Female hypogonadism
Primary ovarian failure
Post menopausal symptoms
Prevention of post menopausal osteoporosis

GU- breakthrough bleeding, spotting, change in menstrual flow, dysmennorrhea,  premenstrual -like  syndrome, amenorrhea during and after treatment, vaginal candidiasis, change in cervical eversion and degree of cervical secretion, cystitis-like syndrome, hemolytic uremic syndrome , endometrial  cystic hyperplasia

GI- nausea, vomiting, abdominal cramps, bloating,cholestatic jaundice,colitis , acute pancreatitis.

Dermatologic- cholasma or melasma (may persist when drug is discontinued ) erythema,
nodusum/multiforme, hemorrhagic eruption, urticaria, dermatitis

Ophthalmic- steepening of corneal curvature, intolerance to contactlens

CNS- headache, migraine, dizziness, mental depression,chorea, convulsions

Local- pain at injectin site, sterile abcess, ostinjectin flare, redness and irritation at appilcation site with estradiol transdermal system, rash (rare)

Miscellaneous- aggravaton of prorphria, edema, changes in libido, breast tenderness,, enlargement  or secretion..

Unopposed replacement therapy in postmenopausal women associated with increase risk of endometrial cancer and cancer breast. Abnormal bleedng, vomiting, nausea, tender breasts, weight gain fluid retension, headache and depression.

Males: Gynaecomastia,impotence.

Topical vaginal appln: Prolonged use causes endometrial  hyperplasia.

 

Patients with markedly impaired liver function,personal/family H/O malignancy(breast and
genital). Thromboemboloic disorders, cardiovascular disease, undiagnosed vaginal
bleeding. Estrogen dependent neoplasia, hypersens,pregnancy.

Special precautions:
Asthma, epilepsy, migraine, heart/kidney dysfunction, diabetes, lactation, hypercalcemia, gall bladder disease.

History/Medical examination- before initiating estrogens take complete medical and family history.
 Pretreatment and and periodic history and physical exams every 12 months should include blood pressure, breast, abdomen, pelvic organs, and a papanicolaou . Generally do not prescribe for > 1 year between physical examinations.

Estropipate vaginal cream- rule out gonorrhea or neoplasia before prescribing estrogen  vaginal cream. Treat trichomonal , monilial or bacterial infection with appropriate anti-microbial therapy.

Excessive estrogenic stimulation- certain patients may develop undesirable manifestatons of excessive estrogenic stimulation( eg. abnormal or excessiveuterine bleeding, mastodynia ) Advice  pathologist of estrogen therapy when relevant specimens are submitted.

Fluid retention- estrogens may cause  some degree of fluid retention, conditions which might be influenced by this factor (eg. epilepsy, migraine, and cardiac or renal dysfunction)require careful observation.

Calcium and phosphorus metabolism- is influenced by estrogens. Use caution in patients with  metabolic bone diseases asociated with hypercalcemia or inrenal insufficiency.

Endometrial hyperplasia- prolonged unopposed estrogen therapy may increase the risk of
 endometrial hyperplasia.

Acute intermittant hyperplasia - may be precipitated by estrogens.

Photosentivity- may occur.Caution patients to protect against undue expoure to ultaviolet or sunlight.
 
Warnings
Induction of malignant neoplasms- estrogern may increase the risk of endometrial carconoma. Closely  monitor patients with an intract uterus for signs of endometrial cancer, and take appropiate measures  to rule out malignancy.

Gall bladder disease- there is a 2-fold to 3 fold increae in risk of gallbladder disease in women  receiving menopausal estrogens. This may be related to large doses.

Effects of similar to those caused by estrogen-progestin oral contraceptives- three is an increased risk of thrombosis in men receiving estrogens for prostatic cancer and in women receiving estrogens for postpatum breast engorgement because lage doses are used in therapy

Elevated blood pressure- is common but is less frequent with estrogen replacement than with OCs  use.

Thromboembolic disease- OCs user have an increased risk of thromboembolic and thrombotic vascular diseases, including thromboplebitis, pulmonary embolism, stroke, and myocardial infarction.

Hypercalemia- estrogens may leadto severe hypercalcemia in patients with breast cancer and bone  metastases.If this occurs, discontinue the drug.

Glucose tolerance- usual replacement doses of estrogen improve insulin sensitivity.

Hepatic functin impairment- if jaundice develpos in any patient on estrogen, discontinue medication  and investigate the cause.

Pregnancy- if estrogens are used during pregnancy or if the patient becomes pregnant while taking  estrogens inform her of the potential risks to the fetus.

