esterified estrogens, Estratab (discontinued); Menest (cont.)

Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Blood clots: Blood clots are occasional but serious side effects of estrogen therapy and are dose-related, that is, they occur more frequently with higher doses. Cigarette smokers are at a higher risk than non-smokers. Therefore, patients requiring estrogen therapy are strongly encouraged to quit smoking.

Uterine cancer: Estrogens can promote a build-up of the lining of the uterus or endometrium (endometrial hyperplasia) and increase the risk of endometrial cancer. At diagnosis, endometrial cancers in estrogen users are generally of an earlier stage and a lesser degree of malignancy than in non-users. Survival, therefore, is better. The addition of a progestin to estrogen therapy prevents endometrial cancer from developing.

Breast cancer: Conflicting data exists on the association between estrogen therapy and breast cancer. There may be a small increase in risk. It is not clear if the addition of a progestin during estrogen therapy reduces the risk of breast cancer (as it does for uterine cancer). The Women's Health Initiative found that postmenopausal women (50-79 years old) taking conjugated estrogens, 0.625 mg daily, in combination with medroxyprogesterone, 2.5 mg daily, for five years, had an increased risk of heart attacks, stroke, breast cancer, and blood clots, while postmenopausal women taking conjugated estrogens without progesterone experienced only increased strokes but not increased blood clots, heart disease, or breast cancer.

There was an increased risk of impaired cognition and/or dementia among women over age 65 treated with either estrogens or estrogens and medroxyprogesterone.

Reference: FDA Prescribing Information

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