Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Note the following important information about estrogen replacement therapy: The Women's Health Initiative (WHI) study results indicated an increased risk of heart attack, stroke, breast cancer, blood clots in the lungs, and blood clots in the leg veins in postmenopausal women during 5 years of treatment with 0.625 mg conjugated equine estrogens and 2.5 mg medroxyprogesterone compared to women receiving sugar tablets. Other combinations of estrogen and progestins were not studied. However, until additional data are available, the risks should be assumed to be similar for other hormone replacement products. Therefore,
- estrogen with or without progestins should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible, as directed by your doctor; and
- estrogen with or without progestins should not be used to prevent heart disease, heart attacks, or strokes.
Blood pressure: Increased or decreased blood pressure may occur for women using this medication. Blood pressure should be monitored with estrogen use.
Blood problems: Women taking estrogen alone or in combination with progesterone have been reported to have an increased risk of conditions associated with blood clotting. Although the risk is small, it's important to be aware of this possibility during estrogen replacement therapy and to report any unusual symptoms to your doctor. Women with severe varicose veins or severe obesity, and those needing to stay in bed for 3 weeks or more, are generally considered to be at increased risk of blood clots.
Breast cancer: Some studies have found an association between a modest increase in the risk of developing breast cancer and the use of hormone replacement therapy after menopause. Women who have history of breast cancer should not use estrogens. If you have a family history of breast cancer, breast nodules, fibrocystic disease of the breast, or abnormal mammograms, you should be closely monitored by your doctor if you use estrogens. Women using estrogens should have regular breast examinations and should be taught how to do a breast self-examination. Your doctor may also recommend regular mammograms, depending on your age, risk factors, and previous mammogram results. Discuss the benefits and risks with your doctor so that you can make an informed choice about using this medication.
Cholesterol: When taken by mouth, estrogen can increase triglycerides in the blood. Your doctor may check your cholesterol levels while you are taking estrogen.
Dementia: Women over age 65 receiving combined estrogen and progestin replacement therapy may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65 years of age, your doctor should closely monitor you for loss of memory and intellectual function.
Diabetes: Estrogens may affect blood sugar control. Anyone with diabetes should carefully monitor their blood glucose levels while taking any medication containing estrogen.
Endometrial cancer: There is evidence from several studies that estrogens, taken without progesterones, increase the risk of uterine cancer. Taking a progesterone (such as medroxyprogesterone) appropriately along with the estrogen reduces this risk to the same level as that of a woman who does not take estrogen. For this reason, all women who have not had their uterus removed should also take progesterone if they use estrogens.
Fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.
Fluid retention: Estrogen may cause fluid retention. Women with heart or kidney problems, epilepsy, or asthma should be monitored carefully when taking it.
Gallbladder: An increased risk of gallbladder disease has been reported in postmenopausal women taking oral estrogens.
Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestins) for postmenopausal women. If you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs) while taking this medication, get immediate medical attention.
Kidney disease: People with kidney disease should be monitored by their doctor while using estrogen.
Liver disease: If you have or have had liver problems, you may require special monitoring by your doctor while you use this medication. Make sure to tell your doctor if you have ever had liver problems.
Pregnancy: This medication should not be taken by pregnant women. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: Estrogen should not be used during breast-feeding. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.