Objective:: As evidenced by results from recent clinical trials and epidemiological studies that have examined the physiological and clinical effects of low levels of estradiol, it is now time to replace the widely held belief that less than the standard dosage of estrogen is without benefit.
Design:: Review of literature and personal experience.
Results:: Studies indicate that low‐dosage estrogen can relieve vasomotor symptoms, can prevent bone loss, and may reduce the risk of coronary heart disease. However, to achieve these health benefits, long‐term estrogen use is required. Women who use low dosages of estrogens are less likely to have unacceptable side effects, such as irregular bleeding, heavy bleeding, or breast tenderness. Thus, long‐term continuance of hormone replacement therapy (HRT) may be improved if lower dosages are given, particularly if the HRT regimen is tailored to the needs of the patient.
Conclusions:: Although standard‐dosage estrogen remains the “gold standard” for HRT, having a low dosage as an alternative regimen can be useful. Attention of clinical researchers should focus on the effects of low‐dosage estrogen on osteoporotic fractures and other health outcomes. (Menopause 1999;6:273‐276. © 1999, The North American Menopause Society.)