How to use estrace cream?

Vaginal Dryness

Vaginal dryness is perhaps the most distressing and least talked about symptom of menopause.

Vaginal dryness probably results from changes that occur when estrogen levels drop. Low estrogen causes the vagina and surrounding connective tissue to lose elasticity and the tissue that lines the vagina becomes thinner and more fragile. Vaginal dryness occurs in about 20% of women, sometimes transiently and other times permanently. If you’re sore from vaginal dryness, you don’t want to have sex and if you don’t have sex, your vaginal dryness gets worse—a classic catch-22.

How does vaginal dryness feel? Itchy is how most women describe it. Vaginal dryness can cause pain and bleeding during intercourse and increase the possibility of developing a vaginal infection.

Like other menopausal symptoms, vaginal dryness is not something you have to accept. There are a number of ways you can counter it. These include:

Lifestyle Changes

Sexual exercise—either alone or with a partner—will increase your natural lubrication.

Drinking lots of water can help your whole body, including your vagina, stay hydrated.

Lubricants

There are lubricants that you can use during sexual activity that will make you more slippery. These include K-Y Jelly and Astroglide. There are also products you can use on a regular basis to eliminate vaginal dryness, such as Replens. You can open vitamin E capsules and apply the oil inside your vagina daily for a week or two and then once or twice a week after that.

Supplements

Herbalists suggest that taking motherwort tincture or dong quai in any form by mouth for three to seven days generally improves vaginal lubrication. Homeopathic remedies suggested include bryony, lycopodium, and belladonna, but there are no good studies to support these recommendations. For more information on these herbal products, try these websites:

  • MedlinePlus—Drugs 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.
  • Consumer Reports Medical Guide: Natural Medicine Ratings
  • 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.

Note to Women with Breast Cancer:

If you have had breast cancer, some of these herbs may not be recommended. You should discuss their use with your physician. You can also find information specific to individuals with cancer on these sites.

Drugs

Vaginal estrogen can be very effective in treating dryness. There are a number of methods currently available for taking estrogen vaginally. Two options are Premarin cream and Estrace. Both are very well absorbed. Some women think that because you apply the cream only inside your vagina, none of it will get into the rest of your body. This isn’t the case. Some of the estrogen is absorbed into your blood. In fact, both Premarin and Estrace raise your blood levels of estrogen much the same as estrogen pills.

You only need a low dose of these products. One study found that a dose of 0.1mg provided effective relief from vaginal dryness. When you start using vaginal cream, you apply a small dab just inside your vagina daily for three or four weeks. Then you can reduce your use to once or twice a week. If you apply it daily for more than four to six weeks, it becomes less effective. It’s important to remember that this is not a lubricant. You should use K-Y Jelly or Astroglide or another type of lubricant before having sex.

Easier and less messy are the new sustained release products, Estring and Vagifem. Estring is a low-dose estrogen ring that is placed in the vagina (much like a diaphragm) for three months at a time. It releases small amounts of estradiol over time. The estrogen dose is so low that it is not absorbed into the rest of the body. Newer products like Vagifem involve placing a tablet in the vagina rather than a ring.

Note to Women with Breast Cancer:

Women who have had breast cancer can use Vagifem or Estring. Estrogen cream, such as Estrace is not recommended. Neither is Femring, which is a form of hormone replacement therapy (HRT).

Is Estrogen Cream Your Solution?

When you hear the word “estrogen,” what is your first thought? Hormone? Women? Right. Estrogens are the hormones most associated with the female reproduction system. There are a three types of estrogens (estrone, estradiol, and estriol) whose levels vary depending on whether the woman is in a regular state, pregnant, breastfeeding, or menopausal. Estrogens play a part in female reproductive diseases, disorders, and discomforts as well, and therefore, estrogen cream is used medicinally to try to alleviate some of the symptoms. Estrogen cream is the estradiol form of estrogen, and is absorbed vaginally by inserting it with an applicator. Commercial names are Estrace or Premarin.

