HRT Equivalent Dose Chart: What Four Published Guides Actually Say

The HRT Index Editorial TeamIndependent women's health research

Last reviewed:August 28, 2026

Editorial research — not medically reviewed by a clinician. Why this label

Last updated: August 28, 2026 · Last verified: August 28, 2026 · By The HRT Index Editorial Team. Educational research, not medical advice, and not reviewed by a clinician. See our medical review policy. Full disclosure.

Start with the comparison

See where the published frameworks agree, where they split, and why none of them is a personal conversion calculator.

Compare the four guide categories

Educational research only. Not medical advice. Do not start, stop, or change any hormone medication based on this page.

There is no single HRT equivalent dose chart. Four major guidance sources classify the same products differently: 1 mg oral estradiol is standard in ACOG and Canadian guidance, medium in current British guidance, and low in Australian guidance. Use the charts below as approximate discussion bands—not as a dose you can copy into a new prescription.

Same pill. Three labels.

That disagreement is not a typo, and it is not sloppy work by anyone. It is the honest state of the evidence, and almost nobody tells you about it. We're going to.

This page is for you if you've been handed a different brand, strength, or route than the one you were using—or you're about to switch—and you want to know what “equivalent” actually means before you agree to it.

This is not the right page if you're trying to change your own dose without a prescriber, convert a compounded custom-mixed hormone, or work out unexplained bleeding. If you have a history of blood clots, stroke, heart attack, an estrogen-sensitive cancer, or liver disease, start with a clinician, not a chart.

The 30-second version

Across the four guides, oral estradiol 0.5 mg and patches around 25–37.5 mcg/day occupy lower categories, while 100 mcg/day patches and oral estradiol 3 mg or more sit high where they are classified. The middle is where the language and product groupings split, so use this table as orientation—not arithmetic.

Approximate dose bands for discussion. Not a conversion calculator, and not your dose.

Product	Lower category in the published guides	Common middle category	Upper category
Oral 17β-estradiol	0.5 mg daily	1–2 mg daily, depending on the guide	3 mg or more in guides that include it
Estradiol patch	25–37.5 mcg/day	50–75 mcg/day; the 75 mcg label varies from medium to high	100 mcg/day
Conjugated estrogens (Premarin)	0.3–0.45 mg daily	0.625 mg daily	1.25 mg in the Canadian guide
Gels and sprays	Product-specific	Product-specific	Product-specific—never compare pump or spray counts without naming the product

The catch that the rest of this page unpacks: “low,” “standard,” “medium,” “moderate-high,” and “high” are categories created by different organizations for different formularies. They are not universal biological thresholds. One milligram of oral estradiol is standard in the United States and Canada, medium in the current United Kingdom guide, and low in Australia. Same pill. Three labels.

The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.

What does an HRT equivalent dose chart actually tell you?

An HRT equivalent dose chart places systemic estrogen products into approximate discussion bands so a clinician has a reference point when starting or switching therapy. It is not a prescription converter, and the sources do not all do the same job: ACOG publishes U.S. dose categories, while the Canadian, British, and Australian documents provide practical equivalency or dose-band guidance.

Here's the thing nobody says out loud: no one trial compared every pill, patch, gel, spray, and ring in these tables. The practical guides combine product labels, pharmacokinetic evidence, clinical trials, expert consensus, and clinical experience.

The Canadian Menopause Society table calls its comparisons rough equivalencies and says absorption varies between products and individuals. The British Menopause Society's August 2026 table says its values are approximate, subject to significant variation in absorption and metabolism, and cannot be precise.

They're being honest. The pages that copy one set of numbers and remove that warning usually aren't.

What each of the four sources contributes

Source	What it actually publishes	How to use it here
ACOG Practice Bulletin No. 141	U.S. ultra-low, low, and standard systemic-estrogen dose categories	A U.S. classification reference—not a complete route-switch calculator
Canadian Menopause Society	A systemic MHT equivalency table with ultra-low through high bands	The most detailed North American route-switch framework, explicitly approximate
British Menopause Society	A 2026 low, medium, and high table for symptomatic women aged 45–55	A current practical-prescribing framework; POI dosing is explicitly excluded
Australasian Menopause Society	Low, medium, and high guidance for products available in Australia	Country-specific guidance that should not be mistaken for a U.S. product label

One hormone, five completely different kinds of number

This is where most of the confusion starts, and it takes 60 seconds to clear up. The number printed on your product does not necessarily measure the same thing as the number printed on someone else's.

Route	What the printed number describes	Current U.S. label example
Pill	Estradiol contained in one tablet	Oral estradiol: 0.5, 1, or 2 mg per tablet
Patch	Nominal estradiol delivery rate per day—not total drug inside the patch	0.05 mg/day = 50 mcg/day
Gel pump	Estradiol contained in one metered actuation	EstroGel: 0.75 mg per pump; Elestrin: 0.52 mg per pump
Gel packet	Estradiol contained in one sealed packet	Divigel: 0.25, 0.5, 0.75, 1.0, or 1.25 mg
Spray	Estradiol contained in one metered spray	Evamist: 1.53 mg per spray
Ring	Nominal release rate over the wear period	Femring: 0.05 or 0.10 mg/day

Look at the spread. A spray says “1.53 mg.” A patch says “0.05 mg/day.” The spray number is more than thirty times larger on the label. The spray is not automatically thirty times stronger. One number describes the amount in a metered spray; the other describes a nominal daily release rate.

