Estrogen currently is indicated for the treatment of moderate to severe vasomotor symptoms and vulvovaginal atrophy associated with menopause. In addition, it is indicated for the prevention of postmenopausal osteoporosis in women with significant risk; however, it is recommended that nonestrogen medications receive consideration for long-term use. Oral or transdermal estrogen products should be prescribed at the lowest effective dose and for the shortest duration possible to provide relief of vasomotor symptoms. Topical products in the form of creams, tablets, or rings should be prescribed for women exclusively experiencing vulvovaginal atrophy.

Many systemically administered estrogen products are available in the United States, but conjugated equine estrogens (CEEs), prepared from the urine of pregnant mares, is the most widely prescribed. Transdermal estrogen preparations are also available and usually are prescribed for patients who experience adverse effects, elevated triglycerides (TG), or liver function abnormalities while taking an oral product. Transdermal preparations also have a lower incidence of venous thromboembolism (VTE) than oral preparations.10



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