Estrace 1mg Tablets
WARNING: Do not use this drug to prevent heart disease or dementia. A study of women taking an estrogen with a progestin showed a raised chance of heart attack, stroke, blood clot, breast cancer, and dementia. The chance of stroke, blood clot, and dementia was also raised when the estrogen was taken alone. Not all products and doses were studied. It is not known if the same effects may happen with this drug.The chance of endometrial cancer may be raised with the use of estrogen alone in patients with a uterus. Use of a progestin along with estrogen may lower the risk. Call your doctor right away if you have unexplained or long-lasting vaginal bleeding.Use this drug for the shortest time needed at the lowest useful dose. Your doctor will talk with you on a regular basis to see if you need to keep taking this drug. @ COMMON USES: It is used to prevent soft, brittle bones (osteoporosis) after menopause.It is used to prevent or lower the signs of the change of life (menopause).It is used to add estrogen to the body when the ovaries have been taken out or do not work the right way.Rarely, it is used to treat breast or prostate cancers.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Estrogen
Pharmacologic Class
Estrogen receptor agonist
Pregnancy Category
X
FDA Approved
Jun 1975
DEA Schedule
Not Controlled
Overview
What is this medicine?
Estrace is a medication that contains estradiol, which is a type of estrogen, a female hormone. It's used to help relieve symptoms of menopause like hot flashes and vaginal dryness, and to treat conditions where the body doesn't make enough estrogen, such as after surgical removal of ovaries. It works by replacing the estrogen your body is no longer producing.
How to Use This Medicine
Taking Your Medication
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Take your medication at the same time every day. Note that there may be days when you are not scheduled to take your medication.
You can take your medication with or without food. If it causes stomach upset, taking it with food may help.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are any drug take-back programs available in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Take your medication at the same time every day. Note that there may be days when you are not scheduled to take your medication.
You can take your medication with or without food. If it causes stomach upset, taking it with food may help.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are any drug take-back programs available in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Do not smoke while taking this medication, as smoking significantly increases the risk of blood clots, stroke, and heart attack.
- Maintain a healthy diet and engage in regular physical activity.
- Discuss any history of blood clots, heart disease, stroke, or cancer with your doctor before starting this medication.
- Report any unusual vaginal bleeding immediately to your doctor.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
For moderate to severe vasomotor symptoms of menopause: 1 mg orally once daily. For vulvar and vaginal atrophy: 0.5 mg to 2 mg orally once daily. For female hypoestrogenism due to hypogonadism, castration, or primary ovarian failure: 1 mg to 2 mg orally once daily, cyclically (e.g., 3 weeks on, 1 week off).
Dose Range:
0.5 - 2 mg
Condition-Specific Dosing:
vasomotorSymptoms:
1 mg orally once daily
vulvarVaginalAtrophy:
0.5 mg to 2 mg orally once daily
hypoestrogenism:
1 mg to 2 mg orally once daily, cyclically
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
For treatment of primary ovarian failure or hypogonadism, dosing is individualized, typically starting at lower doses and titrating up. Not for general pediatric use.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended
Moderate:
No specific adjustment recommended
Severe:
Use with caution; monitor for adverse effects due to potential accumulation of metabolites. No specific dose adjustment guidelines.
Dialysis:
Considered to be dialyzable, but clinical significance for dosing is not well-established. Use with caution.
Hepatic Impairment:
Mild:
Use with caution; monitor for adverse effects.
Moderate:
Use with caution; consider lower starting doses and careful monitoring due to extensive hepatic metabolism.
Severe:
Contraindicated in severe hepatic dysfunction or disease.
Pharmacology
Mechanism of Action
Estradiol is a naturally occurring estrogen. It binds to and activates nuclear estrogen receptors (ERΞ± and ERΞ²) in target tissues, forming a hormone-receptor complex that interacts with estrogen response elements (EREs) on DNA. This interaction modulates gene transcription, leading to the synthesis of specific proteins responsible for the physiological effects of estrogens, including the development and maintenance of the female reproductive system and secondary sex characteristics. In menopausal women, it replaces declining endogenous estrogen levels to alleviate symptoms.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 5% (due to significant first-pass metabolism)
Tmax:
Approximately 5-8 hours
FoodEffect:
Food may slightly decrease the rate but not the extent of absorption.
