This month’s update turns to practical dosing guidance: a clinical review in Menopause makes the case that there is no single transdermal estradiol dose or target serum concentration that delivers symptom relief and bone protection for every woman. The authors argue that the optimal level for an individual varies with tissue sensitivity, the assay used to measure estradiol (immunoassay versus mass spectrometry), the clinical endpoint being targeted (symptom control versus bone protection), and the patient’s own treatment goals. 

For practitioners, the actionable message is that a working grasp of transdermal estradiol pharmacokinetics, pharmacodynamics, and the limitations of serum estradiol measurement is what allows dosing to be titrated to avoid both under-treatment and over-treatment — an approach that aligns squarely with guideline-driven, personalized menopause care.

Glynne SJ, Simon JA. Tailoring transdermal estradiol dose to maximize benefits and minimize risks. Menopause. 2026 Jun;33(6):743–753. doi:10.1097/GME.0000000000002723. PMID: 41529140