Menopause: Estrogen Therapy
Estrogen Therapy
Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women. Many kinds of estrogen therapy are available in the United States and Canada to treat menopause-related symptoms. A variety of estrogen types, delivery systems, and dosage strengths give each woman a better chance to find which option is best for her. Less-expensive generic products are available for some estrogen types. In special cases, estrogen therapies can be custom-made by a compounding pharmacist following a healthcare provider’s prescription. Remember, finding the right regimen may require time, patience, and trying different prescriptions.
Estrogen therapy is available in two main dosage forms—systemic and local.
Systemic dosage form.
When used orally (tablet), through the skin (patch, gel, or emulsion), or as an injection, estrogen circulates throughout the bloodstream and to all parts of the body, affecting many different tissues. Almost all of the systemic forms have the potential to provide the full range of benefits and risks associated with ET. The one exception is the ultralow-dose estradiol skin patch (Menostar); it is FDA approved only for osteoporosis prevention in postmenopausal women. Women with a uterus who use systemic ET typically use another hormone (progestogen) to protect the uterus from endometrial cancer.
Local (nonsystemic) dosage form.
Most current vaginal estrogen products (cream, ring, or tablet) are considered “local” therapy (affecting only a specific or localized area of the body). With a lowdose local form, only a very small amount of estrogen circulates through the body and the bloodstream. Therefore, these vaginal ET products do not relieve hot flashes or lower osteoporosis risk. The estradiol acetate ring (Femring), a vaginal form that is strong enough to be systemic, is an exception; it is approved in the United
States for treating hot flashes as well as vaginal atrophy. It is not clear whether lower dose local ET regimens increase the risk for endometrial cancer. However, with higher doses of local ET, enough estrogen may get into the blood to possibly harm the uterus. Thus, adding progestogen is sometimes recommended.
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