WARNING

Esterified estrogens are a type of hormone replacement therapy (HRT) primarily used to treat symptoms of menopause, such as hot flashes, vaginal dryness, and mood swings. While they can be effective for managing these symptoms, there are several risks associated with taking esterified estrogens:

• Increased risk of blood clots: Estrogen can promote blood clot formation, which may increase the risk of conditions like deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Increased risk of stroke: Estrogen use, particularly in combination with other factors such as smoking, can elevate the risk of ischemic stroke.
• Increased risk of breast cancer: Long-term use of estrogen-only HRT has been associated with a slightly increased risk of developing breast cancer.
• Endometrial cancer risk: Women who still have their uterus and take estrogen therapy without progesterone (a combination known as unopposed estrogen therapy) may have an increased risk of endometrial cancer.
• Gallbladder disease: Estrogen use has been linked to an increased risk of gallbladder disease, including gallstones.
• Potential cardiovascular risks: While the relationship between estrogen therapy and cardiovascular disease is complex and not fully understood, some studies have suggested potential risks, particularly for older women or those with pre-existing cardiovascular conditions.
• Other side effects: Estrogen therapy can also cause side effects such as breast tenderness, nausea, bloating, headaches, mood changes, and vaginal bleeding.

It’s important for individuals considering estrogen therapy to discuss the potential risks and benefits with their healthcare provider, especially considering their individual medical history and risk factors. Hormone replacement therapy should be used at the lowest effective dose for the shortest duration necessary to manage symptoms. Regular monitoring and follow-up with a healthcare provider are essential for managing potential risks associated with estrogen therapy.

Why is this medication prescribed?

Esterified estrogens are prescribed primarily for the management of menopausal symptoms in women, such as hot flashes, vaginal dryness, and mood swings. They are a form of hormone replacement therapy (HRT) used to supplement the declining levels of estrogen that occur during menopause. Additionally, esterified estrogens may be prescribed for the prevention of osteoporosis in postmenopausal women who are at risk.

How should this medicine be used?

The dosage and administration of esterified estrogens can vary depending on the individual’s symptoms, medical history, and response to treatment. Typically, esterified estrogens are taken orally in the form of tablets. The dosage prescribed by a healthcare provider will depend on factors such as the severity of symptoms and whether the woman has had a hysterectomy (removal of the uterus).

Here are some general guidelines for using esterified estrogens:

• Dosage: The usual starting dose for esterified estrogens is 0.3 mg to 1.25 mg per day, taken orally in divided doses. The dose may be adjusted based on individual response and symptom control.
• Administration: Esterified estrogen tablets should be taken orally, typically once daily. It’s essential to follow the specific instructions provided by the healthcare provider or as indicated on the prescription label.
• Timing: Some healthcare providers recommend taking esterified estrogens at the same time each day to maintain consistent hormone levels in the body.
• Duration: Hormone replacement therapy with esterified estrogens is often prescribed for the shortest duration necessary to manage symptoms effectively. It’s essential to follow the healthcare provider’s recommendations regarding the duration of treatment.
• Regular follow-up: Women prescribed esterified estrogens should have regular follow-up appointments with their healthcare provider to monitor their response to treatment, assess any side effects, and adjust the dosage if necessary.
• Combination therapy: In women who still have their uterus, esterified estrogens are often combined with a progestin (synthetic progesterone) to reduce the risk of endometrial cancer. The combination therapy is typically prescribed cyclically, with estrogen taken daily and progestin added for a portion of the treatment cycle.

It’s crucial for individuals prescribed esterified estrogens to adhere to their healthcare provider’s instructions regarding dosage, administration, and follow-up care to maximize the benefits of treatment while minimizing potential risks. Additionally, any concerns or questions about esterified estrogen therapy should be discussed with a healthcare provider.

