrophic vaginitis, kraurosis vulvae, or atrophic urethritis should be limited. Treatment for one to five years is generally sufficient.

Long-term therapy with conjugated estrogen vaginal cream is not recommended. Attempts to discontinue or taper use should be made at three to six month intervals. Conjugated estrogens administered by vaginal application are systemically absorbed (although systemic absorption is variable and unreliable). For the treatment of atrophic vaginitis/urethritis, vaginal creams offer no advantage over oral formulations of conjugated estrogens but the potentially favorable systemic effects of oral therapy are less reliably obtained.

Because of the potential increased risks of cardiovascular events, breast cancer and venous thromboembolic events, use should be limited to the shortest duration consistent with treatment goals and risks for the individual woman, and should be periodically reevaluated. When used solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.

Usual Adult Dose for Atrophic Vaginitis

1/2 to 1 applicatorful (2 to 4 g) vaginally once a day.

-or-

0.3 mg to 1.25 mg orally once a day.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms like atrophic vaginitis, kraurosis vulvae, or atrophic urethritis should be limited. Treatment for one to five years is generally sufficient.

Long-term therapy with conjugated estrogen vaginal cream is not recommended. Attempts to discontinue or taper use should be made at three to six month intervals. Conjugated estrogens administered by vaginal application are systemically absorbed (although systemic absorption is variable and unreliable). For the treatment of atrophic vaginitis/urethritis, vaginal creams offer no advantage over oral formulations of conjugated estrogens but the potentially favorable systemic effects of oral therapy are less reliably obtained.

Because of the potential increased risks of cardiovascular events, breast cancer and venous thromboembolic events, use should be limited to the shortest duration consistent with treatment goals and risks for the individual woman, and should be periodically reevaluated. When used solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.

Usual Adult Dose for Hypoestrogenism

2.5 to 7.5 mg orally once a day repeated for 20 days, then off 10 days until menses occur.

Conjugated estrogens (and other exogenous estrogens) have been used for the treatment of hypoestrogenism due to ovarian disease or hypogonadotropic hypogonadism in young women who require development and maintenance of female secondary sexual characteristics. Treatment is usually initiated at the expected time of puberty and may continue for prolonged periods. Often a progestin, like medroxyprogesterone acetate, is added on the last several days of the monthly treatment.

Usual Adult Dose for Abnormal Uterine Bleeding

5 to 25 mg IM or IV every 6 to 12 hours until bleeding stops.

Usual Adult Dose for Prostate Cancer

1.25 to 2..5 mg orally 3 times a day.

Conjugated estrogen therapy for prostate cancer should only be considered for palliation in the treatment of metastatic disease in select patients.

Usual Adult Dose for Oophorectomy

0.3 mg to 1.25 mg orally once a day.

Usual Adult Dose for Primary Ovarian Failure

0.3 mg to 1.25 mg orally once a day.

Usual Adult Dose for Breast Cancer-Palliative

10 mg three times a day for at least three months. Conjugated estrogen therapy for breast cancer should only be considered for palliation in the treatment of metastatic disease in select patients.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Hepatic metabolism of conjugated estrogens may be impaired in patients with liver disease.

Dialysis

Data not available

Other Comments

Often conjugated estrogens can be administered cyclically (3 weeks on and 1 week off) for all indications except some forms of carcinoma. Progestins given for 10 to 14 days of a cycle may commonly be ordered in conjunction.

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