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:
- Estrogen should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible, as directed by your doctor.
- Estrogens with or without progestins should not be used to prevent heart disease, heart attacks, or strokes.
Allergy: Contact allergy (such as itching and redness) may occur when estrogen is applied to the skin or inside the vagina. Although this allergy is extremely rare, people who develop skin reactions or contact sensitization to any ingredient of the medication are at risk of developing a severe allergic reaction with continued use. Contact your doctor if you experience itching and redness of the skin while using this medication.
Applicator use: Women who have a very dry vagina or those who have some shrinkage in the vaginal area should be careful when inserting the applicator. If it becomes uncomfortable, do not force it. Women who have recently had surgery in the vaginal area or the reproductive system should talk to their doctor before using this medication.
Blood clotting disorders: Estrogens with or without progestins are associated with an increased risk of blood clots in the lungs and legs. This risk also increases with age, a personal or family history of blood clots, smoking, and obesity. The risk of blood clots is also increased if you are immobilized for prolonged periods and with major surgery. If possible, this medication should be stopped 4 weeks before major surgery. Talk about the risk of blood clots with your doctor.
Blood pressure: Women may experience increased blood pressure when using estrogen replacement therapy. Blood pressure should be monitored, especially if high doses of estrogen are used. With estradiol vaginal tablets, an increase in blood pressure is less likely because less estrogen is absorbed into the blood, compared with estrogen oral tablets, patches, or gel. Ask your doctor how often you should have your blood pressure checked.
Bone disease: If you have bone disease due to cancer or a metabolic condition causing too much calcium in your body, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Breast and ovarian cancer: Studies indicate an increased risk of breast and ovarian cancer with long-term use of estrogen replacement therapy. Women who have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer should be closely monitored by their doctor if they use estrogens. Women taking estrogens should have regular breast examinations and should be taught how to do a breast self-examination. This medication must not be applied to the breasts, as it may have harmful effects on the breast tissue.
Dementia: Women over age 65 receiving combined hormone replacement therapy may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65, talk to your doctor about whether you should be tested for dementia.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking this medication, as it may affect blood sugar control.
Endometrial cancer: There is evidence that estrogen replacement therapy can increase the risk of cancer of the endometrium (lining of the uterus). Taking a progestin at the right time along with the estrogen reduces this risk of endometrial cancer to the same level as that of a woman who does not take estrogen. A progestin is not usually needed for women using estradiol vaginal tablets. This is because very little estrogen from the estradiol vaginal tablet is absorbed into the blood, compared with estrogen oral tablets, patches, or gel. For further information, check with your doctor.
Endometriosis: Estrogen replacement therapy can cause endometriosis to reappear or get worse. If you have or have had endometriosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
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 closely monitored by their doctor while taking this medication.
Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting this medication to assess the response to treatment. Examinations should be done at least once a year after the first one.
Gallbladder: This medication can aggravate gallbladder disease or increase the risk of developing it. If you have gallbladder disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
High cholesterol or triglycerides: Estrogen may increase levels of triglycerides (a type of fat found in the blood) in those who already have high levels of triglycerides. This has been observed particularly when estrogen is taken orally (by mouth). The risk is reduced with use of the vaginal tablets. Ask your doctor to monitor your levels of triglycerides.
Liver disease: If you have or have had liver problems, you may require special monitoring by your doctor while you use this medication. If you have ever had liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Migraine headaches: For some people, estrogen can aggravate migraine headaches. Talk to your doctor if you notice any change in your migraine pattern while using estrogen.
Pregnancy: Estradiol vaginal tablets should not be used during pregnancy. If you become pregnant while using this medication, contact your doctor immediately.
Breast-feeding: Estrogen passes into breast milk. If you are a breast-feeding mother and are using estradiol vaginal tablets, it may affect your baby. This medication is not recommended for use by breast-feeding mothers.
Children: The safety and effectiveness of this medication have not been established for use by children. This medication is not intended for use by children.