Two more traps live in the same family:

Milligrams and micrograms are the same mass unit at different scales. 0.05 mg = 50 mcg. There are 1,000 micrograms in a milligram. That arithmetic converts the unit on the same patch label; it does not create a pill, gel, spray, or ring equivalent.
A pump is not a universal unit. One EstroGel pump contains 0.75 mg of estradiol. One Elestrin pump contains 0.52 mg. Any chart that says only “one pump” without naming the product is incomplete.

Was this the confusion? If your whole question was “why is my patch number so much smaller than my pill number,” you now have the answer. If you want to know where your product lands across the four guides, keep going—that is the harder half.

Compare your product across all four guides
Start with the exact product, strength, unit, and schedule. The comparison below flags disagreements instead of averaging them into a fake-precise answer.
Go to the four-guide comparison ↓

The right online HRT provider isn't the same for every woman — it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Some situations belong with an in-person clinician first. Because a general answer can't resolve those for you, use The HRT Index's Find My HRT Path tool to match your situation to the right provider — and to flag when online care isn't the right starting point — before your first consult.

Where do the four published guides disagree—and by how much?

The four sources agree on several lower and upper patch categories, but they label common middle doses differently. The clearest split is oral estradiol 1 mg: ACOG and Canada call it standard, Britain calls it medium, and Australia calls it low. A 75 mcg/day patch is moderate-high in Canada, medium in Britain, and high in Australia.

We read the four source documents in full and mapped comparable rows without pretending foreign brands are interchangeable with U.S. products. That distinction matters. A British Lenzetto spray is not a U.S. Evamist conversion, and a British or Australian Sandrena sachet is not automatically a Divigel conversion.

The four-guide comparison

Band names differ. A dash means the source did not classify that exact product or strength in the table—not that the product is ineffective or unavailable. These are reference categories, never a swap you can make yourself.

Product and strength	ACOG (U.S.)	Canadian Menopause Society	British Menopause Society	Australasian Menopause Society
Oral estradiol 0.25 mg	Ultra-low	—	—	—
Oral estradiol 0.5 mg	Low	Low	Low	—
Oral estradiol 1 mg	Standard	Standard	Medium	Low
Oral estradiol 2 mg	—	Moderate-high	Medium	Medium
Oral estradiol 3–4 mg	—	High, identified for POI/early menopause	3 mg high and outside U.K. licence	—
Conjugated estrogens 0.3 mg	Low	Low	—	Low
Conjugated estrogens 0.45 mg	Low	—	—	—
Conjugated estrogens 0.625 mg	Standard	Standard	—	Medium
Conjugated estrogens 1.25 mg	—	High	—	—
Patch 0.014 mg/day (14 mcg/day)	Ultra-low	—	—	—
Patch 0.025 mg/day (25 mcg/day)	Low	Low	Low	Low
Patch 0.0375 mg/day (37.5 mcg/day)	Standard range	Low	Low	Low
Patch 0.05 mg/day (50 mcg/day)	Standard	Standard	Medium	Medium
Patch 0.075 mg/day (75 mcg/day)	—	Moderate-high	Medium	High
Patch 0.1 mg/day (100 mcg/day)	—	High	High	High

Source: Sources:* ACOG Practice Bulletin No. 141, Canadian Menopause Society equivalency table, British Menopause Society practical-prescribing table, amended August 2026, and Australasian Menopause Society guide.

The gel-pump comparison has a U.S.-label trap

Exact product/context	Canadian guide	British guide	Australian guide	What a U.S. reader must know
EstroGel/Oestrogel, 1 pump	Low	Low	Low	The U.S. EstroGel label has one approved dose: one pump daily
EstroGel/Oestrogel, 2 pumps	Standard range overlaps 1–2 pumps	Medium	Medium	Foreign multi-pump rows are not U.S. dosing instructions
EstroGel/Oestrogel, 3 pumps	Moderate-high range overlaps 2–3 pumps	Medium	High	The three guides classify three pumps differently
EstroGel/Oestrogel, 4 pumps	High	High	High	High-band agreement is not permission to use four pumps under a U.S. prescription

The Canadian table contains overlapping ranges: one to two pumps appears in its standard column, while two to three appears in moderate-high. That is not a transcription error. It is another warning against turning a clinical reference into rigid arithmetic.

Four things the comparison exposes

1. The same pill has three different category labels. One milligram of oral estradiol is standard in the U.S. and Canadian frameworks, medium in the current British framework, and low in Australia. If your clinician uses a different country-specific guide than the page you found online, you may be using the same product and different category language.

2. The current British medium band is deliberately broad. It includes oral estradiol 1–2 mg and patches 40, 50, and 75 mcg/day. That means the current British table does not provide one exact oral number for a 50 mcg patch. It provides a practical band.

3. A 75 mcg/day patch receives three labels. Canada calls it moderate-high. Britain calls it medium. Australia calls it high. ACOG's published category table does not list it.

4. Dose categories are not serum estradiol targets. In a cross-sectional study of 344 postmenopausal women taking oral estrogen, mean serum estradiol was 65.8 pg/mL with oral estradiol 1 mg, 107.6 pg/mL with 2 mg, 60.1 pg/mL with conjugated estrogens 0.45 mg, and 76.8 pg/mL with conjugated estrogens 0.625 mg. Those observations came from different women in routine care; they do not establish route equivalence or an individual target. (Kim et al., 2021)

The most important sentence on this page: this chart cannot tell you your dose.
If you came here for one number to copy from your old prescription onto a new one, we do not have it. Neither does a legitimate universal calculator, because the published frameworks use overlapping bands, country-specific products, and different category names—and the practical guides explicitly say the comparisons are approximate.
That is exactly why this page is worth your time. Because we're not faking precision, we can show you where the guides agree, where they split, which U.S. products they do not cover, and the questions that get you to a defensible prescription faster than a fake-precise number ever would. If you need an actual dose, only a prescriber can give you one.

