Estrogen

Estrogens

Brand Names
Some commonly used brand names are:

In the U.S.—
Alora4 Aquest5 Climara4 Delestrogen4 depGynogen4 Depo-Estradiol4
Depogen4 Dioval 404 Dioval XX4 Dura-Estrin4 Duragen-204 E-Cypionate4
Estinyl7 Estrace4 Estraderm4 Estragyn 55 Estragyn LA 54   Estra-L 404
Estratab3 Estro-Cyp4 Estrofem4 Estro-L.A.4 Estrone `5'5 FemPatch4
Gynogen L.A. 204   Gynogen L.A. 404   Kestrone-55 Menaval-204 Menest3 Ogen .6256
Ogen 1.256 Ogen 2.56 Ortho-Est .6256   Ortho-Est 1.256   Premarin1 Premarin Intravenous1
Stilphostrol2 Valergen-104 Valergen-204 Valergen-404 Vivelle4 Wehgen5
In Canada—
C.E.S.1 Delestrogen4 Estinyl7 Estrace4
Estraderm4   Femogex4 Honvol2 Ogen6
Premarin1 Premarin Intravenous1   Stilbestrol2   Vivelle4
Note:
For quick reference, the following estrogens are numbered to match the corresponding brand names.
Other commonly used names are: DES, Fosfestrol, Oestradiol, Oestrone, Piperazine, estrone, sulfate, Stilboestrol
This information applies to the following medicines
  1. Conjugated Estrogens (CON-ju-gate-ed ES-troe-jenz)§
  2. Diethylstilbestrol (dye-eth-il-stil-BES-trole)
  3. Esterified Estrogens (es-TAIR-i-fyed Es-troe-jenz)
  4. Estradiol (es-tra-DYE-ole)‡
  5. Estrone (ES-trone)‡†
  6. Estropipate (es-troe-PIH-pate)‡
  7. Ethinyl Estradiol (ETH-in-il es-tra-DYE-ole)
‡ Generic name product may be available in the U.S.
§ Generic name product may be available in Canada
* Not commercially available in the U.S.
† Not commercially available in Canada

Category
Antineoplastic --Conjugated Estrogens; Diethylstilbestrol; Esterified Estrogens ; Estradiol; Estradiol valerate; Estrone; Ethinyl Estradiol
Estrogen, systemic --Conjugated Estrogens; Diethylstilbestrol; Esterified Estrogens; Estradiol; Estrone; Estropipate ; Ethinyl Estradiol
Osteoporosis prophylactic --Conjugated Estrogens; Esterified Estrogens; Estradiol; Estropipate
Ovarian hormone therapy -- Conjugated Estrogens; Esterified Estrogens ; Estradiol; Estropipate
Description
    Estrogens ( ES-troe-jenz) are female hormones. They are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years.
    The ovaries begin to produce less estrogen after menopause (the change of life). This medicine is prescribed to make up for the lower amount of estrogen. Estrogens help relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness.
Estrogens are prescribed for several reasons:
  1. to provide additional hormone when the body does not produce enough of its own, such as during menopause or when female puberty (development of female sexual organs) does not occur on time. Other conditions include a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or ovary problems (female hypogonadism or failure or removal of both ovaries).
  2. to help prevent weakening of bones (osteoporosis) in women past menopause.
  3. in the treatment of selected cases of breast cancer in men and women.
  4. in the treatment of cancer of the prostate in men. Estrogens may also be used for other conditions as determined by your doctor.
    There is no medical evidence to support the belief that the use of estrogens will keep the patient feeling young, keep the skin soft, or delay the appearance of wrinkles. Nor has it been proven that the use of estrogens during menopause will relieve emotional and nervous symptoms, unless these symptoms are caused by other menopausal symptoms, such as hot flashes or hot flushes.

Estrogens are available only with your doctor's prescription, in the following dosage forms:

Oral Tablets (U.S. and Canada)
Conjugated Estrogens
Diethylstilbestrol
Esterified Estrogens     
Estradiol     
Estropipate     
Ethinyl Estradiol     
Parenteral Injection (U.S. and Canada)
Conjugated Estrogens     
Diethylstilbestrol     
Estradiol     
Estrone Injection (U.S.)
Topical Transdermal system (skin patch) (U.S. and Canada)
Estradiol


Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For estrogens, the following should be considered:
  1. Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to estrogens. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
  2. Pregnancy—Estrogens are not recommended for use during pregnancy or right after giving birth. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause.
  3. Certain estrogens have been shown to cause serious birth defects in humans and animals. Some daughters of women who took diethylstilbestrol (DES) during pregnancy have developed reproductive (genital) tract problems and, rarely, cancer of the vagina or cervix (opening to the uterus) when they reached childbearing age. Some sons of women who took DES during pregnancy have developed urinary-genital tract problems.
  4. Breast-feeding—Use of this medicine is not recommended in nursing mothers. Estrogens pass into the breast milk and their possible effect on the baby is not known.
  5. Older adults—This medicine has been tested and has not been shown to cause different side effects or problems in older women than it does in younger women.
Other medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking estrogens, it is especially important that your health care professional know if you are taking any of the following:
Use of these medicines with estrogens may increase the chance of problems occurring that affect the liver Other medical problems
The presence of other medical problems may affect the use of estrogens. Make sure you tell your doctor if you have any other medical problems, especially:
For all patients

Estrogens may interfere with the treatment of breast or bone cancer or worsen cancer of the uterus when these conditions are present
Changes in genital or vaginal bleeding of unknown causes
Use of estrogens may delay diagnosis or worsen condition. The reason for the bleeding should be determined before estrogens are used Pancreatitis (inflammation of pancreas)
Estrogens may worsen these conditions.
Although estrogens can improve blood cholesterol, they can worsen blood triglycerides for some people Males with these medical problems may be more likely to have clotting problems while taking estrogens; the high doses of estrogens used to treat male breast or prostate cancer have been shown to increase the chances of heart attack, phlebitis (inflamed veins) caused by a blood clot, or blood clots in the lungs

Proper Use of This Medicine
Estrogens usually come with patient information or directions. Read them carefully before taking this medicine.

Take this medicine only as directed by your doctor. Do not take more of it and do not take or use it for a longer time than your doctor ordered. For patients taking any of the estrogens by mouth, try to take the medicine at the same time each day to reduce the possibility of side effects and to allow it to work better.

For patients taking any of the estrogens by mouth or by injection:

Nausea may occur during the first few weeks after you start taking estrogens. This effect usually disappears with continued use. If the nausea is bothersome, it can usually be prevented or reduced by taking each dose with food or immediately after food.
For patients using the transdermal (skin patch) form of estradiol:
Wash and dry your hands thoroughly before and after handling the patch.
Apply the patch to a clean, dry, nonoily skin area of your lower abdomen, hips below the waist, or buttocks that has little or no hair and is free of cuts or irritation. The manufacturer of the 0.025-mg patch recommends that its patch be applied to the buttocks only. Furthermore, each new patch should be applied to a new site of application. For instance, if the old patch is taken off the left buttock, then apply the new patch to the right buttock.
Do not apply to the breasts. Also, do not apply to the waistline or anywhere else where tight clothes may rub the patch loose. Press the patch firmly in place with the palm of your hand for about 10 seconds. Make sure there is good contact, especially around the edges.
If a patch becomes loose or falls off, you may reapply it or discard it and apply a new patch.
Each dose is best applied to a different area of skin on your lower abdomen, hips below the waist, or buttocks so that at least 1 week goes by before the same area is used again. This will help prevent skin irritation.

Dosing—
The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The number of tablets that you take or the amount of injection you use depends on the strength of the medicine. Also, the number of doses you take or use each day or patches you apply each week, the time allowed between doses, and the length of time you take or use the medicine depend on the medical problem for which you are taking, using, or applying estrogen.

