How long does it take for estradiol to work

Contents

Everything you need to know about estrogen

Synthetic estrogen, bio-identical estrogen, and estrogens derived from pregnant mares (Premarin) are used for a range of medical purposes.

The most common uses of estrogen are in birth control pills and hormone replacement therapy (HRT) and bio-identical hormone replacement therapy (BHRT) for menopause.

Birth control pill

The birth control pill is the most commonly used method of birth control in the United States. Estrogen is included in combination oral birth control pills alongside the hormone progestin.

Many women take low-dose birth control pills, which contain 20 to 50 micrograms (mcg) of estrogen.

The estrogen in the combined pill sends feedback to the brain. This feedback causes a range of effects in the body, including:

  • stopping the pituitary gland from secreting follicle-stimulating hormone (FSH)
  • stopping the production of luteinizing hormone (LH)
  • preventing ovulation
  • supporting the lining of the womb to prevent the breakthrough bleeding that can sometimes cause spotting between periods

Some doctors may prescribe birth control for alternative uses, including:

  • regulating the menstrual cycle
  • easing severe cramping and heavy bleeding
  • reducing the risk of ovarian cancer and the development of ovarian cysts
  • protecting against ectopic pregnancy
  • decreasing perimenopausal symptoms
  • helping reduce the severity of hormone-related acne

Taking a birth control pill carries a range of risks, such as:

  • heart attack
  • stroke
  • blood clots
  • pulmonary embolism
  • nausea and vomiting
  • headaches
  • irregular bleeding
  • weight changes
  • breast tenderness and swelling

Long-term use may also lead to a higher risk of breast cancer.

Hormone replacement therapy

Hormone replacement therapy (HRT) aims to relieve some symptoms of menopause by bringing the levels of female hormones back to normal. The treatment can be provided as estrogen-only or as a combination of estrogen and progestin.

For women who still have a uterus, the hormone progestin is used alongside estrogen to prevent the overgrowth of the uterine lining, which can lead to endometrial cancer. HRT is available as a pill, nasal spray, patch, skin gel, injection, vaginal cream, or ring.

HRT may help relieve symptoms of menopause, such as:

  • hot flashes
  • vaginal dryness
  • painful intercourse
  • mood swings
  • sleep disorders
  • anxiety
  • decreased sexual desire

The US Food and Drug Administration (FDA) recommends that HRT is used at the lowest doses for the shortest duration needed to achieve treatment goals.

This can help to avoid some of the uncomfortable side effects, such as:

  • bloating
  • breast soreness
  • headaches
  • mood swings
  • nausea
  • water retention

Women who use or are considering using hormone therapy after menopause should discuss the possible benefits and health risks with their physicians.

Hormone therapy is also used to help transgender people who wish to transition between genders, with estrogen often being prescribed to help transgender women who are looking to develop female secondary sexual characteristics.

Due to the risks posed by this type of therapy, it is vital that a course of hormone therapy is followed under supervision by a medical professional.

Estrogen replacement therapy (ERT)

Estrogen replacement therapy (ERT) is used to increase estrogen levels in women who have undergone menopause and have had their uterus removed. This is because ERT is linked to uterine cancer but would not have this effect in women after removal of the uterus.

ERT can also treat a range of other conditions, such as delayed puberty, symptomatic vaginal atrophy, and breast atrophy.

This treatment may have additional benefits, including:

  • preventing symptoms during the menopause
  • preventing osteoporosis
  • preventing colon cancer
  • reducing early bone loss and osteoporosis in women who had their ovaries removed between the ages of 20 and 40 years

ERT can reverse the effects of low estrogen levels and may also:

  • control the occurrence and severity of hot flashes
  • improve mood and sleep problems that occur due to hormonal changes
  • maintain the lining and lubrication of the vagina
  • maintain skin collagen levels
  • prevent osteoporosis following the menopause
  • reduce the risk of dental problems, including tooth loss and gum disease

ERT should be avoided if the person taking them:

  • is pregnant
  • has unexplained vaginal bleeding
  • has liver disease or chronically impaired liver function
  • has a strong family history of cancer in the breast, ovaries cancer, or endometrium
  • is a smoker
  • has a history of blood clots
  • has had a stroke

Topical estriol application for vaginal atrophy has been shown to be effective with the least side effects compared to combination estrogen therapy.

Information on Estrogen Hormone Therapy

Hi, I’m Dr. Maddie Deutsch, Director of Clinical Services at the UCSF Center of Excellence for Transgender Health. I’d like to talk to you about some of the risks, expectations, long term considerations, and medications associated with your transition from male to female.

Many people are eager for hormonal changes to take place rapidly- I understand that. But it’s very important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors include your genetics, the age at which you start taking hormones, and your overall state of health.

Consider the effects of hormone therapy as a second puberty, and puberty normally takes years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have read in books or online.

There are four areas where you can expect changes to occur as your hormone therapy progresses.

Physical changes

The first is physical.

The first changes you will probably notice are that your skin will become a bit drier and thinner. Your pores will become smaller and there will be less oil production. You may become more prone to bruising or cuts and in the first few weeks you’ll notice that the odors of your sweat and urine will change. It’s also likely that you’ll sweat less.

When you touch things, they may “feel different” and you may perceive pain and temperature differently.

Probably within a few weeks you’ll begin to develop small “buds” beneath your nipples. These may be slightly painful, especially to the touch and the right and left side may be uneven. This is the normal course of breast development and whatever pain you experience will diminish significantly over the course of several months.

It’s important to note that breast development varies from person to person. Not everyone develops at the same rate and most transgender women, even after many years of hormone therapy, can only expect to develop an “A” cup or perhaps a small “B” cup. Like all other women, the breasts of transgender women vary in size and shape and will sometimes be uneven with each other.

Your body will begin to redistribute your weight. Fat will begin to collect around your hips and thighs and the muscles in your arms and legs will become less defined and have a smoother appearance as the fat just below your skin becomes a bit thicker. Hormones will not have a significant effect on the fat in your abdomen, also known as your “gut”. You can also expect your muscle mass and strength to decrease significantly. To maintain muscle tone, and for your general health, I recommend you exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.

Your eyes and face will begin to develop a more female appearance as the fat under the skin increases and shifts. Because it can take two or more years for these changes to fully develop, you should wait at least that long before considering any drastic facial feminization procedures. What won’t change is your bone structure, including your hips, arms, hands, legs and feet.

Let’s talk about hair. The hair on your body, including your chest, back and arms, will decrease in thickness and grow at a slower rate. But it may not go away all together. For that you might want to consider electrolysis or laser treatment. Remember that all women have some body hair and that this is normal. Your facial hair may thin a bit and grow slower but it will rarely go away entirely without electrolysis or laser treatments. If you have had any scalp balding, hormone therapy should slow or stop it, but how much if it will grow back is unknown.

Some people may notice minor changes in shoe size or height. This is not due to bony changes, but due to changes in the ligaments and muscles of your feet.

Emotional state changes

The second impact of hormone therapy is on your emotional state

Your overall emotional state may or may not change, this varies from person to person. Puberty is a roller coaster of emotions, and the second puberty that you will experience during your transition is no exception. You may find that you have access to a wider range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with other people. While psychotherapy is not for everyone, most people would benefit from a course of supportive psychotherapy while in transition to help you explore these new thoughts and feelings, and get to know your new body and self.

Sexual changes

The third impact of hormone therapy is sexual in nature.

Soon after beginning hormone treatment, you will notice a decrease in the number of erections you have; and when you do have one, you may lose the ability to penetrate, because it won’t be as firm or last as long. You will, however, still have erotic sensations and be able to orgasm.

You may find that you get erotic pleasure from different sex acts and different parts of your body. Your orgasms will feel like more of a “whole body” experience and last longer, but with less peak intensity. You may experience ejaculation of a small amount of clear or white fluid, or perhaps no fluid. Don’t be afraid to explore and experiment with your new sexuality through masturbation and with sex toys such dildos and vibrators. Involve your sexual partner if you have one.
Though your testicles will shrink to less than half their original size, most experts agree that the amount of scrotal skin available for future genital surgery won’t be affected.

Reproductive system changes

The fourth impact of hormone therapy is on the reproductive system.

Within a few months of beginning hormone therapy, you must assume that you will become permanently and irreversibly sterile. Some people may maintain a sperm count on hormone therapy, or have their sperm count return after stopping hormone therapy, but you must assume that won’t be the case for you.

If there’s any chance you may want to parent a child from your own sperm, you should speak to the doctor about preserving your sperm in a sperm bank. This process generally takes 2-4 weeks and costs roughly $2000-$3000. Your sperm should be stored before beginning hormone therapy. All too often, transgender women decide later in life that they would like to parent a child using their own sperm but are unable to do so because they did not take the steps to preserve sperm before beginning hormone treatment.