What changed in the British HRT dose table in 2026?

The British Menopause Society simplified its dose framework in June 2026 from five category concepts—ultra-low, low, standard, moderate, and high—to three practical bands: low, medium, and high. It combined the lower pairs because their recommended progestogen doses were the same, and it amended the clinician tool again in August to add the stand-alone progestogen table.

This is the part almost nobody has caught, and it is the best reason to trust a dated page over an undated one.

The BMS update notice dated June 4, 2026 says the organization was repeatedly asked to simplify the estrogen and stand-alone progestogen tables so recommendations for increasing progestogen were applied correctly.

What changed	Previous framework	Current 2026 framework
Lower categories	Ultra-low and low	Combined as low because the recommended progestogen doses were the same
Middle categories	Standard and moderate	Combined as medium because the recommended progestogen doses were the same
Upper category	High	Remains high
Population	Older tables were easier to strip from their context	Current table states it is for symptomatic women aged 45–55 and excludes POI dosing
Progestogen table	Published across related guidance	Added directly to the practical-prescribing tool in the August 2026 amendment

The product did not change. The framework did.

That reframes the entire topic. In the newest British guidance, the categories are not merely adjectives describing “how much estrogen.” They are tied to the stand-alone progestogen recommendation when one is indicated.

Is 1 mg of oral estradiol the same as a 0.05 mg patch?

One milligram of oral estradiol and a 0.05 mg/day (50 mcg/day) patch sit in the same standard category in ACOG and Canadian guidance. Current British guidance places both inside a broader medium band, while Australia labels oral 1 mg low and the 50 mcg patch medium. It is a useful North American reference point—not an exact international conversion.

Why the distinction matters: “same category” does not mean the same amount reaches the bloodstream, the same symptom response, or the same risk profile.

The KEEPS trial is often used incorrectly here. KEEPS did compare an oral route with a 50 mcg/day estradiol patch, but the oral arm used 0.45 mg conjugated equine estrogens, not 1 mg oral estradiol. The symptom analysis found improvement in both active-treatment groups, making KEEPS a valuable route-comparison trial—but it does not validate a 1 mg oral estradiol-to-50 mcg patch equation. (Santoro et al., 2017)

What the shared category does not mean:

It does not mean a 1 mg pill and 50 mcg/day patch produce the same serum estradiol concentration.
It does not mean they have identical effects on clotting, triglycerides, or other route-sensitive outcomes.
It does not mean you can switch directly without a prescriber's instructions.
It does not mean every international guide chooses 1 mg as the oral comparison.

If someone hands you one exact number for this switch with no named source, no product name, and no follow-up plan, they have hidden the part you need most.

What is Premarin 0.625 mg equivalent to?

Conjugated estrogens 0.625 mg sits in the standard category in ACOG and Canadian guidance and in the medium category in the Australian guide. It is often discussed beside oral estradiol 1 mg and a 50 mcg/day patch, but Premarin contains a mixture of conjugated estrogens—not one 17β-estradiol product—so milligram-for-milligram comparisons overstate the evidence.

This matters more than it sounds. Oral estradiol tablets contain 17β-estradiol. Premarin contains conjugated estrogens. Putting “0.625 mg” next to “1 mg” and treating the ratio as a biochemical conversion erases an ingredient and formulation difference.

KEEPS again shows the right way to talk about this. The trial studied 0.45 mg oral conjugated equine estrogens and a 50 mcg/day estradiol patch as two active low-dose regimens. It did not prove that one was an exact replacement for the other.

The useful conclusion is a category, not an equation:

Premarin 0.625 mg is a standard/medium systemic-estrogen reference dose in the guides that classify it. It is not 0.625 mg of estradiol, and it should not be converted by milligram ratio.

How many pumps of estrogen gel equal a patch?

There is no clean universal answer because “gel” is not one product and a pump is not one unit. EstroGel, Elestrin, and Divigel have different formulations, dispensers, strengths, and U.S. instructions. Only a named product can be interpreted, and no current U.S. label gives a general pump-to-patch conversion.

The per-dose numbers below come from current U.S. labels.

U.S. product	What one labeled unit contains	What the published guides can and cannot tell you
EstroGel 0.06%	One pump contains 0.75 mg estradiol	Canadian, British, and Australian guides classify Oestrogel/EstroGel pump counts, but the current U.S. label has one approved dose: one pump daily
Divigel 0.1%	Unit-dose packets contain 0.25, 0.5, 0.75, 1.0, or 1.25 mg	Canada classifies 0.25, 0.5, and 1.0 mg and combined sachet totals; U.K. and Australian Sandrena rows should not be relabeled as Divigel conversions
Elestrin 0.06%	One pump contains 0.52 mg estradiol	None of the four source tables supplies a direct Elestrin conversion
Evamist	One spray contains 1.53 mg estradiol; its U.S. label permits one to three sprays daily	None of the four source tables supplies a direct Evamist conversion

The British table includes Lenzetto, a spray used there. It also says Lenzetto has a unique mode of action and that its data cannot be extrapolated. That is not an invitation to rename the row “Evamist.” It is the opposite.

So if someone gives you an Evamist-to-patch number by borrowing a Lenzetto row—or turns “one pump” into a universal unit—they have invented certainty that the sources do not provide.

The pharmacy change that is not just a cheaper version

A pharmacy may dispense “estradiol gel” without the product name feeling important. It is important. A metered pump, a sealed packet, the concentration, the application site, and the instructions can all change.

