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Differential diagnosis for hot flashes
Short-term therapy
Long-term therapy r33
Route of administration | Product | Dosages | Comments | Trade name examples |
---|---|---|---|---|
Estrogen | ||||
Oral | Conjugated equine estrogens | 0.3, 0.45, or 0.625 mg/day | Premarin | |
Oral | Synthetic conjugated estrogens | 0.3, 0.45, or 0.625 mg/day | Cenestin | |
Oral | Estradiol-17β | 0.5, 1, or 2 mg/day | Estrace | |
Oral | Esterified estrogens | 0.3, 0.45, or 0.625 mg/day | Menest | |
Transdermal estrogen—patch | Estradiol-17β | 0.025 to 0.1 mg once or twice weekly (1 patch weekly or twice weekly) | An ultralow dose (0.14 mg/week) is also available, which preserves bone in females older than 60 years | Climara, Vivelle, Estraderm |
Transdermal estrogen—gel | Estradiol-17β | 0.25 to 1.5 g daily | Potential transfer to other people or pets | Divigel, Elestrin |
Transdermal estrogen—emulsion | Estradiol-17β | 0.05 mg/day | Comes in foil packets | Estrasorb |
Transdermal estrogen—spray mist | Estradiol-17β | 1.5 mg daily (1 spray daily) | Potential transfer to other people or pets | Evamist |
Intravaginal—tablet | Estradiol hemihydrate vaginal tablet | 0.01 to 0.25 mg once daily for 2 weeks, then continue same dose twice weekly | ||
Intravaginal—cream | Estradiol-17β | 2 to 4 g daily for 1 week, then 1 g 3 times weekly | Estrace | |
Intravaginal—cream | Conjugated equine estrogens | 0.5 g once daily for 21 days, then no treatment for 7 days; can increase up to 2 g/day (cyclically) | Alternatively, a continuous dose of 0.5 g twice weekly can be used | Premarin |
Intravaginal—ring | Estradiol acetate | Systemic dosing at 0.05 to 0.10 mg/day | For systemic (vasomotor) and local symptoms; 90-day duration of ring | Femring |
Intravaginal—ring | Estradiol-17β | Local dosing, delivering estradiol 7.5 mcg/24 hours | For genitourinary symptoms only; 90-day duration of ring | Estring |
Progestin | ||||
Oral | Medroxyprogesterone acetate | 2.5 to 10 mg PO daily for continuous use; or 2.5 to 10 mg PO daily 12 to 14 consecutive days per month for cyclic use | Continuous regimen is preferred, but cyclical regimen may be used initially to limit irregular bleeding | |
Oral | Micronized progesterone | 100 mg PO daily for continuous use; or 200 mg PO daily for 12 days each month for cyclic use | ||
Combined estrogen plus progestin | ||||
Oral | Conjugated equine estrogens plus medroxyprogesterone | CEE 0.625 mg/MPA 2.5 mg; CEE 0.625 mg/MPA 5 mg (1 tablet daily) | Prempro | |
Oral | Conjugated equine estrogens plus medroxyprogesterone, used cyclically | CEE 0.625 mg tablet days 1 to 14, then CEE 0.625 mg/MPA 5 mg tablet days 15 to 28 | Premphase | |
Oral | Estradiol-17β plus norethindrone acetate | Estradiol-17β 1 mg/norethindrone 0.5 mg (1 tablet daily) | Activella | |
Oral | Ethinyl estradiol plus norethindrone acetate | Ethinyl estradiol 0.005 mg/norethindrone 0.5 mg (1 tablet daily) | Femhrt | |
Transdermal | Estradiol-17β plus norethindrone acetate | Estradiol-17β 0.05 mg/0.14 mg norethindrone acetate (delivered per day) | 1 patch applied every 3 to 4 days | CombiPatch |
Transdermal | Estradiol-17β plus levonorgestrel | Estradiol-17β 0.045 mg/0.015 mg levonorgestrel (delivered per day) | 1 patch applied per week | ClimaraPro |
Combined estrogen plus selective estrogen receptor modulator | ||||
Oral | Conjugated equine estrogens plus bazedoxifene | CEE 0.45 mg/bazedoxifene 20 mg (1 tablet daily) |