Menopausal hot flashes are treated effectively by a transdermal, low-dose estradiol spray

Abstract

This Practice Point commentary discusses a randomized, double-blind, placebo-controlled trial that assessed the use of a transdermal estradiol spray to treat hot flashes in 454 postmenopausal women. Participants applied 1, 2, or 3 daily sprays containing estradiol (1.53 mg per spray) or placebo to the inner aspect of the forearm. Estradiol administered in 1, 2 or 3 daily sprays reduced the daily frequency of hot flashes at week 4 by −6.26, −7.30, and −6.64, respectively (P <0.001, P = 0.003, and P <0.001 compared with placebo, respectively). Participants using 1 spray daily had a mean serum estradiol level of 71.6–84.0pmol/l, which is higher than serum estradiol levels in untreated symptomatic postmenopausal women. These findings indicate that a transdermal estradiol spray can improve menopausal symptoms even at a very low dose. Furthermore, this preparation allows health care providers to individualize the estradiol dose that is required for the control of hot flashes in each patient.