Also, if you are on hormones but remaining sexually active with a woman who is able to become pregnant, you should always continue to use a birth control method to prevent unwanted pregnancy.

Many of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking them. Breast growth and possibly sterility are not reversible. If you have an orchiectomy, which is removal of the testicles, or genital reassignment surgery, you will be able to take a lower dose of hormones but should remain on hormones until you’re at least 50 to prevent weakening of the bones, otherwise known as osteoporosis.

Treatments

Now let’s talk about treatments. Cross gender hormone therapy for transwomen may include three different kinds of medicines: Estrogen, testosterone blockers and progesterones.

Estrogen

Estrogen is the hormone responsible for most female characteristics. It causes the physical changes of transition and many of the emotional changes. Estrogen may be given as a pill, by injection, or by a number of skin preparations such as a cream, gel, spray or a patch.

Pills are convenient, cheap and effective, but are less safe if you smoke or are older than 35. Patches can be very effective and safe, but they need to be worn at all times. They could also irritate your skin. .

Many transwomen are interested in estrogen through injection. Estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines. Additionally, little is known about the effects of these high levels over the long term. If injections are used, it should be at a low dose and with an understanding that there may be uncomfortable side effects, and that switching off of injections to other forms may cause mood swings or hot flashes.

Contrary to what many may have heard, you can achieve the maximum effect of your transition with relatively small doses of estrogen. Taking high doses does not necessarily make changes happen quicker it could, however, endanger your health. And after you’ve had genital surgery or orchiectomy—removal of the testicles—your estrogen dose will be lowered. Without your testicles you need less estrogen to maintain your feminine characteristics and overall health

To monitor your health while on estrogen, your doctor will periodically check your liver functions and cholesterol and screen you for diabetes.

Testosterone blockers

Let’s move on to testosterone blockers.

There are a number of medicines that can block testosterone and they fall into two categories: those that block the action of testosterone in your body and those that prevent the production of it. Most testosterone blockers are very safe but they can have side effects.

The blocker most commonly used, spironolactone, can cause you to urinate excessively and feel dizzy or lightheaded, especially when you first start taking it. It’s important to drink plenty of fluids with this medication. Because spironolactone can be dangerous for people with kidney problems and because it interacts with some blood pressure medicines, it’s essential you share with your doctor your full medical history and the names of all the medications you’re taking. A rare but potentially dangerous side effect of spironolactone is a large increase in the production of potassium, which could cause your heart to stop, so while on this medication you should have your potassium levels checked periodically.

Finasteride and dutasteride are medicines which prevent the production of dihydrotestosterone, a specific form of testosterone that has action on the skin, hair, and prostate. These medicines are weaker testosterone blockers than spironolactone but have few side effects, and are useful for those who can not tolerate spironolactone. It is unclear if there is any added benefit to taking one of these medicines at the same time as spironolactone.

Progesterone

Lastly, let’s talk about Progesterone.

Progesterone is a source of constant debate among both transwomen and providers. Though it’s commonly believed to have a number of benefits, including: improved mood and libido, enhanced energy, and better breast development and body fat redistribution, there is very little scientific evidence to support these claims. Nevertheless, some transwomen say they experience some or all of these benefits from progesterone. Progesterone may be taken as a pill or applied as a cream.

Risks

So what are the risks? The risk of things like blood clots, strokes and cancer are minimal, but may be elevated. There is not much scientific evidence regarding the risks of cancer in transgender women. We believe your risk of prostate cancer will go down but we can’t be sure, so you should follow standard testing guidelines for someone your age. Your risk of breast cancer may increase slightly, but you’ll still be at less of a risk than a non-transgender female. When you’ve been on hormones for at least 2-3 years, we recommend you begin breast cancer screenings depending on your age and risk factors after discussion with your doctor. Since there is not a lot of research on the use of estrogen in transwomen, there may be other risks that we won’t know about, especially for those who have used estrogen for many years

In conclusion, please be patient and remember that all of the changes associated with the puberty you’re about to experience can take years to develop.

Thank you for reading and for taking care of your health.

Minivelle

SIDE EFFECTS

The following serious adverse reactions are discussed elsewhere in labeling:

  • Cardiovascular Disorders
  • Endometrial Cancer

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

There were no clinical trials conducted with MINIVELLE. MINIVELLE is bioequivalent to Vivelle®. The following adverse reactions are reported with Vivelle therapy:

Table 1: Summary of Most Frequently Reported Adverse Reactions (Vivelle versus Placebo) Regardless of Relationship Reported at a Frequency ≥5 Percent

During the clinical pharmacology studies with MINIVELLE, 35 percent or less of subjects experienced barely perceptible erythema. No transdermal systems were removed due to irritation. Three subjects (2.2 percent) reported mild discomfort while wearing MINIVELLE (N=136).

Postmarketing Experience

The following additional adverse reactions have been identified during post-approval use of Minivelle. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Breast

Breast enlargement

Cardiovascular

Palpitations, angina unstable

Gastrointestinal

Hemorrhage, diarrhea

Skin

Application site reactions, erythema, rash, hyperhidrosis, pruritis, urticaria

Central Nervous System

Dizziness, paresthesia, migraine, mood swings, emotional disorder, irritability, nervousness

Miscellaneous

Portal vein thrombosis, dyspnea, malaise, fatigue, peripheral edema, muscle spasms, paresthesia oral, swollen tongue, lip swelling, pharyngeal edema

Read the entire FDA prescribing information for Minivelle (Estradiol Transdermal System)

Minivelle Side Effects

Incidence not known

Abdominal or stomach cramps or pain

acid or sour stomach

anxiety

backache

belching

blistering, peeling, or loosening of the skin

bloating

blurred vision

breast tenderness, enlargement, pain, or discharge

change in vaginal discharge

changes in skin color

changes in vision

chest pain or discomfort

chills

clay-colored stools

clear or bloody discharge from the nipple

confusion

constipation

convulsions

cough

darkening of the urine

diarrhea

difficulty with breathing

difficulty with swallowing

dimpling of the breast skin

dizziness or lightheadedness

double vision

fainting

fast heartbeat

fever

fluid-filled skin blisters

full or bloated feeling or pressure in the stomach

headache

headache, severe and throbbing

heartburn

indigestion

inverted nipple

irregular heartbeat

itching of the vagina or genital area

joint or muscle pain

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

light-colored stools

loss of appetite

loss of bladder control

lump in the breast or under the arm

migraine headache

mood or mental changes

muscle cramps in the hands, arms, feet, legs, or face

muscle spasm or jerking of all extremities

nausea

noisy breathing

numbness and tingling around the mouth, fingertips, or feet

pain during sexual intercourse

pain in the ankles or knees

pain or discomfort in the arms, jaw, back, or neck

pain or feeling of pressure in the pelvis

pain, redness, or swelling in the arm, foot, or leg

painful, red lumps under the skin, mostly on the legs

pains in the stomach, side, or abdomen, possibly radiating to the back

persistent crusting or scaling of the nipple

poor insight and judgment

problems with memory or speech

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

rash, hives, or itching

red, irritated eyes

redness or swelling of the breast

sensitivity to the sun

skin thinness

sore on the skin of the breast that does not heal

sore throat

sores, ulcers, or white spots in the mouth or on the lips

stomach discomfort, upset, or pain

sudden loss of consciousness

sudden shortness of breath or troubled breathing

sweating

swelling

swelling of the abdominal or stomach area

thick, white vaginal discharge with no odor or with a mild odor

tightness in the chest

tremor

trouble recognizing objects

trouble thinking and planning

trouble walking

unexpected or excess milk flow from the breasts

unpleasant breath odor

unusual tiredness or weakness

unusually heavy or unexpected menstrual bleeding

vaginal bleeding or spotting

vomiting

vomiting of blood

yellow eyes or skin

Does Estrogen Make You Gain Weight?

Postmenopausal women suffering from hot flashes, may hesitate to take estrogen because they’ve heard it can cause weight gain. Who needs any extra help to gain weight? Is there any truth to all this?

What are Bioidentical Hormones?

When you’re replacing deficient estrogen, it’s important to respect the wisdom of the body. No drug we give can approach the amazing complexity of the endocrine system. However, you can start by giving a hormone that is identical to the hormone that’s missing. We call these bioidentical hormones.

Another important factor is the route of administration. Estrogen is most commonly given as a pill that’s taken orally. It’s convenient and easy to pop a pill. But easy isn’t always the best. If we’re wanting to mimic the body, how does the ovary deliver estrogen to your tissues? I assure you the ovary doesn’t dump a big load of estrogen in your stomach once a day!! A more natural way to take estrogen is by applying it to the skin as a patch or cream. Estrogen taken in a pill form overloads your liver with excessive amounts of estrogen that increase harmful proteins, clotting factors and proinflammatory substances leading to various problems. Let me explain how oral estrogen leads to weight gain.

