Oral estrogens: 17 beta estradiol (Estrace), conjugated estrogen (Premarin)
Vaginal estrogens: estrone (Estragyn), 17 beta estradiol (Estrogel, Climara, Estring, Vagifem)
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Indication: Menopause symptoms (hot flashes, vaginal dryness)
Dosing:
Oral: once daily
Vaginal: various doses, ranges from once every 3 months (Estring), once weekly (Climara), twice weekly (Vagifem, Estragyn) or once daily (Estrogel)
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Oral Adverse Effects:
-common: bloating, breast tenderness, increased cholesterol, nausea, headache, breakthrough bleeding
-SERIOUS (based on Women’s Health Initiative): cardiovascular risk, breast cancer, deep vein thrombosis
** endometrial cancer risk with oral estrogen (and sometimes long term vaginal estrogen) - make sure to prescribe an oral progestin such as medroxyprogesterone or micronized progesterone to counter the hyperplasia in women with intact uterus
-Benefits of oral estrogen: increased bone density, less colon cancer
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Vaginal Adverse Effects: spotting, discharge, itching, burning
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Drug Interactions:
-watch for inducers such as phenobarbital, rifampin, phenytoin which can reduce estrogen levels