Distribution:
Vd:
Approximately 1.2 L/kg
ProteinBinding:
Approximately 98% (primarily to sex hormone-binding globulin (SHBG) and albumin)
CnssPenetration:
Limited, but active metabolites may cross the blood-brain barrier.
Elimination:
HalfLife:
Approximately 13-17 hours (for estradiol, but active metabolites have longer half-lives)
Clearance:
Not readily available for oral estradiol due to extensive first-pass metabolism.
ExcretionRoute:
Primarily renal (90%) as glucuronide and sulfate conjugates, with a small amount excreted in feces via biliary excretion.
Unchanged:
<1%
Pharmacodynamics
OnsetOfAction:
Symptomatic relief may begin within days to weeks.
PeakEffect:
Full therapeutic effect may take several weeks to months.
DurationOfAction:
Daily dosing maintains therapeutic levels.
Safety & Warnings
BLACK BOX WARNING
Estrogens and progestins should not be used for the prevention of cardiovascular disease or dementia. The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50-79 years of age) during 5.6 years of treatment with daily oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo. The WHI estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis in postmenopausal women (50-79 years of age) during 7.1 years of treatment with daily oral conjugated estrogens (0.625 mg) relative to placebo. The WHI Memory Study (WHIMS) reported an increased risk of probable dementia in postmenopausal women 65 years of age or older. Estrogens increase the risk of endometrial cancer in a woman with a uterus. Adequate diagnostic measures, including directed or random endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurrent abnormal vaginal bleeding.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems: dark urine, fatigue, decreased appetite, stomach pain or upset, light-colored stools, vomiting, or yellow skin and eyes
Signs of gallbladder problems: pain in the upper right belly area, right shoulder area, or between the shoulder blades, yellow skin and eyes, fever with chills, bloating, or severe stomach upset or vomiting
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe stomach upset or vomiting
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Weakness on one side of the body, difficulty speaking or thinking, balance problems, drooping on one side of the face, or blurred vision
Changes in vision or loss of vision, bulging eyes, or changes in how contact lenses feel
Breast lump, breast pain or tenderness, or nipple discharge
Vaginal itching or discharge
Abnormal vaginal bleeding
Depression or mood changes
Memory problems or loss
Fever
Difficulty urinating or changes in urine output
Pain while urinating
Swelling or fluid retention in the body (tell your doctor if you experience swelling, weight gain, or breathing difficulties)
Additional Serious Side Effects
Blood clots: chest pain or pressure, coughing up blood, shortness of breath, swelling, warmth, numbness, color changes, or pain in a leg or arm, or difficulty speaking or swallowing
High calcium levels (more common in people with cancer): weakness, confusion, fatigue, headache, stomach upset or vomiting, constipation, or bone pain
Common Side Effects
Most people do not experience severe side effects, but some may have mild or moderate side effects. If you experience any of the following, contact your doctor if they bother you or do not go away:
Dizziness or headache
Hair loss
Stomach upset or vomiting
Constipation
Stomach pain or cramps
Bloating
Enlarged or tender breasts
Vaginal bleeding or spotting
Painful periods
Common cold symptoms
Nose or throat irritation
Weight gain or loss
Joint pain
Leg cramps
* Changes in sex drive
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems: dark urine, fatigue, decreased appetite, stomach pain or upset, light-colored stools, vomiting, or yellow skin and eyes
Signs of gallbladder problems: pain in the upper right belly area, right shoulder area, or between the shoulder blades, yellow skin and eyes, fever with chills, bloating, or severe stomach upset or vomiting
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe stomach upset or vomiting
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Weakness on one side of the body, difficulty speaking or thinking, balance problems, drooping on one side of the face, or blurred vision
Changes in vision or loss of vision, bulging eyes, or changes in how contact lenses feel
Breast lump, breast pain or tenderness, or nipple discharge
Vaginal itching or discharge
Abnormal vaginal bleeding
Depression or mood changes
Memory problems or loss
Fever
Difficulty urinating or changes in urine output
Pain while urinating
Swelling or fluid retention in the body (tell your doctor if you experience swelling, weight gain, or breathing difficulties)
Additional Serious Side Effects
Blood clots: chest pain or pressure, coughing up blood, shortness of breath, swelling, warmth, numbness, color changes, or pain in a leg or arm, or difficulty speaking or swallowing
