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Estrogen-like drugs are being used ever more widely to treat a number of conditions associated with menopause and later life in women.

In addition to menopausal symptoms such as hot flashes or vaginal dryness, Estrace may also be prescribed to prevent osteoporosis and reduce the risk of heart disease.

Estrogen can also be helpful in various conditions where a woman does not produce enough natural estrogen.

Certain cancers in men and women may benefit from estrogen therapy.

Estradiol is also the active ingredient in Climara, Estraderm, and Vivelle skin patches, which are prescribed primarily to menopausal women.

Estrace vaginal cream is used primarily to counteract vaginal symptoms following menopause; estradiol is absorbed from the vagina into the bloodstream.

Side Effects and Interactions

Estrace has several potential side effects, including breakthrough menstrual bleeding, breast tenderness, bloating, nausea, vomiting, stomach pain, headache, gallbladder problems, liver tumors, depression, jaundice and high blood pressure.

Some women experience an increase in blood sugar and may go on to develop diabetes.

The skin may become more sensitive to sun, so it is wise to use sunscreen and wear protective clothing (including a hat and sunglasses) if you will be outside.

Other adverse reactions include changes in weight, fluid retention, alteration in sex drive, and change in the curvature of the cornea. This may make contact lenses inappropriate. Report any symptoms or suspected side effects to the physician promptly.

Your doctor should be notified immediately of any of the following symptoms: pain in the calf or groin, sudden shortness of breath or sharp chest pain, sudden severe headache, blurred vision or speech, weakness or numbness in an arm or leg, yellow skin or eyes or severe abdominal pain.

Let your doctor know if you suspect you may have become pregnant, if you feel seriously depressed, if you notice lumps in your breast, or if vaginal bleeding is abnormal.

Estrace may interfere with tests of prothrombin time and certain thyroid tests.

Estradiol may interact with prescription drugs such as theophylline and beta blocker blood pressure pills.

The activity of the anticoagulant Coumadin and that of certain antidepressants may be altered.

Alcohol can raise circulating levels of estradiol significantly. The equivalent of half a glass of wine doubled estradiol blood levels, while three glasses’ worth more than tripled the effective dose of Estrace. Skin patches are also affected, though less dramatically. Blood levels of estradiol rose 40 percent after alcohol consumption.

Estradiol levels also get a boost from grapefruit. Regular consumption of grapefruit or juice has a cumulative effect that increases estradiol exposure.

Until the estrogenic activity of hops is further studied, taking this herb in combination with medicines such as oral contraceptives or hormone replacement therapy is an experiment best avoided.

In general, the herb chaste tree berry should not be combined with menopausal hormone replacement therapies.

Saw palmetto berries, which have both estrogenic and antiestrogenic activity, are not recommended.

Check with your doctor and pharmacist before taking any other medicine or herbs while taking Estrace.

Special Precautions

Pregnant women should not take Estrace, as it could have a negative effect on the fetus.

Women with a history of breast cancer or other malignant disease responsive to estrogen are generally advised to avoid this hormone.

Blood clotting disorders such as thrombophlebitis are also a reason to be wary of Estrace.

Prolonged use of postmenopausal estrogen has been controversial because of questions about cancer. Endometrial carcinoma or cancer of the uterine lining is more of a risk for women exposed to estrogen. This adverse reaction may be counteracted by simultaneous administration of progestins.

Vaginal bleeding could be an early warning sign of cancer and requires immediate medical attention.

Long-term use of postmenopausal estrogen protects against heart disease, but it increases the risk of breast cancer by approximately 40 percent, according to data from the Nurses’ Health Study.

Women with a strong family history of breast cancer will want to discuss this issue with their doctor and may want to delay use of Estrace until later in life when heart disease becomes a more urgent threat.

Taking the Medicine

The best dose and timing of Estrace tablets differ depending on the purpose for which they are prescribed.

Postmenopausal women experiencing hot flashes or other symptoms generally take one pill daily for three weeks, and no Estrace for the following week.

Doctors often prescribe a progestin compound in addition for women who have not had a hysterectomy.

Make sure you understand the schedule of when to take Estrace and when to take the progestin.

Transdermal patches are applied to clean, dry, intact skin on the trunk of the body, but not to the breast.

The usual treatment regimen calls for a patch to be applied at the beginning of the week and left in place until another is applied to a different site halfway through the week.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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