Estradiol Dosage

Medically reviewed by Drugs.com. Last updated on Dec 19, 2024.

Usual Adult Dose for Postmenopausal Symptoms

ORAL TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms
• Administration should be cyclic (e.g., 3 weeks on, 1 week off)

TRANSDERMAL:
Transdermal Patch TWICE-weekly (Vivelle-Dot, Minivelle, Alora, Dotti, Lyllana):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

Transdermal 0.1% Gel Packets (Divigel):

• Initial dose: Apply 0.25 mg estradiol 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)
• Maximum dose: 1.25 mg estradiol/day

Transdermal Metered-Dose Pump

• Initial dose (Elestrin): Apply 1 pump (0.52 mg estradiol) topically to upper arm once a day; dose adjustments can be made based on clinical response
• Recommended dose (Estrogel): Apply 1 pump (0.75 mg estradiol) topically once a day to arm

Transdermal Spray:

• Initial dose (Evamist): Apply 1 spray (1.53 mg) topically to the forearm once a day in the morning; adjust dose based on clinical response
• Maintenance dose: 1 to 3 sprays topically once a day

VAGINAL RING:

• Initial dose (Femring): Insert 1 ring intravaginally once every 90 days
• 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).
• 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 (e.g., every 3 to 6 months) 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

ORAL TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms
• Administration should be cyclic (e.g., 3 weeks on, 1 week off)

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-dot, Alora, Dotti):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

Transdermal Metered-Dose Pump

• Recommended dose (Estrogel): Apply 1 pump (0.75 mg estradiol) topically once a day to arm

VAGINAL RING:

• Initial dose (Femring): Insert 1 ring intravaginally once every 90 days
• Therapy should generally be initiated at 0.05 mg estradiol/day; adjust dose based on clinical response; a 0.1 mg/day vaginal ring is also 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 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).
• 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

ORAL TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms
• Administration should be cyclic (e.g., 3 weeks on, 1 week off)

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-dot, Alora, Dotti):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

Transdermal Metered-Dose Pump

• Recommended dose (Estrogel): Apply 1 pump (0.75 mg estradiol) topically once a day to arm

VAGINAL RING:

• Initial dose (Femring): Insert 1 ring intravaginally once every 90 days
• Therapy should generally be initiated at 0.05 mg estradiol/day; adjust dose based on clinical response; a 0.1 mg/day vaginal ring is also 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 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).
• 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 TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-Dot, Alora, Dotti):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

PARENTERAL:

• Estradiol cypionate (Depo-estradiol): 1.5 to 2 mg IM at monthly intervals for hypoestrogenism due to hypogonadism only
• 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.

Uses: For the treatment of female hypoestrogenism due to hypogonadism, castration, or primary ovarian failure

Usual Adult Dose for Oophorectomy

ORAL TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-Dot, Alora, Dotti):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

PARENTERAL:

• Estradiol cypionate (Depo-estradiol): 1.5 to 2 mg IM at monthly intervals for hypoestrogenism due to hypogonadism only
• 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.

Uses: For the treatment of female hypoestrogenism due to hypogonadism, castration, or primary ovarian failure

Usual Adult Dose for Primary Ovarian Failure

ORAL TABLETS:
Initial dose: 1 to 2 mg orally once a day

• Adjust dose as necessary to control symptoms

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-Dot, Alora, Dotti):

• Initial dose: 0.0375 or 0.05 mg/24 hours applied topically twice a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly (Climara):

• Initial dose: 0.025 mg/24 hours applied topically once a week; adjust dose based on clinical response
• Maintenance dose: 0.025 to 0.1 mg/24 hours applied topically once a week

PARENTERAL:

• Estradiol cypionate (Depo-estradiol): 1.5 to 2 mg IM at monthly intervals for hypoestrogenism due to hypogonadism only
• 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.

Uses: For the treatment of female hypoestrogenism due to hypogonadism, castration, or 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 Prevention of Osteoporosis

ORAL TABLETS: At least 0.5 orally once a day

• Use lowest effective dose; however, the lowest effective dose has not been determined.

TRANSDERMAL:
Transdermal Film/Patch TWICE-weekly (Vivelle-Dot, Minivelle, Alora, Dotti, Lyllana):

• Initial dose: 0.025 mg/24 hours applied topically twice a week

Transdermal Film/Patch ONCE-weekly:

• Climara: Initial dose: 0.025 mg/24 hours applied topically once a week
• Menostar: Initial dose: 0.014 mg/24 hours applied topically once a week

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).
• 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.
• According to some manufacturers, perform, bone mineral density measurements to assess efficacy and adjust dose as necessary. No studies have been conducted using an intermittent regimen.

