Estradiol Dosage
Medically reviewed by Drugs.com. Last updated on Nov 2, 2020.
Applies to the following strengths: valerate 40 mg/mL; valerate 10 mg/mL; valerate 20 mg/mL; cypionate 5 mg/mL; 0.05 mg/24 hr; 0.1 mg/24 hr; 0.025 mg/24 hours twice weekly; 0.05 mg/24 hours twice weekly; 0.075 mg/24 hours twice weekly; 0.1 mg/24 hours twice weekly; 0.52 mg/0.87 g (0.06%); 0.75 mg/1.25 g (0.06%); 0.025 mg/24 hours weekly; 0.0375 mg/24 hours twice weekly; 0.5 mg; 1 mg; 2 mg; 0.25 mg/0.25 g (0.1%); 0.5 mg/0.5 g (0.1%); 1 mg/1 g (0.1%); 0.05 mg/24 hours weekly; 0.075 mg/24 hours weekly; 0.1 mg/24 hours weekly; 0.0375 mg/24 hours weekly; 0.06 mg/24 hours weekly; 1.5 mg; acetate 0.45 mg; acetate 0.9 mg; acetate 1.8 mg; 1.53 mg/spray; benzoate; valerate; 14 mcg/24 hours weekly; hemihydrate; 0.75 mg/0.75 g (0.1%); 1.25 mg/1.25 g (0.1%)
Usual Adult Dose for:
- Postmenopausal Symptoms
- Atrophic Urethritis
- Atrophic Vaginitis
- Hypoestrogenism
- Oophorectomy
- Primary Ovarian Failure
- Breast Cancer-Palliative
- Osteoporosis
- Prostate Cancer
- Dyspareunia
Additional dosage information:
Usual Adult Dose for Postmenopausal Symptoms
ORAL:
Initial dose: 0.5 to 2 mg orally once a day
- Adjust dose as necessary to control symptoms
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Minivelle, Alora, Dotti, Lyllana): Initial dose: 0.0375 to 0.05 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
Transdermal 0.1% Gel Packets (Divigel):
Initial dose: Apply 0.25 mg topically once a day to the skin of either the right or left upper thigh
- Adjust the dose as needed (packets available as estradiol 0.25, 0.5, 0.75, 1, and 1.25 mg)
Transdermal Metered-Dose Pump
Initial dose (Elestrin): Apply 1 pump (0.52 mg) topically to upper arm once a day; dose adjustments can be made based on clinical response
Initial dose (Estrogel): Apply 1 pump (0.75 mg) topically once a day to arm; dose adjustments can be made based on clinical response
Transdermal Spray: (Evamist; 1 spray delivers 1.53 mg of estradiol):
Initial dose: 1 spray once a day in the morning to the forearm
- Adjust dose based on clinical response
VAGINAL:
Vaginal ring (Femring): 1 ring intravaginally once every 3 months
- Therapy should generally be initiated with 0.05 mg estradiol/day; adjust dose based on clinical response; a second strength delivering estradiol 0.1 mg/day is available
PARENTERAL:
- estradiol cypionate (Depo-estradiol): 1 to 5 mg IM every 3 to 4 weeks
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
Comments:
- When estrogen is prescribed for a postmenopausal woman with a uterus, a progestogen should be co-prescribed to reduce the risk of endometrial cancer; some hysterectomized women with a history of endometriosis may need a progestogen (i.e., residual endometrial implants post hysterectomy).
- See Other Comments/Administration Advice for administration instructions.
- Estrogen should be used at the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman; reevaluate periodically as clinically appropriate to determine whether treatment is still necessary.
Uses: For the treatment of moderate to severe vasomotor symptoms associated with menopause.
