estropipate, Ogen (cont.)

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Blood clots are occasional, serious adverse reactions of estrogen therapy and are dose-related: the higher the dose, the more likely are clots. Cigarette smokers are at a higher risk for developing clots while taking estrogens, and patients requiring estrogen therapy are strongly encouraged to quit smoking.

Estrogens can promote a buildup of the uterine lining (endometrial hyperplasia) and increase the risk of endometrial carcinoma (cancer). At diagnosis, endometrial cancers in estrogen recipients are generally at an earlier stage and a lower grade making cure more likely. As a result, survival is better in women with endometrial cancer exposed to estrogens than in those not exposed to estrogens. The addition of a progestin to estrogen therapy offsets the risk of endometrial cancer by counteracting the stimulatory effects of estrogens on the endometrium.

Conflicting data exists on the association between estrogens and breast cancer, but there may be a small increase in risk. It is unclear if concomitant estrogen and progestin therapy, as with endometrial cancer, reduces the risk of estrogen-induced breast cancer.

Estrogens should not be used for the prevention of heart disease. 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; however, it did not reduce the risk of heart disease. In addition, there was an increased risk of dementia among women over age 65 treated with estrogens and medroxyprogesterone.

Reference: FDA Prescribing Information

Last Editorial Review: 10/12/2009

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