Use: For the prevention of postmenopausal 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 or 2 weeks

Use: For the treatment (palliation only) of advanced androgen-dependent prostate carcinoma

Renal Dose Adjustments

Use with caution in patients with renal dysfunction; 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:
Estrogen-Alone Therapy:

• ENDOMETRIAL CANCER: There is an increased risk of endometrial cancer in woman with a uterus using unopposed estrogens; adding a progestin has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Diagnostic measures, including directed or random endometrial sampling should be performed when indicated, to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding.
• CARDIOVASCULAR DISORDERS and PROBABLE DEMENTIA: Do not use estrogen-alone therapy for the prevention of cardiovascular disease or dementia. The Women's Health Initiative (WHI) estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis (DVT) in postmenopausal women (50 to 79 years) taking conjugated estrogen (CE; 0.625 mg/day) for 7.1 years, relative to placebo. The WHI-Memory Study (WHIMS) substudy reported an increased risk of developing probable dementia in postmenopausal women over 65 years taking CE (0.625 mg/day) for 5.2 years, relative to placebo; it is unknown if this applies to younger postmenopausal women. The only estrogen in the WHI studies was CE 0.625 mg/day. The relevance of findings to lower doses, other routes of administration, or other estrogen-alone products is unknown. Without such data, it is not possible to definitively exclude these risks or determine the extent of these risks to other products. Discuss the benefits and risks of estrogen-alone therapy with patients, taking into account their individual risk profiles.

Estrogen Plus Progestin Therapy:

• CARDIOVASCULAR DISORDERS and PROBABLE DEMENTIA: Do not use estrogen plus progestogen therapy for the prevention of cardiovascular disease or dementia. The WHI estrogen plus progestin substudy reported increased risks of stroke, DVT, pulmonary embolism (PE), and myocardial infarction (MI) in postmenopausal women (50 to 79 years) taking daily CE 0.625 mg plus medroxyprogesterone (MPA; 2.5 mg) for 5.6 years, relative to placebo. The WHIMS estrogen plus progestin substudy reported an increased risk of developing probable dementia in postmenopausal women over 65 years taking daily CE 0.625 mg plus MPA 2.5 mg for 4 years, relative to placebo; it is unknown if this applies to younger postmenopausal women.
• BREAST CANCER: The WHI estrogen plus progestin substudy reported an increased risk of invasive breast cancer. The only estrogen-progestogen studied was once daily CE 0.625 mg plus MPA 2.5 mg and therefore, the relevance of these findings regarding adverse cardiovascular events, dementia and breast cancer to lower CE plus other MPA doses, other routes of administration, or other estrogen plus progestogen products is unknown. Without such data, it is not possible to definitively exclude these risks or determine the extent of these risks for other products. Discuss the benefits and risks of estrogen plus progestogen therapy with patients, taking into account their individual risk profiles.

CONTRAINDICATIONS:

• Undiagnosed abnormal genital bleeding
• Breast cancer, or history of breast cancer (unless treated for metastatic disease/palliative therapy)
• Estrogen dependent neoplasia
• Active, or a history of DVT or PE
• Active, or a history (within past year) 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 (oral tablets)

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Due to a multitude of different products, the manufacturer product information 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
• Depo-estradiol: Short-term cyclic administration is recommended for vasomotor symptoms

TRANSDERMAL: Apply to clean, dry, unbroken skin; wash hands after application; do not apply to breasts

• Patches/Film: Apply to clean, dry area of the lower abdomen (below the umbilicus) or upper quadrant of the buttock. Replace every 3 to 4 days, rotating the application sites. Administration (of Vivelle-Dot, Dotti) should be cyclic in women with an intact uterus, or continuous in women without a uterus.
• Estrogel: Prime canister before first use (depress pump 5 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 30 minutes.

VAGINAL RING:

• Femring: Insert as deeply as possible into the upper vagina; allow to remain in place for 90 days, then remove and replace with a new ring.

Storage requirements:

• Consult the manufacturer product information.

Reconstitution/preparation techniques:

• Parenteral products: Visually inspect for particulate matter and discoloration before administration. Warm or shake the vial to redissolve any crystals.

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, and adequate diagnostic measures, such as endometrial sampling, should be undertaken to rule out malignancy for undiagnosed persistent or recurring abnormal vaginal bleeding.
• 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.
• Estradiol tablets may contain tartrazine (a synthetic colorant) which may cause allergic-type reactions, including bronchial asthma, in susceptible individuals such as those with aspirin hypersensitivity.

Monitoring:

• Endocrine: Thyroid function in women on thyroid replacement (during therapy)
• Other: Mammography (yearly during therapy, or 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.
• Patients of childbearing potential: Notify health care provider of a known/suspected pregnancy.

See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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