Why Some Women Use Estrogen Cream

Estrogen helps to aid the vagina in becoming more elastic and moist, which in turn, decreases pain and discomfort. Your gynecologist might prescribe estrogen cream if you experience any of the following symptoms due to low estrogen levels:

  1. Vaginal dryness
  2. Vaginal soreness
  3. Vulva ailments – Itchiness, soreness, inflammation, redness
  4. Overactive bladder – The urgent and/or overly-frequent need to urinate day or night
  5. Urination pain
  6. Pain during sexual intercourse

Note that estrogen cream usage can take up to 3 months to become effective.

Possible Side Effects of Estrogen Cream

If used in small amounts (1/2 gram twice weekly), you will not likely experience any of the alarming side effects listed on the medication insert. A low-dose estrogen topical treatment is similar to a lotion for your vagina.

Immediate side effects of estrogen cream might include symptoms similar to PMS or early pregnancy, namely: bloating, breast tenderness, headache, nausea/vomiting or weight changes.

Estrogen cream is a form of HRT – Hormone Replacement Therapy. You may have heard about HRT, especially as it garnered a lot of press in the ’90s when it was determined to be a causative factor in breast cancer. Because estrogen is one of the hormones used in HRT, women understandably are concerned about any type of hormone replacement, such as estrogen creams. At the same time, not all types of HRT are created equal, and while you should be concerned about possible side effects, be aware that the risks might not be as high with each type of hormone replacement.

Alternatives to Estrogen Cream

Depending upon your situation and personal preference, you might be interested in other types of treatments which have the same or similar benefits as estrogen cream. These alternatives include the following:

  • Mona Lisa Touch™ – A CO2 non-fractionated vaginal laser designed to treat vaginal atrophy and dryness with three painless 3-minute sessions, spaced 6 weeks apart.
  • Osphena® – A non-estrogen oral medication for menopause-related vaginal discomforts
  • Evening Primrose Oil capsules
  • Lubricants or suppositories, such as KY Pearls

Vaginal insertion allows for the lowest-dose release, reducing the risk of side effects in comparison with skin application or oral administering. So, when it comes to estrogen replacement therapy, one advantage of estrogen cream is that it is inserted vaginally. Speak to your gynecologist about the best option for you.

By the way, doctor: Is vaginal estrogen safe?

Updated: March 18, 2019Published: November, 2007

Q. My doctor prescribed a low-dose vaginal estrogen cream, applied twice a week, for atrophic vaginitis. I’ve heard this dose is so low that it carries no health risk. Do you agree?

A. Estrogen cream and other vaginal estrogens are very effective treatments for atrophic vaginitis, a condition that’s common in postmenopausal women and results from a drop in estrogen levels. Estrogen loss can lead to thinning (atrophy) of the cells lining the vagina and urethra. As a result, women may develop vaginal dryness, itching, and pain with intercourse, as well as a high risk of urinary and vaginal infections.

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A Comparison of Estradiol Vaginal Cream to Estrace® Cream in 350 Postmenopausal Females With Atrophic Vaginitis

Inclusion Criteria:

  1. Capable of providing informed consent.
  2. Age: 40-70 years old.
  3. Sex: Female
  4. Postmenopausal defined as at least 12 months of spontaneous amenorrhea or at least 6 months of spontaneous amenorrhea with serum FSH levels > 40 mIU/ml or at least 6 weeks postsurgical bilateral oophorectomy with or without hysterectomy.
  5. Weight: At least 48 kg with all subjects having a Body Mass Index less than or equal to 38 kg/m2 but greater than or equal to 19 kg/m2.
  6. Baseline evaluation requirements:

    • ≤5% superficial cells on vaginal smear cytology
    • Vaginal pH > 5.0
    • At least one patient self-assessed moderate to severe symptom of vulvar and/or vaginal atrophy (VVA) from the following list that is identified by the subject:
    • Vaginal dryness
    • Vaginal and/or vulvar irritation/itching
    • Dysuria
    • Vaginal pain associated with sexual activity
    • Vaginal bleeding associated with sexual activity (absence vs. presence)
  7. All subjects should be judged to be eligible for participation in this study by the principal or sub-investigator physician during a pre-study medical evaluation performed within 28 days of the initial dose of study medication which will include:

    1. a normal or non-clinically significant physical examination, including vital signs
    2. a normal or non-clinically significant pelvic examination that was consistent with hypoestrogenemia
    3. a normal or non-clinically significant breast exam and mammogram
    4. a normal or non-clinically significant ASCUS Papanicolaou (“Pap”) smear that is negative for HPV for subjects with an intact uterus and cervix
    5. within normal limits or non-clinically significant laboratory evaluation results (unless otherwise noted in the exclusion criteria) for the following tests:

      • Serum Chemistry
      • Hematology
      • Coagulogram
      • Urinalysis
    6. normal or non-clinically significant 12- Lead ECG.
    7. negative urine drug screen including amphetamine, barbiturates, benzodiazepines, cannabinoid, cocaine, opiates, methadone and phencyclidine with the following exceptions: positive tests for amphetamines, barbiturates, benzodiazepines, or opiates may be allowed provided the subject has a valid prescription and is on a stable regimen that complies with Exclusion Criteria, Section 6.3.2.
    8. negative urine cotinine test.
  8. For women with an intact uterus, an endometrial thickness < 5 mm as determined by vaginal ultrasonography.
  9. If warranted, other tests or examinations may be performed at the discretion of the Principal Investigator or responsible physician.
  10. Ability to use applicator properly.

Exclusion Criteria:

  1. Institutionalized subjects will not be used.
  2. Any contraindication to estrogen therapy.
  3. Social Habits:

    1. Use of any tobacco-containing products within 1 year of the start of the study.
    2. Regular intake of more than 7 units of alcohol per week.
    3. Beginning any new regimens of vitamins or herbal products within 7 days prior to the initial dose of the study medication.
    4. Any recent, significant change in dietary or exercise habits.
    5. History of drug and/or alcohol abuse within one year of start of study.
  4. Medications:

    1. Use of any new prescription or over-the-counter (OTC) medication regimens within fourteen (14) days prior to the initial dose of study medication (any necessary medication, unless otherwise noted in the exclusion criteria, for which dosing has been stabilized for a period of at least 14 days prior to initial dosing of study drug and is expected to remain stable for the entire study period is allowed, with the exception of acetaminophen, which may be administered as needed to treat minor adverse events).
    2. Use of hormonal replacement therapies for the following time periods:

      • within 2 weeks of baseline assessment for vaginal therapy (rings, creams, gels)
      • within 4 weeks of baseline assessment for transdermal estrogen alone or estrogen/progestin therapy
      • within 8 weeks of baseline assessment for oral estrogen and/or progestin therapy or intrauterine progestin therapy
      • within 3 months of baseline assessments for progestin implants or estrogen alone injectable therapy
      • within 6 months of baseline assessments for estrogen pellet or progestin injectable therapy
    3. A depot injection or implant of any drug within 3 months prior to administration of study medication.
    4. Currently taking medication indicated for anticoagulation as a result of an excluded condition listed in #5 below. This includes but is not limited to warfarin, heparin, NSAIDs, clopidogrel, dabigatran, etc.
  5. Diseases:

    1. History of any significant cardiovascular, hepatic, renal, pulmonary, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, psychological, urinary, musculoskeletal disease or malignancies unless under medical control and/or deemed not clinically significant by the Principal Investigator or Medical Sub-investigator.
    2. Manifestation or treatment for significant cardiovascular disease (congestive heart failure, stroke or ischemic attack, myocardial infarction, coronary artery bypass, percutaneous angioplasty or > 50% angiographic narrowing of coronary artery, thrombosis of deep veins and arteries, thromboembolic disorders, pulmonary embolism) or history of these conditions.
    3. Coronary artery or cerebrovascular disease.
    4. Current clinically significant liver or kidney dysfunction/disorders.
    5. Current clinically significant gallbladder dysfunction/disorders.
    6. Abnormal or clinically significant breast examination. Acceptable breast examination is defined as no masses or other findings identified that are suspicious of malignancy.
    7. First degree family history of breast cancer.
    8. Current non diet controlled diabetes mellitus or other clinically significant endocrinological disease.
    9. Estrogen-dependent neoplasia
    10. Postmenopausal uterine bleeding
    11. Endometrial hyperplasia
    12. Uncontrolled hypothyroidism
    13. Urinalysis showing an ongoing clinically significant urinary tract infection that requires treatment.
    14. Current clinically significant vaginal infection that requires treatment.
    15. Known chronic lichen sclerosis
    16. Acute illness at the time of either the pre-study medical evaluation or dosing.
    17. History of allergy or hypersensitivity to estradiol, other related products, or any inactive ingredients.
    18. Undiagnosed vaginal bleeding or history of significant risk factors for endometrial cancer.
    19. Increased frequency or severity of headaches while on previous hormone or estrogen therapy.
    20. History of psychiatric disorders occurring within the last 6 months that require hospitalization or medication.
    21. Current hypercalcemia, hypocalcemia, and/or hypertriglyceridemia.
    22. Clinically significant eye/visual abnormalities such as retinal vascular thrombosis, partial or complete loss of vision, proptosis, diplopia, papilledema, retinal vascular lesions.
  6. Any reason which, in the opinion of the Principal Investigator or Medical Sub-Investigator, would prevent the subject from safely participating in the study.
  7. Subjects who have received an investigational drug within 30 days prior to the initial dose of study medication.
  8. Sitting blood pressure higher than 150/90 mmHg at screening.
  9. Baseline serum estradiol levels >30 pg/mL at screening.

Estrace

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

Estradiol-17ß (micronized) belongs to the class of medications known as estrogen replacement therapy. Estrogen is a female hormone produced by the ovaries. Once menopause is reached, the ovaries produce less estrogen and progesterone (another hormone), and symptoms of menopause can occur.

Estradiol-17ß (micronized) is an estrogen replacement hormone used to manage menopausal symptoms such as abnormal uterine bleeding, hot flashes, sweating, and chills. (See warnings about duration of use further in this article.)

It may also contribute to the prevention of osteoporosis in women when combined with diet, calcium, vitamin D, smoking cessation, and exercise. The decision to use this medication should be weighed against other options available for the treatment and prevention of osteoporosis.

Women who have not had a hysterectomy must also take a progestogen while they are taking this medication.

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 taking this medication, speak to your doctor. Do not stop taking 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 take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

0.5 mg
Each white, round, flat-faced, bevel-edged compressed tablet, with MJ logo and “021” on one side and scored on the reverse, contains estradiol-17ß (micronized) 0.5 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, lactose, magnesium stearate, silicon dioxide, and talc.

1 mg
Each lavender, round, flat-faced, bevel-edged compressed tablet, with MJ logo and “755” on one side and scored on the reverse, contains estradiol-17ß (micronized) 1 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, D&C Red No. 27 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, lactose, magnesium stearate, silicon dioxide, and talc.

2 mg
Each turquoise, round, flat-faced, bevel-edged compressed tablet, with MJ logo and “756” on one side and scored on the reverse, contains estradiol-17ß (micronized) 2 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 5 Aluminum Lake (tartrazine), lactose, magnesium stearate, silicon dioxide, and talc.

How should I use this medication?

Typically, estrogen is taken for the first 21 to 25 days of each month. Women who have not had a hysterectomy (i.e., they still have a uterus) should take a progestin (e.g., medroxyprogesterone) for the last 12 to 14 days of each estrogen cycle.

Women who have had a hysterectomy may take estrogen daily, without a break.

For treatment of menopausal symptoms, the usual dose is 1 mg daily for 21 to 25 days of each month. Attempts to discontinue the medication should be made every 3 to 6 months. If symptoms return, the medication should be continued.

For prevention of osteoporosis, the usual dose is 0.5 mg daily as soon as possible after the onset of menopause. The dose may be increased or decreased according to the level of estradiol in the blood.

