Usual Adult Dose for Atrophic Urethritis

1 tablet orally once a day

• Start with the first tablet in the first row

Comments:

• Consider topical vaginal products if using solely for vulvar and vaginal atrophy.
• Re-evaluate vulvar and vaginal atrophy patients at 3 to 6 month intervals to determine if treatment is still necessary.
• If one or more tablets are missed, resume therapy with the next available tablet and continue to take one tablet per day in sequence.

Use(s): Treatment of moderate to severe vasomotor symptoms or vulvar and vaginal atrophy associated with menopause

Usual Adult Dose for Atrophic Vaginitis

1 tablet orally once a day

• Start with the first tablet in the first row

Comments:

• Consider topical vaginal products if using solely for vulvar and vaginal atrophy.
• Re-evaluate vulvar and vaginal atrophy patients at 3 to 6 month intervals to determine if treatment is still necessary.
• If one or more tablets are missed, resume therapy with the next available tablet and continue to take one tablet per day in sequence.

Use(s): Treatment of moderate to severe vasomotor symptoms or vulvar and vaginal atrophy associated with menopause

Usual Adult Dose for Postmenopausal Symptoms

1 tablet orally once a day

• Start with the first tablet in the first row

Comments:

• Consider topical vaginal products if using solely for vulvar and vaginal atrophy.
• Re-evaluate vulvar and vaginal atrophy patients at 3 to 6 month intervals to determine if treatment is still necessary.
• If one or more tablets are missed, resume therapy with the next available tablet and continue to take one tablet per day in sequence.

Use(s): Treatment of moderate to severe vasomotor symptoms or vulvar and vaginal atrophy associated with menopause

Usual Adult Dose for Prevention of Osteoporosis

1 tablet orally once a day

• Start with the first tablet in the first row

Comments:

• Consider therapy only for patients at significant osteoporosis risk.
• Consider using non-estrogen medications.
• Osteoporosis risk is decreased by weight bearing exercise and adequate calcium and vitamin D intake.
• Postmenopausal women require an average of 1500 mg of elemental calcium daily.
• When not contraindicated, calcium supplementation may be helpful for patients with suboptimal dietary intake.
• Vitamin D supplementation of 400 to 800 IU per day may be needed to ensure adequate intake.
• If one or more tablets are missed, resume therapy with the next available tablet and continue to take one tablet per day in sequence.

Use(s): Prevention of postmenopausal osteoporosis

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Contraindicated

Precautions

US BOXED WARNING(S):
CARDIOVASCULAR DISORDERS, BREAST CANCER, ENDOMETRIAL CANCER, AND PROBABLE DEMENTIA

• Estrogens and progestins should not be used for the prevention of cardiovascular disease.
• The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years old) taking conjugated estrogens (CE) (0.625 mg) combined with medroxyprogesterone acetate (MPA) (2.5 mg) relative to placebo.
• The WHI Memory Study (WHIMS) study reported an increase of developing probable dementia in postmenopausal women 65 years and older treated with daily CE (0.625 mg) with MPA (2.5 mg) during 4 years compared to placebo; it is unknown if this applies to younger postmenopausal women.
• Lacking comparable data, assume the risk is similar for other doses and dosage forms of estrogens.

Recommendation:

• Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available