Weight Gain & Oral Estrogen

Weight gain from oral estrogen causes visceral obesity, the medical term for increased fat around your middle from fat that gets deposited in vital organs like the heart, kidneys and liver. This increased fat mass leads to increases in leptin produced by the fat cells. Topical, but not oral, estradiol prevents this increase in body fat and leptin. An interesting fact about visceral obesity is that women who take NO estrogen can also get weight gain around their middle because they develop insulin resistance. This is a frequent complaint from older women who are not on estrogen!

Oral, but not topical, estrogen increases the production of thyroxine-binding globulin (TBG) the carrier for thyroid hormone. Higher levels of TBG lower the amount of available thyroid hormone thereby lowering your metabolism. Oral, but not topical, estrogen also suppresses IGF-1, a marker for growth hormone. Growth hormone is needed to build muscle and burn fat. All this explains a common complaint I hear from women who’ve been on oral estrogen. “After starting oral estrogen, I gained 15 pounds in the first month and I didn’t increase my calories or lower my exercise. Now I’m eating less and exercising more and I just keep gaining!” Estrogen from injections or pellets can also lead to weight gain because the blood levels produced are much too high.

Weight gain from oral or injectable estrogen occurs because these preparations violate the natural physiology of the body. The ovary is amazing…it releases tiny bits of estradiol throughout the day directly into the blood stream. Even topical estradiol preparations can’t reproduce this same elegant effect, but it’s the closest delivery system we have. That’s why your chances of maintaining a healthy metabolism and weight are best when you choose topical estradiol preparations.

O’Sullivan, AJ, Crampton LJ, Freund, et al, “The route of estrogen replacement therapy confers divergent effects on substrate oxidation and body composition in postmenopausal women,” The Journal of Clinical Investigation, vol 102, (1998): pp 1035-1040.
Lwin R., Darnell B. Oster R, et al, Effect of oral estrogen on substrate utilization in postmenopausal women,” Fertility and Sterility, vol. 90, no 4, (2008): pp 1275-1278
DeCarlo C, Tommaselli G, et al, “Serum leptin levels and body composition in postmenopausal women: effects of hormone therapy,” Menopause, vol 11, no 4 (2004): pp 466-473
Nachtigall LE, Raju U, Banerjee S, et al, “Serum estradiol binding profiles in postmenopausal women undergoing three common estrogen replacement therapies: association with sex hormone binding globulin, estradiol and estrone levels,” Menopause, vol 7, (2000): pp 243-250.
Slater CC, Hodis HN, Mack WJ, et al, “Markedly elevated levels of estrone sulfate after long-term oral, but not transdermal, administration of estradiol in postmenopausal women,” Menopause, vol 8, (2001): pp 200-203

How Too Much Estrogen Can Mess with Your Weight and Health

When I met my trainer, Tomery, the first time, she looked me up and down and said, “I want you to take a test that will measure your estrogen levels. We are going to discover some interesting things.”

The results of the saliva test indeed revealed some interesting things, including that my estrogen was very high. A woman my age (37) should have an estradiol + estrone: progesterone ratio between 10:1 and 14:1; mine was 635:1.

The first thing I wanted to know was how Tomery knew my estrogen was off. She explained that women (and sometimes men) with high estrogen tend to hold their weight in their hips and middle section. I am the perfect example.

My next question was, “What does high estrogen mean?”

“Am I extra womanly?” I said with a laugh.

It turns out high estrogen isn’t a funny thing. It may increase the risk of high blood pressure, ovarian cysts, endometriosis, depression, PMS, and breast, ovarian, and uterine cancer. It also plays a role in fibrocystic breast changes, which explains why every time I go in for a mammogram I’m called back for additional screening because of my dense breast tissue. Luckily none of my symptoms-muscle aches, miserable PMS, dense breasts, and occasional mild depression-are severe or life-threatening.

RELATED: Too much estrogen is bad, but other hormones can help you lose weight. Meet the eight essential fat-loss hormones your body naturally produces.

But I didn’t want to ignore my high estrogen. After all, prevention is the key to a healthy life.

I talked to my experts about a strategy to lower my estrogen, and both recommended I stop adding soy milk to my coffee and oatmeal, especially because I was drinking it every day. While soy has its place in the world, it has been linked to increased estrogen levels. To be on the safe side, I’ve switched to almond and coconut milk.

Lauren also told me some chemicals in and on our food appear to raise estrogen, and she suggested that I opt for organic fruits and vegetables when I can and make an effort to include cruciferous vegetables such cauliflower and broccoli in my diet since some studies show they help lower estrogen. Since then I’ve been having fun trying new recipes with things like mustard greens and kale.

RELATED: Don’t know how to prepare mustard greens or kale? Try these super tasty leafy green recipes using the healthiest greens.

Tomery and Lauren also said that giving up alcohol is key to lowering estrogen because the liver metabolizes the hormone and alcohol can affect that process. Even though I’ve written off alcohol for the time being, it will make me think twice in the future when I’m offered a glass of wine.

Tomery warned me that it could take some time for my estrogen to lower and for the weight to come off in these areas. So far, she’s right. My weight’s not falling off as quickly as I had hoped, but I am starting to feel toned in my arms and legs thanks to all of my hard work in the gym.

On the positive side, my PMS and cramps are non-existent, which seems incredulous considering I’ve always suffered monthly. I’m excited to take a follow-up test in a few months to see how my numbers have improved.

I’ve made so many healthy changes recently and I know that everything thus far (eating healthier and more varied vegetables, exercise, and taking regular vitamins) is contributing to my overall well-being, long-term health, and upbeat attitude. Maybe that’s why I keep singing, “Man! I feel like a woman…”

  • By Beth Blair

Here’s a mind-bender: Being overweight often has nothing to do with calories or exercise. For a huge number of us, the problem is misfiring hormones. Research is still catching up with this paradigm shift, which has yet to be comprehensively studied. But seeing how this revelation has helped my patients and I slim down and feel better gives me confidence that it’s true for most women who are trying to lose weight and can’t. You already know about some weight-affecting hormone issues, like thyroid and insulin imbalances. But more subtle ones could also be keeping you from the body you want. Here are some other ways your hormones might be causing weight gain.

Amazon The Hormone Reset Diet: Heal Your Metabolism to Lose Up to 15 Pounds in 21 Days amazon.com $16.19

You’re consuming too much sugar.

I think of leptin as the hormone that says, “Darling, put down the fork.” Under normal circumstances, it’s released from your fat cells and travels in the blood to your brain, where it signals that you’re full. But leptin’s noble cause has been impeded by our consumption of a type of sugar called fructose, which is found in fruit and processed foods alike.

Related Story

When you eat small amounts of fructose, you’re OK. But if you eat more than the recommended five daily servings of fruit (which in recent decades has been bred to contain more fructose than it used to)—plus processed foods with added sugar—your liver can’t deal with the fructose fast enough to use it as fuel. Instead, your body starts converting it into fats, sending them off into the bloodstream as triglycerides and depositing them in the liver and elsewhere in your belly.

As more fructose is converted to fat, your levels of leptin increase (because fat produces leptin). And when you have too much of any hormone circulating in your system, your body becomes resistant to its message. With leptin, that means your brain starts to miss the signal that you’re full. You continue to eat, and you keep gaining weight.

🚨If you eat more than the recommended five daily servings of fruit, plus processed foods with added sugar, your liver can’t deal with the fructose fast enough to use it as fuel. 🚨

You’re super stressed.

The so-called stress hormone cortisol can create all kinds of trouble for women who want to shed weight. When cortisol rises, it encourages the conversion of blood sugar into fat for long-term storage. Hoarding body fat in this way was a useful survival adaptation for our ancestors when they faced stressful famines. But not so much today. Obviously, reducing stress in your life will help rein in this fat-storing hormone, but there’s another very common source of the problem: daily coffee, which elevates cortisol levels dramatically, causing your body to hoard fat when you least need to.

Your high estrogen levels are expanding your fat cells.

Although estrogen is responsible for making women uniquely women, it’s also the hormone that can be the most troublesome in the fat department. At normal levels, estrogen actually helps keep you lean by goosing the production of insulin, a hormone that manages blood sugar. When estrogen gets thrown off, though, it turns you into a weight-gain machine.

Here’s how: When you eat, your blood sugar rises. Like a bodyguard, insulin lowers it by escorting glucose into three different places in your body. When insulin is in good working form—not too high and not too low—it sends a small amount of glucose to your liver, a large amount to your muscles to use as fuel, and little to none for fat storage.

