One Size Doesn’t Fit All: Groupthink in Medicine May Be Leaving Women Behind
Many women have long suspected that transdermal estradiol absorption is anything but predictable. Now, a groundbreaking study has put numbers to the claim that they were right!
In a real-world sample of 1,508 peri- and postmenopausal women, researchers found that estradiol levels varied greatly among women using the same dose of patch or gel. Even more striking, one in four women using the highest licensed dose had subtherapeutic levels (<200 pmol/L or <55 pg/mL) – meaning their bodies weren’t absorbing enough to achieve meaningful biological effects.
The Numbers:
- Median estradiol level: 355 pmol/L (~97 pg/mL)
- Therapeutic target: 220–550 pmol/L (60–150 pg/mL)
- Low levels: <200 pmol/L (<55 pg/mL)
Women using gel formulations tended to have higher—but more variable—levels. In contrast, patch users and older women (≥50) were significantly more likely to have subtherapeutic results.
The message is clear: there is no single “right” dose that works for everyone.
Why This Matters Beyond Numbers
Estradiol absorption can vary based on factors such as:
- Skin thickness and hydration
- Temperature and application site
- Body composition
- Genetic and metabolic differences
Women and their clinicians can’t avoid dealing with this variation. To do so risks under-treatment of symptoms — it also risks long-term health consequences. Estradiol isn’t just about comfort; it supports health throughout midlife and beyond.
Caution: Medical Groupthink at Work
The authors refer to a growing problem in women’s health: groupthink. When regulators and medical organizations discourage off-label dosing without acknowledging real-world variability, they risk prioritizing regulatory uniformity over individualized care.
Women who don’t respond to standard doses can be labeled “noncompliant,” “anxious,” or even “difficult,” when the real issue may simply be that their bodies don’t absorb estradiol efficiently.
Groupthink has a way of silencing nuance. It can make clinicians hesitant to personalize care and women reluctant to speak up when their lived experience doesn’t align with protocol.
Personalized Care is Preventive Care
The authors conclude that personalized dosing is key to ensuring women receive the full benefits of therapy.
They recommend:
- Using clinical response (symptom relief, bone health markers) as the primary guide.
- Measuring serum estradiol only when absorption issues are suspected.
- Recognizing that for some women, an “off-label” dose may simply be the effective dose.
Failing to reach therapeutic levels carries greater proven risks: continued bone loss, and the cascade of preventable health issues associated with chronic estradiol deficiency.
My28Days Perspective: Putting Women Back at the Center
This study is a reminder that personalized medicine is not a luxury – it’s a necessity. Women differ in their absorption, metabolism, and responses, yet some clinic visits still offer cookie-cutter solutions.
At My28Days, progress in women’s health means moving away from rigid protocols toward evidence-based, personalized care.
Women must advocate for individualized care. Clinicians must tailor their approach. This approach means listening to women and measuring when needed. Good science and compassionate care demand this approach.
Takeaway
For women using transdermal estradiol who have their symptoms persist, or women seeking treatment for bone and general health protection, it’s worth a discussion with their clinician.
Ask, “Is my dose optimized for me?”
In personalized care, precision replaces assumption – and women reclaim agency over their health.
See the full study at NIH:
