Estrogen patch

Last updated
Estrogen patch
Drug class
Estrogen patch.jpg
Vivelle-Dot, an estrogen patch.
Class identifiers
Use Menopause, hypogonadism, feminizing hormone therapy, contraception, prostate cancer, others
Biological target Estrogen receptors (ERα, ERβ, mERs (e.g., GPER, others))
Legal status
In Wikidata

An estrogen patch, or oestrogen patch, is a transdermal delivery system for estrogens such as estradiol and ethinylestradiol which can be used in menopausal hormone therapy, feminizing hormone therapy for transgender women, hormonal birth control, and other uses. [1] Transdermal preparations of estrogen are metabolized differently than oral preparations. Transdermal estrogens avoid the first pass through the liver and thus potentially reduce the risk of blood clotting and stroke. [2]

Contents

An estrogen patch is applied directly to the skin, preferably near the lower abdomen, hips, or buttocks, and is usually changed once or twice per week. For women who have not undergone a hysterectomy, it is often suggested that they take progestogen in addition to an estrogen patch in order to protect the endometrium of the uterus. [1] [2] Transdermal estrogens are not recommended for all women; there are important precautions and side effects that should be considered before use. [2]

Medical uses

Available transdermal estradiol patches in the United States [3] [4] [a]
Brand nameDose
(µg/day)		DOA (d)Size [b] [c]
(cm2)		Levels
(pg/mL)		Intro.
Alora25, 50, 75, 1003–49, 18, 27, 3643–1441996
Climara [d] 25, 37.5, 50,
60, 75, 100		76.5, 9.375, 12.5,
15, 18.75, 25		17–1741994
Climara Pro [e] E2 (45)
LNG Tooltip Levonorgestrel (15)		72227–542003
CombiPatch [e] E2 (50)
NETA Tooltip Norethisterone acetate (14, 25)		3–49, 1627–711998
Menostar1473.2513–212004
Minivelle25, 37.5, 50,
75, 100		3–41.65, 2.48, 3.3,
4.95, 6.6		30–1172012
Vivelle50, 1003–414.5, 2930–1452000
Vivelle-Dot [d] 25, 37.5, 50,
75, 100		3–42.5, 3.75, 5,
7.5, 10		30–1451996
  1. ↑ Specific links for each patch's FDA approval and label are not given.
  2. ↑ For comparison, a United States quarter is about 4.6 cm2 (0.72 in2).
  3. ↑ Sizes are respective to the dosages in the dose column.
  4. 1 2 Generic version available.
  5. 1 2 Combined with a progestin.

Menopause

An estrogen patch may be recommended for women experiencing moderate to severe symptoms of menopause, such as vasomotor symptoms and vaginal atrophy. During menopause, the ovaries stop producing estrogen which causes estrogen levels to fall. The sudden change in estrogen levels may cause vasomotor symptoms, such as hot flashes. Research suggests that the estrogen patch can relieve both the frequency and severity of vasomotor symptoms by increasing estrogen levels. An estrogen patch may also be used to treat vulvar and vaginal atrophy, another symptom of menopause associated with the sudden change in estrogen levels. [1]

Hypoestrogenism

Hypoestrogenism, or estrogen deficiency, may suggest menopause is approaching for middle aged women. Other causes of hypoestrogenism are excessive exercise, restrictive diet, underactive pituitary gland, ovarian failure, Turner Syndrome, and kidney disease. Symptoms of hypoestrogenism may include pain during sex, irregular periods, mood swings, hot flashes, breast tenderness, headache, depression, fatigue, weak bones, and an increase risk of urinary tract infections. Estrogen therapies, including the use of an estrogen patch, can be used to alleviate these symptoms by increasing estrogen levels to a normal state. Premenopausal women may be recommended to take progestin with estrogen therapy. [2]

Prevention of osteoporosis

Estrogen patches may be effective in preventing osteoporosis in postmenopausal women. Research suggests that estrogen patches can significantly increases bone mineral density and reduce risks of fractures in postmenopausal women by raising estrogen levels and avoiding first-pass metabolism. [5]

There is evidence that the combination of an estrogen patch with a progestin pill can improve bone mineral density in young, premenopausal amenorrheic athletes, and may be more effective than an oral estrogen with progestin. [6]

Hormonal birth control

Contraceptive patches such as norelgestromin/ethinylestradiol are a form of estrogen patch which are used for hormonal birth control.

