First-lineEvorel, Estradot
Estradiol (HRT)
Oestrogen replacement
Transdermal preferred — no first-pass, no VTE excess.
TransdermalOralVaginal
First-line for
- Vasomotor menopausal symptoms
- Premature ovarian insufficiency
- GSM (vaginal route)
Mechanism
Replaces ovarian 17β-estradiol → restores oestrogen-dependent tissue function.
HRT pearls
- Add progestogen if uterus present
- Transdermal = no VTE excess
- Vaginal = local only, safe long-term
- Review annually
Dosing
- Transdermal
- 25–100 µg/24h patch twice weekly
- Oral
- 1–2 mg OD
- Vaginal
- 10 µg estradiol pessary BIW
Contraindications
- AbsoluteCurrent breast / endometrial Ca
- AbsoluteActive VTE, undiagnosed PV bleeding
Side effects
- Breast tenderness
- Bloating
- Headache
- Small VTE risk (oral only)
Fetal & maternal notes
- • Not contraceptive — needs separate method if perimenopausal.
Key interactions
Enzyme inducers
Caution↓ HRT levels
Clinical pearls
- 💡 Transdermal first-line if BMI >30, VTE history, or migraine.
- 💡 Add cyclical progestogen if perimenopausal, continuous if >1 y amenorrhoea.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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