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PEBC: What You Need to Know: Estrogens for Menopause

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

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