Usual Adult Dose for Atrophic Urethritis
VAGINAL:
Vaginal cream (Estrace): Initial dose: 2 to 4 g intravaginally once a day for 1 or 2 weeks, then gradually reduce dose by half (goal to restore vaginal mucosa)
- Maintenance dose: 1 g intravaginally 1 to 3 times a week
Vaginal inserts (Vagifem): 10 mcg intravaginally once a day for 2 weeks
- Maintenance dose: 10 mcg intravaginally twice a week
Vaginal ring (Femring, Estring): 1 ring intravaginally once every 3 months
- Therapy should generally be initiated at 0.0075 mg/day or 0.05 mg estradiol/day; adjust dose based on clinical response; a 0.1 mg/day vaginal ring is also available
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Alora): Initial dose: 0.0375 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
Transdermal Metered-Dose Pump
Initial dose (Estrogel): Apply 1 pump (0.75 mg) topically once a day to arm; dose adjustments can be made based on clinical response
ORAL:
Initial dose: 0.5 to 2 mg orally once a day
- Adjust dose as necessary to control symptoms
PARENTERAL:
- estradiol cypionate (Depo-estradiol): 1 to 5 mg IM every 3 to 4 weeks
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
Comments:
- When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, first consider topical vaginal products.
- When estrogen is prescribed for a postmenopausal woman with a uterus, a progestogen should be co-prescribed to reduce the risk of endometrial cancer; some hysterectomized women with a history of endometriosis may need a progestogen (i.e., residual endometrial implants post hysterectomy).
- See Other Comments/Administration Advice for administration instructions.
- Use estrogen at the lowest effective dose and the shortest duration consistent with treatment goals and risks for the individual woman; reevaluate periodically as clinically appropriate to determine whether treatment is still necessary.
Use: For the treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause.
Usual Adult Dose for Atrophic Vaginitis
VAGINAL:
Vaginal cream (Estrace): Initial dose: 2 to 4 g intravaginally once a day for 1 or 2 weeks, then gradually reduce dose by half (goal to restore vaginal mucosa)
- Maintenance dose: 1 g intravaginally 1 to 3 times a week
Vaginal inserts (Vagifem): 10 mcg intravaginally once a day for 2 weeks
- Maintenance dose: 10 mcg intravaginally twice a week
Vaginal ring (Femring, Estring): 1 ring intravaginally once every 3 months
- Therapy should generally be initiated at 0.0075 mg/day or 0.05 mg estradiol/day; adjust dose based on clinical response; a 0.1 mg/day vaginal ring is also available
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Alora): Initial dose: 0.0375 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
Transdermal Metered-Dose Pump
Initial dose (Estrogel): Apply 1 pump (0.75 mg) topically once a day to arm; dose adjustments can be made based on clinical response
ORAL:
Initial dose: 0.5 to 2 mg orally once a day
- Adjust dose as necessary to control symptoms
PARENTERAL:
- estradiol cypionate (Depo-estradiol): 1 to 5 mg IM every 3 to 4 weeks
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
Comments:
- When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, first consider topical vaginal products.
- When estrogen is prescribed for a postmenopausal woman with a uterus, a progestogen should be co-prescribed to reduce the risk of endometrial cancer; some hysterectomized women with a history of endometriosis may need a progestogen (i.e., residual endometrial implants post hysterectomy).
- See Other Comments/Administration Advice for administration instructions.
- Use estrogen at the lowest effective dose and the shortest duration consistent with treatment goals and risks for the individual woman; reevaluate periodically as clinically appropriate to determine whether treatment is still necessary.
Use: For the treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause.
Usual Adult Dose for Hypoestrogenism
ORAL:
Initial dose: 1 to 2 mg orally once a day
- Adjust dose to control symptoms
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Minivelle, Alora): Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
PARENTERAL:
- estradiol cypionate (Depo-estradiol): 1.5 to 2 mg IM every 4 weeks
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
Comments:
- Adjust dose as needed to control symptoms; the minimal effective dose for maintenance therapy should be determined by titration.
- See Other Comments/Administration Advice for administration instructions.
