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.
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.
DRUG INTERACTIONS: Estrogens increase the liver's ability to
manufacture factors that promote the clotting of blood. Because of this,
patients receiving warfarin (Coumadin), a drug that thins the blood and prevents
clotting by reducing clotting factors, need to be monitored for loss of the
blood thinning effect if treatment with an estrogen is begun.
Rifampin (Rifadin),
barbiturates, carbamazepine (Tegretol), griseofulvin (Grifulvin), phenytoin (Dilantin),
St. John's wort, and primidone all increase the elimination of estrogen by
enhancing the liver's ability to eliminate estrogens. Use of any of these
medications with estrogens may result in a reduction of the beneficial effects
of estrogens.
Conversely, drugs such as erythromycin, ketoconazole (Nizoral),
itraconazole (Sporanox), and ritonavir (Norvir) may reduce the elimination of
estrogens by the liver and lead to increased levels of estrogens in the blood.
Grapefruit juice also may increase levels of estrogen by increasing the
absorption of estrogens from the intestine. Increased levels of estrogens in the
blood may result in more estrogen-related side effects.
PREGNANCY: Estrogens should not be given to
pregnant women due to the
risk of harm to the fetus.
NURSING MOTHERS: Estrogens are secreted in breast milk and may cause
unpredictable effects in the infant. Estrogens may also reduce the quality of
breast milk. They should not be taken by women who are
breastfeeding.
SIDE EFFECTS: Common side effects of conjugated estrogens include
headache, abdominal pain, nervousness, nausea,
back pain, joint pain and vaginal
bleeding. Patients also may experience vaginal spotting, loss of periods or
excessively prolonged periods, breast pain, breast enlargement and an increase
or decrease in sexual drive.
Effects of estrogen on the skin include rash, and
melasma (tan or brown patches) that may develop on the forehead, cheeks, or
temples and may persist even after estrogens are stopped.
In the eyes,
conjugated estrogens may cause an increase in the curvature of the cornea, and,
as a result, patients with contact lenses may develop intolerance to their
lenses.
Estrogens may increase calcium levels in the blood (hypercalcemia) in
patients with breast and bone cancer.
There is an increased risk of cholesterol gallstones among men and women taking estrogens.
Estrogens also may
inhibit the flow of bile from the liver (cholestasis) and uncommonly cause
jaundice.
Estrogens can cause salt (sodium) and water retention (edema).
Therefore, patients with heart failure or reduced function of their kidneys who
are taking estrogens should be carefully observed for retention of water and its
complications.
Blood clots in the legs or lungs occasionally occur in women
taking conjugated estrogens. This potentially serious complication of estrogen
therapy is dose-related, that is, it occurs more commonly with higher doses.
Therefore, the lowest effective doses that relieve symptoms should be used.
Cigarette smokers are at a higher risk for blood clots. Therefore, patients
requiring estrogen therapy should
quit smoking.
Estrogens can promote a build up
of the lining of the uterus (endometrial hyperplasia) and increase the risk of
endometrial cancer. (Women who have undergone surgical removal of the
uterus--hysterectomy--are not susceptible to endometrial hyperplasia.) The
addition of a progestin to estrogen therapy prevents the development of
endometrial 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.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.
Premature menopause is when a woman goes through menopause before the age of 40 because of genetics, illness, or a medical procedure. Symptoms of premature menopause include irregular or missed periods, mood swings, hot flashes, periods that are heavier or lighter than usual, vaginal dryness, bladder irritability, incontinence, dry skin, eyes or mouth, sleeplessness, and decreased sex drive. Though premature menopause cannot be reversed, the symptoms can be managed with methods similar to those used for natural menopause.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Pseudotumor Cerebri (intracranial hypertension) is a condition where there is an increase in pressure of fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) mimicing a brain tumor. The cause is unknown. The most common symptom is headache but also include eye-pain, vision loss and double vision. Pseudotumor cerebri is diagnosed with MRI or CAT scans and treated by discontinuing offending medications (if applicable), weight loss and diuretic medications. The condition can also be helped by repeated drainage of spinal fluid using the lumbar puncture.
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