Estrogen Replacement Therapy Guidelines

Standard Dosing Recommendations

• The standard adult dose for hormone replacement therapy is 50 μg daily, with patches releasing 50-100 μg per 24 hours 1, 2
• Sequential combined patches can be used, with 50 μg estradiol daily for 2 weeks, followed by 50 μg estradiol + 10 μg levonorgestrel daily for 2 weeks 1, 2
• Continuous combined patches can be used, with 50 μg estradiol + 7 μg levonorgestrel daily without interruption for women avoiding withdrawal bleeding 1, 2

Required Progestin Supplementation

• For women with an intact uterus, progestin must be added to reduce endometrial cancer risk, with options including micronized progesterone 200 mg daily for 12-14 days every 28 days 1, 2, 3
• Alternative progestin options include medroxyprogesterone acetate 10 mg daily for 12-14 days per month 1, 2, 3
• Minimum doses for continuous regimens include 1 mg oral norethisterone daily, 2.5 mg MPA daily, or 5 mg dydrogesterone daily 1, 2, 3

Special Dosing Considerations

• The American College of Obstetricians and Gynecologists recommends using the lowest effective dose for the shortest duration consistent with treatment goals 3
• Avoid starting with high doses (>50 μg daily) as initial therapy, as evidence shows no additional benefit and increased harm 3
• Do not use progestins with anti-androgenic effects in women with low testosterone or sexual dysfunction 1, 2