If you’re healthy and in good shape, your pancreas produces exactly the right amount of insulin to have your blood sugar softly rise and fall within a narrow range (fasting levels of 70 to 85 mg/dl). But when your estrogen levels climb, the cells that produce insulin become strained, and you can become insulin resistant. That’s when insulin starts to usher less glucose to the liver and muscles, raising the levels of sugar in your bloodstream and ultimately storing the glucose as fat. Your fat tissue can expand by as much as four times to accommodate the storage of glucose.

How do estrogen levels climb, exactly? Meat is one of the primary reasons. You take in a lot less fiber when you eat meat. Research suggests that vegetarians get more than twice as much fiber as omnivores. Because fiber helps us stay regular, and we process excess estrogen through our waste, eating less fiber drives up our estrogen.

Meat also contains a type of fat with its own estrogen problem. Conventionally raised farm animals are overloaded with steroids, antibiotics, and toxins from their feed and the way they’ve been raised. When you eat them, those substances are released into your system. They can behave like estrogen in the body, adding to your overload.

Your low testosterone levels are slowing down your metabolism.

You are confronted with an astounding number of toxins each day, including pesticides, herbicides, genetically modified foods, and about six different synthetic hormones in meat. Toxins are lurking in face creams, prescription drugs, processed foods, your lipstick, the linings of tuna fish cans, the fire-retardant materials in couches, and even the air you breathe. The list goes on.

Many types of these toxins, such as pesticides, plastics, and industrial chemicals, behave like estrogen when absorbed in the body. Experts believe that our increasing exposure to toxins helps explain why so many girls are entering puberty earlier and why many boys exhibit feminine characteristics such as developing breasts. Xeno-estrogens, as these particular toxins are called, have been associated with an elevated risk of estrogen-driven diseases like breast and ovarian cancers and endometriosis.

All this fake estrogen overwhelms your body’s testosterone—which is vital for hormone balance—and contributes to estrogen overload. Testosterone contributes to muscle growth, which in turn supports metabolism. And, as we already know, estrogen overload raises insulin insensitivity. The combination adds pounds to your frame: A study from Sweden published in the journal Chemosphere showed that exposure to a particular type of pesticide called organochloride was linked to a weight gain of 9½ pounds over 50 years.

And that’s just one type of toxin. Your risk of weight gain and disease from exposure to toxins may be greater than you realize. A survey by the CDC demonstrated that 93 percent of the population has measurable levels of bisphenol A (BPA), a chemical found in store receipts and canned foods that disrupts estrogen, thyroid, and androgen hormones. Endocrine disruptors have been shown to interfere with the production, transportation, and metabolism of most hormones.

The bottom line: You have to to address your hormone imbalances.

Now you know the “whys” of your broken metabolism, these are reasons regular diets don’t address the root cause of your weight gain. Hormones dictate what your body does with food. Talk to a doctor about fixing your hormones, and your body will slim down without any extra effort from you.

From the book The Hormone Reset Diet: Balance Your Hormones and Lose Up to 15 Pounds in Just 3 Weeks! by Sara Gottfried. Copyright © 2015 by Sara Gottfried. Reprinted by permission of HarperOne, an imprint of HarperCollins Publishers.

Weight and appetite experts from around the world met at a conference in Bangkok 1 earlier this year to discuss sex differences in obesity. One line of discussion looked at factors leading to women’s weight gain during menopause, and how it might be avoided.

Co-chairs of the conference, Dr Amanda Sainsbury-Salis from Sydney’s Garvan Institute of Medical Research and Dr Jennifer Lovejoy from the University of Washington, Seattle have summarised the conference consensus for the December issue of Obesity Reviews. The paper is available online.

“One of the most interesting things that came out of the conference – with applicability to large numbers of women – was the discussion about why women gain weight during menopause,” said Dr Sainsbury-Salis.

“So many women get confused when they start to gain weight during menopause, because their eating habits haven’t changed.”

More Garvan research

Find more medical breakthroughs in metabolism research and our laboratories.

“What the research shows clearly is that menopause causes a dramatic and sudden reduction in physical activity levels. Just prior to menopause, women halve their amount of activity compared to pre-menopause levels.”

“So one reason women gain weight in menopause is because of a reduction in energy expenditure. Combine this with unchanged eating habits and weight gain is almost inevitable.”

“We don’t know exactly why menopausal women stop moving as much. But we know it’s not because of their age and the lifestyle constraints happening at that time of life. Research suggests it’s directly related to the lack of oestrogen, which has dramatic effects on signals the brain sends to the body. We’re doing research to see what causes these effects and whether or not they continue long-term.

“A lot of women ask whether they can actively counteract that tendency. In fact, it’s been shown that women who maintain or increase their level of physical activity during menopause tend to come out the other end without gaining weight.”

“Another thing, when physical activity levels drop and your energy needs are less, it’s really important to stay in tune with your hunger signals because you just don’t need to eat as much in order to feel satisfied.”

There was a related discussion about hormone replacement therapy (HRT) at the conference. Garvan’s Professor Lesley Campbell, also Director of the St. Vincent’s Diabetes Centre, was an invited speaker and put forward her view that HRT can actually help protect women against harmful abdominal fat gain and the development of heart disease and Type 2 diabetes.

“During menopause, most women experience redistribution of fat, often gaining weight around the middle,” said Professor Campbell. “As we have demonstrated in our research, abdominal fat is a risk factor in the development of cardio-metabolic diseases, such as diabetes. Prior to menopause, women have a lower risk of heart disease than men. Menopause equalises that risk. Women taking HRT appear to maintain their pre-menopausal risk levels.”

“It’s also worth mentioning that around 10 years ago, Garvan endocrinologists made a very significant breakthrough discovery that is known by surprisingly few women and GPs. They found that taking HRT by wearing transdermal patches – so bypassing the liver – may be better for women than taking HRT orally.2”

So the overall take home message for women in menopause is eat less, move more and if you’re on HRT, consider transdermal patches.

1. The International Association for the Study of Obesity (IASO) convened a conference in Bangkok, Thailand in March 2008

2. O’Sullivan AJ, Crampton LJ, Freund J, Ho KK. The Route of Estrogen Replacement Therapy Confers Divergent Effects on Substrate Oxidation and Body Composition in Postmenopausal Women. J Clin Invest. 1998 Sept; 102(5):1035-1040.

NOTES TO EDITORS
Whether or not to use HRT is a choice women must make themselves. It is a complex and controversial area. Many clinicians believe that the concerns about HRT which arose from the National Institutes of Health’s Women’s Health Initiative 3 may have been exaggerated. Others believe they were warranted.

Garvan does not adopt a particular stance on the topic, but rather encourages its experts, who look at different aspects of the data from a variety of perspectives, to express the conclusions that arise from their research and clinical expertise.

There is no doubt that oestrogen has some beneficial effects on the body. It helps maintain bone strength and can help protect against Type 2 diabetes.

At the same time, it has some adverse affects. For example, it may help stimulate those cancers that have oestrogen receptors, or increase development of such cancers if they already exist when oestrogen supplementation begins.

It has been reported that HRT (like the contraceptive pill) can increase a woman’s risk of developing deep vein thrombosis (DVT).

Before making the decision to take HRT, each woman would be wise to consult her doctor.

HRT Trial
Professor Lesley Campbell (Director of the St. Vincent’s Diabetes Centre and senior clinical researcher at Garvan) and Associate Professor Katherine Samaras (Head of Garvan’s Clinical Diabetes Research Group) conducted a trial in 1999 on the effects of HRT on women at menopause4. They found that HRT prevented gain in abdominal fat mass. Essentially this explained why diabetic postmenopausal women, not using oestrogen replacement, increased their risk of developing cardiovascular problems. Prior to menopause, their own oestrogen had kept their risk lower. A similar study exists in non-diabetic women.

Transdermal vs Oral administration of HRT
Professor Ken Ho, Endocrinologist and Head of Garvan’s Pituitary Research Unit, demonstrated that how oestrogen is administered is important. When given as a pill, oestrogen reduces lipid oxidation (fat burning), increases fat mass, and reduces lean body mass, changes which do not occur when oestrogen is administered transdermally.

As people age, they tend to gain fat and lose muscle. Over a 6-month period, oral oestrogen treatment induced a gain in fat mass and a loss in lean mass equivalent to that occurring over a 5-10 year period of the normal ageing process. The route of oestrogen therapy (oral or transdermal) is therefore significant in terms of body composition and postmenopausal health.

When a woman takes HRT orally, it goes directly to the liver, exposing it to relatively higher levels of oestrogen – which interferes with the liver’s ability to burn fat and make a hormone called IGF-1 (Insulin-like growth factor-1).

Growth hormone is secreted from the pituitary gland, goes to the liver and stimulates the production of IGF-1, which in turn stimulates muscle synthesis and strengthens bones. Oestrogen, by direct action on liver, suppresses the production of IGF-1 in accordance with the dose of oestrogen used.

