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ESTROGENS AND PROGESTINS (OVARIAN HORMONE THERAPY) (Systemic)

Some commonly used brand names are:

In the U.S.—

Activella ³
femhrt ²
Ortho-Prefest ¹

Other commonly used names are:

Ethinylestradiol [Ethinyl estradiol]
Ethinyloestradiol [Ethinyl estradiol]
Norethindrone [Norethisterone]

Note:

For quick reference, the following estrogens and progestins are numbered to match the corresponding brand names.

This information applies to the following medicines:
1.	17 beta-estradiol and norgestimate (seh-ven-TEEN BAY-tuh es-tra-DYE-ole and nor-JES-ti-mate)
2.	Ethinyl estradiol and norethindrone (ETH-in-il es-tra-DYE-ole and nor-eth-IN-drone)
3.	Estradiol and norethindrone (es-tra-DYE-oleand nor-eth-IN-drone)

Description

Estrogens (ES-troe-jenz) and progestins (pro-GEST-ins) are female hormones. They are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years.

The ovaries begin to produce less estrogen after menopause (the change of life). This medicine is prescribed to make up for the lower amount of estrogen. Estrogens help relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness. Progestins help to regulate the effects of estrogens.

Estrogens are prescribed for several reasons:

to provide additional hormone when the body does not produce enough of its own, such as during menopause. They can also help to relieve a genital skin condition called vaginal or vulvar atrophy.
to help prevent weakening of bones (osteoporosis) in women past menopause.

Estrogens may also be used for other conditions as determined by your doctor.

There is no medical evidence to support the belief that the use of estrogens will keep the patient feeling young, keep the skin soft, or delay the appearance of wrinkles. Nor has it been proven that the use of estrogens during menopause will relieve emotional and nervous symptoms, unless these symptoms are caused by other menopausal symptoms, such as hot flashes or hot flushes.

Estrogens and progestins are available only with your doctor"s prescription, in the following dosage forms:

Oral
17 beta-estradiol and norgestimate
- Tablets (U.S.)
Ethinyl estradiol and norethindrone
- Tablets (U.S.)
Estradiol and norethindrone
- Tablets (U.S.)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For estrogens and progestins, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to estrogens or progestins. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes

Pregnancy—Estrogens and progestins are not recommended for use during pregnancy or right after giving birth. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause.

Breast-feeding—Estrogens and progestins pass into the breast milk and can change the content or lower the amount of breast milk. Use of this medicine is not recommended in nursing mothers.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of estrogens and progestins in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking estrogens and progestins, it is especially important that your health care professional know if you are taking any of the following:

Cyclosporine (e.g., Sandimmune)—Estrogens can prevent cyclosporine"s removal from the body; this can lead to kidney or liver problems caused by too much cyclosporine

Other medical problems—The presence of other medical problems may affect the use of estrogens and progestins. Make sure you tell your doctor if you have any other medical problems, especially:

Asthma or
Calcium, too much or too little in blood or
Diabetes mellitus (sugar diabetes)
Epilepsy (seizures) or
Heart problems or
Kidney problems or
Liver tumors, benign or
Lupus erythematosus, systemic or
Migraine headaches or
Porphyria—Estrogens may worsen these conditions.

Blood clotting problems (or history of during previous estrogen therapy)—Estrogens usually are not used until blood clotting problems stop; using estrogens is not a problem for most patients without a history of blood clotting problems due to estrogen use

Breast cancer or
Bone cancer or
Cancer of the uterus or
Fibroid tumors of the uterus—Estrogens may interfere with the treatment of breast or bone cancer or worsen cancer of the uterus when these conditions are present

Changes in genital or vaginal bleeding of unknown causes—Use of estrogens may delay diagnosis or worsen condition. The reason for the bleeding should be determined before estrogens are used

Endometriosis or
Gallbladder disease or gallstones (or history of) or
High cholesterol or triglycerides (or history of) or
Liver disease or
Pancreatitis (inflammation of pancreas)—Estrogens may worsen these conditions; while estrogens can improve blood cholesterol, they may worsen blood triglycerides for some people

Hypothyroid (too little thyroid hormone)—Dose of thyroid medicine may need to be increased.