Feminizing hormone therapy

Estrogen patches are commonly used for feminizing hormone therapy for transgender women as part of gender-affirming care. [7]

Patches with progestogens

Sandoz Estradiol Transdermal System with oral progestin Estrogen patch with oral progestogen.jpg
Sandoz Estradiol Transdermal System with oral progestin

Taking a progestogen in addition to an estrogen patch should be considered for women who have not undergone a hysterectomy to regulate the thickness of the endometrial lining [2] and reduce the risk of endometrial cancer. Hysterectomized women rarely need a progestogen, however it may be considered if a history of endometriosis exists. [1] There are different types of delivery systems of progestogens that can be used in addition to an estrogen patch, including pills, injections, [8] and patches, among others. [9]

Research has suggested that estrogen plus progestogen therapy may increase the risk of heart attacks, stroke, breast cancer, blot clots, and dementia in postmenopausal women. Taking the lowest effective dose of both estrogen and a progestogen may reduce risks. [1]

Administration

Depending on the brand, patches are applied to the skin once or twice weekly. Patches should be placed on clean skin where hair and moisture is not present. Preferred areas of application include lower abdomen, hip, and buttocks. Patches should never be applied to the breasts. To reduce the risk of the patch detaching from the skin and skin irritation, skin care products, sun exposure, damaged skin, and tight-fitting clothing should be avoided where the patch is placed. [2]

Side effects

Headache, breast pain or tenderness, nausea, vomiting, hair loss, vaginal discharge or irritation, and mood changes are some of the common side effects that may occur while using an estrogen patch. [10] More serious side effects may include fever, loss of appetite, joint pain, difficulty breathing or swallowing, and yellowing of the skin or eyes. [10] [11]

Seeing a health professional regularly, taking progestin, having pelvic and breast exams, lowering blood pressure, and lowering cholesterol may reduce the likelihood of developing severe side effects while using an estrogen patch. [1]

Precautions

Women who have experienced vaginal bleeding post menopause, certain cancers, stroke, heart attack, blood clotting, or uncontrollable bleeding, and women who are pregnant or allergic to ingredients in estrogen patches should not use an estrogen patch as serious adverse effects may occur. [1]

Society and culture

Brand names

Estrogen patches are available in multiple brand names in different countries. Some patches are available with a progestin such as levonorgestrel, norethisterone acetate, or norelgestromin. [4] [12]

See also

Related Research Articles

<span class="mw-page-title-main">Progestogen (medication)</span> Medication producing effects similar to progesterone

A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a synthetic progestogen. Progestogens are used most commonly in hormonal birth control and menopausal hormone therapy. They can also be used in the treatment of gynecological conditions, to support fertility and pregnancy, to lower sex hormone levels for various purposes, and for other indications. Progestogens are used alone or in combination with estrogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of progestogens include natural or bioidentical progesterone as well as progestins such as medroxyprogesterone acetate and norethisterone.

Hot flashes, also known as hot flushes, are a form of flushing, often caused by the changing hormone levels that are characteristic of menopause. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to 30 minutes for each occurrence.

Bioidentical hormone replacement therapy (BHRT), also known as bioidentical hormone therapy (BHT) or natural hormone therapy, is the use of hormones that are identical on a molecular level with endogenous hormones in hormone replacement therapy. It may also be combined with blood and saliva testing of hormone levels, and the use of pharmacy compounding to obtain hormones in an effort to reach a targeted level of hormones in the body. A number of claims by some proponents of BHT have not been confirmed through scientific testing. Specific hormones used in BHT include estrone, estradiol, progesterone, testosterone, dehydroepiandrosterone (DHEA), and estriol.

<span class="mw-page-title-main">Ethinylestradiol</span> Estrogen medication

Ethinylestradiol (EE) is an estrogen medication which is used widely in birth control pills in combination with progestins. In the past, EE was widely used for various indications such as the treatment of menopausal symptoms, gynecological disorders, and certain hormone-sensitive cancers. It is usually taken by mouth but is also used as a patch and vaginal ring.