For conjugated estrogens
For oral dosage form (tablets):
For treating breast cancer in women after menopause and in men:
Adults—10 milligrams (mg) three times a day for at least three months.
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
Adults—0.3 to 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
To prevent loss of bone (osteoporosis):
Adults—0.625 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating ovary problems (female hypogonadism or for starting puberty):
Adults and teenagers—2.5 to 7.5 mg a day. This dose is divided up and taken in smaller doses. Your doctor may want you to take the medicine only on certain days of the month.
For treating ovary problems (failure or removal of both ovaries):
Adults—1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating prostate cancer:
Adults—1.25 to 2.5 mg three times a day.
For injection dosage form: For controlling abnormal bleeding of the uterus:
Adults—25 mg injected into a muscle or vein. This may be repeated in six to twelve hours if needed.
For diethylstilbestrol
For oral dosage form (tablets):
For treating prostate cancer:
Adults—At first, 1 to 3 milligrams (mg) a day. Later, your doctor may decrease your dose to 1 mg a day.
For diethylstilbestrol diphosphate
For oral dosage form (tablets):
For treating prostate cancer:
Adults—50 to 200 milligrams (mg) three times a day.
For injection dosage form:
For treating prostate cancer:
Adults—At first, 500 mg is mixed in solution with sodium chloride or dextrose injection and injected slowly into a vein. Your doctor may increase your dose to 1 gram a day for five or more straight days as needed. Then, your doctor may lower your dose to between 250 and 500 mg one or two times a week.
For esterified estrogens
For oral dosage form (tablets):
For treating breast cancer in women after menopause and in men:
Adults—10 milligrams (mg) three times a day for at least three months.
For treating a genital skin condition (vulvar atrophy) or inflammation of the vagina (atrophic vaginitis), or to prevent loss of bone (osteoporosis):
Adults—0.3 to 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating ovary problems (failure or removal of both ovaries):
Adults—1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating ovary problems (female hypogonadism):
Adults—2.5 to 7.5 mg a day. This dose may be divided up and taken in smaller doses. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating symptoms of menopause:
Adults—0.625 to 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating prostate cancer: Adults—1.25 to 2.5 mg three times a day.
For estradiol
For oral dosage form (tablets):
For treating breast cancer in women after menopause and in men:
Adults—10 milligrams (mg) three times a day for at least three months.
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), ovary problems (female hypogonadism or failure or removal of both ovaries), or symptoms of menopause:
Adults—0.5 to 2 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating prostate cancer:
Adults—1 to 2 mg three times a day.
To prevent loss of bone (osteoporosis):
Adults—0.5 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For transdermal dosage form (skin patches):
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), symptoms of menopause, ovary problems (female hypogonadism or failure or removal of both ovaries), or to prevent loss of bone (osteoporosis):
For the Climara or FemPatch patches
Adults—0.025 to 0.1 milligram (mg) (one patch) applied to the skin and worn for one week. Then, remove that patch and apply a new one. A new patch should be applied once a week for three weeks. During the fourth week, you may or may not wear a patch. Your health care professional will tell you what you should do for this fourth week. After the fourth week, you will repeat the cycle.
For the Alora, Estraderm, or Vivelle patches
Adults—0.025 to 0.1 mg (one patch) applied to the skin and worn for one half of a week. Then, remove that patch and apply and wear a new patch for the rest of the week. A new patch should be applied two times a week for three weeks. During the fourth week, you may or may not apply new patches. Your health care professional will tell you what you should do for this fourth week. After the fourth week, you will repeat the cycle.
For estradiol cypionate
For injection dosage form:
For treating ovary problems (female hypogonadism):
Adults—1.5 to 2 milligrams (mg) injected into a muscle once a month.
For treating symptoms of menopause:
Adults—1 to 5 mg injected into a muscle every three to four weeks.
For estradiol valerate
For injection dosage form:
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), symptoms of menopause, or ovary problems (female hypogonadism or failure or removal of both ovaries):
Adults—10 to 20 milligrams (mg) injected into a muscle every four weeks as needed.
For treating prostate cancer:
Adults—30 mg injected into a muscle every one or two weeks.
For estrone
For injection dosage form:
For controlling abnormal bleeding of the uterus:
Adults—2 to 5 milligrams (mg) a day, injected into a muscle for several days.
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
Adults—0.1 to 0.5 mg injected into a muscle two or three times a week. Your doctor may want you to receive the medicine each week or only during certain weeks of the month.
For treating ovary problems (female hypogonadism or failure or removal of both ovaries):
Adults—0.1 to 1 mg a week. This is injected into a muscle as a single dose or divided into more than one dose. Your doctor may want you to receive the medicine each week or only during certain weeks of the month.
For treating prostate cancer:
Adults—2 to 4 mg injected into a muscle two or three times a week.
For estropipate
For oral dosage form (tablets):
For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
Adults—0.75 to 6 milligrams (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating ovary problems (female hypogonadism or failure or removal of both ovaries):
Adults—1.5 to 9 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
To prevent loss of bone (osteoporosis):
Adults—0.75 mg a day. Your doctor may want you to take the medicine each day for twenty-five days of a thirty-one–day cycle.
For ethinyl estradiol
For oral dosage form (tablets):
For treating breast cancer in women after menopause and in men:
Adults—1 milligram (mg) three times a day.
For treating ovary problems (female hypogonadism or failure or removal of both ovaries):
Adults—0.05 mg one to three times a day for three to six months. Your doctor may want you to take the medicine each day or only on certain days of the month.
For treating prostate cancer:
Adults—0.15 to 3 mg a day.
For treating symptoms of menopause:
Adults—0.02 to 0.05 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
For ethinyl estradiol and norethindrone
For oral dosage form (tablets):
For treating symptoms of menopause:

