- What are conjugated estrogens?
- What are examples of conjugated estrogens available in the US?
- What are the side effects of conjugated estrogens?
- What drugs interact with conjugated estrogens?
- What formulations of conjugated estrogens are available?
- What about taking conjugated estrogens during pregnancy or while breastfeeding?
What are conjugated estrogens?
Conjugated estrogens are mixtures of man-made or natural estrogens used as an external source and replacement for the natural female hormone. Estrogens have widespread effects on many tissues in the body. Estrogens cause growth and development of the female sexual organs and maintain female sexual characteristics such as the growth of underarm and pubic hair, body contours, and skeleton. Estrogens also increase secretions from the cervix and growth of the inner lining of the uterus (endometrium).
Menopausal women produce less estrogen which leads to symptoms of hot flashes, vaginal dryness, shrinking in vaginal tissue and painful intercourse. Using conjugated estrogens can help treat such symptoms in menopausal women. Conjugated estrogens can also help in prevention of bone loss in menopausal women.
What are examples of conjugated estrogens available in the US?
Examples of oral conjugated estrogens are:
Premarin vaginal cream is a topical form of estrogen.
Enjuvia and Cenestin are synthetic conjugated estrogens produced from plant material.
Premarin is derived from natural sources and blended to approximate the composition of estrogens found in urine of pregnant horses.
What are the side effects of conjugated estrogens?
There are many side effects of conjugated estrogens. Common side effects of conjugated estrogens are nausea, headache, pain, swelling of breasts, weight change, abdominal pain, anxiety, edema, vaginal bleeding, and mood disturbances.
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 (deep vein thrombosis or DVT) or lungs (pulmonary embolism) 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 to 79 years old) taking conjugated estrogens, 0.625 mg daily, in combination with medroxyprogesterone (Provera, Depo-Provera, Depo-Sub Q Provera 104), 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.
What drugs interact with conjugated estrogens?
Medications like St. John's Wort, phenobarbital, carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), and rifampin (Rifadin) can accelerate the breakdown of conjugated estrogens, leading to low levels of absorbed drug and reduced effectiveness. Grapefruit juice and medications like erythromycin, clarithromycin (Biaxin, Biaxin XL), ketoconazole (Nizoral, Extina, Xolegel, Kuric), and ritonavir can slow down the breakdown of conjugated estrogens in the liver, leading to increased levels of estrogens and increased estrogen side effects.
What formulations of conjugated estrogens are available?
Conjugated estrogens are available as oral tablets and topical cream.
What about taking conjugated estrogens during pregnancy or while breastfeeding?
Conjugated estrogens are not recommended during pregnancy because it may cause birth defects in the unborn. Use of conjugated estrogens is not recommended in nursing mothers because conjugated estrogens enter breast milk and may have harmful effects on the newborn. Conjugated estrogens can also affect the quality and quantity of breast milk.
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Conjugated Estrogens (Cenestin, Enjuvia, Estrace, and Others) is a class of drug that comprises mixtures of man-made natural estrogens to be prescribed as a source of replacement for the natural female hormone. Side effects, drug interactions, dosage, storage, and risks should be reviewed prior to taking conjugated estrogens.
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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.
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Natural Remedies for Hot Flashes
Hot flashes are experienced by many women, especially at night. However, not all women undergoing menopause experience hot flashes. What causes 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 natural remedies for hot flashes (for example phytoestrogens - isoflavones, black cohosh, and vitamin E) have been scientifically studied.
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.
Premature Menopause (Symptoms, Causes, and Treatments)
Premature menopause is when menopause occurs in a woman before the age of 40. Causes of premature menopause include premature ovarian failure, treatments for cancer and other conditions, surgical removal of the ovaries, or chronic diseases of the pituitary or thyroid gland, or psychiatric disorders. Treatment is directed at menopausal symptoms.
Sex and Menopause (What to Expect)
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.
Perimenopause is the time in a woman's life when she is approaching menopause. During this time a woman starts to develop symptoms of declining estrogen levels that may include mood swings, painful sex, night sweats, hot flashes, and weight gain. Every adult woman eventually will experience perimenopause.
Night Sweats (In Men and Women) Causes, Remedies, and Treatments
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Hot Flashes (Causes, Symptoms & Medication Treatment in Men and Women)
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Vaginal Pain (Vulvodynia)
Vulvodynia or vaginal pain, genital pain is a condition in which women have chronic vulvar pain with no known cause. There are two types of vulvodynia, generalized vulvodynia and vulvar vestibulitis. Researchers are trying to find the causes of vulvodynia, for example, nerve irritation, genetic factors, hypersensitivity to yeast infections, muscle spasms, and hormonal changes.The most common symptoms of vaginal pain (vulvodynia) is burning, rawness, itching, stinging, aching, soreness, and throbbing. There are a variety of treatments that can ease the symptoms of vulvodynia (vaginal pain).
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Treatment & Diagnosis
Medications & Supplements
- estrogens conjugated (Premarin)
- conjugated equine estrogens and medroxyprogesterone acetate, Prempro, Premphase
- esterified estrogens (Menest)
- esterified estrogens and methyltestosterone, Estratest, Estratest HS
- estrogens conjugated synthetic (Cenestin)
- conjugated estrogens vaginal cream (Premarin Vaginal Cream)
- methyltestosterone w/ estrogen - oral, Estratest
- estrogens cream - vaginal
Prevention & Wellness
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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
REFERENCE: FDA Prescribing Information.