High calcium levels (more common in people with cancer): weakness, confusion, fatigue, headache, stomach upset or vomiting, constipation, or bone pain
Common Side Effects
Most people do not experience severe side effects, but some may have mild or moderate side effects. If you experience any of the following, contact your doctor if they bother you or do not go away:
Dizziness or headache
Hair loss
Stomach upset or vomiting
Constipation
Stomach pain or cramps
Bloating
Enlarged or tender breasts
Vaginal bleeding or spotting
Painful periods
Common cold symptoms
Nose or throat irritation
Weight gain or loss
Joint pain
Leg cramps
* Changes in sex drive
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Sudden chest pain or shortness of breath
- Sudden severe headache or migraine
- Sudden vision changes (e.g., partial or complete loss of vision)
- Numbness or weakness in an arm or leg, especially on one side of the body
- Slurred speech
- Severe pain, swelling, or redness in your leg (especially calf)
- Yellowing of your skin or eyes (jaundice)
- Lump in your breast
- Unusual vaginal bleeding or spotting after menopause
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
A history of certain health conditions, such as:
+ Bleeding disorders
+ Blood clots or an increased risk of blood clots
+ Breast cancer
+ Liver problems or liver tumors
+ Heart attack
+ Stroke
+ Tumors that are estrogen-dependent
Unexplained vaginal bleeding
Pregnancy or potential pregnancy. Note: This medication is contraindicated during pregnancy and should not be taken if you are pregnant.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Do not initiate, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
A history of certain health conditions, such as:
+ Bleeding disorders
+ Blood clots or an increased risk of blood clots
+ Breast cancer
+ Liver problems or liver tumors
+ Heart attack
+ Stroke
+ Tumors that are estrogen-dependent
Unexplained vaginal bleeding
Pregnancy or potential pregnancy. Note: This medication is contraindicated during pregnancy and should not be taken if you are pregnant.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Do not initiate, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may advise you to stop taking this drug before certain surgical procedures, and will provide guidance on when to resume taking it after the surgery or procedure.
If you will be immobile for extended periods, such as during long trips, bedrest after surgery, or illness, discuss this with your doctor, as prolonged immobility may increase your risk of developing blood clots.
If you have a known allergy to tartrazine (FD&C Yellow No. 5), consult your doctor, as some products contain this ingredient.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. This medication may cause high blood pressure, so regular blood pressure checks are necessary, as advised by your doctor.
Regular blood tests and bone density checks are also recommended, as directed by your doctor. Additionally, schedule regular breast exams and gynecology check-ups, and perform breast self-exams as instructed by your doctor.
The risk of certain side effects, such as heart attack, stroke, breast cancer, ovarian cancer, and others, may vary depending on factors like the duration of estrogen use, whether it is taken with or without a progestin, and other individual factors. Discuss the benefits and risks of using this medication with your doctor.
High triglyceride levels have been associated with this medication, so inform your doctor if you have a history of elevated triglyceride levels.
This medication may cause dark skin patches on the face, so it is essential to avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear.
This medication may interfere with certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this drug.
Smoking increases the risk of heart disease, so it is recommended that you do not smoke. Consult your doctor for guidance on quitting.
Limit your alcohol consumption, and if you regularly drink grapefruit juice or eat grapefruit, discuss this with your doctor.
To maximize the effectiveness of this medication, use it in conjunction with calcium and vitamin D supplements, and engage in weight-bearing exercises, such as walking or physical therapy, as directed by your doctor. Follow the diet and exercise plan recommended by your doctor.
In rare cases, this medication may affect growth in children and teenagers, so regular growth checks may be necessary. Consult your doctor if you have concerns.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
If you are breastfeeding, consult your doctor to discuss any potential risks to your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may advise you to stop taking this drug before certain surgical procedures, and will provide guidance on when to resume taking it after the surgery or procedure.