Adults—1 tablet (5 mcg ethinyl estradiol and 1 mg of norethindrone) each day
To prevent loss of bone (osteoporosis):
Adults—1 tablet (5 mcg ethinyl estradiol and 1 mg of norethindrone) each day

Missed dose—
For patients taking any of the estrogens by mouth: If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. For patients using the transdermal (skin patch) form of estradiol: If you forget to apply a new patch when you are supposed to, apply it as soon as possible. However, if it is almost time for the next patch, skip the missed one and go back to your regular schedule. Always remove the old patch before applying a new one. Do not apply more than one patch at a time.

Storage—
To store this medicine:
Precautions While Using This Medicine
    It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects . These visits will usually be every year, but some doctors require them more often.
    In some patients using estrogens, tenderness, swelling, or bleeding of the gums may occur. Brushing and flossing your teeth carefully and regularly and massaging your gums may help prevent this. See your dentist regularly to have your teeth cleaned. Check with your medical doctor or dentist if you have any questions about how to take care of your teeth and gums, or if you notice any tenderness, swelling, or bleeding of your gums.
    It is not yet known whether the use of estrogens increases the risk of breast cancer in women. Therefore, it is very important that you regularly check your breasts for any unusual lumps or discharge. Report any problems to your doctor. You should also have a mammogram (x-ray pictures of the breasts) done if your doctor recommends it. Because breast cancer has occurred in men taking estrogens, regular breast self-exams and exams by your doctor for any unusual lumps or discharge should be done.
    If your menstrual periods have stopped, they may start again. This effect will continue for as long as the medicine is taken. However, if taking the continuous treatment (0.625 mg conjugated estrogens and 2.5 mg medroxyprogesterone once a day), monthly bleeding usually stops within 10 months.
    Also, vaginal bleeding between your regular menstrual periods may occur during the first 3 months of use. Do not stop taking your medicine. Check with your doctor if bleeding continues for an unusually long time, if your period has not started within 45 days of your last period, or if you think you are pregnant.
    Tell the doctor in charge that you are taking this medicine before having any laboratory test because some results may be affected.

Side Effects of This Medicine
Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:
The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer.
It is not yet known whether the use of estrogens increases the risk of breast cancer in women. Although some large studies show an increased risk, most studies and information gathered to date do not support this idea. Breast cancer has been reported in men taking estrogens.
The following side effects may be caused by blood clots, which could lead to stroke, heart attack, or death. These side effects occur rarely, and, when they do occur, they occur in men treated for cancer using high doses of estrogens. Get emergency help immediately if any of the following side effects occur:
Rare—for males being treated for breast or prostate cancer only Headache (sudden or severe); loss of coordination (sudden); loss of vision or change of vision (sudden); pains in chest, groin, or leg, especially in calf of leg; shortness of breath (sudden and unexplained) ; slurring of speech (sudden); weakness or numbness in arm or leg

Also, check with your doctor as soon as possible if any of the following side effects occur:
More common Less common or rare Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
More common Less common Also, many women who are taking estrogens with a progestin (another female hormone) will start having monthly vaginal bleeding, similar to menstrual periods, again. This effect will continue for as long as the medicine is taken. However, monthly bleeding will not occur in women who have had the uterus removed by surgery (total hysterectomy).
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Additional Information
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, estrogen is used in certain patients with the following medical conditions:
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.
Revised: 01/16/2001