Estradiol

Brand Name:imara, Estraderm, Estradot, Estring, Sandoz Estradiol derm, Vagifem, Oesclim, Vivelle, Estrace, Estrogel, Delestrogen

Prescription needed: Yes

What is this drug used for?

Estradiol is a form of female sex hormone called estrogen. The abrupt reduction of estrogen hormone is what causes the symptoms of menopause to appear. It is most commonly prescribed as hormone replacement therapy (HRT) to treat the symptoms of menopause and post-menopause, including hot flashes, night sweats and vaginal atrophy. Hormone replacement therapy also helps prevent the loss of bone tissue, which is commonly associated with osteoporosis. It is used alone or in combination with another female hormone called progestin.

Estradiol is available in many different forms:

Oral tablets (Estrace): Can be used to relieve symptoms of menopause, such as hot flashes or vaginal dryness. It may also be used to prevent post-menopausal osteoporosis. It may be used for other medical conditions. Ask your doctor or pharmacist.

Vaginal cream, vaginal tablet, gel, vaginal ring (Estring): Used for vaginal discomfort (dryness, redness and itchiness), pain during intercourse.

Transdermal patch: Can be used to relieve symptoms of menopause, such as hot flashes or vaginal dryness. It may also be used to prevent post-menopausal osteoporosis.

Injection form: Used to control abnormal bleeding of the uterus, abnormal menstrual cycles, treatment of certain cancers in men and women, or to treat low estrogen levels. May be used to treat other conditions as determined by your doctor.

Is there any reason not to take this drug?

You should not take this drug if you are allergic to estradiol. If you are allergic to tartrazine dye, check with your pharmacist before taking Estrace tablets, which contain tartrazine in certain tablet strengths.

Do not take this medication if you are pregnant, have cancer or problems of the breast or uterus, blood clotting problems, abnormal vaginal bleeding, migraine headaches, liver disease.

Before taking this medication, tell your doctor specifically if you have or have ever had:

  • asthma
  • diabetes
  • seizures
  • high triglycerides
  • heart disease
  • high blood pressure
  • stroke
  • kidney problems
  • migraine headaches
  • thyroid problems
  • gallbladder disease or gallstones
  • inflammation of the pancreas
  • you are a smoker

What about possible side effects?

The risk of any serious side effect is unlikely for most women using low doses of estrogen vaginally (for example, in the form of vaginal gel, cream, ring).

The most common side effects of estradiol include:

  • headache
  • breast tenderness
  • nausea or vomiting (if taking tablets, may take with food to minimize stomach upset)
  • changes in vaginal bleeding (such as spotting, breakthrough bleeding)
  • weight change
  • bloating
  • vaginal discharge

Some of these side effects may be less severe with lower doses and may decrease with time. If any of these effects persist or worsen, please talk to your doctor.

Other possible side effects:

  • brown or black skin patches (melasma)
  • changes in contact lenses fit
  • high blood sugars
  • increase/decrease in sex drive
  • mood changes
  • local sensitivity or allergic reaction to transdermal patch

Other less common, rare and possibly severe side effects include:

Call your doctor immediately if you experience any of the following side effects:

  • pain in the legs or chest
  • swelling of the hands, legs or feet
  • sudden, severe headaches
  • severe dizziness
  • difficulty breathing
  • persistent abdominal pain
  • numbness of one side (rare)
  • changes in vision such as loss of vision, double vision (rare)
  • persistent vaginal bleeding or unusual bleeding
  • breast lumps

Rare cases of hepatitis (inflammation of the liver) and jaundice (yellowing of skin and eyes) have been reported - call your doctor if you experience unexplained nausea, vomiting, stomach pain, fatigue, loss of appetite, dark urine, yellowing of the skin and/or eyes.

This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication, ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or change the safety or effectiveness of either drug. Tell your doctor specifically if you are taking any of these drugs as he/she may need to make changes or monitor you more closely:

  • warfarin - may decrease how well warfarin can work
  • levothyroxine - may decrease how well levothyroxine works
  • phenytoin, phenobarbital, St. John’s Wort - may reduce the beneficial effects of estrogen
  • cyclosporine - may increase amount of cyclosporine in the blood and increase chances for side effects
  • antifungals (such as itraconazole, ketoconazole) - may increase the amount of estrogen in your blood and increase your chances for side effects.
  • medicine for insomnia or anxiety (e.g. alprazolam, diazepam, lorazepam, temazepam) and depression (e.g. imipramine, amitriptyline) - may have increased amounts and increased side effects such as dizziness and drowsiness
  • corticosteroids (such as prednisone) – may have increased corticosteroid levels and increase chances for side effects

This is not a complete list of drug interactions. Ask your doctor or pharmacist to review your list of medications.

Other information:

Before you have any medical, dental treatments or surgery, tell your doctor, dentist or surgeon you are taking this medication.

Check with your doctor of pharmacist for specific instructions on how to administer the different dosage forms. Follow your doctor’s specific dosage schedule and directions for each dosage form.

Management of side effects: This drug may cause a patchy darkening of the skin on the face (melasma). Since sunlight may intensify this darkening, it is recommended that you use sunscreen and wear protective clothing to decrease the chances of this happening. These patches may disappear or fade after you stop taking the drug.

Smoking may decrease the effectiveness of this medication and can increase the chance of blood clots. Patients requiring estrogen therapy should quit smoking.

Many women who are using estrogens with a progestin (another female hormone) will start having monthly vaginal bleeding, similar to menstrual periods, again. This effect will continue for as long as the medicine is taken. However, monthly bleeding will not occur in women who have had the uterus removed by surgery (total hysterectomy).

Monitoring: Long-term use of estrogen has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women. This risk is lowered significantly when estrogen is used with a progestin. Talk to your doctor about the benefits and risks prior to taking this medication.

It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects. Regular breast self-examination, mammograms, pelvic examinations and blood pressure checks are recommended.

Children: Not generally recommended.

Seniors: Are more sensitive to side effects and lower doses are usually necessary, especially at the start of therapy.

Pregnant women: Do not take as it can cause birth defects. Talk to your doctor.

Women who are nursing: Not recommended. Talk to your doctor.

People who drive or operate machinery: No known problems, although should not do so until they know how this drug affects them personally.

Alcohol: If you drink always drink in moderation.

Overdose: A large overdose of this medicine could cause unusual symptoms. If you experience any unusual reactions, or if you seriously exceed the recommended dosage, call your doctor or 911.

Stopping the drug: Talk to your doctor before you stop taking this drug as the original symptoms may recur.

If you miss a dose: Take it as soon as you remember. However, do not take a double dose to make up for the missed dose. If you are unsure, check with your doctor or pharmacist.

Storage conditions: Closed container; cool, dry location away from excess moisture (not in the bathroom) and light; always out of reach of children. Check with your pharmacist for specific handling instructions for specific dosage forms.

Dietary precautions: None unless prescribed by your doctor.