Before accepting a gel substitution, ask:

1. What is the exact product?
2. Is it a pump or a packet?
3. How much estradiol is in that exact unit?
4. Where does its own label say to apply it?
5. Is the prescriber aiming for the same broad band, a lower band, or a higher one?

Read the box. “Estradiol gel” is not enough information.

Which U.S. HRT products or strengths are missing from every guide?

More than a dozen products or strengths listed in current U.S. labeling do not appear as direct rows in any of the four source frameworks. The missing set includes a systemic vaginal ring, U.S.-specific gel and patch strengths, combination patches and pills, esterified estrogens, and injectable estrogens. If your exact product is missing, no published row gives a direct conversion.

This is the gap almost nobody covers. The Canadian, British, and Australian tables reflect their own formularies and purposes. A large part of the U.S. label set was never meant to fit into them.

U.S.-labeled systemic product or strength	Current U.S. labeled strength(s) relevant here	Direct row in any of the four guides?
Oral estradiol tablets	0.5, 1, 2 mg	Yes
Premarin	0.3, 0.45, 0.625, 0.9, 1.25 mg	Partly; 0.9 mg is not classified
Common twice-weekly estradiol patches	0.025, 0.0375, 0.05, 0.075, 0.1 mg/day	The release rates are represented
Climara and weekly generics	0.025, 0.0375, 0.05, 0.06, 0.075, 0.1 mg/day	Partly; 0.06 mg/day is not classified
Menostar	0.014 mg/day	ACOG lists an ultra-low patch category; Menostar's U.S. indication context differs from ordinary VMS switching
Divigel	0.25, 0.5, 0.75, 1.0, 1.25 mg packets	Partly; 0.75 and 1.25 mg are not direct rows
Elestrin	0.52 mg estradiol per pump	No direct row
Evamist	1.53 mg estradiol per spray	No direct row
Femring	0.05 or 0.10 mg/day	No direct row
CombiPatch	Estradiol 0.05 mg/day with norethindrone acetate 0.14 or 0.25 mg/day	No direct row
Climara Pro	Estradiol 0.045 mg/day with levonorgestrel 0.015 mg/day	No direct row
Prempro / Premphase	Multiple conjugated-estrogen/medroxyprogesterone regimens	No direct row for the complete U.S. regimens
Menest	Esterified estrogens 0.3, 0.625, or 1.25 mg	No direct row
Depo-Estradiol	Estradiol cypionate 5 mg/mL injection	No direct row
Delestrogen	Estradiol valerate 10 or 20 mg/mL injection	No direct row
Bijuva	Estradiol/progesterone 0.5 mg/100 mg or 1 mg/100 mg	Canadian guide lists 1 mg/100 mg; 0.5 mg/100 mg is not a direct row
U.S. Angeliq	Estradiol/drospirenone 0.5 mg/0.25 mg or 1 mg/0.5 mg	The Canadian guide's Angeliq row uses a different country-specific strength

What to do when your product is missing: do not guess, and do not accept a guess disguised as a calculator. Ask this:

“Which broad band are you aiming for, and what product-specific evidence or experience are you using for this exact formulation?”

A good clinician may tell you they are extrapolating and then give you a follow-up plan. That is an honest answer. Silence is not.

The injection rows show the limits of the dataset, not a recommendation to use an injection for an ordinary menopause switch. The exact U.S. indication, current availability, and clinical purpose still have to fit the person.

If no guide covers your product, the follow-up model matters
Some telehealth models provide ongoing visits and can revise the route or regimen after assessing the response. Others are built around a narrower default offering. Use the care-path tool to see which model fits your symptoms, insurance, state, and need for follow-up before you pay.
Get my care-path match →

Which vaginal estrogen products are systemic, and which are local?

Femring is systemic estrogen delivered by a vaginal ring. Estring, Vagifem, Yuvafem, and Imvexxy are local vaginal therapies for genitourinary symptoms and should not be placed into a systemic pill-or-patch conversion. The route name alone does not tell you whether the treatment is local or whole-body.

This is the most dangerous confusion on the page, and it comes down to one wrong assumption: vaginal means local. Not always.

Product	Form and labeled strength	Systemic or local?
Femring	Vaginal ring releasing 0.05 or 0.10 mg/day for three months	Systemic; labeled for vasomotor symptoms and vulvar/vaginal atrophy
Estring	Vaginal ring releasing about 7.5 mcg/day for 90 days	Local vaginal therapy
Vagifem / Yuvafem	10 mcg vaginal insert	Local vaginal therapy
Imvexxy	4 mcg or 10 mcg vaginal insert	Local vaginal therapy

Now look at the numbers side by side, because this is what a lazy chart can hide.

Femring 0.05 mg/day and a 0.05 mg/day patch print the same nominal daily number. Femring's U.S. label reports mean serum estradiol concentrations of 40.6 pg/mL with the 0.05 mg/day ring and 76 pg/mL with the 0.10 mg/day ring. That still does not make Femring an automatic patch swap; it proves that Femring belongs in the systemic conversation.

Estring is also a vaginal ring worn for about 90 days, but it releases approximately 7.5 mcg/day and is a local treatment. The Menopause Society describes systemic therapy as pills, patches, sprays, gels, or a vaginal ring, while low-dose vaginal therapy sends very little estrogen into the circulation. (The Menopause Society)

Two rings. Same route. Similar wear period. Different treatment roles.

The one-question check: What is this exact product labeled to treat—whole-body vasomotor symptoms such as hot flashes and night sweats, local vaginal and urinary symptoms, or both?

The indication answers it. Not the shape. Not the route. Not the size of the number.

