(017) Systemic Estradiol Menopause Management: Return to the Old-Fashioned Way

Abstract Introduction The mean systemic estradiol value in menopausal women is < 10 pg/ml, consistent with ovarian failure. Such low values are associated multiple symptoms including hot flashes, night sweats, insomnia, mood changes and irritability, cognitive changes, weight gain slowed metabolism. Contemporary management estradiol, maximizing safety efficacy, emphasizes non-oral, non-injection replacement therapies daily gels, twice weekly or patches three-month vaginal rings. Most (>60%) who try these our sexual medicine clinic have been successful at reducing bothersome symptoms. We identified a subset of cannot achieve sufficient symptom relief despite using contemporary strategies due to lack negative side effects, (rings stay the vagina too high initially then low, cause rashes fall off, gels messy) financial concerns. For patients, we advised return “old-fashioned way” intramuscular (IM) injection either valerate cypionate. Estradiol cypionate was first described as well introduced for medical use 1952. Objectives This study examines experiences this one practice injections efficacy reasons. Methods chart review 16 patients (mean age 59 +/− 8 years) single site had prescribed when genitourinary syndrome menopause (GSM) persisted rings, cost prohibitive. IM (20 mg/ml; starting dose 0.05 ml 1 mg) (5 0.2 mg). compared from earlier treatments current monthly costs each treatment based on GoodRx prices, assuming medications were not covered by insurance. Results All their estradiol-based GSM ameliorated without complaint inconvenience discomfort injections. risks similar those topical administration, requiring concomitant progesterone uterus. Concerning finances, coupon, 5 bottle approximately $50 should last least year, $5/month. A $150 6 months, thus about $25/month. In contrast, generic $40/month, $150/month ring $170/month. While there remains an abhorrence injections, motivation superseded any injectable medication 27-gauge ½ inch needle minimal pain. No significant effects noted injection. Conclusions certain individuals, sometimes works better both terms cost, providing Disclosure No.