Converting Between Estrogen Products

The following dose comparisons of estrogen products are approximations based on average blood levels of estradiol resulting from administration of each product, as well as information from current literature on biologically equivalent doses. Ultra-low doses result in estradiol levels of <20 pg/mL (73.5 pmol/L), low doses result in estradiol levels of around 20 pg/mL, standard doses result in estradiol levels of around 30 to 40 pg/L (110 to 147 pmol/L), and high doses result in estradiol levels of more than 40 pg/mL. Blood levels of hormones are less variable for topical products than for oral products in individual patients, although there's still a lot of variability in general between patients. Guidelines and product labeling recommend using the lowest effective dose for the shortest duration of time consistent with treatment goals for postmenopausal symptoms. Estrogen therapy should always be tailored for each individual patient. Product labeling should be consulted for specific indications and doses of each product.

Product

Ultra-low Dose

Low Dose

Standard Dose

High Dose

Oral

Conjugated estrogens

Premarin

NA

0.3 mg1
0.45 mg2
(U.S. only)

0.625 mg2,9,22

0.9 mg18
(U.S. only)
1.25 mg2

Synthetic conjugated estrogens

C.E.S.
(Canada only)

NA

0.3 mg23

0.625 mg22,23

0.9 mg23
1.25 mg23

Cenestin
(U.S. only)

NA

0.3 mg19
0.45 mg19

0.625 mg19,22

0.9 mg19
1.25 mg19

Enjuvia
(U.S. only)

NA

0.3 mg20
0.45 mg20

0.625 mg20,22

0.9 mg20
1.25 mg20

PMS-Conjugated Estrogens
(Canada only)

NA

0.3 mg24

0.625 mg22,24

0.9 mg24
1.25 mg24

Esterified estrogens

Menest
(U.S. only)

NA

0.3 mg2,21

0.625 mg2,21,22

1.25 mg2,21
2.5 mg21

Estropipate

Ogen

NA

NA

0.625 mg
(0.75 mg estropipate)10,22
1.25 mg
(1.5 mg estropipate)10

2.5 mgb
(3 mg estropipate)

17beta-estradiol

Estrace

NA

0.5 mg1

1 mg10,22
2 mg2

NA

Estradiol acetate

Femtrace
(U.S. only)

NA

0.45 mg1,16

0.9 mg16,22

1.8 mg16

Topical/Transdermal Estradiol

Patches (Doses indicate patch release rate of estrogen. See product labeling for frequency of patch application.)

Alora
(U.S. only)

NA

0.025 mg/day10,11

0.05 mg/day9,11,22

0.075 mg/day10,11
0.1 mg/day10,11

Climara
(0.0375 and 0.06 mg/day are U.S. only)

NA

0.025 mg/day12,29

0.0375 mg/dayb
0.05 mg/day9,12,22,26

0.06 mg/dayb
0.075 mg/dayb,29
0.1 mg/day12,26

Estraderm

NA

0.025 mg/day27
(Canada only)

0.05 mg/day13,22,27

0.1 mg/day13,27

Estradot
(Canada only)

NA

25 mcg/day17

37.5 mcg/day17
50 mcg/day17,22

75 mcg/day17
100 mcg/day17

Menostara
(U.S. only)

14 mcg/day1

NA

NA

NA

Oesclim
(Canada only)

NA

25 mcg/day25

50 mcg/day22,25

NA

Vivelle
(U.S. only)

NA

NA

0.05 mg/day15,22

0.1 mg/day15

Vivelle-Dot
(U.S. only)

NA

0.025 mg/dayb

0.0375 mg/day14
0.05 mg/day14,22

0.075 mg/day14
0.1 mg/day14

Gels/pumps/sprays

Divigel
(U.S. only)

0.25 gm3

0.5 gm3

1 gm3

NA

Elestrin gel
(U.S. only)

1 actuation4

NA

2 actuations4

NA

Evamist spray
(U.S. only)

NA

1 spray5

2-3 sprays5

NA

EstroGel pump

NA

NA

1 actuation6

2 actuations30
4 actuations30

Estrasorb emulsion
(U.S. only)

NA

NA

NA

2 pouches7

Vaginal Estradiol (Femring is the only vaginal estrogen product with systemic effects. Vaginal products with only local effects are not included in this chart.)

