Evamist® is an estrogen spray approved by the FDA to treat hot flashes. There are at least two good reasons to avoid it.

1) Although advertised as a low dose spray, Evamist delivers 1.53 mg of estradiol per spray, which is a very high dose.

Why does Big Pharma persist in their belief that dosing should be the same for oral and transdermal hormone delivery? Oral (pill) estrogen is processed through the liver before reaching the bloodstream, and up to 80 percent can be dumped along the way. Thus, a 1.53 mg dose of estradiol taken in pill form may only deliver 0.31 mg. In contrast, when delivered through the skin in a cream, patch or in this case a spray, the full 1.53 mg of estradiol is delivered directly to the bloodstream and then to the tissues.

This error is likely caused by measuring hormone levels in serum, which is the watery part of the blood. When your doctor sends you to a lab and blood is taken from a vein in your arm, the serum is then extracted and the amount of estradiol measured. This works OK when you have taken an estradiol pill, but when you use transdermal estradiol, it rides in the fatty part of the blood, not in the serum. So, you can measure serum all day long but transdermal hormones won’t show up there unless you take mega-doses!

When estradiol patches were first on the market they came in huge doses, and I sometimes wonder how many women were killed or crippled by strokes caused by way too much estradiol.

The safest way to determine the best individual dose of estradiol is to measure hormone levels and then start with a dose of 0.025 or 0.05 mg. Keep track of symptoms and test again in a month or two. Very few women need more than 0.5 mg of transdermal estradiol to relieve menopausal symptoms. Women who still have vaginal dryness on 0.5 mg can try a vaginal estriol cream, available from compounding pharmacies.  Here’s a helpful article: Estrogen Advice from Dr. John Lee

And remember, never ever use any type of estrogen without also using progesterone. Here’s an article that explains why women without a uterus still need progesterone: Hysterectomy and Bioidentical Hormones.

2) The Evamist spray is delivered with a device that looks like an asthma inhaler with a cup on it. The cup is placed on the inside of the forearm and one pump delivers the 1.53 mg of estradiol. Although I don’t have any direct evidence of this, my guess is that unless the cup remains securely on the forearm for at least a minute, there is going to be estrogen in the air, which the user is going to breathe. It’s just not a good idea to be breathing estrogen mist. Nowhere in nature is estrogen delivered directly to the brain and the lungs via the nose.

In 2010 the FDA issued an advisory that women using Evamist should avoid unintentional exposure of children and pets. According the to the FDA, there were “…eight post-marketing cases of unintended exposure to Evamist in children ages 3 years to 5 years. Adverse events reported in unintentionally exposed children include premature puberty, nipple swelling and breast development in females, and breast enlargement in males. Since 2007, two reports of secondary exposure to Evamist in dogs also have been received…”

The patch seems to be the best way to deliver estrogen without the risk of transferring it to other people and to pets. Here’s an article about Hormone Transfer to Children, Pets and Partners.

  estrogen spray, Evamist spray