estropipate (cont.)
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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