Estradiol Dosage

Medically reviewed on February 16, 2019.

Usual Adult Dose for Postmenopausal Symptoms

Depo-estradiol (estradiol cypionate) for injection:
Usual dose: 1 to 5 mg intramuscularly every 3 to 4 weeks

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks

Oral tablets:
Initial dose: 1 to 2 mg orally once a day
-Administration should be cyclic (e.g. 3 weeks on, 1 week off)

Topical gel: 1 pump of gel once a day, applied as a thin layer

Topical spray:
Initial dose: 1 spray once a day, to the inner surface of the forearm, starting near the elbow
Maintenance dose: 1 to 3 sprays once a day to adjacent, non-overlapping areas on the inner surface of the forearm
-Application site should not be washed for at least 1 hour

Transdermal film: 1 film, applied twice weekly

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Vaginal insert:
Initial dose: 10 mcg; 1 insert intravaginally daily for 2 weeks, followed by 1 insert twice weekly (e.g. Tuesday and Friday)


Comments:
-When prescribed for a woman with a uterus, consider adding a progestin to reduce endometrial cancer risk.
-Women without uteruses generally do not need a progestin, but those with a history of endometriosis may need a progestin.
-Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.
-Attempt to discontinue or taper at 3 to 6 month intervals.

Usual Adult Dose for Atrophic Urethritis

Depo-estradiol (estradiol cypionate) for injection:
Usual dose: 1 to 5 mg intramuscularly every 3 to 4 weeks
-Attempt to discontinue or taper at 3 to 6 month intervals

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks
-Attempt to discontinue or taper at 3 to 6 month intervals

Oral tablets:
Initial dose: 1 to 2 mg orally once a day
-Administration should be cyclic (e.g. 3 weeks on, 1 week off)

Topical gel: 1.25 grams of gel once a day, applied as a thin layer over the entire arm, inside and outside, from wrist to shoulder

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Vaginal cream:
Initial dose: 2 to 4 grams intravaginally once a day for 2 weeks, then reduce dose by half for a similar period.
Maintenance dose: 1 gram, three times a week - use after restoration of vaginal mucosa has been achieved

Vaginal tablets and inserts:
Initial dose: 10 mcg
-1 tablet/insert intravaginally once a day for 2 weeks, followed by 1 tablet/insert twice weekly (e.g. Tuesday and Friday)

Vaginal ring:
Initial dose: 0.05 mg/day ring, intravaginally; change every 90 days


Comments:
-Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Usual Adult Dose for Atrophic Vaginitis

Depo-estradiol (estradiol cypionate) for injection:
Usual dose: 1 to 5 mg intramuscularly every 3 to 4 weeks
-Attempt to discontinue or taper at 3 to 6 month intervals

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks
-Attempt to discontinue or taper at 3 to 6 month intervals

Oral tablets:
Initial dose: 1 to 2 mg orally once a day
-Administration should be cyclic (e.g. 3 weeks on, 1 week off)

Topical gel: 1.25 grams of gel once a day, applied as a thin layer over the entire arm, inside and outside, from wrist to shoulder

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Vaginal cream:
Initial dose: 2 to 4 grams intravaginally once a day for 2 weeks, then reduce dose by half for a similar period.
Maintenance dose: 1 gram, three times a week - use after restoration of vaginal mucosa has been achieved

Vaginal tablets and inserts:
Initial dose: 10 mcg
-1 tablet/insert intravaginally once a day for 2 weeks, followed by 1 tablet/insert twice weekly (e.g. Tuesday and Friday)

Vaginal ring:
Initial dose: 0.05 mg/day ring, intravaginally; change every 90 days


Comments:
-Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Usual Adult Dose for Hypoestrogenism

Depo-estradiol (estradiol cypionate) for injection:
Usual dose: 1.5 to 2 mg intramuscularly every 4 weeks

Oral tablets:
Initial dose: 1 to 2 mg orally once a day

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks

Comments:
-Adjust dose as needed to control symptoms.

Uses: 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

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Usual Adult Dose for Primary Ovarian Failure

Oral tablets:
Initial dose: 1 to 2 mg orally once a day

Injectable estradiol valerate:
Usual dose: 10 to 20 mg intramuscularly every 4 weeks

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Usual Adult Dose for Breast Cancer-Palliative

Oral tablets: 10 mg orally 3 times a day for at least 3 months

Usual Adult Dose for Osteoporosis

Transdermal film: 1 film, applied twice weekly

Transdermal patches: 1 patch, applied weekly
-Some patches are applied twice a week: the manufacturer product information should be consulted.

Oral tablets - lowest effective dose has not been determined


Comments:
-If using solely for postmenopausal osteoporosis prevention, use only for significant risk when non-estrogen medications are not appropriate.

Usual Adult Dose for Prostate Cancer

Oral tablets: 1 to 2 mg orally 3 times a day

Injectable estradiol valerate:
Usual dose: 30 mg or more intramuscularly every 1 to 2 weeks


Comments:
-For palliation only.
-Effectiveness of therapy can be judged by phosphatase determinations and symptomatic improvement.

Use: Palliation of advanced androgen-dependent prostate carcinoma

Renal Dose Adjustments

Data not available
-Carefully observe patients with renal impairment.

Liver Dose Adjustments

Contraindicated

Precautions

US BOXED WARNING(S):
CARDIOVASCULAR DISORDERS, BREAST CANCER, ENDOMETRIAL CANCER, AND PROBABLE DEMENTIA
Estrogen Plus Progestin Therapy:
--Cardiovascular Disorders and Probable Dementia
-Estrogen plus progestin therapy should not be used for prevention of cardiovascular disease or dementia.
-The Women's Health Initiative (WHI) estrogen plus progestin substudy reported an increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and myocardial infarction (MI) in postmenopausal women (50 to 79 years old) taking conjugated estrogens (CE) (0.625 mg) combined with medroxyprogesterone acetate (MPA) (2.5 mg) for 5.6 years, compared to placebo.
-The WHI Memory Study (WHIMS) estrogen plus progestin ancillary study reported an increase of developing probable dementia in postmenopausal women over 65 years old treated with daily CE (0.625 mg) with MPA (2.5 mg) compared 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.
-Lacking comparable data, assume the risk is similar for other doses of CE and MPA doses, and other combinations and dosage forms of estrogens and progestins.

Estrogen Alone Therapy:
--Endometrial Cancer
-Endometrial cancer risk is increased in a woman with a uterus using unopposed estrogens.
-Adding a progestin to estrogen therapy reduces the risk of endometrial hyperplasia, which may be an endometrial cancer precursor.
-Perform diagnostic measures, including directed or random endometrial sampling when indicated, to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding.

--Cardiovascular Disorders and Probable Dementia
-Estrogen alone therapy should not be used for prevention of cardiovascular disease or dementia.
-The WHI estrogen-alone ancillary study reported increased risks of stroke and DVT in postmenopausal women (50 to 79 years old) taking daily CE (0.625 mg) for 7.1 years, relative to placebo.
-The WHIMS estrogen-alone ancillary study reported an increased risk of probable dementia in postmenopausal women over 65 taking daily CE (0.625 mg) for 5.2 years, relative to placebo; it is unknown if this applies to younger postmenopausal women.
-Lacking comparable data, assume the risk is similar for other doses and dosage forms of estrogens.

Recommendation:
-Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Further information

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

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