If your real question is vaginal dryness, painful sex, or urinary symptoms, our vaginal estrogen guide is the right page, and the systemic dose bands above do not apply to Estring, Vagifem, Yuvafem, or Imvexxy.

Does my progesterone dose change if my estrogen dose changes?

The sources do not give one universal answer. British and Canadian guidance increase stand-alone progestogen recommendations at higher estrogen bands; the Australian guide says evidence is insufficient to support increasing micronized progesterone with higher estrogen and keeps the same listed dose across its bands. The complete regimen is a prescriber's decision.

Do not change, reduce, or stop progesterone or another prescribed endometrial-protection component on your own. If you have a uterus and use systemic estrogen, endometrial protection has to be addressed. That may involve a prescribed progestogen or another clinician-selected regimen; an estrogen chart cannot choose it for you.

Every generic estrogen chart that stops before this question gives you only half the decision. The 2026 British update makes the connection explicit: it combined estrogen categories because the recommended stand-alone progestogen doses were the same within each merged group.

What the current documents say about micronized progesterone

Source	Continuous micronized progesterone	Sequential/cyclical micronized progesterone	Does the listed dose rise with the estrogen band?
British Menopause Society, 2026	100 mg at low and medium; 200 mg at high	200 mg at low and medium; 300 mg at high	Yes, at high-dose estrogen
Canadian Menopause Society	Starts at 100 mg in lower bands and rises in higher bands	Starts at 200 mg for 12–14 days per cycle and rises in higher bands	Yes
Australasian Menopause Society	100 mg across low, medium, and high rows	200 mg for 12 days across its rows	No; the guide says evidence is insufficient to support the higher-dose assumption

Those are clinician references, not instructions for a reader to copy. The documents also differ in population, available products, licensing, and how they handle high-dose or off-label use.

The smallest-tablet finding that explains a real prescribing frustration

The August 2026 British stand-alone table contains a revealing norethisterone footnote: it says 1 mg provides endometrial protection with low-to-medium estrogen, while the lowest stand-alone U.K. dose available is 5 mg.

That is a U.K. product-availability problem, not a U.S. dose recommendation. But it explains why real-world prescribing can look coarser than the evidence. The tablet on the market and the dose discussed in the evidence are not always the same number.

Bleeding is not a chart adjustment

Unexpected bleeding on HRT deserves a clinician conversation, and postmenopausal bleeding requires evaluation. The British Menopause Society's 2026 guidance uses timing, bleeding pattern, risk factors, regimen, and endometrial findings to decide whether adjustment or investigation is needed.

If you are bleeding unexpectedly, call the prescriber. Do not turn tonight into a home progesterone experiment.

Do blood estradiol levels reveal the equivalent dose?

No universal blood level converts one HRT product into another. The Canadian guide says its table is not based on serum estradiol and does not recommend routine serum monitoring solely to adjust ordinary menopause therapy, except in selected suspected non-response situations. Different products, studies, assays, and people produce overlapping values.

A blood test feels objective in a way a chart does not. Here is why it still cannot do the job you want.

Product and dose	Reported mean serum estradiol	What the number can and cannot show
Oral estradiol 1 mg	65.8 pg/mL	Cross-sectional mean from women already using therapy; not a conversion target
Oral estradiol 2 mg	107.6 pg/mL	About 64% higher than the 1 mg group—not a simple doubling
Conjugated estrogens 0.45 mg	60.1 pg/mL	Similar group mean to oral estradiol 1 mg in this study; does not make ingredients interchangeable
Conjugated estrogens 0.625 mg	76.8 pg/mL	Group mean, not a target or patch equivalent
Femring 0.05 mg/day	40.6 pg/mL	Product-label mean supporting systemic exposure
Femring 0.10 mg/day	76 pg/mL	Product-label mean; individual values vary

The oral values came from a cross-sectional study of 344 postmenopausal women, not a randomized dose-conversion trial. The Femring values came from a separate product label. You cannot subtract one row from another and prescribe the difference.

Which is exactly the point. The “objective shortcut” does not reproduce a universal conversion chart either.

For ordinary menopause symptom treatment, clinical response and tolerability—not a universal target estradiol number—usually drive adjustment. A clinician may order testing for a specific reason. That is different from chasing a chart-generated level.

Is a generic estradiol patch the same dose as the brand I used before?

An FDA-approved generic transdermal system must meet product-specific evidence requirements, including bioequivalence and adhesion-performance expectations. The familiar 80%–125% rule applies to the 90% confidence interval around population-average pharmacokinetic ratios; it does not mean a patch may contain 20% less or 25% more active ingredient than its label.

This shortage-era question is usually answered badly.

The widely repeated version says generics can legally vary by 20%, so two refills could differ dramatically. That is not what the rule means. For pharmacokinetic bioequivalence, the 90% confidence interval for the test-to-reference ratio of measures such as AUC and Cmax generally must fall within 80%–125%. It is a statistical standard for study results—not a license to mislabel the drug content in an individual patch. (FDA bioequivalence guidance)

The FDA also issued final guidance in August 2026 on adhesion-performance studies for generic transdermal and topical delivery systems. Adhesion is not cosmetic. It is part of product performance. (FDA, August 2026)

What can genuinely differ between two patches that print the same daily release rate:

Adhesive and patch size. Manufacturers use different systems and patch areas.
Wear schedule. A twice-weekly patch and a once-weekly patch can both say 0.05 mg/day and create completely different routines.
Total drug content. The daily release rate can match while the total drug held in the system differs because one patch is worn for three or four days and another for seven.
How the patch behaves on your skin. Lifting, skin irritation, or a schedule mistake should be reported with the product and manufacturer named.

