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Estrogen Replacement Therapy uses many types and forms of estrogen which are available replacement in the United States. Included are tablets, injections, creams, patches, pellets, and vaginal inserts. Each has its advantages and disadvantages.

One medication is not perfect for everyone.

These are the different therapeutic approaches to menopause.

First, tablets available in the United States:

Tablets.........................available dosages (mg)

Conjugated Estrogens (Premarin) 0.3 0.625 0.9 1.25

Estropipate (Ortho Est, Ogen) 0.75 1.5

Esterified Estrogens (Estratab) 0.625 1.25

Estradiol (Estrace) 0.5 1.0 2.0

Ethinyl Estradiol (Estinyl - used in OCPs) 20ug 50ug

Micronized Compounded Estradiol

Premarin has been the 'gold standard' for many years and is available in a wide range of dosages.

The 0.625mg dose is standard for most women, but it is probably to start a younger woman, especially if their ovaries have been surgically removed, on a higher dose such as 1.25mg.

Elderly women taking Premarin for osteoporosis management after many years of estrogen deprivation probably should start with a very low dose such as 0.3mg and gradually increase the dosage to a more therapeutic level after a month or so.

Estrace (estradiol) is an excellent product.

This form of estrogen has recently become available generically and there appears to be some problems with the quality of manufacture of the generic product.

Patients who are being converted to the generic estradiol by their pharmacists are experiencing problems associated with inconsistent dosing including abnormal and irregular bleeding.

If you are taking Estrace, it is probably better to insist on the brand name product.

Unfortunately a significant precentage of woman have problems absorbing estrogen tablets. For estrogen to be effective it must reach the blood stream but estrogen taken by mouth has to pass through the liver before reaching estrogen sensitive tissues.

The liver contains enzymes which can alter the estrogen before it even reaches the places in the body where it is supposed to work.

Unfortunately, if the physician fails to determine the estrogen is working effectively, these are the women who can take estrogen for many years and receive no benefits from the therapy.

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