Table 2.

Available estrogen preparations in India

Estrogen preparations	Dose	Advantages	Limitations
Oral Estradiol Valerate	2 to 8 mg per day	Estradiol levels can be monitored, Risk of VTE is slightly less than with Ethinyl Estradiol or Conjugated Equine Estrogen	High risk of VTE
Oral 17-beta Estradiol	1-6 mg daily	Inexpensive and estradiol levels can be monitored	High risk of VTE specially in older patients (>40 yrs )
Oral Ethinyl Estradiol	50-100 ug per day	Inexpensive	Cannot be monitored by measurement of serum levels and high risk of VTE
Conjugated Equine Estrogen	1.25 to 5 mg per day	Widely available	Cannot be monitored by measurement of serum levels, high risk of VTE, expensive and contains impurities
Parenteral Estradiol Valerate	10-20 mg IM every 1-2 week	Estradiol levels can be monitored, Risk of VTE is slightly less than with Ethinyl Estradiol or Conjugated Equine Estrogen	Injectable preparation
Transdermal 17-beta Estradiol gel (0.06%) for application	1.25 gm gel per day (0.75 mg estradiol) to 5 gm gel per day (3 mg estradiol) (Application in the arms or in the upper half of the body)	Low risk of venous thromboembolism	Not easily available in India May not be successful in a tropical country like India