Estrace

Typically, estrogen is taken for the first 21 to 25 days of each month. Women who have not had a hysterectomy (i.e., they still have a uterus) should take a progestin (e.g., medroxyprogesterone) for the last 12 to 14 days of each estrogen cycle.

Women who have had a hysterectomy may take estrogen daily, without a break.

For treatment of menopausal symptoms, the usual dose is 1 mg daily for 21 to 25 days of each month. Attempts to discontinue the medication should be made every 3 to 6 months. If symptoms return, the medication should be continued.

For prevention of osteoporosis, the usual dose is 0.5 mg daily as soon as possible after the onset of menopause. The dose may be increased or decreased according to the level of Estrace (Estradiol) in the blood.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Estrace (Estradiol) at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may decrease your appetite; it may cause bloating; it may cause headaches; it may cause nausea or, rarely, vomiting; it could cause water retention and swelling; it may increase breast size. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

0.5 mg
Each white, round, flat-faced, bevel-edged compressed tablet, with MJ logo and "021" on one side and scored on the reverse, contains estradiol-17ß (micronized) 0.5 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, lactose, magnesium stearate, silicon dioxide, and talc.

1 mg
Each lavender, round, flat-faced, bevel-edged compressed tablet, with MJ logo and "755" on one side and scored on the reverse, contains estradiol-17ß (micronized) 1 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, D&C Red No. 27 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, lactose, magnesium stearate, silicon dioxide, and talc.

2 mg
Each turquoise, round, flat-faced, bevel-edged compressed tablet, with MJ logo and "756" on one side and scored on the reverse, contains estradiol-17ß (micronized) 2 mg. Nonmedicinal ingredients: acacia, dibasic calcium phosphate, cornstarch, FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 5 Aluminum Lake (tartrazine), lactose, magnesium stearate, silicon dioxide, and talc.

Do not take estradiol-17ß (micronized) if you:

• are allergic to any ingredients of the medication
• are breast-feeding
• are or may be pregnant
• have a known or suspected estrogen-dependent tumour
• have endometrial hyperplasia (thickening of the lining of the uterus)
• have had a blockage in an artery feeding the heart caused by a blood clot (coronary thrombosis)
• have had a Stroke
• have had diseases of circulation or clotting
• have migraine Headaches
• have had partial or complete loss of vision or double-vision from eye disease related to circulation problems
• have liver impairment or disease, especially of the obstructive type
• have or have had Breast Cancer or endometrial cancer, except in special circumstances
• have undiagnosed vaginal bleeding

There may be an interaction between Estrace (Estradiol) and any of the following:

• Abiraterone acetate
• Amiodarone
• Anastrozole
• Aripiprazole
• ascorbic acid (vitamin C)
• Atorvastatin
• "azole" antifungals (e.g., ketoconazole, itraconazole, vorionazole)
• barbiturates (e.g., Phenobarbital)
• Bosentan
• blood pressure-lowering medications (e.g., Propranolol, Enalapril, Diltiazem)
• Carbamazepine
• Carvedilol
• Celecoxib
• Cobicistat
• corticosteroids (e.g., Hydrocortisone, Prednisolone, Prednisone)
• Crizotinib
• Cyclosporine
• Cyproterone
• Dabrafenib
• Deferasirox
• dehydroepiandosterone
• Dexamethasone
• diabetes medications (e.g., chlorpropamide, glipizide, Glyburide, insulin, Metformin, Nateglinide, Rosiglitazone, Saxagliptin)
• Dipyridamole
• Doxorubicin
• Dronedarone
• efavirenz
• etravirine
• grapefruit juice
• HIV protease inhibitors (e.g., lopinavir, ritonavir, saquinavir)
• Lenalidomide
• Mefloquine
• Mitotane
• Modafinil
• nefazodone
• Nilotinib
• Phenytoin
• primidone
• progesterone
• propranolol
• quinidine
• quinine
• rifabutin
• rifampin
• Ropinirole
• St. John's wort
• Somatropin
• Sunitinib
• Tacrolimus
• Tamoxifen
• telaprevir
• Temazepam
• tenofovir
• Teriflunomide
• thalidomide
• theophyllines (e.g., Aminophylline, Oxtriphylline, Theophylline)
• thyroid medications (e.g., Levothyroxine, Liothyronine)
• Tizanidine
• Tocilizumab
• Trazodone
• Ursodiol
• Verapamil
• Vinblastine
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Estrace (Estradiol).