Vision changes, sudden onset including
Bulging eyes or
Double vision or
Migraine headache or
Vision loss, partial or complete—Estrogens may cause these problems. Tell your doctor if you have had any of these problems, especially while taking estrogen or oral contraceptives (“birth control pills”).

Proper Use of This Medicine

Estrogens and progestins usually come with patient information or directions. Read them carefully before taking this medicine.

Take this medicine only as directed by your doctor. Do not take more of it and do not take or use it for a longer time than your doctor ordered . Try to take the medicine at the same time each day to reduce the possibility of side effects and to allow it to work better.

For patients taking estrogens and progestins by mouth:

Nausea may occur during the first few weeks after you start taking estrogens. This effect usually disappears with continued use. If the nausea is bothersome, it can usually be prevented or reduced by taking each dose with food or immediately after food.

Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

For 17 beta-estradiol and norgestimate
For oral dosage forms (tablets)
- For treating a genital skin condition (vaginal or vulvar atrophy), or vasomotor symptoms of menopause:
  - Adults—Oral, 1 mg estradiol for three days followed by 1 mg of estradiol combined with 0.09 mg of norgestimate for three days. The regimen is repeated continuously without interruption.
- To prevent loss of bone (osteoporosis):
  - Adults—Oral, 1 mg estradiol for three days followed by 1mg of estradiol combined with 0.09 mg of norgestimate for three days. The regimen is repeated continuously without interruption.

For ethinyl estradiol and norethindrone
For oral dosage forms (tablets)
- For treating vasomotor symptoms of menopause:
  - Adults—Oral, 2.5 mcg (0.025 mg) ethinyl estradiol and 0.5 mg norethindrone once daily.
- To prevent loss of bone (osteoporosis):
  - Adults—Oral, 2.5 mcg (0.025 mg) ethinyl estradiol and 0.5 mg norethindrone once daily.

For estradiol and norethindrone
For oral dosage forms (tablets)
- For treating vasomotor symptoms of menopause or treatment of vaginal or vulvar atrophy:
  - Adults—Oral, 1 mg estradiol and 0.5 mg norethindrone once daily.
- To prevent loss of bone (osteoporosis):
  - Adults—Oral, 1 mg estradiol and 0.5 mg norethindrone once daily.

Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not double doses.

Storage—To store this medicine:

Keep out of the reach of children.
Store away from heat and direct light.
Do not store in the bathroom medicine cabinet because the heat or moisture may cause the medicine to break down.
Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects . These visits will usually be every year, but some doctors require them more often.

It is not yet known whether the use of estrogens increases the risk of breast cancer in women . Therefore, it is very important that you regularly check your breasts for any unusual lumps or discharge. Report any problems to your doctor . You should also have a mammogram (x-ray pictures of the breasts) done if your doctor recommends it. Because breast cancer has occurred in men taking estrogens, regular breast self-exams and exams by your doctor for any unusual lumps or discharge should be done.

Tell the doctor in charge that you are taking this medicine before having any laboratory test because some results may be affected.

Side Effects of This Medicine

Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:

The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer, and no need to take an estrogen and progestin combination.
It is not yet known whether the use of estrogens increases the risk of breast cancer in women. Although some large studies show an increased risk, most studies and information gathered to date do not support this idea.

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

More common

Breast pain or tenderness; dizziness or light-headedness; headache; swelling of feet and lower legs; rapid weight gain; vaginal bleeding

Rare

Breast lumps; change in vaginal discharge; discharge from nipple; nausea and vomiting; pains in stomach, side, or abdomen; pain or feeling of pressure in pelvis; yellow eyes or skin; severe or sudden headache; sudden loss of coordination; pains in chest, groin, or leg, especially calf; sudden and unexplained shortness of breath; sudden slurred speech; sudden vision changes; weakness or numbness in arm or leg

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

More common

Back pain; dizziness; general feeling of tiredness; bloating or gas; flu-like symptoms; mental depression; muscle aches; nausea—taking tablet with food may decrease; vaginitis

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Developed: 04/10/2000
Revised: 03/25/2005

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