If something changed after a substitution, you do not have to prove a manufacturing defect before you are allowed to report it. Say what changed, when it changed, which manufacturer was dispensed, whether the schedule changed, and whether the patch stayed attached.

Why can an “equivalent” HRT dose still feel different?

Two products in the same category can feel different because route, formulation, application, adhesion, metabolism, symptom target, and individual absorption all matter. Swallowed estrogen passes through the liver before reaching the systemic circulation; transdermal estrogen avoids that first-pass route. Same category does not establish identical exposure, response, or risk.

That liver step is why route belongs in the medical decision rather than being treated as a packaging preference.

The Menopause Society's 2022 position statement says transdermal routes and lower doses may reduce venous-thromboembolism and stroke risk, while also noting the lack of comparative randomized-trial evidence. ACOG has similarly described oral estrogen as potentially more prothrombotic and transdermal estrogen as having little or no effect on prothrombotic markers. (The Menopause Society position statement; ACOG route statement)

Practical implications:

Route is part of the risk conversation, not just the convenience conversation. Your history can change which route a clinician prefers.
A band-matched switch can still miss. Both the Canadian and British guides explicitly warn that absorption varies.
Application matters with gels and sprays. Site, drying, washing, and skin-contact instructions are product-specific.
Patch performance matters. Daily release rate, replacement schedule, and adhesion are separate facts.
The symptom target matters. Systemic vasomotor symptoms and local genitourinary symptoms are not solved by the same conversion.

We cover route tradeoffs in estradiol patch vs pill and product-level differences in estradiol patch vs estradiol gel.

What can this HRT equivalent dose chart not convert?

This chart cannot convert local vaginal estrogen, custom-compounded hormones, testosterone, contraceptives, gender-affirming protocols, a cut patch, or a blood level into a personal menopause prescription. Those products or situations use different ingredients, treatment goals, evidence, formulations, or safety frameworks.

Product or situation	Convertible here?	Why not
Low-dose vaginal estrogen such as Estring, Vagifem, Yuvafem, Imvexxy, and local creams	No	Local therapy for vaginal and urinary symptoms; it is not a systemic pill-or-patch substitute
Custom-compounded estrogen creams, troches, or pellets	No	Custom compounded drugs are not FDA-approved, and the FDA does not review their safety, effectiveness, or quality before marketing; there is no standardized FDA-verified crosswalk
Testosterone	No	Different hormone and clinical framework; no testosterone product is FDA-approved for women in the U.S. Testosterone is prescription-only and federally controlled as Schedule III
Combined hormonal contraceptives	No	Different estrogen/progestin products, purposes, and dosing framework
Gender-affirming hormone regimens	No	Different clinical goals and treatment framework
Premature ovarian insufficiency replacement	No	Different replacement context; the BMS table explicitly excludes POI
Cutting a patch	No	Patch design and label instructions differ; do not use cutting as a general-purpose conversion method—see can you cut an estradiol patch?
A serum estradiol value by itself	No	There is no universal menopause conversion target
An unknown “click,” pump, percentage, or compounded label	No	The product, ingredient, concentration per gram, dispenser output, route, and intended treatment role are missing

Compounded products stay in a separate lane

We keep FDA-approved and compounded products strictly separated on every page because the distinction changes what can be verified.

A compounded cream's percentage, grams, clicks, or pump count cannot be mapped onto an FDA-approved product's labeled strength through this chart. The custom product has no FDA-approved prescribing label establishing that crosswalk. The FDA says compounded drugs are not FDA-approved and are not reviewed for safety, effectiveness, or quality before marketing. (FDA compounded-drug facts)

That does not mean no clinician may ever determine that a compounded product is appropriate. It means this page will not pretend it is equivalent to an FDA-approved product. If a compounded option has been proposed, a fair question is: Why is an FDA-approved option not a fit for me? See FDA-approved vs compounded HRT for the full distinction.

Testosterone is not an estrogen-chart add-on

No testosterone product is FDA-approved for women in the United States. FDA-approved testosterone products are prescription drugs approved for men with specific associated medical conditions, and testosterone is a Schedule III controlled substance under federal law. This page does not provide a dose, conversion, or acquisition shortcut. (FDA; DEA)

What about premature ovarian insufficiency and surgical menopause?

A general menopause dose chart is the wrong reference for premature ovarian insufficiency, early menopause, or some surgical-menopause situations. The current British table explicitly excludes POI, while the Canadian table labels its highest band for POI and early menopause. Those different goals require clinician-led replacement planning, not a consumer conversion.

The BMS table is written for symptomatic women aged 45–55 and states that POI doses are not included. The Canadian guide takes the opposite structural approach and identifies its highest band for POI or early menopause.

ACOG's POI guidance also discusses replacement-level therapy separately from ordinary natural-menopause symptom dosing. That is the point: the population and goal change the framework. (ACOG POI guidance)

If this is your situation, you need care from someone who treats POI or surgical menopause specifically. Start with premature menopause vs premature ovarian insufficiency and take the questions to a clinician.

What should I ask before switching HRT doses or routes?

Eight confirmations turn a confusing substitution into a short, useful conversation: the intended band, exact product, source behind the comparison, reason for switching, schedule, endometrial-protection plan if you have a uterus, safety plan, and follow-up date. The goal is not to argue with a clinician; it is to make the handoff specific enough that nothing important is assumed.

You do not need to memorize this page. You need eight questions and about four minutes.