Important information about estrogen:

The Women's Health Initiative (WHI) study results indicated an increased risk of heart attack, stroke, breast cancer, Blood Clots in the lungs, and blood clots in the leg veins in postmenopausal women during 5 years of treatment with 0.625 mg conjugated equine estrogens and 2.5 mg medroxyprogesterone compared to women receiving sugar tablets.

• Estrace (Estradiol) should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible.
• You should not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes.

Blood clotting disorders: Estrogens should not be used if you have active Thrombophlebitis or a thromboembolic disorder (diseases of blood clotting and abnormal circulation). They should also not be used (except in the treatment of cancer) if you have a history of a clotting disorder that is likely to be caused by estrogen use. Finally, they should be used with caution if you have any cerebral vascular disease or Coronary Artery Disease, and then, only used if clearly needed.

Some studies have suggested that there is an increased relative risk for healthy women to develop deep vein thrombosis or pulmonary Embolism when they use hormone replacement therapy. Women with severe Varicose Veins or severe Obesity, and those needing to stay in bed for 3 weeks or more, are generally considered to be at increased risk of venous thromboembolism (blood clots in the bloodstream).

Blood pressure: There have been reports of increased blood pressure in women taking Estrace (Estradiol). Your doctor should monitor your blood pressure if you are using estrogen, especially if high doses are used. Regular checkups by your doctor are recommended. If you have high blood pressure, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Breast cancer: Studies indicate an increased risk of breast cancer with long-term use of estrogen replacement therapy. If you have have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed. Women who take estrogens should have regular breast examinations and should be instructed in breast self-examination.

Cholesterol: Oral estrogens can increase triglycerides in the blood. If you have high blood cholesterol levels, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

Dementia: Women over age 65 receiving estrogen, with or without a progestin may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65 years of age, your doctor should closely monitor you for loss of memory and intellectual function.

Diabetes: Estrogens can cause changes in blood glucose control for people who have diabetes or have risk factors for developing diabetes. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

People who have diabetes (or a predisposition to diabetes) should monitor their blood glucose levels closely to detect changes in blood glucose.

Endometrial cancer: There is evidence from several studies that estrogen replacement therapy increases the risk of cancer of the endometrium (uterus). Taking a progestin appropriately along with the estrogen reduces this risk to the same level as that of a woman who does not take estrogen. For this reason, all women who have not had their uterus removed should also take progestin if they use estrogens.

Fibroids: Estrace (Estradiol) may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Fluid retention: Estrogen may cause sodium (salt) and fluid retention. This can be dangerous for women with heart or kidney dysfunction, Epilepsy, or Asthma. If you have any of these conditions, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

If you notice the symptoms of any of these conditions getting worse, contact your doctor.

Gallbladder disease: An increased risk of gallbladder disease has been reported in postmenopausal women who take estrogens. If you have a history of gallbladder disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

If you experience symptoms of gallbladder disease, such as abdominal pain, possibly with Fever and chills, contact your doctor as soon as possible.

Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestins) for postmenopausal women. If you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs) while taking Estrace (Estradiol), get immediate medical attention.

Liver function: If you have or have had liver problems, you may require special monitoring by your doctor while you use Estrace (Estradiol). Make sure to tell your doctor if you have ever had liver problems.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Migraine: People who are at risk of experiencing migraine may have an increased risk of stroke when taking conjugated estrogens. If you have migraine with aura, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

Ovarian Cancer: Recent studies have linked long term use of estrogen with an increased risk of ovarian cancer. This increased risk appears to occur whether estrogen is used with a progestin or alone. Discuss the risks and benefits of prolonged use of hormone replacement therapy with your doctor.

Seizures: Hormone replacement therapy may increase the frequency of seizures for people with a history of seizure disorder. If you have a history of seizures, discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estrace (Estradiol), and whether any special monitoring is needed.

Thyroid conditions: Estrogens can increase the amount of thyroid hormone your body needs to work properly. If you are hypothyroid (have reduced amount of thyroid hormone in your body) and need estrogens, you may require an increased amount of thyroid hormone for your body to continue to work properly. Discuss with your doctor how Estrace (Estradiol) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Estrogen should not be used during pregnancy. If you become pregnant while taking Estrace (Estradiol), contact your doctor.

Breast-feeding: Estrogen is not safe for use during breast-feeding. A decision should be made whether to discontinue breast-feeding or to discontinue the medication, taking into account the importance of the medication to the mother.

Children: The safety and effectiveness of Estrace (Estradiol) have not been established for children.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Take it regularly and continuously to maintain its beneficial effects. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may irritate the stomach, and should be taken with food.