Pubertal induction

1
Pubertal induction with transdermal plasters
containing natural oestrogen Ensio
Norjavaara Carina Ankarberg Lindgren Maria
Elfving Kerstin Albertsson Wikland GP-GRC Drottni
ng Silvias Barn och Ungdomssjukhus Göteborg
2
Pubertal inductionEvorel depot plaster
(25µg/24h)

• Start dose 0.08- 0.12 µg/kg body weight
• girls lt 40 kg 1/8 patch
• girls 40 - 55 kg 1/6 patch
• girls gt 55 kg 1/4 patch
• Check that the start dose is adequate by a serum
  profile, or if not possible at least by morning
  levels of 17?-oestradiol.
• The concentration should be below 40 pmol/L (11
  pg/mL) just before the plaster is removed.

3
Induction Progress Progress Progress
Nocturnal application of Evorel depot plaster, i.e. 2200-0800 hours Nocturnal application of Evorel depot plaster, i.e. 2200-0800 hours Semi-nocturnal application of Evorel depot plaster (Keep half of the nocturnal applied patch during daytime) Semi-nocturnal application of Evorel depot plaster (Keep half of the nocturnal applied patch during daytime)
Early puberty (0.08-0.12 µg/kg) Nocturnally With these doses, breast development starts, but do not progress further than Tanner stage B2. Intermediate dose nocturnally Mid-puberty (0.23-0.34 µg/kg) nocturnally, half dose during daytime With these doses, breast development progresses and Tanner breast stage B3 will be achieved. Mid-puberty (0.23-0.34 µg/kg) nocturnally, half dose during daytime With these doses, breast development progresses and Tanner breast stage B3 will be achieved.
9 months 6 months
Gestagen 5 mg daily For the first 14 days/month Gestagen 5 mg daily For the first 14 days/month Gestagen 5 mg daily For the first 14 days/month Gestagen 5 mg daily For the first 14 days/month
Example of Evorel (25 µg/24 hours) dosing Example of Evorel (25 µg/24 hours) dosing Example of Evorel (25 µg/24 hours) dosing Example of Evorel (25 µg/24 hours) dosing
3 µg (1/8) 4 µg (1/6) 6 µg (1/4) 4 µg (1/6) 6 µg (1/4) 12 µg (1/2) 6 µg (1/4) 12 µg (1/2) 19 µg (3/4) Remove half of the attached plaster in the morning.