If you will be immobile for extended periods, such as during long trips, bedrest after surgery, or illness, discuss this with your doctor, as prolonged immobility may increase your risk of developing blood clots.
If you have a known allergy to tartrazine (FD&C Yellow No. 5), consult your doctor, as some products contain this ingredient.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. This medication may cause high blood pressure, so regular blood pressure checks are necessary, as advised by your doctor.
Regular blood tests and bone density checks are also recommended, as directed by your doctor. Additionally, schedule regular breast exams and gynecology check-ups, and perform breast self-exams as instructed by your doctor.
The risk of certain side effects, such as heart attack, stroke, breast cancer, ovarian cancer, and others, may vary depending on factors like the duration of estrogen use, whether it is taken with or without a progestin, and other individual factors. Discuss the benefits and risks of using this medication with your doctor.
High triglyceride levels have been associated with this medication, so inform your doctor if you have a history of elevated triglyceride levels.
This medication may cause dark skin patches on the face, so it is essential to avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear.
This medication may interfere with certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this drug.
Smoking increases the risk of heart disease, so it is recommended that you do not smoke. Consult your doctor for guidance on quitting.
Limit your alcohol consumption, and if you regularly drink grapefruit juice or eat grapefruit, discuss this with your doctor.
To maximize the effectiveness of this medication, use it in conjunction with calcium and vitamin D supplements, and engage in weight-bearing exercises, such as walking or physical therapy, as directed by your doctor. Follow the diet and exercise plan recommended by your doctor.
In rare cases, this medication may affect growth in children and teenagers, so regular growth checks may be necessary. Consult your doctor if you have concerns.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
If you are breastfeeding, consult your doctor to discuss any potential risks to your baby.
Overdose Information
Overdose Symptoms:
- Nausea
- Vomiting
- Breast tenderness
- Abdominal pain
- Drowsiness/fatigue
- Withdrawal bleeding (in females)
What to Do:
There is no specific antidote. Treatment is symptomatic and supportive. In case of suspected overdose, contact a poison control center (1-800-222-1222) or seek emergency medical attention immediately.
Drug Interactions
Contraindicated Interactions
- Aromatase inhibitors (e.g., anastrozole, letrozole) - concurrent use would counteract the effect of the aromatase inhibitor.
Major Interactions
- CYP3A4 inducers (e.g., carbamazepine, phenobarbital, phenytoin, rifampin, St. John's Wort) - may decrease estradiol levels, reducing efficacy.
- CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, ketoconazole, ritonavir, grapefruit juice) - may increase estradiol levels, increasing risk of adverse effects.
- Thyroid hormone replacement therapy (e.g., levothyroxine) - estrogens can increase thyroid-binding globulin, potentially increasing thyroid hormone requirements.
- Warfarin - estrogens may alter the effects of anticoagulants; monitor INR closely.
Moderate Interactions
- Corticosteroids (e.g., prednisone) - estrogens may decrease the clearance of corticosteroids, leading to increased effects.
- Cyclosporine - estrogens may inhibit cyclosporine metabolism, increasing its levels and toxicity.
- Lamotrigine - estrogens may decrease lamotrigine levels, potentially leading to loss of seizure control.
- Fluvoxamine - may increase estradiol levels.
Minor Interactions
- Not readily available for minor interactions with significant clinical impact.
Monitoring
Baseline Monitoring
Complete medical history and physical examination (including blood pressure, breast exam, pelvic exam with Pap smear)
Rationale: To identify contraindications, risk factors for cardiovascular disease, breast cancer, and endometrial cancer.
Timing: Prior to initiation of therapy.
Lipid profile (total cholesterol, HDL, LDL, triglycerides)
Rationale: Estrogens can affect lipid metabolism; baseline assessment is important.
Timing: Prior to initiation of therapy.
Liver function tests (ALT, AST, bilirubin)
Rationale: To assess hepatic function, as estradiol is extensively metabolized by the liver.
Timing: Prior to initiation of therapy.
Routine Monitoring
Annual physical examination (including blood pressure, breast exam, pelvic exam)
Frequency: Annually, or as clinically indicated.
