English
Mild to moderate symptoms
Moderate to severe and persistent mild to moderate symptoms
Treatment | Brand name | Initial dosage | Maintenance dosage | Comments |
---|---|---|---|---|
Vaginal cream | ||||
Estradiol-17β | Estrace | 0.5-1 g daily for 2 weeks | 0.5-1 g, 1-3 times weekly | Initial dose approved by FDA is higher (2-4 g daily) |
Conjugated estrogens | Premarin | 0.5-1 g daily for 2 weeks | 0.5-1 g, 1-3 times weekly | FDA approval calls for cyclical administration and higher dose (for genitourinary syndrome of menopause: 0.5-2 g daily for 21 days then off for 7 days; for dyspareunia: 0.5 g daily for 21 days then off for 7 days or 0.5 g twice weekly) |
Vaginal insert | ||||
Estradiol hemihydrate | Vagifem, Yuvafem | 10 mcg tablet insert daily for 2 weeks | 1 twice weekly | |
Estradiol tear-shaped vaginal inserts | Imvexxy | 4 mcg insert daily for 2 weeks | 4-10 mcg insert twice weekly | FDA approved May 2018 Initial dose is 4 mcg, may titrate dose based on clinical response; Max dose: 10 mcg/dose vaginally |
Dehydroepiandrosterone | Intrarosa | 6.5 mg once daily | 6.5 mg once daily | Steroid prohormone with effects from local conversion to testosterone and estrogen; associated with minimal increase in systemic hormone levels and may be safer option than vaginal estrogen in patients with contraindications to use of estrogen (eg, hormone-sensitive breast and endometrial cancer survivors) |
Vaginal ring | ||||
Estradiol-17β | Estring | Insert for 90 days | Change every 90 days | 2 mg releases approximately 7.5 mcg daily |
Estradiol acetate | Femring | Insert for 90 days | Change every 90 days | Vaginal delivery provides systemic hormone levels to treat vasomotor symptoms and genitourinary syndrome of menopause; 12.4 mg releases 0.05 mg and 24.8 mg releases 0.1 mg daily |
Other supportive measures