3. The Women’s Health Initiative was launched in 1991 and consisted of a set of clinical trials and an observational study, which together involved 161,808 generally healthy postmenopausal women. The clinical trials were designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

4. Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycaemic control, lipid metabolism and vascular factors in Type 2 diabetes mellitus. A prospective study. Samaras K, Hayward CS, Sullivan D, Kelly RP, Campbell LV. Diabetes Care, 22; 9:1401-1407, 1999.

Hot Flashes

Hot flashes have become known as the hallmark of menopause, although they are far from universal. Only about 50% of postmenopausal women have hot flashes, and only about 15% have severe ones. Most women have hot flashes for about two years; few have them for more than six years.

Hot flashes seem to be the result of fluctuating estrogen levels

Hot flashes are bursts of heat that may begin at a particular point, such as the nape of the neck, and radiate throughout the upper body. Or the whole body may get hot at once. Perspiration, flushing, and heart palpitations often accompany the feeling of heat. A variant of hot flashes—night sweats—can disrupt sleep.

Hot flashes seem to be the result of fluctuating estrogen levels and probably occur during estrogen valleys rather than peaks. Although we think of hot flashes as heat surges, they are actually the body’s attempt to cool off. Blood vessels dilate and the heart races to pump more blood to reach the surface of the body where it’s cooler—an effect that can produce a blush or flush. Sweating is another attempt to bring the body’s temperature down. Hot flashes are often triggered by external factors, such as alcohol, caffeine, and hot foods or beverages. They may also be stimulated by emotional upsets.

There are a variety of ways to treat hot flashes.

Menopausal Hormone Therapy

In July 2002, everything many doctors thought they knew about menopausal hormone therapy (called hormone replacement therapy (HRT) at the time) was called into question when researchers announced that they were stopping the Women’s Health Initiative (WHI), a large randomized placebo-controlled study designed to measure the benefits and risks of menopausal hormone therapy. The study was stopped because an interim data analysis indicated that the risks of this therapy outweighed any benefits the drugs had to offer.

Estrogen was first approved by the FDA to treat menopausal symptoms in 1942. In the mid-1970s, progestin was added to estrogen after studies found that giving women estrogen alone increased the risk of uterine cancer. By the 1990s, the combination of estrogen and progestin, which had become known as hormone replacement therapy, had become the second most frequently prescribed medication in the US. It was widely marketed as a drug that would not only prevent hot flashes but also keep postmenopausal women healthier as they aged.

Now, due to the WHI, we are aware that taking estrogen does not keep women healthy. More than 16,000 women between the ages of 50–79 were enrolled in the WHI trial. Half of the women were given menopausal hormone therapy; half of women were given a placebo. To ensure women’s safety during the trial, the researchers had established an independent data and safety monitoring board (DSMB) to review interim results semiannually. During the tenth analysis, on May 31, 2002, the DSMB found an increased risk for breast cancer, coronary heart disease, stroke, and blood clots that outweighed the benefit of reduced fractures or colon cancer risk. This finding led the DSMB to recommend that the trial be stopped. Today, it is not recommended that women who have or have had breast cancer take menopausal hormone therapy.

How big of a risk did the study find? If 10,000 women were taking menopausal hormone therapy for a year and 10,000 women were not, there would be eight more women in the menopausal hormone therapy group who would develop invasive breast cancer, seven more who would develop heart disease, eight more who would have a stroke, and eight more who would develop blood clots. There would also be six fewer colorectal cancers and five fewer hip fractures.

The WHI trial began around the same time that Wyeth, the drug company that makes the leading HRT drug Prempro, began a randomized, controlled trial called the Heart and Estrogen/Progestin Replacement Study (HERS). This trial included about 2,700 women; half were given Prempro while the other half received a placebo. Findings from the HERS trial, published on July 3, 2002, in the Journal of the American Medical Association, indicated that menopausal hormone therapy did not prevent heart attacks in older women with heart disease and that it increased blood clots and gallbladder disease. This confirmed previous findings from the HERS trial that had been published in 1998.

It is now clear that menopausal hormone therapy is not the women’s wonder drug that many thought it would be. We now know that menopausal hormones:

  • If used for more than five years, increase the risk for invasive breast cancer.
  • Increase the risk for heart attacks, strokes, and blood clots.
  • Increase the rate of incontinence and uterine prolapse.
  • Don’t appear to prevent heart disease.
  • Have not been proven to prevent Alzheimer’s disease.
  • Does not improve quality of life in women who do not have menopausal symptoms.

As a result, it is now recommended that only a low dose of menopausal hormone therapy be used. Several studies have shown that low-dose hormone therapy (.3mg or .15mg of Premarin, Menest, Estratab, Ogen, Ortho-Est, or Cenestin) combined with a daily supplement of 1,000mg of calcium maintains bone density as well as high-dose HRT.

Women should stay on hormones for as short a time as is possible—at most three to five years—to help with menopausal symptoms, like severe hot flashes, night sweats, or vaginal dryness, and then begin tapering off. Women who begin taking hormones in their 30s and 40s following an oophorectomy should begin tapering off in their early 50s.

We currently don’t know if one form of estrogen is better than any other. If one type of hormone therapy is not working for you, you may want to try another. The steadfast rule is that any woman who has a uterus must take an estrogen and a progesterone. (Progesterone was added to decrease the risk of uterine cancer.) Women who do not have a uterus can take only estrogen. In addition to pills, several patches are now available that deliver micronized estradiol. The estrogen passes through the skin into the blood without being broken down in the digestive system (as a pill would be).

Bioidentical Hormones: Are They Better?

After concerns began to be raised about the dangers of menopausal hormone therapy, some women and their doctors began to tout the benefits of bioidentical hormones. Practitioners who use these drugs and the compounding pharmacies that make them claim that bioidentical hormones are better because they are made with natural, rather than synthetic, hormones that are better absorbed by the body. They also claim that because these hormones are similar to those a woman produces, side effects are less likely to occur. Is this true?

Bioidentical hormones are plant-derived; they are made from concentrated soy and yam. So, yes, they are natural in that they are produced by nature. But that doesn’t necessarily mean they are better than the drugs made by pharmaceutical companies. In fact, Premarin (estrogen alone) and Prempro (a combination of estrogen and progestin) contain estrogen that comes from pregnant mares’ urine. That is certainly natural. (Whether it is right is another question. PETA and other animal rights activists are opposed to the practice.)

But just because something is “natural” does not mean it’s safe. Currently, only a handful of small studies have been conducted on compounded bioidentical hormones. They indicate that these drugs are effective. But that does not mean they are safe, or safer than other types of HRT. Not one large randomized trial—the gold standard of medical research—has been conducted with bioidentical hormones. And there have been no randomized trials comparing bioidentical hormones to a drug like Prempro.

Practitioners who recommend bioidentical hormones give women prescriptions to be filled by pharmacies that have the ability to “compound,” or make, individualized doses. Typically, the practitioner determines which hormone to use and at what strength by conducting hormone tests on a woman’s blood or saliva. There is currently no evidence to support these methods as a means of determining what levels of hormones a woman’s individualized menopausal hormones cocktail should be comprised of.

The real benefit of the bio-identical movement is that it has spearheaded a move away from the one-size-fits-all approach of recommending menopausal hormones to all women as they enter menopause. If you prefer using a product that is plant-derived rather than animal-derived, then they might be a good option for you. But there is no indication that these drugs are safer than other forms of menopausal hormones, and you should not stay on them for more than three to five years.

Going Off Menopausal Hormone Therapy

As women who have been diagnosed with breast cancer know firsthand, it is possible—and from a medical perspective, perfectly okay—to stop hormones cold turkey. In fact, about half of all women who stop taking hormones cold turkey will do just fine. The other half will find that the menopausal symptoms that led them to take hormones in the first place come back with a vengeance. This is because stopping hormones turns on the menopausal switch, and that is likely to result in the side effects that women typically go on menopausal hormones to avoid—hot flashes, vaginal dryness, and sleep problems.

Since there is no way to predict which women will experience symptoms and which women won’t when they go off menopausal hormones, every woman must determine which method of going off menopausal hormones is right for her. One option is to taper off menopausal hormones gradually, which allows the body to adjust to decreasing doses of hormones and helps to reduce side effects. The second option is to quit cold turkey and then see if you are one of the lucky ones who don’t have symptoms. If you are in the lucky 50%, you can throw your menopausal hormones away. If you’re not, you can go back on and then begin tapering off gradually.

If you take combination menopausal hormones, which has estrogen and progesterone in the same pill, to begin tapering off you should ask your doctor for two separate prescriptions. This will allow you to better control the dose of each aspect of your menopausal hormones as you taper off. As you taper off, you should also begin taking a daily supplement of 1,000mg of calcium. Once you have tapered off completely, you should take a daily supplement of 1,200mg of calcium along with 400¬–800 IU of vitamin D.

