Initial 17β-Estradiol Dose for Treating Vasomotor Symptoms

In Brief Objective To compare the efficacy of different doses of 17β-estradiol (E2) for relief of vasomotor symptoms in menopausal women. Methods This was a randomized, double-masked, placebo-controlled, 12-week study in which 333 menopausal women with moderate or severe hot flushes were assigned to treatment with 0.25 mg, 0.5 mg, 1 mg, or 2 mg oral micronized 17β-E2, or placebo. The number and severity of hot flushes were recorded daily. Results There was a significant linear correlation between increased dosage of 17β-E2 and decreased moderate to severe hot flushes per week (P < .001). Rapid reduction in moderate to severe hot flushes was only achieved with 1 and 2 mg, showing a significant difference from placebo at week 4 (P < .05). At week 4, half the women on placebo had reduced moderate to severe hot flushes of at least 52%; the corresponding figures were 56%, 69%, 86%, and 91% for 0.25, 0.5, 1, and 2 mg, respectively. At week 12, all doses except 0.25 mg were significantly better than placebo for reducing moderate to severe hot flushes (P < .001). Although there were no significant differences, twice as many women in the 2-mg group discontinued treatment due to adverse events, compared with the placebo group. Conclusion Oral micronized 17β-E2 showed a dose-response effect for reducing moderate and severe hot flushes in menopausal women. 17β-E2 1 mg appeared to be the most useful initial dose. Estrogen therapy at the time of coronary artery bypass grafting does not influence surgical mortality, perioperative cardiac morbidity, or early or late complications.