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 taking the medication without consulting your doctor.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

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 take estradiol-17ß (micronized) if you:

  • are allergic to any ingredients of the medication
  • are breast-feeding
  • are or may be pregnant
  • have a known or suspected estrogen-dependent tumour
  • have endometrial hyperplasia (thickening of the lining of the uterus)
  • have had a blockage in an artery feeding the heart caused by a blood clot (coronary thrombosis)
  • have had a stroke
  • have had diseases of circulation or clotting
  • have migraine headaches
  • have had partial or complete loss of vision or double-vision from eye disease related to circulation problems
  • have liver impairment or disease, especially of the obstructive type
  • have or have had breast cancer or endometrial cancer, except in special circumstances
  • have undiagnosed vaginal bleeding

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.

  • acne
  • bloating of stomach
  • breast pain or swelling
  • changes in cholesterol levels
  • dizziness
  • hair loss
  • headache (mild)
  • irritability
  • nausea
  • stomach cramps
  • vaginal itching, discharge, or pain
  • vomiting
  • 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:

  • blood pressure changes
  • breast lumps or discharge
  • groin pain
  • nervousness
  • rash
  • 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)
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • unexpected vaginal bleeding

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

  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • 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 heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
  • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

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.

Important information about estrogen:

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.

  • This medication should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible.
  • You should not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes.

Blood clotting disorders: Estrogens should not be used if you have active thrombophlebitis or a thromboembolic disorder (diseases of blood clotting and abnormal circulation). They should also not be used (except in the treatment of cancer) if you have a history of a clotting disorder that is likely to be caused by estrogen use. Finally, they should be used with caution if you have any cerebral vascular disease or coronary artery disease, and then, only used if clearly needed.

Some studies have suggested that there is an increased relative risk for healthy women to develop deep vein thrombosis or pulmonary embolism when they use hormone replacement therapy. Women with severe varicose veins or severe obesity, and those needing to stay in bed for 3 weeks or more, are generally considered to be at increased risk of venous thromboembolism (blood clots in the bloodstream).

Blood pressure: There have been reports of increased blood pressure in women taking this medication. Your doctor should monitor 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.

Breast cancer: Studies indicate an increased risk of breast cancer with long-term use of estrogen replacement therapy. If you have have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer, 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. Women who take estrogens should have regular breast examinations and should be instructed in breast self-examination.

Cholesterol: Oral estrogens can increase triglycerides in the blood. If you have high blood cholesterol levels, 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.

Dementia: Women over age 65 receiving estrogen, with or without a progestin may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65 years of age, your doctor should closely monitor you for loss of memory and intellectual function.

Diabetes: Estrogens 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, 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 increases the risk of cancer of the endometrium (uterus). Taking a progestin appropriately along with the estrogen reduces this risk to the same level as that of a woman who does not take estrogen. For this reason, all women who have not had their uterus removed should also take progestin if they use estrogens.

Fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Fluid retention: Estrogen may cause sodium (salt) and fluid retention. This can be dangerous for women with heart or kidney dysfunction, epilepsy, 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.

Gallbladder disease: An increased risk of gallbladder disease has been reported in postmenopausal women who take estrogens. If you have a history of 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.

If you experience symptoms of gallbladder disease, such as abdominal pain, possibly with fever and chills, contact your doctor as soon as possible.

Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestins) for postmenopausal women. If you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs) while taking this medication, get immediate medical attention.

Liver function: If you have or have had liver problems, you may require special monitoring by your doctor while you use this medication. Make sure to tell your doctor if you have ever had liver problems.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Migraine: People who are at risk of experiencing migraine may have an increased risk of stroke when taking conjugated estrogens. If you have migraine with aura, 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.

Ovarian cancer: Recent studies have linked long term use of estrogen with an increased risk of ovarian cancer. This increased risk appears to occur whether estrogen is used with a progestin or alone. Discuss the risks and benefits of prolonged use of hormone replacement therapy with your doctor.

Seizures: Hormone replacement therapy may increase the frequency of seizures for people with a history of seizure disorder. If you have 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 conditions: Estrogens can increase the amount of thyroid hormone your body needs to work properly. If you are hypothyroid (have reduced amount of thyroid hormone in your body) and need estrogens, you may require an increased amount of thyroid hormone for your body to continue to work properly. 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.