Femring
(U.S. only)

NA

NA

0.05 mg/day8

0.1 mg/day8
  1. Menostar is only indicated for prevention of postmenopausal osteoporosis.28
  2. Estimated estradiol level based on the assumption of a linear relationship between dose and estradiol levels.

Project Leader in preparation of this Detail-Document: Stacy A. Hester, R.Ph., BCPS, Assistant Editor

References

  1. Reid RL, Blake J, Abramson B, et al. Menopause and osteoporosis update 2009. J Obstet and Gynaecol Can 2009;31:S1-S48.
  2. Furness S, Roberts H, Marjoribanks J, et al. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev 2009;2:CD000402.
  3. Product information for Divigel. Upsher-Smith. Minneapolis, MN 55447. June 2007.
  4. Product information for Elestrin. Kenwood Therapeutics. Fairfield, NJ 07004. December 2006.
  5. Product information for Evamist. Ther-Rx. St. Louis, MO 63044. April 2008.
  6. Product information for Estrogel. ASCEND. Herndon, VA 20170. January 2008.
  7. Product information for Estrasorb. Novavax. Columbia, MD 21046. October 2003.
  8. Product information for Femring. Warner Chilcott. Rockaway, NJ 07866. February 2007.
  9. Grady D. Clinical Practice. Management of menopausal symptoms. N Engl J Med 2006;355;2338-47.
  10. Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause 2004;11:356-67.
  11. Product information for Alora. Watson. Corona, CA 92880. May 2005.
  12. Product information for Climara. Bayer. Wayne, NJ 07470. January 2008.
  13. Product information for Estraderm. Novartis. East Hanover, NJ 07936. June 2004.
  14. Product information for Vivelle-Dot. Novartis. East Hanover, NJ 07936. June 2004.
  15. Product information for Vivelle. Novartis. East Hanover, NJ 07936. June 2004.
  16. Product information for Femtrace. Warner Chilcott. Rockaway, NJ 07866. November 2007.
  17. Product monograph for Estradot. Novartis Pharmaceuticals Canada. Dorval, Quebec H9S 1A9. February 2009.
  18. Product information for Premarin. Wyeth. Philadelphia, PA 19101. March 2008.
  19. Product information for Cenestin. Duramed. Pomona, NY 10970. September 2004.
  20. Product information for Enjuvia. Duramed. Pomona, NY 10970. April 2007.
  21. Product information for Menest. Monarch. Bristol, TN 37620. July 2004.
  22. North American Menopause Society. Menopause practice: a clinician's guide. Section G. Hormonal drugs. October 2007 (Edition 3). http://www.menopause.org/Portals/0/Content/PDF/G.pdf (Accessed May 10, 2009).
  23. eCPS [Internet]. Ottawa (ON): Canadian Pharmacists Association. c2009. C.E.S. prodcuct monograph (June 2009). http://www.e-cps.ca (Accessed October 21, 2009).
  24. Product monograph for PMS-Conjugated Estrogens. Montreal, Quebec H4P 2T4. February 2004.
  25. Product monograph for Oesclim. Triton Pharma. Concord, Ontario L4K 3T8. September 2008.
  26. roduct monograph for Climara. Bayer. Toronto, ON M9W 1G6. March 2007.
  27. Product monograph for Estraderm. Novartis Canada. Dorval, Quebec H9S 1A9. January 2009.
  28. Product monograph for Menostar. Bayer. Wayne, NJ 07470. June 2009.
  29. Personal communication. Z. Farrell. Medical and Scientific Affairs. Bayer. Toronto, ON M9W 1G6. October 20, 2009.
  30. Product monograph for EstroGel. Schering-Plough Canada. Kirkland, QC. H9H 4M7. February 2009.

Cite this Detail-Document as follows: Converting between estrogen products. Pharmacist's Letter/Prescriber's Letter 2009;25(11):251109.

November 2009

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