If you are taking standard menopausal hormones, the best way to begin tapering off is to start taking low-dose menopausal hormones—0.3mg (.5mg of Estrace). If you have symptoms on the lower dose, you will need to raise your dose and decrease it more gradually. You can do this by alternating low- and high-dose pills (Monday = high dose, Tuesday = low dose, Wednesday = high dose, Thursday = low dose, etc.) for three to six months before trying to take only the low-dose pills.

A second option is to take the high-dose pills Monday through Friday and not take any pills on the weekends. After you have done this for three to six months, you can then try the low-dose pills again. The only way to know when you can fully drop down to the low dose is by trying it and then seeing if symptoms develop. If they do, and are unbearable, you will need to go back to the routine you were on and taper more gradually. If you are alternating a high-dose pill with a low-dose pill, you can do this by replacing one of the days you are taking a high-dose pill with a low-dose pill (Monday = high dose, Tuesday = low dose, Wednesday = low dose instead of high dose, Thursday = low dose, etc.). Once you have done this for a few months, then try adding in another low-dose day.

If you are taking menopausal hormones Monday through Friday and skipping weekends, try skipping another day, like Wednesday. Then, after a few months, you can try skipping another day. In general, the rule to follow is to go as slowly as you need to and to not go to the next reduction until symptoms that may have developed are easy to handle.

After a few months on the lower dose, you have two options: You can discontinue estrogen altogether or you can continue to take a smaller amount by cutting your pills first in half and taking a half dosage for a few weeks, and then cutting the pills in quarters and taking a quarter dose for a few weeks. Another option is to take a low-dose pill every other day.

If you are currently taking a higher dose of menopausal hormones—1.25mg (2mg Estrace)—you should begin tapering by dropping down to the standard dose—.635mg (1mg Estrace). You should continue to take the progesterone until you taper down to the low-dose level—0.3mg (0.5mg of Estrace). Once you are at the lower dose, you can discuss with your clinician whether to remain on the progesterone while you finish tapering off.

Money tip: menopausal hormones costs the same regardless of the dosage you are prescribed. To help reduce your costs you may want to keep your prescription dosage the same, but cut your pills in half.

Alternatives to HRT: Prescription Options

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence. What options are available to these women?

Prescription options for treating hot flashes include antidepressants, gabapentin, and clonidine.

Antidepressants

Studies have found that the antidepressant venlafaxine (brand name Effexor) decreased hot flashes by 50%. Studies of two SSRIs (selective serotonin reuptake inhibitors), fluoxetine (brand name Prozac) and paroxetine (brand name Paxil), found that these also reduced hot flashes by 50% when compared to placebo. That means if you have six hot flashes a day, taking an SSRI may reduce this to three. If your hot flashes are bad, these drugs may be worth a try. Because each drug works slightly differently, if one doesn’t work, you may want to try another before giving up on all of them.

Antidepressants might be especially helpful to women whose symptoms include both hot flashes and depression. SSRIs are believed to work because of the role serotonin plays in regulating the body’s temperature. When used to treat hot flashes, these drugs are prescribed at half of the daily dose that would be used to treat depression. This is done to try to decrease SSRI-associated side effects, such as dry mouth, nausea, appetite change, and decreased libido.

Gabapentin

Gabapentin (brand name Neurontin) is another drug that may have found a home as a treatment for hot flashes. It’s typically used to treat migraines, but when women using it for that purpose found it also stopped their hot flashes, researchers began to study the drug more closely.

In September 2005, results from a study conducted at the University of Rochester of 420 women with breast cancer who were having two or more hot flashes a day were published in Lancet. The study, which randomized women to two different doses of gabapentin or to a placebo, found that 900mg of gabapentin reduced hot flashes by about half. (A dose of 300mg/day was not effective.) That means if you had four hot flashes a day, you would now have two. Although the study was conducted in women with breast cancer, there is no reason to believe these findings are limited to that group, making the drug an option for all women in need of symptom relief.

Clonidine

Clonidine (brand name Catapres) is normally used to control blood pressure, but it is now sometimes recommended for women who experience hot flashes while on tamoxifen, a hormone used to treat breast cancer. In an eight-week placebo-controlled trial in postmenopausal women with tamoxifen-induced hot flashes, 38% of the women on clonidine reported a reduction in hot flash frequency compared with 24% of the women on placebo. However, there were a lot of side effects: fatigue, nausea, irritability, headache, and dizziness. So, while this drug may be an option for some women, the side effects may be a huge drawback for others.

Note:

In May 2006, the Journal of the American Medical Association published “Nonhormonal Therapies for Menopausal Hot Flashes.” This paper is a review and assessment of the previously published studies on the use of antidepressants, gabapentin, and clonidine for treating hot flashes. The authors concluded that these drugs are less effective than estrogen in reducing hot flashes and that “these therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women.”

In an accompanying editorial, Jeffrey A. Tice, MD, and Deborah Grady, MD, of the University of California, San Francisco, discuss the research findings. They note, “Women with hot flashes should understand that most symptoms resolve over several months to several years … For women with more bothersome symptoms, clinicians should understand the advantages and disadvantages of both hormone therapy and nonhormonal alternatives. Hormone therapy is more effective than nonhormonal alternatives but should probably be avoided by women at high risk for venous thromboembolic events , cardiovascular disease, and breast cancer.”

Alternatives to HRT: Lifestyle Options

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence.

The other option is to try to avoid hot flash triggers like spicy foods, caffeine, stressful situations, and hot drinks. You may also want to try sleeping in a cool room; carrying a hand fan; dressing in cotton and in layers; or paced respiration exercises (deep, slow abdominal breathing).

Here are some other things you can do on a day-to-day basis to help alleviate hot flashes—or at least make them easier to bear:

  • Keep the heat turned down, especially in the bedroom at night.
  • Dress in layers that can be easily shed when your temperature rises.
  • Wear exercise clothing that wicks away sweat during the day and at night.
  • Exercise regularly.
  • Learn and practice stress reduction.
  • Learn and practice paced respiration. Paced respiration is breathing from deep inside your abdomen, while slowing your breaths to five to six times a minute (normal is 10–15 breaths per minute). You practice breathing in for five seconds and breathing out for five seconds to get the timing right. Practice every day for 15 minutes. Then, if you feel a hot flash coming on, try decreasing your breathing, which may help nip that hot flash in the bud.

    Alternatives to HRT: Complementary Care

  • Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence.

    Complementary care options include acupuncture; eating a serving of soy foods and ground flaxseeds daily; or walking, swimming, dancing, or bike riding every day for 30 minutes or more. You can also try vitamin E (800mg) or the herb black cohosh. If nothing helps alleviate your symptoms, you may want to join or create a support group to help you deal with them.

    The following herbs, supplements, and complementary care practices may help alleviate hot flashes in some women.

Acupuncture

Acupuncture is designed to influence the body’s life force, which is known as “qi” or “chi” (pronounced chee). According to acupuncture principles, chi flows through the body along paths called meridians. By twirling hair-thin needles inserted at specific points along meridians, each of which is associated with a particular physical problem, acupuncture seeks to correct imbalances.

Acupuncture has been gaining an increased role in Western medicine, first in Europe, then in the United States. In 1997, the National Institutes of Health acknowledged that acupuncture is effective in treating certain conditions. Although hot flashes weren’t among those listed, there is some evidence from studies conducted in Europe that it is effective. In one Swedish study, women who underwent acupuncture therapy had relief from hot flashes that lasted several months.

If you decide to try acupuncture, you should be sure to see a licensed acupuncturist. You may also want to check to see if your health insurance covers acupuncture as part of its alternative and complementary medicine coverage.

Black Cohosh

Black cohosh is an herb that has long been used by Native Americans to treat menstrual and menopausal symptoms, but its mechanism is not understood. More recently it has become popular in the United States as a suggested treatment for hot flashes. A study of Remifemin Menopause, made from an extract of black cohosh, found that 70% of the 150 peri-and postmenopausal women in the study who took 40mg of Remifemin for 12 weeks reported a decrease in menopausal symptoms, including hot flashes. The group taking the higher dose did not do better than the lower standard-dose group. There was no placebo group in this study to compare the response with.

Black cohosh may be a good option for some women. The advantage of it over other alternatives is that it doesn’t have side effects, like clonidine and antidepressants. But it’s also clear that more is not better, and that women who do decide to try it should stick to the standard dose.

The question for breast cancer survivors is whether it is estrogenic. On this front we actually have some data. First of all there is no known phytoestrogen in black cohosh. Second, there is no evidence that black cohosh binds to the estrogen receptor. Finally, in a petri dish, breast cancer cells were exposed to black cohosh in the absence of estrogen, in the presence of estrogen, and in the presence of tamoxifen. They found that the black cohosh given alone inhibited cell growth. When estrogen was added it blunted the growth usually seen and it enhanced the effects of tamoxifen. This effect has been replicated in four other studies on cell lines. Studies in women have confirmed this lack of estrogenic effect.