Ask about	The question
Intended band	“Is the new regimen meant to be lower, similar, or higher than what I use now?”
Basis	“Which guide or product data are you using, and does it cover this exact product?”
Reason	“Are we switching because of symptoms, side effects, risk history, cost, insurance, shortage, adhesion, or convenience?”
Exact product	“What exact product, strength, unit, and manufacturer should the pharmacy dispense?”
Schedule	“Is it once weekly, twice weekly, a daily gel, a daily spray, a ring, or a pill?”
Uterus/endometrium	“Does this change the progesterone, progestogen, or other endometrial-protection plan?”
Safety	“Which bleeding or other symptoms should make me call sooner?”
Follow-up	“When will we decide whether the switch is working, and what is the backup plan if it is not?”

Two scripts for when the answer gets vague

If someone tells you two products are simply the same:

“Which guide or product data is that based on? I can see that the published categories overlap, but they do not all classify the same products the same way.”

If someone tells you every chart is meaningless:

“Fair enough—then which broad response are you aiming for, and when will we reassess whether this product achieved it?”

Both are respectful. Both are specific. Both get you a better answer than “is this the same?”

Why the exact product matters during a supply disruption

As of August 2026, ASHP's shortage listing is product-, strength-, manufacturer-, and package-specific. A pharmacy may be able to obtain one estradiol patch while another strength or package remains constrained. Do not translate “patch shortage” into “every patch is unavailable.” (ASHP estradiol transdermal-system shortage)

If supply is the issue, ask whether the substitute has the same nominal daily release rate and the same replacement schedule. We track the changing product details in our estradiol patch shortage tracker.

If you need a clinician who can review a route switch
A chart can show the source bands. Only a licensed prescriber can choose a prescription and adjust it after seeing how you respond.
Editorial fit: among the platforms we track, Midi Health is a strong first route for an insurance-based menopause switch review because it is available in all 50 states, is in-network with most PPO plans, and says clinicians can adjust a dose or switch the form when relief is inadequate. Current self-pay prices are $250 for an initial visit and $150 for a continued-care visit; prescriptions, labs, supplements, and other services can cost extra.
The honest limitation: Midi is not covered by Medicare or Medicare-related plans. Medicare beneficiaries may use self-pay but cannot submit claims related to Midi visits, medications, or associated services. Midi also says it cannot treat Medicaid or Medi-Cal patients, even as self-pay patients. Coverage, deductibles, copays, and coinsurance vary by exact plan. If that rules Midi out, compare cash-pay and insurance HRT costs instead of forcing the wrong model.
If that model fits your situation: Check your care-path match and state options →
Disclosure: The HRT Index is reader-supported and may earn a commission if you choose certain providers. That never changes what we verify or what we recommend.

How did The HRT Index build this HRT equivalent dose chart?

We kept three kinds of information separate: U.S. product facts from current labels, dose categories from four professional guidance sources treated as approximate frameworks, and our own editorial comparisons labeled as editorial findings. We did not fill missing rows with guesses or turn a foreign product into a U.S. conversion.

Most dose charts fail the same way: they blend a British table, an American product list, and a confident tone into something that looks precise and cannot be traced. We'd rather show the joins.

What we actually verified in August 2026

The current British Menopause Society practical-prescribing table, reviewed May 2026 and amended August 2026.
The BMS June 2026 explanation of why its dose categories were consolidated.
The current Canadian Menopause Society systemic MHT equivalency table and its footnotes.
The current Australasian Menopause Society Australia guide and country-specific context.
ACOG's published ultra-low, low, and standard systemic-estrogen categories.
Current U.S. label strengths and unit meanings for oral estradiol, common patches, EstroGel, Divigel, Elestrin, Evamist, Femring, Estring, Vagifem, Yuvafem, Imvexxy, Premarin, and the U.S.-specific products in the gap table.
The systemic-versus-local distinction for vaginal products.
The BMS, Canadian, and Australian stand-alone progestogen differences.
KEEPS, including the fact that its oral arm used 0.45 mg conjugated equine estrogens—not 1 mg oral estradiol.
The 2021 serum-estradiol study and its cross-sectional design.
FDA's generic bioequivalence and transdermal-adhesion frameworks.
Midi Health's current availability, insurance limits, and self-pay prices.

What we did not verify or calculate

Any individual's correct dose.
Any individual's serum level or absorption.
A direct conversion for Evamist, Elestrin, Femring, injections, or a custom compound.
A pharmacy's live inventory.
A reader's insurance benefit or final out-of-pocket cost.
Whether online care is appropriate for a specific reader.

This page was produced under The HRT Index Verification Standard—the documented process by which we read every published price, separate FDA-approved from compounded, verify state availability and insurance, and re-check on a fixed schedule: top providers monthly and the full roster quarterly. The framework evaluates providers on five pillars, always in this order: clinical legitimacy, care quality, medication fit, price transparency, access. We do not publish invented per-provider numeric scores.

See our medical review policy.

We're editorial researchers, not your doctor. This page exists to make you a sharper, calmer patient before your appointment—not to replace it.

HRT equivalent dose chart FAQ

These direct answers cover the follow-up questions most likely to send someone back to search: oral-to-patch comparisons, mg versus mcg, gels, vaginal rings, progesterone, generics, blood levels, compounded products, testosterone, and POI. Every answer keeps the line between a broad reference band and a personal prescription visible.

What is a standard dose of HRT?

In ACOG and Canadian guidance, the standard systemic-estrogen category includes oral estradiol 1 mg, an estradiol patch around 0.0375–0.05 mg/day in ACOG or 0.05 mg/day in the Canadian table, and conjugated estrogens 0.625 mg. Britain now calls the corresponding broad category medium, and Australia labels oral estradiol 1 mg low. There is no single international definition.

Is 1 mg of estradiol equivalent to a 0.05 mg patch?