<span class="mw-page-title-main">Estradiol acetate</span> Chemical compound

Estradiol acetate (EA), sold under the brand names Femtrace, Femring, and Menoring, is an estrogen medication which is used in hormone therapy for the treatment of menopausal symptoms in women. It is taken by mouth once daily or given as a vaginal ring once every three months.

<span class="mw-page-title-main">Drospirenone</span> Medication drug

Drospirenone is a progestin and antiandrogen medication which is used in birth control pills to prevent pregnancy and in menopausal hormone therapy, among other uses. It is available both alone under the brand name Slynd and in combination with an estrogen under the brand name Yasmin among others. The medication is an analog of the drug spironolactone. Drospirenone is taken by mouth.

<span class="mw-page-title-main">Norethisterone acetate</span> Chemical compound

Norethisterone acetate (NETA), also known as norethindrone acetate and sold under the brand name Primolut-Nor among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication available in low-dose and high-dose formulations and is used alone or in combination with an estrogen. It is ingested orally.

<span class="mw-page-title-main">Norelgestromin</span> Pharmaceutical drug

Norelgestromin, or norelgestromine, sold under the brand names Evra and Ortho Evra among others, is a progestin medication which is used as a method of birth control for women. The medication is available in combination with an estrogen and is not available alone. It is used as a patch that is applied to the skin.

Hypoestrogenism, or estrogen deficiency, refers to a lower than normal level of estrogen. It is an umbrella term used to describe estrogen deficiency in various conditions. Estrogen deficiency is also associated with an increased risk of cardiovascular disease, and has been linked to diseases like urinary tract infections and osteoporosis.

Estradiol/norethisterone acetate (E2/NETA), sold under the brand name Activella among others, is a combination of estradiol (E2) and norethisterone acetate (NETA) which is used in the treatment of vasomotor symptoms, vulvar and vaginal atrophy, and osteoporosis associated with menopause. Activella specifically is marketed by Novo Nordisk and is supplied as film-coated tablets containing 1 mg estradiol and 0.5 mg norethisterone acetate. CombiPatch is a combination of estradiol and NETA provided as a transdermal patch.

Feminizing hormone therapy, also known as transfeminine hormone therapy or male-to-female (MTF) is a hormone therapy and sex reassignment therapy to change the secondary sex characteristics of transgender people from masculine or androgynous to feminine. It is a common type of transgender hormone therapy and is used to treat transgender women and non-binary transfeminine individuals. Some, in particular intersex people, but also some non-transgender people, take this form of therapy according to their personal needs and preferences.

Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. Effects of menopause can include symptoms such as hot flashes, accelerated skin aging, vaginal dryness, decreased muscle mass, and complications such as osteoporosis, sexual dysfunction, and vaginal atrophy. They are mostly caused by low levels of female sex hormones that occur during menopause.

<span class="mw-page-title-main">Trimegestone</span> Chemical compound

Trimegestone, sold under the brand names Ondeva and Totelle among others, is a progestin medication which is used in menopausal hormone therapy and in the prevention of postmenopausal osteoporosis. It was also under development for use in birth control pills to prevent pregnancy, but ultimately was not marketed for this purpose. The medication is available alone or in combination with an estrogen. It is taken by mouth.

<span class="mw-page-title-main">Nomegestrol acetate</span> Chemical compound

Nomegestrol acetate (NOMAC), sold under the brand names Lutenyl and Zoely among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. It is available both alone and in combination with an estrogen. NOMAC is taken by mouth. A birth control implant for placement under the skin was also developed but ultimately was not marketed.

<span class="mw-page-title-main">Conjugated estrogens</span> Estrogen medication

Conjugated estrogens (CEs), or conjugated equine estrogens (CEEs), sold under the brand name Premarin among others, is an estrogen medication which is used in menopausal hormone therapy and for various other indications. It is a mixture of the sodium salts of estrogen conjugates found in horses, such as estrone sulfate and equilin sulfate. CEEs are available in the form of both natural preparations manufactured from the urine of pregnant mares and fully synthetic replications of the natural preparations. They are formulated both alone and in combination with progestins such as medroxyprogesterone acetate. CEEs are usually taken by mouth, but can also be given by application to the skin or vagina as a cream or by injection into a blood vessel or muscle.