Uses: For the treatment of female hypoestrogenism due to hypogonadism, castration, or primary ovarian failure.
Usual Adult Dose for Oophorectomy
ORAL:
Initial dose: 1 to 2 mg orally once a day
- Adjust dose as necessary to control presenting symptoms
PARENTERAL:
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Minivelle, Alora): Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
Comments:
- Adjust dose as needed to control symptoms; the minimal effective dose for maintenance therapy should be determined by titration.
- See Other Comments/Administration Advice for administration instructions.
Use: For treatment of female hypoestrogenism due primary ovarian failure.
Usual Adult Dose for Primary Ovarian Failure
ORAL:
Initial dose: 1 to 2 mg orally once a day
- Adjust dose as necessary to control presenting symptoms
PARENTERAL:
- estradiol valerate (Delestrogen): 10 to 20 mg IM every 4 weeks
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Minivelle, Alora): Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week
- Adjust dose based on clinical response
ONCE-weekly (Climara): Initial dose: 0.025 mg/24 hours applied topically once a week
- Adjust dose based on clinical response
Comments:
- Adjust dose as needed to control symptoms; the minimal effective dose for maintenance therapy should be determined by titration.
- See Other Comments/Administration Advice for administration instructions.
Use: For treatment of female hypoestrogenism due primary ovarian failure.
Usual Adult Dose for Breast Cancer-Palliative
10 mg orally 3 times a day for at least 3 months
Comments:
- As a palliative treatment for breast cancer in appropriately selected women and men with metastatic disease.
Use: For treatment of breast cancer (palliation only).
Usual Adult Dose for Osteoporosis
TRANSDERMAL:
Extended-release (ER) Transdermal Film:
TWICE-weekly (Vivelle-dot, Minivelle, Alora): Initial dose: 0.025 mg/24 hours applied topically twice a week
- Adjust dose as needed
- Adjust dose as needed
ORAL: 0.5 to 2 mg orally once a day
- Use lowest effective dose; however, lowest effective dose has not been definitively determined.
Comments:
- If estrogen is being used solely for postmenopausal osteoporosis prevention, first consider the use of non-estrogen medications; consider estrogen only for women at significant risk of osteoporosis.
- When estrogen is prescribed for a postmenopausal woman with a uterus, a progestogen should be co-prescribed to reduce the risk of endometrial cancer; some hysterectomized women with a history of endometriosis may need a progestogen (i.e., residual endometrial implants post hysterectomy).
- See Other Comments/Administration Advice for administration instructions.
- Use estrogen at the lowest effective dose and the shortest duration consistent with treatment goals and risks for the individual woman; reevaluate periodically as clinically appropriate to determine whether treatment is still necessary.
Use: For the treatment of osteoporosis.
Usual Adult Dose for Prostate Cancer
ORAL: 1 to 2 mg orally 3 times a day
PARENTERAL:
estradiol valerate (Delestrogen): 30 mg or more IM every 1 to 2 weeks
Use: For the treatment (palliation only) of advanced androgen-dependent prostate carcinoma
Usual Adult Dose for Dyspareunia
Vaginal Insert:
Initial dose: 1 insert (4 mcg) intravaginally once a day for 2 weeks
Maintenance dose: 1 insert (4 or 10 mcg) intravaginally twice a week
Comments:
- Dose adjustment should be guided by clinical response. Women should generally start with the 4 mcg dose.
- When estrogen is prescribed for a postmenopausal woman with a uterus, a progestogen should be co-prescribed to reduce the risk of endometrial cancer; some hysterectomized women with a history of endometriosis may need a progestogen (i.e., residual endometrial implants post hysterectomy).
- See Other Comments/Administration Advice for administration instructions.
- Use estrogen at the lowest effective dose and the shortest duration consistent with treatment goals and risks for the individual woman; reevaluate periodically as clinically appropriate to determine whether treatment is still necessary.
Use: For the treatment of moderate to severe dyspareunia, a symptoms of vulvar and vaginal atrophy due to menopause.