Breast-feeding: Estrogen is not safe for use during breast-feeding. A decision should be made whether to discontinue breast-feeding or to discontinue the medication, taking into account the importance of the medication to the mother.

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

What other drugs could interact with this medication?

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

  • abiraterone acetate
  • amiodarone
  • anastrozole
  • aripiprazole
  • ascorbic acid (vitamin C)
  • atorvastatin
  • “azole” antifungals (e.g., ketoconazole, itraconazole, vorionazole)
  • barbiturates (e.g., phenobarbital)
  • bosentan
  • blood pressure-lowering medications (e.g., propranolol, enalapril, diltiazem)
  • carbamazepine
  • carvedilol
  • celecoxib
  • cobicistat
  • corticosteroids (e.g., hydrocortisone, prednisolone, prednisone)
  • crizotinib
  • cyclosporine
  • cyproterone
  • dabrafenib
  • deferasirox
  • dehydroepiandosterone
  • dexamethasone
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone, saxagliptin)
  • dipyridamole
  • doxorubicin
  • dronedarone
  • efavirenz
  • etravirine
  • grapefruit juice
  • HIV protease inhibitors (e.g., lopinavir, ritonavir, saquinavir)
  • lenalidomide
  • mefloquine
  • mitotane
  • modafinil
  • nefazodone
  • nilotinib
  • phenytoin
  • primidone
  • progesterone
  • propranolol
  • quinidine
  • quinine
  • rifabutin
  • rifampin
  • ropinirole
  • St. John’s wort
  • somatropin
  • sunitinib
  • tacrolimus
  • tamoxifen
  • telaprevir
  • temazepam
  • tenofovir
  • teriflunomide
  • thalidomide
  • theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
  • thyroid medications (e.g., levothyroxine, liothyronine)
  • 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 that 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/Estrace

“If we were having this conversation in the context of drug prices being reasonable across the board — hey, good news,” said Cynthia Pearson, the executive director of the National Women’s Health Network, a consumer group. “It’s just infuriating that the price has gone up and up and up for no good reason.”

She said the issue has not gotten more attention because “how many people will say ‘vagina’ in a public setting?”

Some companies are using a playful marketing approach, signaling the issue is not as taboo as it once was. The website of Imvexxy — which rhymes with sexy — features an image of a ripe, juicy peach, boasting the product is “distinctly designed for sweet relief.” A similar product, Intrarosa, which does not contain estradiol, features a photo of a nude older woman, her head thrown back in pleasure.

Some of these products may soon come down in price. In October 2016, a generic of Vagifem, called Yuvafem, entered the market at a slightly reduced list price. Then, in July of last year, Teva Pharmaceuticals began selling a second generic at an even cheaper price. But the pharmacy cash price for Teva’s product — $163.91 for a month’s supply of eight tablets in May — is still higher than what Vagifem cost in 2015, according to the GoodRx analysis.

If more generic manufacturers enter the market, the price could tumble more and Vagifem could become an inexpensive drug like many cholesterol or blood pressure medicines. The same could become true for Estrace cream, which lost its patent protection at the end of last year and now has several generic competitors.

With two generics for Vagifem now available, the drug companies are most likely negotiating big discounts with insurers, meaning patients with coverage may see their costs drop. Elizabeth Traynor, an illustrator in Guntersville, Alabama, had tried virtually every estradiol product and balked at the prices, frequently doing without. But she recently called her insurer, the Government Employees Health Association, and learned she would have to pay $20 for a three-month supply of Yuvafem. “It’s about time,” she said. “Hooray!”

Estradiol has been around for so long that it has survived several rounds of debate over high prices. In 1959, a Senate inquiry found that the drug maker Schering, now part of Merck, had marked up estradiol — which comes in many forms — by more than 7,000 percent over the cost of materials.

In an echo of modern-day industry talking points, a Schering executive was quoted in an article in The New York Times, saying the high prices were necessary to finance new medical research. “The consumers of today must contribute to the benefits which the future will bring,” the drug executive said.

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