They sit in the same standard category in ACOG and Canadian guidance, and both fall within the current British medium ranges. Australia labels oral 1 mg low and the 50 mcg patch medium. Treat 1 mg oral/50 mcg patch as a common North American reference—not an exact personal swap.

Is 0.05 mg the same as 50 mcg?

Yes. There are 1,000 micrograms in one milligram, so 0.05 mg and 50 mcg are the same mass. On a patch label, both describe the same nominal daily release rate. That arithmetic does not create an equivalent pill or gel dose.

What is Premarin 0.625 mg equivalent to?

It sits in the standard category in ACOG and Canadian guidance and in the medium category in Australia. It is often discussed beside oral estradiol 1 mg and a 50 mcg/day patch, but Premarin contains a mixture of conjugated estrogens, so there is no defensible milligram-for-milligram estradiol conversion.

Is 2 mg of oral estradiol a high dose?

The label depends on the guide. Canada calls 2 mg moderate-high. Britain and Australia call it medium. ACOG's published category table does not list 2 mg. “High” is not a universal label, and the category is not a self-dosing instruction.

Is a 0.1 mg/day estradiol patch a high dose?

A 0.1 mg/day patch equals 100 mcg/day. The Canadian, British, and Australian guides place 100 mcg/day in their high category. That is a reference classification, not permission to start, combine, cut, or change patches.

How many pumps of EstroGel equal a 50 mcg patch?

No U.S. label gives a universal pump-to-patch conversion. The Canadian, British, and Australian guides place Oestrogel/EstroGel pump counts into broad bands, but the U.S. EstroGel label has one approved dose: one pump daily. Do not translate foreign multi-pump rows into U.S. instructions.

Is one Elestrin pump the same as one EstroGel pump?

No. One Elestrin pump contains 0.52 mg estradiol, while one EstroGel pump contains 0.75 mg. The formulations and instructions also differ. “One pump” is not a drug unit.

Is Divigel 1 mg the same as oral estradiol 1 mg?

No direct milligram equality exists. Divigel is a transdermal unit-dose gel packet; oral estradiol is a swallowed tablet. The same printed number describes the amount contained in two different products and routes, not identical exposure.

Are Evamist and Lenzetto equivalent?

Do not infer that. Evamist has its own U.S. label, and the British table specifically says Lenzetto's unique delivery data cannot be extrapolated. The similar “spray” label does not establish a conversion.

Is Femring the same as Estring?

No. Femring is systemic estrogen and is labeled in 0.05 and 0.10 mg/day strengths. Estring releases about 7.5 mcg/day and is a local vaginal treatment. Same route and similar wear period; different treatment role.

Is vaginal estrogen equivalent to a patch or pill?

Low-dose local products such as Estring, Vagifem, Yuvafem, and Imvexxy are not systemic substitutes. Femring is the vaginal-ring exception on this page because it is systemic, but it still does not have an automatic patch conversion.

Do I need more progesterone if my estrogen dose goes up?

British and Canadian guidance increase listed stand-alone progestogen doses at higher estrogen bands. The Australian guide says evidence is insufficient to support increasing micronized progesterone and keeps the same listed dose across its bands. The answer depends on the complete regimen and must come from the prescriber.

Are all estradiol patches with the same number interchangeable?

The nominal daily release rate may match, but the patch can differ in schedule, adhesive, size, total drug content, and manufacturer. Confirm the exact release rate and whether the replacement schedule is once weekly or twice weekly.

Can a generic patch legally be 20% weaker?

That is a misreading of the bioequivalence framework. The 80%–125% range generally applies to the 90% confidence interval around population-average pharmacokinetic ratios, not to the labeled drug content of an individual patch.

Do blood estradiol levels show whether my dose is right?

Not by themselves. Current Canadian guidance says its equivalency table is not based on serum estradiol and does not recommend routine monitoring solely for dose adjustment, except in selected suspected non-response situations. There is no universal menopause target that converts products.

Can I use this chart for a compounded estrogen cream?

No. Custom compounded products are not FDA-approved, and concentration, dispenser output, formulation, and absorption are not standardized through an FDA-approved label. This page will not imply that a compounded product is equivalent to a labeled one.

Does this chart cover testosterone?

No. Testosterone is a different hormone, no testosterone product is FDA-approved for women in the United States, and testosterone is a prescription Schedule III controlled substance. This page provides no testosterone dose or conversion.

Does this chart cover premature ovarian insufficiency?

No. The current BMS table explicitly excludes POI, while the Canadian guide treats POI/early menopause as a separate high-dose context. Use clinician-led POI guidance rather than this consumer route-switch chart.

Why are some U.S. products missing?

The professional tables were built for specific countries, products, and clinical purposes. A missing row means the guide did not classify that exact product or strength. It does not authorize an estimate.

Still deciding your next step?

A general chart cannot combine your symptoms, uterus status, risk history, state, insurance, and route preference into one safe answer. The free routing tool organizes those factors, shows a best-fit care path and two backups, and flags when online care is not the right starting point.

Still not sure which HRT program is right for you? Take our free 90-second matching quiz.

The HRT Index is the independent decision resource for online menopause and HRT care for women. We're reader-supported and may earn a commission if you choose certain providers after using our tools, at no cost to you. That never changes our editorial research or what we recommend. FDA-approved and compounded options are always labeled distinctly.

Sources

These are the primary labels, professional guidance documents, and peer-reviewed studies used to verify the page in August 2026. Product and provider facts should be rechecked on the stated update cadence before the visible verification date changes.

Use the chart as a conversation starter

Take the exact product, strength, unit, and schedule to your prescriber. For the broader product context, start with the types of HRT guide and review the linked evidence before changing a regimen.

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