Renal Dose Adjustments
Use caution; estrogens may cause some degree of fluid retention
Liver Dose Adjustments
Contraindicated in patients with hepatic impairment or disease
Precautions
US BOXED WARNINGS: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER - Prescribe estrogens, with or without progestogens, at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman:
CONTRAINDICATIONS:
- Undiagnosed abnormal genital bleeding
- Breast cancer, or history of breast cancer
- Estrogen dependent neoplasia
- Active, or a history of DVT or PE
- Active, or history of arterial thromboembolic disease (e.g. stroke or MI)
- Anaphylactic reaction or angioedema, or hypersensitivity to active substance or any of the product ingredients
- Hepatic impairment or disease
- Protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
- Pregnancy
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Use caution; dose reduction may be advisable in women with ESRD receiving hemodialysis
Other Comments
Administration advice:
- Due to number of different products, the manufacturer's product labeling should be consulted for brand specific administration instructions and storage; illustrations are often provided for further guidance
PARENTERAL: IM administration only
- Delestrogen: Administer IM only into upper, outer quadrant of the gluteal muscle
TRANSDERMAL: Apply to clean, dry, unbroken skin; wash hands after application; do not apply to breasts
- Patches: Apply to clean, dry area of the lower abdomen (below the umbilicus) or upper quadrant of the buttock
- Estrogel: Prime canister before first use (depress pump 3 times); apply a thin layer over the entire arm on the inside and outside from wrist to shoulder
- Elestrin: Prime pump before first use; apply onto skin in a thin layer; the recommended area of application is the upper arm to shoulder; allow gel to dry for at least 5 minutes before dressing; do not apply sunscreen to area for at least 25 minutes
- Divigel: Apply entire contents of unit dose packet to skin of either the right or left upper thigh; application surface area should be about 5 by 7 inches; allow to dry before dressing, do not wash site within 1 hour
- Evamist: Pump should be primed by spraying 3 sprays with the cover on; the container should be held upright and vertical for spraying; sprays are applied to adjacent, non-overlapping areas on the inner surface of the forearm, starting near the elbow; allow to dry for approximately 2 minutes before dressing; the site should not be washed for at least 1 hour
VAGINAL:
Vaginal Cream: Gently squeeze tube from bottom to expel the prescribed amount into the applicator; insert applicator deeply into vagina and press plunger downward
Vaginal Insert:
- Imvexxy: Insert with smaller end up for a depth of about 2 inches into the vaginal canal
- Estring, Femring: Insert as deeply as possible into the upper one-third of the vaginal vault; allow to remain in place for 3 months, then remove and replace with a new ring
Storage requirements:
- Consult manufacturer's product information
General:
- For women with an intact uterus, studies have shown the addition of progestin for 10 or more days of an estrogen cycle, or daily with estrogen in a continuous regimen, result in a lower incidence of endometrial hyperplasia than estrogen alone. Endometrial hyperplasia may be a precursor to endometrial cancer.
- There are possible risks associated with use of progestins and these risks should be considered.
- Estrogen therapy should be guided by goals of therapy and clinical response; the lowest effective dose should be used for the shortest duration consistent with treatment goals and risks for the individual woman. Patients should be reevaluated periodically, as clinically appropriate (e.g., 3-month to 6-month intervals) to determine if treatment is still necessary.
Monitoring:
- Monitor thyroid function in women on thyroid replacement
- Women should receive yearly mammography, with increased frequency as needed
Patient advice:
- Patients should be instructed to read the US FDA-approved patient labeling (Patient Information and Instructions for Use).
- Patients should be instructed to report vaginal bleeding to their healthcare provider as soon as possible.
- Patients should discuss with their healthcare provider the possible serious adverse reactions of therapy including cardiovascular disorders, malignant neoplasms, and possible dementia.
- For patients with an intact uterus, they should understand the benefit of concomitant progestin use.
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