Target: Normal for age and health status.
Action Threshold: Abnormal findings (e.g., new breast lump, abnormal bleeding) require immediate investigation.
Mammography
Frequency: As recommended by national guidelines (e.g., annually or biennially for women over 40-50).
Target: Normal findings.
Action Threshold: Suspicious findings require further diagnostic evaluation.
Blood pressure
Frequency: Regularly, at least annually.
Target: <130/80 mmHg (or as per individual goals).
Action Threshold: Sustained elevation requires evaluation and management.
Symptoms of venous thromboembolism (VTE) or stroke
Frequency: Ongoing patient education and self-monitoring.
Target: Absence of symptoms.
Action Threshold: New onset of leg pain/swelling, chest pain, shortness of breath, sudden severe headache, visual disturbances, or speech changes require immediate medical attention.
Symptom Monitoring
- Unusual vaginal bleeding or spotting
- Breast lumps or changes
- Calf pain, swelling, or tenderness (signs of DVT)
- Sudden severe headache
- Chest pain or shortness of breath
- Sudden vision changes
- Slurred speech or weakness/numbness on one side of the body
- Yellowing of skin or eyes (jaundice)
- Severe abdominal pain
Special Patient Groups
Pregnancy
Contraindicated during pregnancy. There is no indication for estrogen therapy during pregnancy, and there is evidence of potential harm to the fetus (e.g., genital abnormalities in female fetuses exposed to diethylstilbestrol (DES)).
Trimester-Specific Risks:
First Trimester:
Potential for adverse effects on fetal development, particularly genital abnormalities.
Second Trimester:
Potential for adverse effects on fetal development.
Third Trimester:
Potential for adverse effects on fetal development.
Lactation
Not recommended during lactation. Estrogens are excreted in breast milk and may reduce the quantity and quality of breast milk. Potential adverse effects on the breastfed infant are not fully established but include possible effects on infant development.
Infant Risk:
L4 (Possibly Hazardous) - Estrogens can decrease milk production and may be excreted in milk. Consider risk vs. benefit; generally avoid if possible.
Pediatric Use
Generally not indicated for pediatric use, except in specific cases of hypoestrogenism due to primary ovarian failure or hypogonadism, where dosing is carefully individualized by a specialist. Safety and efficacy in prepubertal children for other indications have not been established.
Geriatric Use
Use with caution in women 65 years of age or older. The WHIMS study showed an increased risk of probable dementia in women 65 years of age or older treated with conjugated estrogens plus medroxyprogesterone acetate or conjugated estrogens alone. Increased risk of stroke and VTE also observed. Use the lowest effective dose for the shortest duration consistent with treatment goals and risks.
Clinical Information
Clinical Pearls
- Always use the lowest effective dose for the shortest duration consistent with treatment goals and risks, especially for menopausal symptom management.
- For women with an intact uterus, estradiol must be prescribed with a progestin to reduce the risk of endometrial hyperplasia and cancer.
- Patients should be advised to report any unusual vaginal bleeding, breast lumps, or symptoms of blood clots (e.g., leg pain, chest pain, sudden shortness of breath) immediately.
- Regular follow-up appointments, including annual physical exams and mammograms, are crucial during estrogen therapy.
- Smoking is a major contraindication due to significantly increased cardiovascular risks.
- Oral estradiol undergoes significant first-pass metabolism; transdermal or vaginal formulations may be preferred in some cases to avoid this.
Alternative Therapies
- Other estrogen formulations (transdermal patch, gel, spray, vaginal ring, vaginal cream, vaginal tablet)
- Selective Estrogen Receptor Modulators (SERMs) (e.g., ospemifene for dyspareunia, bazedoxifene/conjugated estrogens for vasomotor symptoms and osteoporosis)
- Non-hormonal therapies for vasomotor symptoms (e.g., SSRIs/SNRIs like paroxetine, venlafaxine; gabapentin; clonidine)
- Non-hormonal therapies for vaginal atrophy (e.g., vaginal moisturizers, lubricants)
Cost & Coverage
Average Cost:
$50 - $150 per 30 tablets (1mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic estradiol); Tier 3 or higher (for brand Estrace)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.