WARNING

Estrogen and progestin hormone replacement therapy (HRT) can provide relief for symptoms of menopause such as hot flashes, night sweats, and vaginal dryness. However, there are several risks associated with HRT, including:

• Increased risk of blood clots: Estrogen can increase the risk of blood clots forming in the veins, which can lead to conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Increased risk of stroke: Estrogen may slightly increase the risk of stroke, particularly in older women or those with other risk factors such as high blood pressure or smoking.
• Increased risk of breast cancer: Some studies suggest that long-term use of estrogen-progestin HRT may slightly increase the risk of breast cancer. This risk appears to decrease after stopping HRT.
• Increased risk of heart disease: The effects of HRT on heart disease risk are complex and may depend on factors such as age, timing of HRT initiation, and pre-existing heart health. In some cases, HRT may increase the risk of heart disease, while in others, it may have a protective effect.
• Increased risk of gallbladder disease: Estrogen can increase the risk of developing gallstones and may lead to complications such as inflammation of the gallbladder.
• Other side effects: HRT may also cause side effects such as bloating, breast tenderness, nausea, and headaches.

It’s essential for individuals considering HRT to discuss the potential risks and benefits with their healthcare provider, taking into account their personal medical history, risk factors, and symptoms. In many cases, the benefits of HRT may outweigh the risks, particularly for managing severe menopausal symptoms. However, it’s important to weigh these factors carefully and make an informed decision in collaboration with a healthcare professional. Additionally, HRT should be used at the lowest effective dose for the shortest duration necessary to achieve treatment goals.

Why is this medication prescribed?

Estrogen and progestin hormone replacement therapy (HRT) is prescribed primarily to alleviate symptoms associated with menopause, which occurs when a woman’s ovaries stop producing estrogen. Common symptoms of menopause include hot flashes, night sweats, vaginal dryness, mood swings, and sleep disturbances. HRT can effectively relieve these symptoms and improve quality of life for many women experiencing menopause.

Additionally, HRT is sometimes prescribed to prevent or manage certain health conditions associated with estrogen deficiency, such as osteoporosis (loss of bone density) and the thinning of vaginal tissues (which can lead to discomfort during intercourse).

How should this medicine be used?

The specific regimen for estrogen and progestin HRT can vary depending on individual factors such as the severity of symptoms, medical history, and risk factors. Here are some general guidelines for using HRT:

• Types of HRT: There are different types of HRT, including estrogen-only therapy (ET) for women who have had a hysterectomy (removal of the uterus) and combined estrogen-progestin therapy (EPT) for women with an intact uterus. EPT includes both estrogen and progestin to reduce the risk of endometrial cancer, which can develop when estrogen is taken alone.
• Dosage: The dosage of estrogen and progestin prescribed will depend on factors such as the severity of symptoms, age, and overall health. It’s essential to follow the prescribed dosage carefully and not to exceed it without consulting a healthcare provider.
• Administration: HRT can be administered in various forms, including pills, patches, creams, gels, and vaginal rings. The choice of administration method depends on individual preferences and medical considerations.
• Timing: For women who still have a uterus and are taking combined estrogen-progestin therapy, it’s typically recommended to take the progestin component for a certain number of days each month to induce withdrawal bleeding and reduce the risk of endometrial hyperplasia (abnormal thickening of the uterine lining).
• Monitoring: Women prescribed HRT should undergo regular medical check-ups to monitor their response to treatment, assess any potential side effects, and adjust the treatment plan as needed. This may include monitoring blood pressure, cholesterol levels, and mammograms, depending on individual risk factors.

It’s crucial for individuals considering or using HRT to have open and ongoing discussions with their healthcare provider to ensure that the treatment plan is appropriate for their specific needs and circumstances. Additionally, it’s essential to weigh the potential benefits of HRT against the associated risks and to explore alternative treatment options if necessary.

Other uses for this medicine

Some potential off-label uses may include:

• Management of certain gynecological conditions, such as ovarian insufficiency or vulvovaginal atrophy.
• Treatment of hormone-sensitive cancers, under specific circumstances and in combination with other therapies.
• Off-label use for certain neuroprotective effects or in the management of cognitive decline associated with aging, although evidence for these uses is still being studied.

What special precautions should I follow?

Special precautions should be followed when using estrogen and progestin hormone replacement therapy. These precautions include:

• Regular medical check-ups: Women prescribed HRT should undergo regular medical check-ups to monitor their response to treatment, assess any potential side effects, and adjust the treatment plan as needed.
• Breast cancer risk: Women with a history of breast cancer or at high risk for breast cancer should discuss the potential risks and benefits of HRT with their healthcare provider before initiating treatment. In some cases, alternative treatments may be recommended.
• Cardiovascular health: Women with a history of cardiovascular disease, stroke, blood clots, or other cardiovascular risk factors should use caution when considering HRT. Estrogen therapy may increase the risk of blood clots and cardiovascular events in some individuals.
• Smoking: Smoking may increase the risk of certain side effects associated with HRT, such as blood clots and cardiovascular disease. Women who smoke should be advised to quit smoking before starting HRT.
• Individualized treatment: HRT should be tailored to each woman’s specific needs, taking into account factors such as age, menopausal symptoms, medical history, and risk factors. The lowest effective dose of estrogen and progestin should be used for the shortest duration necessary to achieve treatment goals.
• Regular breast exams: Women using HRT should perform regular breast self-exams and undergo clinical breast exams as recommended by their healthcare provider. Mammograms may also be recommended based on individual risk factors.
• Vaginal bleeding: Women using combined estrogen-progestin therapy should report any unusual vaginal bleeding or spotting to their healthcare provider, as this may indicate a potential problem that needs to be evaluated.