Lactation- estrogen have beenshown to decrease the quantity and quality of breast milk and may be  excreted in breast milk. Administer only when needed

Children- safety and efficacy are not established

 





 

 

Indications:
Female hypogonadism
Primary ovarian failure
Post menopausal symptoms
Prevention of post menopausal osteoporosis


Dosage:
Administer cyclically ,3 weeks on and 1 week off. Give  2 or  4g  daily vaginally depending  on severity of condition.

                       Overdosage

Serious ill effects have been reported following ingestion of large doses estyrogen-containing OCS by young children.
Overdosage of estrogen may cause nausea, withdrawal bleeding may occur in females.

Missed dose-
 If you miss  adose of this medicine and your dosing schedule is-
One dose a day-
1. Take, use or apply the missed dose as soon as possible.
2.However, if you do not remember it until the next day, skip the missed dose and go back to your regular dosing
schedule.
3. Do not double doses.

More than one dose a day-
1. Take or use the missed dose as soon as possible.
2.However, ifit is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses
4.If you have question about this check with your doctor.  

 

1. Diabetic patients- notify physician if any of the following occur.-
 pain in groin, or calves, of the leg, sharp chest pain,or sudden shortness of breath, abnormal vaginal  bleeding,  missed menstrual period, or suspected pregnancy, lumps in the breast, sudden severe  headache, dizziness or fainting, vision or speech disturbance, weakness or nunbness in the arm or   the leg, severe abdominal pain, yellowing of the   skin or eyes, severe depression

2. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to estrogens or    related medicines. Also tell your doctor  if your are allergic to any other substances such as foods,   preservatives or dyes.

3. Pregnancy-  oestrogens are not recommended for use during pregnancy since some have been   shown to cause serious birth defects in humans and animals.  
   
4. Breast feeding-  use of this medicine not recommended in nursing mothers    
       
5. Elderly- this medicine is not expected to cause different side effects or problems in older people    than it does in younger women

6. Other medicines- tell your doctor if you are taking any of the following-
    
      Acetaminophen or
      Amiadarone or
      Anabolic steroids or
      Androgens or
      Anti-infectives by mouth or or by injection
      Carbamazepine or
      Carmustine or
      Chloroquine or
      Dantrolene or
      Daunorubicin or
      Disulfram or
      Divalproex or
      Etretinate or
      Gold salts or
      Hydroxychloroquine or
      Mercaptopurine or
      Methotrexate  or
      Methyldopa or
      Naltexone or
      Oral contraceptives or
      Phenothiazines  or
      Phenytoin or
      Plicamycin or
      Valproic acid  - estrogens and all these medicines can cause liver damage. Your doctor          may want
      to have extra blood tests that tell about your liver  
      
      Bromocriptine  - estrogens may interfere with the effects of bromocriptine
      Cyclosporine - estyrogens can increase the chance of toxic effects to the kidney or liver       from   cyclosporine  out of blood stream as it normally would.   
      
      
7.  Other medical problems- presence of other medical problems may afect the use of erythromycin-

       Blood clots - estrogens may worsen blood clots or cause new clots to form
       Breast cancer- estrogens may cause growth of the tumor in some cases

       Changes in vaginal bleeding-  some irregular vaginal bleeding is a sign that the lining of         the    utreus is growing too much or is sign of cancer of the uterus lining  

       Endometriosis- estrogens may worsen endometriosisby causing growth of                               endometriosis implants

       Fibroid tomors of the uterus - estrogens may cause fibroid tumors to increase in size

       Gall bladder disease or gallstones -estrogens may possibly increase te risk of                      gallbladder  disease or gallstones

       Jaundice -estrogens may worsen or cause jaunduce in these patients

       Liver disease- toxic drug effects may occur in patients with liver disease because the             body is not   able this medicine out of the bloodstream asit normally would

       Porphyria- estrogens can make porphyria worse
          
8. Missed dose-
    If you miss a dose of this medicine take it as soon as possible. However if it is almost            time for your  next dose  go back to your regular dosing schedule.
    Do not double doses.

 

Pharmacology-
Estrogens induce proliferatin in the epithelium of the fallopian tubes ,endometrium, cervix, vagina, and muscosa of GI tractand increase vacxularity.Estrogens are responsible for the vaginal acidity caused  by deposition of glycogen in vaginal epithelum.

Pharmacokinetics-
Absorption of most natural occuring estrogens and their derivatives from the GI tract is complete. Therefore transdermal use produces the therapeutic serumlevels of estrodiol with lower circulating  levels of estrone and estrone conjugates and requires smaller total doses.

Pregnancy-
If estrogens are used during pregnancy or if the patient becomes pregnant while taking estrogens
 inform her of the potential risks to the fetus.

Lactation-
Estrogen have beenshown to decrease the quantity and quality of breast milk and may be excreted in
breast milk. Administer only when needed

Children-
Safety and efficacy are not established