Red Clover

Another commonly used herb, red clover, contains the daidzein and genistein found in soy as well as formononetin and biochanin. It is marketed for hot flashes and menopausal symptoms. There have been two randomized controlled studies comparing it to placebo. Neither study found that red clover was better than the placebo. There is concern about its ability to stimulate breast cancer, but this has not been studied. In addition, red clover produces dicumarol, which can block blood clotting.

Soy

Soy is a food source of isoflavones. Sometimes it is called a phytoestrogen. This is a poor word choice. Although soy acts like estrogen in some organs, it blocks estrogen in others—so it’s more like a phytoSERM (selective estrogen receptor modulator) than a pure estrogen. There have been several randomized controlled studies on hot flashes and soy, showing a reduction in hot flashes not only in countries where soy is a large part of the diet, like China and Japan, but also in the West. But there are other studies that didn’t show that soy was effective at all. In addition, soy not only decreases LDL cholesterol (the bad kind), but also increases the good cholesterol, HDL, significantly. And unlike Premarin, which increases triglycerides, soy decreases them. It also increases bone density.

Some women who have had breast cancer report that they are worried about eating soy because it might fuel their ER-positive tumors. There is no evidence that eating small amounts of soy is a problem. But if this concerns you, just don’t eat it.

Additional Resources:

You can learn more about what is known about these and other herbs and supplements on these websites:

  • MedlinePlus—Drugs and Supplements Provides a searchable database on herbs, botanicals, and other products.
  • National Center for Complementary and Alternative Medicine Provides extensive information on herbs and other alternative treatments.
  • Information specific to cancer survivors is available on these sites:
  • Memorial Sloan-Kettering Cancer Center Provides a searchable database on herbs, botanicals, and other products.
  • American Cancer Society’s Information on Complementary and Alternative Therapies Provides information about common CAM treatments.

Estradiol Transdermal Patch

Transdermal estradiol comes as a patch to apply to the skin. Transdermal estradiol is usually applied once or twice a week, depending on the brand of patch that is used. Some women wear a patch all the time, and other women wear a patch according to a rotating schedule that alternates 3 weeks when the patch is worn followed by 1 week when the patch is not worn. Always apply your transdermal patch on the same day(s) of the week every week. There may be a calendar on the inner flap of your medication carton where you can keep track of your patch change schedule. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use transdermal estradiol exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.

Your doctor will start you on a low dose of transdermal estradiol and may increase your dose if your symptoms are still bothersome. If you are already taking or using an estrogen medication, your doctor will tell you how to switch from the estrogen medication you are taking or using to transdermal estradiol. Be sure you understand these instructions. Talk to your doctor about how well transdermal estradiol works for you.

You should apply estradiol patches to clean, dry, cool skin in the lower stomach area, below your waistline. Some brands of patches may also be applied to the upper buttocks or the hips. Ask your doctor or pharmacist or read the manufacturer’s information that comes with your patches to find the best place(s) to apply the brand of patches you have received. Do not apply any brand of estradiol patches to the breasts or to skin that is oily, damaged, cut, or irritated. Do not apply estradiol patches to the waistline where they may be rubbed off by tight clothing or to the lower buttocks where they may be rubbed off by sitting. Be sure that the skin in the area where you plan to apply an estradiol patch is free of lotion, powders, or creams. After you apply a patch to a particular area, wait at least 1 week before applying another patch to that spot. Some brands of patches should not be applied to an area of the skin that is exposed to sunlight. Talk to your doctor or pharmacist to find out whether your patch should be applied to an area that will not be exposed to sunlight.

Talk to your doctor or pharmacist or read the manufacturer’s information that came with your medication to find out if you need to be careful when you swim, bathe, shower, or use a sauna while wearing an estradiol transdermal patch. Some brands of patches are not likely to be affected by these activities, but some brands of patches may loosen. Some types of patches may also be pulled and loosened by your clothes or towel when you change clothes or dry your body. You may need to check that your patch is still firmly attached after these activities.

If the patch loosens or falls off before it is time to replace it, try to press it back in place with your fingers. Be careful not to touch the sticky side of the patch with your fingers while you are doing this. If the patch cannot be pressed back on, fold it in half so it sticks to itself, dispose of it safely, so that it is out of the reach of children and pets, and apply a fresh patch to a different area. Replace the fresh patch on your next scheduled patch change day.

  1. Tear open the pouch with your fingers. Do not use scissors because they may damage the patch. Do not open the pouch until you are ready to apply the patch.
  2. Remove the patch from the pouch. There may be a silver foil sticker used to protect the patch from moisture inside the pouch. Do not remove this sticker from the pouch.
  3. Remove the protective liner from the patch and press the sticky side of the patch against your skin in the area you have chosen to wear your patch. Some patches have a liner that is made to peel off in two pieces. If your patch has that type of liner, you should peel off one part of the liner and press that side of the patch against your skin. Then fold back the patch, peel off the other part of the liner and press the second side of the patch against your skin. Always be careful not to touch the sticky side of the patch with your fingers.
  4. Press down on the patch with your fingers or palm for 10 seconds. Be sure that the patch is firmly attached to your skin, especially around its edges.
  5. Wear the patch all the time until it is time to remove it. When it is time to remove the patch, slowly peel it off of your skin. Fold the patch in half so that the sticky sides are pressed together and dispose of it safely, so that is out of reach of children and pets.
  6. Some brands of patches may leave a sticky substance on your skin. In some cases, this can be rubbed off easily. In other cases, you should wait 15 minutes and then remove the substance using an oil or lotion. Read the information that came with your patches to find out what to do if a substance is left on your skin after you remove your patch.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

Sandoz Estradiol derm

How does this medication work? What will it do for me?

Estradiol patch belongs to the class of medications known as estrogen replacement therapy. It is used for the management of menopausal symptoms such as abnormal uterine bleeding, hot flushes, sweating, and chills.

Estradiol is a type of estrogen, a female hormone that is produced by the ovaries. At menopause, the amount of estrogen made by the ovaries declines and symptoms such as hot flashes (sudden, extreme feeling of warmth) and vaginal dryness can occur. Most women reach menopause naturally around the age of 50, but some women may undergo menopause sooner due to many causes, including surgery.

When an estradiol patch is applied to your skin, it releases estradiol into your blood through the skin. Women who have not had a hysterectomy (removal of their uterus or womb) must also take another female hormone called progestin while they are taking this medication to prevent complications associated with taking estrogen alone.

Some forms of the estradiol patch are also used to prevent osteoporosis when there are low estrogen levels in the body. In situations where bone loss or fracture has already occurred, using the estradiol patch may help to slow down further bone loss. It is used in addition to other measures to help prevent osteoporosis, such as calcium and vitamin D supplements, quitting smoking, and regular weight-bearing exercise.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

50 µg
Each thin, oval, multilayer, transparent, 20 cm² transdermal therapeutic system contains 4.1 mg of estradiol hemihydrate equivalent to 4 mg of estradiol-17β for continuous delivery of 50 µg per day. Nonmedicinal ingredients: acrylic copolymer and d-α-tocopherol.

75 µg
Each thin, oval, multilayer, transparent, 30 cm² transdermal therapeutic system contains 6.2 mg of estradiol hemihydrate equivalent to 6 mg of estradiol-17β for continuous delivery of 75 µg per day. Nonmedicinal ingredients: acrylic copolymer and d-α-tocopherol.

100 µg
Each thin, oval, multilayer, transparent, 40 cm² transdermal therapeutic system contains 8.3 mg of estradiol hemihydrate equivalent to 8 mg of estradiol-17β for continuous delivery of 100 µg per day. Nonmedicinal ingredients: acrylic copolymer and d-α-tocopherol.

How should I use this medication?

A new patch should be applied to your skin on the same days twice a week (i.e., the patch should be changed once every 3 to 4 days). Depending on the individual, your doctor may advise you to use the patches continuously or in a cyclic schedule (approximately 3 weeks of treatment with patches followed by approximately one week without patch use). Talk to your doctor if you are not sure whether you are using estradiol patch continuously or with a patch-free period.

Women who have not had a hysterectomy (removal of their uterus) must also take a progestin while they are taking this medication to prevent adverse effects associated with the use of estrogen.

The patch is often applied to the buttocks, lower abdomen, or hip. Many women have found that less skin irritation occurs when the patch is applied to the buttocks. Talk to your doctor or pharmacist about the most appropriate site to apply the patch. Do not apply the patch to your breasts. Do not apply patches to the same site on the skin twice in a row.

