Audit of use of transdermal oestradiol for pubertal induction in girls
Girls with ovarian failure or delayed puberty may be treated with incremental doses of oestrogen to induce puberty. Transdermal natural oestradiol is more physiological than oral synthetic ethinyl oestradiol but it is unclear how effective it is for inducing puberty and whether it confers any benefit.
The aims of the audit were to review whether transdermal oestradiol was effective in inducing puberty, the optimal dosing regimen, effects on breast development & uterine growth, adolescent growth spurt, and the usefulness of serum levels of oestradiol in monitoring therapy.
Twenty prepubertal girls attending a paediatric endocrine unit were studied using a retrospective clinical notes review. Ten girls were treated with transdermal oestradiol (Evorel) and ten girls were treated with oral ethinyloestradiol.
Transdermal group: The median age at start of treatment was 12.7 years, with starting dose 412.5 μg. The median height gain was 10.6 cm over 2 years. Three girls had poor breast development. Breakthrough bleeding occurred in five girls at variable doses of oestradiol (6.2525 μg). Pelvic ultrasound scan in four showed a mature uterus but small in two. The medication was well tolerated. Serum oestradiol levels were variable (<60278 pmol/l).
Oral ethinyl oestradiol group: The median age at start of treatment was 12.6 years with starting dose 14 μg. The median height gain was 14 cm over 2 years. One girl had poor breast development and had compliance issues. Breakthrough bleeding occurred in seven girls at variable doses (610 μg). Pelvic ultrasound scan in four girls showed a mature uterus in three, small uterus in one.
Conclusion: Puberty can be induced in girls using transdermal oestradiol. However, further work is needed to establish the optimal dosing regimen. It is unclear whether there are any advantages to the transdermal approach.