ESTROGENS TAB
Clinical Criteria Summary
Criteria for Systemic Hormonal Menopausal Medications
- Bazedoxifene/Estrogens: Bazedoxifene is an alternative to progestin for patients with a uterus.
- General Systemic Estrogen Therapy:
- All systemic estrogen preparations are effective in treating vasomotor symptoms.
- Transdermal estrogen may have lower risk of thrombosis.
- The lowest effective dose of estrogen should be used.
- Choice of product should consider patient symptoms, risk-benefit profile, and patient preference.
- A progestin should be prescribed to all patients with an intact uterus receiving systemic estrogen therapy to reduce the risk of endometrial hyperplasia and cancer.
Criteria for Genitourinary Symptoms of Menopause (GSM) Medications
- Prasterone (DHEA): PA-F (Prior Authorization, Facility Level) applies; PBM Criteria for Use available. Classified as low dose vaginal estrogen.
- Estradiol vaginal ring (Estring): Not to be confused with FEMRING.
Criteria for Systemic Nonhormonal Medications
- Ospemifene: Oral option indicated for vaginal dryness and dyspareunia.
- Fezolinetant: PBM Criteria for Use available.
- Citalopram, Escitalopram, Paroxetine, Desvenlafaxine, Venlafaxine, Gabapentin, Oxybutynin: PBM Criteria for Use available; all marked as off-label use.