Other uses for this medicine

• Hypoestrogenism: Esterified estrogens may be prescribed to women who have low estrogen levels due to conditions such as primary ovarian insufficiency or certain surgical procedures.
• Hormone Replacement Therapy (HRT) in transgender individuals: Esterified estrogens may be a component of hormone therapy for transgender women as part of gender-affirming treatment.
• Certain gynecological conditions: In some cases, esterified estrogens may be used to manage conditions such as atrophic vaginitis or dyspareunia (painful intercourse) associated with estrogen deficiency.
• Certain cancers: In rare cases, esterified estrogens may be used in the treatment of certain hormone-sensitive cancers, such as breast cancer or prostate cancer, under the supervision of an oncologist.

What special precautions should I follow?

Special precautions should be taken when using esterified estrogens, and it’s essential to follow healthcare provider recommendations closely. Here are some specific precautions to consider:

• Medical history: Before starting esterified estrogens, inform your healthcare provider about your complete medical history, including any past or present medical conditions, surgeries, allergies, and medications you are taking.
• Breast and gynecological exams: Women taking esterified estrogens should have regular breast examinations and gynecological check-ups, including pelvic exams and Pap smears, as recommended by their healthcare provider.
• Monitoring: Regular monitoring of blood pressure, blood sugar levels, and lipid profiles may be recommended during estrogen therapy, especially in individuals with pre-existing conditions such as hypertension, diabetes, or hyperlipidemia.
• Risk of blood clots: Estrogen therapy can increase the risk of blood clots, particularly in individuals with a history of clotting disorders, smoking, obesity, or prolonged immobility. It’s important to promptly report any signs or symptoms of blood clots, such as leg swelling, chest pain, or shortness of breath, to a healthcare provider.
• Cardiovascular health: Estrogen therapy may have implications for cardiovascular health, especially in individuals with pre-existing heart disease or risk factors such as smoking, obesity, or hypertension. Healthcare providers may evaluate cardiovascular risk factors before initiating estrogen therapy and monitor cardiovascular health during treatment.
• Interactions with other medications: Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with esterified estrogens and affect their effectiveness or increase the risk of side effects.
• Pregnancy and breastfeeding: Esterified estrogens are contraindicated during pregnancy and breastfeeding due to potential risks to the fetus or infant. If pregnancy is detected during estrogen therapy, treatment should be discontinued, and alternative contraceptive methods should be used if appropriate.
• Smoking cessation: Smoking can increase the risk of cardiovascular complications associated with estrogen therapy. Healthcare providers may recommend smoking cessation programs for individuals using estrogen therapy.

It’s essential to communicate openly with your healthcare provider about any concerns or questions regarding esterified estrogen therapy and to follow their recommendations for monitoring and management of potential risks.

What special dietary instructions should I follow?

• There are no specific dietary restrictions associated with esterified estrogens. However, maintaining a healthy diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health and complement hormone therapy.
• Some individuals may experience gastrointestinal side effects such as nausea or bloating while taking esterified estrogens. Eating small, frequent meals and avoiding spicy or greasy foods may help alleviate these symptoms.

What should I do if I forget a dose?

• If you forget to take a dose of esterified estrogens, take it as soon as you remember. However, if it’s almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule.
• Do not take a double dose to make up for a missed one, as this can increase the risk of side effects and complications.
• If you have questions about what to do if you forget a dose or if you miss multiple doses, consult your healthcare provider or pharmacist for guidance.

What side effects can this medication cause?