<span class="mw-page-title-main">Estradiol (medication)</span> Steroidal hormone medication

Estradiol (E2) is a medication and naturally occurring steroid hormone. It is an estrogen and is used mainly in menopausal hormone therapy and to treat low sex hormone levels in women. It is also used in hormonal birth control for women, in feminizing hormone therapy for transgender women and some non-binary individuals, and in the treatment of hormone-sensitive cancers like prostate cancer in men and breast cancer in women, among other uses. Estradiol can be taken by mouth, held and dissolved under the tongue, as a gel or patch that is applied to the skin, in through the vagina, by injection into muscle or fat, or through the use of an implant that is placed into fat, among other routes.

<span class="mw-page-title-main">Progesterone (medication)</span> Medication and naturally occurring steroid hormone

Progesterone (P4), sold under the brand name Prometrium among others, is a medication and naturally occurring steroid hormone. It is a progestogen and is used in combination with estrogens mainly in hormone therapy for menopausal symptoms and low sex hormone levels in women. It is also used in women to support pregnancy and fertility and to treat gynecological disorders. Progesterone can be taken by mouth, vaginally, and by injection into muscle or fat, among other routes. A progesterone vaginal ring and progesterone intrauterine device used for birth control also exist in some areas of the world.

<span class="mw-page-title-main">Estrogen (medication)</span> Type of medication

An estrogen (E) is a type of medication which is used most commonly in hormonal birth control and menopausal hormone therapy, and as part of feminizing hormone therapy for transgender women. They can also be used in the treatment of hormone-sensitive cancers like breast cancer and prostate cancer and for various other indications. Estrogens are used alone or in combination with progestogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of estrogens include bioidentical estradiol, natural conjugated estrogens, synthetic steroidal estrogens like ethinylestradiol, and synthetic nonsteroidal estrogens like diethylstilbestrol. Estrogens are one of three types of sex hormone agonists, the others being androgens/anabolic steroids like testosterone and progestogens like progesterone.

<span class="mw-page-title-main">Pharmacokinetics of estradiol</span>

The pharmacology of estradiol, an estrogen medication and naturally occurring steroid hormone, concerns its pharmacodynamics, pharmacokinetics, and various routes of administration.

References

  1. 1 2 3 4 5 6 7 "ESTRADIOL TRANSDERMAL SYSTEM- estradiol patch". dailymed.nlm.nih.gov. Retrieved 2020-02-07.
  2. 1 2 3 4 5 6 Beck KL, Anderson MC, Kirk JK (August 2017). "Transdermal estrogens in the changing landscape of hormone replacement therapy". Postgraduate Medicine. 129 (6): 632–636. doi:10.1080/00325481.2017.1334507. PMID   28540770. S2CID   205452835.
  3. ↑ Henzl MR, Loomba PK (July 2003). "Transdermal delivery of sex steroids for hormone replacement therapy and contraception. A review of principles and practice". J Reprod Med. 48 (7): 525–40. PMID   12953327.
  4. 1 2 "Drugs@FDA: FDA Approved Drug Products". United States Food and Drug Administration. Retrieved 26 July 2018.
  5. ↑ Abdi F, Mobedi H, Bayat F, Mosaffa N, Dolatian M, Ramezani Tehrani F (2017). "The Effects of Transdermal Estrogen Delivery on Bone Mineral Density in Postmenopausal Women: A Meta-analysis". Iranian Journal of Pharmaceutical Research. 16 (1): 380–389. PMC   5423263 . PMID   28496491.
  6. ↑ Ackerman KE, Singhal V, Baskaran C, Slattery M, Campoverde Reyes KJ, Toth A, et al. (February 2019). "Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial". British Journal of Sports Medicine. 53 (4): 229–236. doi:10.1136/bjsports-2018-099723. PMC   6686188 . PMID   30301734.
  7. ↑ https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy
  8. ↑ "Progestin-Only Hormonal Birth Control: Pill and Injection - ACOG". www.acog.org. Retrieved 2020-02-10.
  9. ↑ "Sequidot". Drugs.com. Retrieved 1 March 2014.
  10. 1 2 "Estradiol Transdermal Patch: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2020-10-29.
  11. ↑ "Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route) Side Effects - Mayo Clinic". www.mayoclinic.org. Retrieved 2020-10-29.
  12. ↑ "Available Forms of HRT (UK)".
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