It’s essential for individuals considering or using HRT to have open and ongoing discussions with their healthcare provider to ensure that the treatment plan is appropriate for their specific needs and circumstances. Additionally, they should be aware of the potential risks and benefits associated with HRT and make informed decisions in collaboration with their healthcare provider.

What special dietary instructions should I follow?

Regarding special dietary instructions for estrogen and progestin HRT, there are no specific dietary restrictions associated with this treatment. However, maintaining a healthy diet rich in fruits, vegetables, whole grains, and lean proteins is generally recommended for overall health. If you have specific dietary concerns or medical conditions, consult with your healthcare provider or a registered dietitian for personalized dietary recommendations.

What should I do if I forget a dose?

If you forget to take a dose of estrogen and bazedoxifene, take it as soon as you remember. However, if it is 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. If you have any questions or concerns about missed doses, consult your healthcare provider or pharmacist for guidance.

What side effects can this medication cause?

Estrogen and progestin hormone replacement therapy (HRT) can potentially cause various side effects. It’s important to note that not everyone will experience these side effects, and their severity can vary from person to person. Some common side effects of estrogen and progestin HRT include:

• Breast tenderness: Some women may experience breast tenderness or swelling while taking HRT.
• Spotting or irregular bleeding: Women using combined estrogen-progestin therapy may experience spotting or irregular bleeding, especially during the first few months of treatment. This is particularly common during the progestin phase of the menstrual cycle.
• Nausea: Nausea is a possible side effect of estrogen and progestin HRT, especially when starting treatment. Taking HRT with food may help alleviate nausea in some cases.
• Bloating: Some women may experience bloating or fluid retention while taking HRT.
• Headaches: Headaches, including migraines, can occur as a side effect of estrogen and progestin HRT.
• Mood changes: HRT may affect mood in some individuals, leading to changes such as irritability or mood swings.
• Vaginal discharge or discomfort: Estrogen therapy can sometimes cause vaginal discharge or discomfort, including itching or dryness.
• Increased risk of blood clots: Estrogen therapy, particularly when taken orally, may increase the risk of blood clots forming in the veins, which can lead to conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Increased risk of stroke: Estrogen therapy may slightly increase the risk of stroke, particularly in older women or those with other risk factors such as high blood pressure or smoking.
• Increased risk of breast cancer: Some studies suggest that long-term use of estrogen-progestin HRT may slightly increase the risk of breast cancer. This risk appears to decrease after stopping HRT.
• Gallbladder disease: Estrogen therapy can increase the risk of developing gallstones and may lead to complications such as inflammation of the gallbladder.
• Other side effects: Additional side effects of estrogen and progestin HRT may include changes in libido (sex drive), changes in appetite, weight changes, and changes in menstrual bleeding patterns.

It’s essential to discuss any side effects or concerns with your healthcare provider, as they can provide guidance on managing side effects and adjusting your treatment plan if necessary. Additionally, some side effects may indicate a more serious problem and should be promptly evaluated by a healthcare professional.

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

Storage and Disposal:

Storage:

• Follow the storage instructions provided by your pharmacist or healthcare provider.
• Store estrogen and progestin HRT medications at room temperature away from moisture and heat.
• Keep medications out of reach of children and pets.

Disposal:

• Dispose of expired or unused estrogen and progestin HRT medications properly.
• Follow any specific disposal instructions provided by your pharmacist or healthcare provider.
• Do not flush medications down the toilet unless instructed to do so by disposal instructions or local regulations.
• Consider utilizing medication take-back programs or community disposal programs for safe disposal.

In case of emergency/overdose

• In case of an emergency or suspected overdose, contact your local poison control center or seek emergency medical attention immediately.
• Be prepared to provide information about the medication ingested, including the name of the medication, dosage strength, and the amount ingested.

What other information should I know?

• Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with estrogen and progestin HRT.
• Attend regular follow-up appointments with your healthcare provider to monitor your response to treatment, assess any potential side effects, and adjust the treatment plan as needed.
• Be aware of the potential risks and benefits associated with estrogen and progestin HRT, and discuss any concerns or questions with your healthcare provider.
• Report any new or unusual symptoms experienced while taking estrogen and progestin HRT to your healthcare provider.
• Follow your prescribed medication schedule and do not alter the dosage or frequency of administration without consulting your healthcare provider.
• Keep a list of emergency contact numbers, including your healthcare provider, pharmacist, and local poison control center.
• Be aware of any warning signs or symptoms of serious side effects, such as chest pain, shortness of breath, severe headache, vision changes, or signs of allergic reaction, and seek prompt medical attention if any occur.

By following these guidelines and staying informed about your medication, you can help ensure safe and effective use of estrogen and progestin hormone replacement therapy.