pills is what is often needed to control estrogen-deficiency symptoms in younger women and at the same time provides contraceptive protection should the ovaries begin to function again.
When vaginal or urinary symptoms persist despite systemic hormonal therapy, local hormonal therapy is prescribed. This may be in the form of estrogen vaginal cream (Premarin, dienestrol). A small vaginal tablet containing estrogen (Vagifem) and a small, soft silastic vaginal ring providing a continuous release of estradiol (Estring) are in use in several European countries and should be on the North American market in the near future.
Standard hormonal replacement therapy consists of oral estrogen preparations, which include conjugated estrogen tablets (Premarin), estrone (Ogen) and estradiol (Estrace). If the woman has had a hysterectomy , a progestin needs to be added: either medroxyprogesterone acetate (Provera) or norethindrone (Norlutate). Usually, these are given cyclically—that is, estrogen alone for about two weeks, then a progestin is added for an additional 10 to 15 days. Estrogen and progestin can also be given through a transdermal patch: Estraderm (estradiol), Estragest (estradiol + norethindrone acetate) together called Estracomb. Not yet available in North America but popular in some European countries is Estragel, a skin gel applied to the abdomen for direct absorption.
Another possibility is an implant under the skin (subdermal implant of 17ß estradiol), which needs to be replaced every six months. This approach is being tested in North America.
