Menopausal Hormone Replacement Therapy with Estradiol Transdermal Patch and Medroxyprogesterone Acetate

Recommended Regimen

The American College of Obstetricians and Gynecologists recommends a transdermal 17β-estradiol patch releasing 50-100 μg daily, combined with oral medroxyprogesterone acetate (MPA) 10 mg daily for 12-14 days every 28 days, for menopausal women with an intact uterus, to provide symptom relief and minimize cardiovascular risk 1, 2
For continuous combined regimens, a minimum of 2.5 mg of oral MPA daily is recommended, to provide endometrial protection and minimize the risk of venous thromboembolism and stroke 2

The North American Menopause Society recommends this combination for effective relief of menopausal symptoms, including vasomotor symptoms and vaginal dryness, with a moderate benefit in reducing fracture risk 2, 3
Transdermal estradiol with progestin provides complete endometrial protection when used at appropriate doses, and has a lower risk of venous thromboembolism compared to oral estrogen formulations 1, 2

The American Heart Association notes that combined estrogen and progestin therapy may have a less favorable cardiovascular profile compared to micronized progesterone, and recommends considering individual risk factors such as cardiovascular disease, breast cancer risk, or thromboembolic history 1, 2, 5
MPA may have a less favorable cardiovascular profile compared to micronized progesterone, and women with cardiovascular risk factors should consider micronized progesterone instead of MPA 1, 2

The Endocrine Society recommends starting with the lowest effective dose to minimize side effects, and adjusting the estradiol dose according to each woman's tolerance and symptom control 2, 4
For women with intact uterus, progestin is mandatory for endometrial protection, and sequential regimens will typically induce withdrawal bleeding, while continuous combined regimens may eventually lead to amenorrhea 2

The American College of Obstetricians and Gynecologists recommends that women with premature ovarian insufficiency continue HRT until the average age of natural menopause (45-55 years), and that women with history of hormone-dependent cancers avoid HRT 1, 2, 5

Regular follow-up is recommended to assess symptom control, side effects, and bleeding patterns, with consideration of individual risk factors such as cardiovascular disease, breast cancer risk, or thromboembolic history 2