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


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.

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  1. Kronenberg F (1991) Menopausal hot flashes: randomness or rhythmicity. Chaos 1: 271–278

    Article  Google Scholar 

  2. Aksel S et al. (1976) Vasomotor symptoms, serum estrogens, and gonadotropin levels in surgical menopause. Am J Obstet Gynecol 126: 165–169

    Article  CAS  Google Scholar 

  3. Freedman RR (2005) Pathophysiology and treatment of menopausal hot flashes. Semin Reprod Med 23: 117–125

    Article  Google Scholar 

  4. Pinkerton JV and Zion AS (2006) Vasomotor symptoms in menopause: where we've been and where we're going. J Womens Health (Larchmt) 15: 135–145

    Article  Google Scholar 

  5. Buster JE et al. (2008) Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstet Gynecol 111:1343–1351

    Article  CAS  Google Scholar 

  6. Archer DF (2001) The effect of the duration of progestin use on the occurrence of endometrial cancer in postmenopausal women. Menopause 8: 245–251

    Article  CAS  Google Scholar 

  7. North American Menopause Society (2003) Role of progestogen in hormone therapy for postmenopausal women: position statement of The North American Menopause Society. Menopause 10: 113–132

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The author has been a consultant for the following companies: Agile Therapeutics, Bayer Healthcare, Berlex, ConCert Pharmaceutical, Johnson and Johnson, Merck, Novo Nordisk, Radius, Schering Plough, Warner Chilcott, and Wyeth Laboratories. He has received research support from the following companies: Bayer Healthcare, Duramed, Organon, Solvay, Warner Chilcott, and Wyeth Laboratories. He has received direct industry lecture fees from the following companies: Novo Nordisk, Organon, Solvay, and Wyeth Laboratories.

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Archer, D. Menopausal hot flashes are treated effectively by a transdermal, low-dose estradiol spray. Nat Rev Endocrinol 5, 18–19 (2009).

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