To apply the patch:

  1. Choose a clean and dry area of intact skin that is not oily, damaged, irritated, or exposed to the sun. To avoid irritation, do not apply to the same site on the skin 2 times in a row.
  2. Tear open the pouch containing the patch rather than using scissors – if you accidentally cut the patch, it will be useless.
  3. Remove the protective layer. Apply the patch to the selected area immediately. Avoid touching the adhesive.
  4. Use your fingers to hold the patch in place for about 10 seconds and make sure that the patch is affixed to your skin, especially around its edges.

When changing the patch, remove the old one carefully, fold it in half so that the adhesive sides stick together, and throw it away or bring it to the pharmacy for proper disposal. Keep it out of the reach of children or pets. If adhesive remains on your skin, rub it off gently.

Bathing, showering, swimming, or other contact with water does not affect the patch. However, hot water or steam may cause the patch to loosen. If your patch falls off, try to reapply it. If that doesn’t work, apply a new patch.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you forget to apply or change your patch, change it as soon as you remember. If it is close to the day when you normally change your patch, still apply it but change the patch again on your usual day and continue on with your regular schedule. Do not wear 2 patches at once. If you are not sure what to do after forgetting to apply or change the patch, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children. Do not store the patches out of the pouch.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to estradiol or any ingredients of this medication
  • are breast-feeding
  • are or may be pregnant
  • have, have had, or may have breast cancer
  • have a blood clotting disorder
  • have a history of known or suspected estrogen-dependent tumours (e.g., endometrial cancer)
  • have active phlebitis (inflamed varicose veins)
  • have classical migraines (migraines with aura)
  • have endometrial hyperplasia (thickening of the inner lining of the uterus)
  • have liver dysfunction or disease where liver function tests have not returned to normal
  • have or have ever had liver tumours
  • have or have had a stroke, heart attack, or coronary heart disease
  • have or have had blood clots in the legs or lungs, or coronary thrombosis
  • have partial or complete loss of vision from eye disease related to circulation problems
  • have porphyria
  • have unusual vaginal bleeding that has not been checked by a doctor

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • bloating
  • breakthrough menstrual bleeding or spotting
  • breast tenderness
  • change in sex drive
  • contact lens discomfort
  • darkening of the skin around areas where the patch is applied
  • dizziness
  • headache
  • increased frequency of menstrual bleeding
  • migraine headache
  • mood swings
  • nausea
  • redness or irritation underneath or around the area of the skin on which the patch is applied
  • weight changes

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal pain with nausea or vomiting
  • breast lumps
  • easy bruising
  • frequent or prolonged, exceptionally heavy periods
  • flu-like symptoms
  • fluid retention (swelling of the lower legs, ankles, feet, or fingers) lasting 6 weeks or longer
  • high blood pressure
  • lower abdominal pain or swelling, painful or heavy periods
  • first migraine headache
  • signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
  • signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worst when breathing in, coughing, coughing up blood, sweating, or passing out)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • tender or painful inflammation of the veins (e.g., pain in groin, calf)
  • vomiting

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
  • symptoms of a severe allergic reaction (e.g., hives; difficult breathing; swelling of the face, mouth, throat, or tongue)
  • symptoms of a stroke (e.g., sudden and severe headache, sudden vision changes, sudden difficulty speaking, sudden weakness or numbness in arms or legs, sudden dizziness, fainting, or vomiting)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

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,

  • estrogens 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.
  • 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, is known to occur with the application of estrogen to the skin. Although this allergy is extremely rare, people who develop skin reactions or contact sensitization to any component of the medication are at risk of developing a severe allergic reaction with continued use. If you have a skin reaction to the patch, contact your doctor for advice.

Blood clotting disorders: Estrogens with or without progestins are associated with an increased risk of blood clots in the lungs (pulmonary embolism) and legs (deep vein thrombosis). If you have or have had a heart attack, a stroke, heart disease, a blood clot in your leg, or have medical conditions that increase your risk of blood clots, you should not use this medication.

The risk of developing blood clots also increases with age, a personal or family history of blood clots, smoking, and obesity. It 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. Your doctor should monitor your blood pressure or advise you on how often you should measure your blood pressure if you are using estrogen, especially if high doses are used. Regular checkups by your doctor are recommended. If you have high blood pressure, 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.

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 show there is an increased risk of breast and ovarian cancer with long-term use of estrogen replacement therapy. Women with a history of breast cancer should not use estrogens. Women who have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer should be closely monitored by their doctor.

Women taking estrogens should have regular breast examinations and should be instructed in breast self-examination. The estradiol patch must not be applied to the breasts, as it may have harmful effects on the breast tissue.

Dementia: Women over the age of 65 receiving combined hormone replacement therapy (estrogen and progestin) 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: Estrogens can cause changes in blood glucose control for people who have diabetes or have risk factors for developing diabetes. If you have diabetes or are at risk for developing diabetes (e.g., have a family history of diabetes, have high blood pressure or high cholesterol, or are obese), 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.

People who have diabetes (or a predisposition to diabetes) should monitor their blood glucose levels closely to detect changes in blood glucose.

Endometrial cancer: There is evidence from several studies 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. For this reason, all women who have not had their uterus removed should also take a progestin if they are using estrogens.

If you develop any abnormal vaginal bleeding while using this medication, contact your doctor. If you have or have had endometrial cancer, you should not use this medication.

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 by causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Fluid retention: Estrogen may cause sodium (salt) and fluid retention. This can be dangerous for women with heart or kidney dysfunction or asthma. If you have any of these conditions, 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.

If you notice the symptoms of any of these conditions getting worse, contact your doctor.

Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting this medication to assess your response to treatment. Examinations should be done at least once a year after the first one.

Gallbladder disease: 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.

Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestin) 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.

High cholesterol or triglycerides: Estrogen may increase triglyceride levels in those who already have high levels. This has been observed particularly when estrogen is taken orally – the risk is reduced with use of the patch. Your doctor will monitor your cholesterol and triglyceride levels while you are taking this medication.

Kidney function: Estrogen can affect how calcium and phosphorus are used by your body. If you have kidney disease, this may be a concern and you should 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.

Liver function: If you have reduced liver function, 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. People with active liver disease or liver tumours should not use the estradiol patch.

If you experience symptoms of liver problems (e.g., yellowing of the skin or eyes, abdominal pain, loss of appetite, dark urine, pale stools, nausea, or vomiting), contact your doctor immediately.

Migraine headaches: If you have migraines with aura (headache is associated with symptoms such as flashes of light, tingling sensations, blind spots, muscle weakness, difficulty speaking either before or during the headache), you should not use this medication.

For some people who experience migraine headaches, estrogen can make the condition worse. Talk to your doctor if you notice any change in your migraine pattern while using estrogen.

Seizures: Estrogens may increase your risk of having a seizure. If you have a seizure disorder or a history of seizures, 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.

Thyroid disease: Estrogen may affect how thyroid hormone is used by the body. If you are taking thyroid medication to supplement an underactive thyroid gland, 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.

Pregnancy: Estrogen should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking estrogen, it may affect your baby. This medication is not recommended for breast-feeding women.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between the estradiol patch and any of the following medications:

  • abiraterone
  • alcohol
  • amiodarone
  • anastrozole
  • apixaban
  • ascorbic acid (vitamin C)
  • atorvastatin
  • “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • barbiturates (e.g. pentobarbital, phenobarbital)
  • boceprevir
  • bosentan
  • bromocriptine
  • carbamazepine
  • cannabis
  • carvedilol
  • celecoxib
  • certain protein kinase inhibitors (e.g., crizotinib, dabrafenib, lapatinib, nilotinib, sunitinib)
  • cobicistat
  • corticosteroids (e.g., dexamethasone, prednisolone, prednisone)
  • cyclosporine
  • cyproterone
  • dabigatran
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • deferasirox
  • dehydroepiandrosterone
  • dipyridamole
  • dronedarone
  • doxorubicin
  • enzalutamide
  • exemestane
  • grapefruit juice
  • heparin
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
  • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
  • hyaluronidase
  • hydrocodone
  • low-molecular-weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • medications used to treat high blood pressure (e.g., atenolol, rampiril, enalapril, lisinopril, amlodipine)
  • mefloquine
  • mirabegron
  • mitotane
  • modafinil
  • nefazodone
  • oxcarbazepine
  • phenytoin
  • primidone
  • progesterone
  • propranolol
  • quinidine
  • quinine
  • rifabutin
  • rifampin
  • rivaroxaban
  • ropinirole
  • St. John’s wort
  • saw palmetto
  • simeprevir
  • somatropin
  • soybean
  • tacrolimus
  • tamoxifen
  • telaprevir
  • tenofovir
  • thalidomide
  • theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
  • thyroid replacements (e.g., dessicated thyroid, levothyroxine)
  • tizanidine
  • tocilizumab
  • trazodone
  • ursodiol
  • verapamil
  • vinblastine
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Sandoz-Estradiol-derm

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