Table 3.

Oestrogen and progesterone preparations that can be used for pubertal induction and replacement therapy. This s not meant to be exhaustive, multiple preparations and brand names are available throughout the world.

Preparation	Doses available	Starting dose of puberty	Increase approximately every 6 months* to adult dosing	Considerations for use
E2: transdermal options TD (some brands examples)		3–7 µg/day	25–100 µg/day	See text on applying patches
Menostar	14 µg	Part of patch twice weekly	Only used for low dosing situations, not fully hypogonadal replacement	The easiest way to give a low dose
Vivelle Dot	25, 37.5, 50, 75, 100 µg	Part of patch twice weekly or 1 patch per month (no patch for 3 weeks)**	25–100 µg twice weekly	Designed for twice weekly but can be given once per week to increase the dose slower
Vivelle Mini	25, 37.5, 50, 75, 100 µg	Part of patch twice weekly or 1 patch per month (no patch for 3 weeks)**	25–100 µg twice weekly	Smaller size patch, but not smaller dosing
Generic (different brands in different countries; e.g. Oesclim Estradot, Evorel, Systen, Climara, Demestril)	25, 37.5, 50, 75, 100 µg	Part of patch twice weekly or 1 patch per month (no patch for 3 weeks)**	25–100 µg twice weekly	Estradot: too small to properly cut into low doses and not stable in elevated temperature
Estraderm	25, 50, 100 µg	Part of patch twice weekly or 1 patch per month (no patch for 3 weeks)**	25–100 µg twice weekly	Reservoir form cannot be used to initiate puberty
Estraderm MX
Divigel 0.1%	0.5 and 1.0 mg E2/sachet	Too potent for pubertal initiation	1–2 sachets daily	Cannot use to initiate puberty
Estragel 0.06%	0.75 mg E2/pump	Too potent for pubertal initiation	1–3 pumps daily	Cannot use to initiate puberty
E2: oral options		5 µg/kg/day
17β-oestradiol (e.g.: Estrace, Cetura; Zumenon, Ormone, Estrofem mite, Estrofem)	0.5, 1, 2, 4 mg	Part of a pill daily***	1–4 mg/day	The cheapest option, brands vary by country
Oestradiol valerate (e.g. Climaval, Progynova)
Ethinyloestradiol (EE2)		2 µg/day	10–20 µg/day	Not available in many countries
Premarin (CEE)	0.3, 0.625, 0.9, 1.25 mg	Part of pill daily	0.625–1.25 mg/day	Not available in many countries
Depot options
Depot E2 (cypionate)	5 mg/mL	0.2 mg/mL	2 mg/mL	Not available in Europe
Adding Gestagen options		Not needed to initiate puberty		Add once bleeding occurs or after 2 years
Medroxyprogesterone acetate (e.g. Provera)	10 mg/tablet		Give with E2, or alone for 10 days/cycle
Dydrogesterone (Duphaston)	10 mg/tablet		Give with E2, or alone for 10 days/cycle
Micronised progesterone (e.g. Prometrium, Utrogestan, Progesterone Besins)	100 and 200 mg /tablet		Give with E2, or alone for 10 days/cycle	Utrogestan: before going to bed, lactose-free, indication: galactosemia
Progesterone (e.g. Luttagen, Luteina)
Jaydess, Kyleena, Mirena	Intrauterine device		Give with E2
Combined E2/Gestagen sequential patch		Do not use to initiate puberty
Climara Pro	E20.045 mg/levonorgestrel 0.015 mg/24 h		1 patch weekly
Combipatch	E20.045 mg/norethidrone 0.14 or 0.25 mg/24 h		1 patch weekly
Evo-Sequi	E250 µg/norethisterone acetate 170 µg/24 h		1 patch twice weekly
Systen Sequi
Combined E2/Gestagen sequential pills		Do not use to initiate puberty
Trisequens	E22 mg/norethisterone acetate 1 mg		1 pill/day
Divina plus	Oestradiol valerate 2 mg/medroxyprogesterone acetate 10 mg		1 pill/day
Femoston 1/10 or 2/10	Tablet 1–14: 1–2 mg E2; Tablet 15–28: 1–2 mgE2+ 10 mg dydrogesterone		1 tablet/day
Femoston Continu	All tablets: 1 mg E2/5 mg dydrogesterone		1 tablet/day
Oral contraceptive pills	Ethinyl estradiol and progestins	Do not use it to initiate puberty
Loestrin (norethindrone)				Less progestational, less androgenic, low estrogenic
Lo-ovral (norgestrel)				More progestational, intermediate androgenic, low estrogenic
Orthotricylcen (norgestimate)				Less androgenic but progestational and more estrogenic

^*Detailed comments are in the text; ^**To avoid cutting (in daily practice, we cut the patches and inform our patients how to cut them; however, there is no manual in the product’s label); ^***The preparation with the appropriate dose should be prepared by a pharmacist.