Esterified estrogens, like any medication, can potentially cause side effects in some individuals. It’s important to note that not everyone will experience these side effects, and some people may experience them to varying degrees of severity. Common side effects associated with esterified estrogens include:

• Breast tenderness: Some individuals may experience breast tenderness or enlargement as a result of estrogen therapy.
• Nausea: Nausea is a common side effect of estrogen therapy, especially when treatment is first initiated. Taking esterified estrogens with food or adjusting the timing of doses may help alleviate this symptom.
• Bloating: Estrogen therapy can sometimes cause bloating or fluid retention, leading to feelings of fullness or discomfort in the abdomen.
• Headaches: Headaches are a potential side effect of estrogen therapy, although they often improve with continued use or by adjusting the dosage.
• Mood changes: Some individuals may experience changes in mood or emotional well-being while taking esterified estrogens. This can include symptoms such as irritability, mood swings, or changes in libido.
• Vaginal bleeding: Estrogen therapy can cause irregular vaginal bleeding or spotting, particularly during the first few months of treatment. This side effect typically resolves over time but should be reported to a healthcare provider if persistent or severe.
• Fluid retention: Estrogen therapy may lead to fluid retention, which can manifest as swelling in the extremities (edema) or weight gain.
• Gastrointestinal disturbances: Some individuals may experience gastrointestinal side effects such as stomach cramps, bloating, or changes in bowel habits while taking esterified estrogens.
• Skin changes: Estrogen therapy may affect skin health, leading to changes such as acne, increased facial hair growth, or skin pigmentation.
• Changes in libido: Estrogen therapy can influence sexual desire and arousal in some individuals, leading to changes in libido or sexual function.
• Headaches: Some individuals may experience headaches as a side effect of estrogen therapy. These headaches can vary in intensity and frequency.
• Vision changes: Estrogen therapy may rarely cause changes in vision, including blurred vision or difficulty wearing contact lenses.

It’s important to discuss any concerns or side effects experienced while taking esterified estrogens with a healthcare provider. In some cases, adjustments to the dosage or switching to an alternative treatment may be recommended to minimize side effects while still effectively managing menopausal symptoms or other medical conditions. Additionally, individuals should seek immediate medical attention if they experience severe or concerning side effects while taking esterified estrogens.

What should I know about storage and disposal of this medication?

Storage and disposal of esterified estrogens:

Storage:

• Store esterified estrogens at room temperature, away from moisture and heat.
• Keep the medication in its original packaging and away from children and pets.
• Do not store esterified estrogens in the bathroom, as moisture and humidity can affect the medication’s stability.
• If you have any questions about storage, consult your healthcare provider or pharmacist.

Disposal:

• Dispose of unused or expired esterified estrogens properly according to local regulations or guidelines.
• Do not flush medications down the toilet unless instructed to do so. Instead, take unused or expired medications to a medication take-back program or a pharmacy for safe disposal.
• Follow any specific disposal instructions provided by your healthcare provider or pharmacist.

In case of emergency/overdose

In case of emergency or overdose of esterified estrogens:

• In case of an overdose of esterified estrogens, seek emergency medical attention or contact a poison control center immediately.
• Symptoms of overdose may include nausea, vomiting, breast tenderness, vaginal bleeding, and other signs of estrogen excess.
• Be prepared to provide information about the amount of medication ingested and any symptoms experienced.

What other information should I know?

• Inform all healthcare providers involved in your care that you are taking esterified estrogens, including dentists and specialists.
• Attend regular follow-up appointments with your healthcare provider to monitor your response to treatment and any potential side effects.
• Report any new or worsening symptoms to your healthcare provider promptly.
• Avoid smoking while taking esterified estrogens, as smoking can increase the risk of certain side effects and complications.
• Be aware of potential drug interactions with esterified estrogens and inform your healthcare provider of all medications, supplements, and herbal products you are taking.
• If you are pregnant, breastfeeding, or planning to become pregnant, discuss the risks and benefits of estrogen therapy with your healthcare provider.
• Follow your healthcare provider’s instructions regarding dosage, administration, and duration of treatment for esterified estrogens.
• If you have any questions or concerns about esterified estrogens or your treatment plan, do not hesitate to discuss them with your healthcare provider or pharmacist.

By following these guidelines, you can ensure safe storage, disposal, and use of esterified estrogens while minimizing the risk of complications.