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 CLASS AND MECHANISM: Estropipate is a crystalline form of estrone, a
form of estrogen. Estrogens occur in nature in several forms. In women with
active menstrual cycles, the ovaries produce between 70 and 500 micrograms of
one estrogen, estradiol, daily. The estradiol is converted to estrone and to a
lesser extent estriol. After menopause, estrone is the most active circulating
estrogen but is then produced by the adrenal glands. Estrogens cause growth and
development of female sex organs and maintain sexual characteristics, including
underarm and pubic hair and the shape of body contours and the strength of
bones. They increase secretions from the cervix and growth of the inner lining
of the uterus (endometrium). They also reduce LDL-cholesterol ("bad"
cholesterol) and increase HDL-cholesterol ("good" cholesterol) concentrations in
the blood. Estrogens, when taken alone or in combination with a progestin, have
been shown to reduce the risk for hip fractures due to osteoporosis by 25%. The
FDA approved estropipate in June 1977.
STORAGE: Tablets should be stored below 25 C (77 F).
PRESCRIBED FOR: Estropipate is prescribed for treatment of symptoms
associated with menopause (hot flashes, vaginal dryness), prevention of bone
fractures associated with osteoporosis, low estrogen levels, and dysfunctional
(excessive and painful) uterine bleeding.
DOSING: The recommended dose is 0.75-9 mg orally daily. Administration
usually is cycled; 21 days on and 7-10 days off.
DRUG INTERACTIONS: Estrogens can inhibit the metabolism of cyclosporine,
resulting in increased cyclosporine levels in blood. Such increased blood levels
can result in kidney and/or liver damage. If this combination cannot be avoided,
cyclosporine concentrations can be monitored, and the dose of cyclosporine can
be adjusted to assure that its blood levels are not elevated.
Estrogens appear to increase the risk of liver disease in patients receiving
dantrolene through an unknown mechanism. Women over 35 years of age and those
with a history of liver disease are especially at risk. Estrogens increase the
liver's ability to manufacture clotting factors. Because of this, patients
receiving warfarin (Coumadin) need to be monitored for loss of the anticoagulant
(blood thinning) effect of warfarin if estrogens like estropipate are added.
Rifampin (Rifadin), barbiturates, carbamazepine (Tegretol), griseofulvin, phenytoin
(Dilantin) and primidone (Mysoline), all can increase the elimination of estrogens by
enhancing the liver's ability to metabolize (break down) the estrogens. Thus,
concurrent use of these drugs and estrogens may result in reduction of the
beneficial effects of estrogens.
PREGNANCY: Estrogens should be avoided during
pregnancy due to an increased
risk of fetal abnormalities.
NURSING MOTHERS: Estrogens are secreted in
breast milk and cause unpredictable
effects in the infant. They generally are not recommended for nursing mothers.
SIDE EFFECTS: Common side effects include break-through vaginal bleeding or
spotting, loss of periods or excessively prolonged periods, breast pain, breast
enlargement, and changes in sexuality (increased or decreased libido).
Abdominal
pain may result from obstruction of the gallbladder due to gallstones caused by
the estrogen. Migraine headaches have been associated with estrogen therapy.
Estrogens can cause sodium and fluid retention leading to swelling in the legs
(edema). Melasma - tan or brown patches
- may develop on the forehead, cheeks, or
temples. These may persist even after the estrogen is stopped. Estrogens may
cause an increase in the curvature of the cornea, and patients with contact
lenses may develop intolerance to their lenses.
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.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
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.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Hot flashes (or flushing) is the most common symptom experienced by a woman prior to and during the early stages of menopause. Hot flashes can be caused by other conditions. Diagnosis is made by taking a patient history and at times, blood tests. Treatment options include hormone therapy, bioidentical hormone therapy, and medications. There are non-FDA approved natural remedies.
Hot flashes are experienced by many women, however, not all women undergoing menopause experience hot flashes. A hot flash is a feeling of warmth that spreads over the body. Treatment for hot flashes include hormone replacement therapy and alternative prescription medications such as SSRIs (Effexor, Paxil, Prozac), clonidine (Catapres), megestrol (Megace), and gabapentin (Neurontin). Few alternative treatments for hot flashes (for example phytoestrogens - isoflavones, black cohosh, and vitamin E have been scientifically studied.
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.
Menopause is often associated with a change in sexual functioning. Loss of estrogen, bladder control issues, anxiety, stress, health concerns, medications, and sleep disturbances often result in a decrease in libido. Though there are currently no good drugs for treating sexual problems in women, there are ways to increase intimacy with a partner and treat vaginal dryness.
Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
Normal vaginal bleeding is the periodic blood that flows
as a discharge from
the woman's uterus. Normal vaginal bleeding is also called menorrhea. The
process by which menorrhea occurs is called
menstruation.
Normal vaginal bleeding occurs as a result of cyclic
hormonal changes. The ovaries are the main source of female hormones, which
control the development of
female body characteristics such as the
breasts, body shape, and body hair. The
hormones also regulate the menstrual cycle. The ovary, or female gonad, is one of
a pair of reproductive glands in women. They are located in the pelvis, one on
each side of the uterus. Each ovary is about the size and shape of an almond.
The ovaries produce eggs (ova) and female hormones. During each monthly
menstrual cycle, an egg is released from one ovary. The egg travels from the
ovary through a Fallopian tube to the
uterus.
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