How should this medicine be used?
Estrogen comes as a tablet to take by mouth, patches to apply externally to the skin, and as a cream to be inserted into the vagina.
Oral estrogen is usually taken by mouth with food or milk either every day or on a cyclical basis: once a day for 21 days and then none for 7 days; then the cycle is repeated. However, for treating cancer it usually is taken three times a day every day for at least 3 months.
Skin patches are usually applied either once or twice weekly for three weeks (on the same days each week), followed by 1 week without the drug (patch); then the cycle is repeated. The package is designed to help you remember when to apply fresh skin patches.
To apply a skin patch, follow the directions provided and these steps:
* Remove the skin patch from its protective pouch and peel off the protective strip, exposing the adhesive surface.
* Place the adhesive side against a clean, dry, and not excessively hairy area of skin on the trunk of your body, preferably your abdomen (not your waistline or breasts, since tight clothing may rub the patch). Do not apply the patch to oily, broken, or irritated skin.
* Press the patch on the selected site firmly with the palm of your hand for about 10 seconds, making sure that the edges adhere to your skin. If the patch accidentally comes off, you can either reapply it or apply a fresh patch, but follow your regular dosing schedule.
Remove and discard the patch and apply a fresh patch according to the schedule prescribed by your doctor. To prevent skin irritation, use a different site for each application and wait at least 1 week before using a particular area again. Used patches should be cut up and disposed in a way that keeps them out of reach of children and pets.
To use the vaginal cream, your doctor will set up a dosage schedule for you. If you are to use it once a day, it is best to use it at bedtime. Follow the directions that come with the vaginal cream and these steps:
* Fill the special applicator that comes with the cream to the level indicated.
* Lie on your back with your knees drawn upward and spread apart.
* Gently insert the applicator into the vagina; then push the plunger to release the medication.
* Withdraw the applicator.
* Discard the applicator if it is disposable. If the applicator is reusable, pull it apart and clean it with soap and warm water after each use.
* Wash your hands promptly.
Ask your pharmacist or doctor any questions you have about using the vaginal cream. You may wish to wear a sanitary napkin after inserting the cream to keep your clothes clean.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take estrogen exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking estrogen without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking estrogen,
* tell your doctor and pharmacist if you are allergic to estrogen, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other medications.
* tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antibiotics or anti-infectives, anticoagulants ('blood thinners') such as warfarin (Coumadin), carbamazepine (Tegretol), phenobarbital, phenylbutazone, phenytoin (Dilantin), primidone (Mysoline), rifampin, steroids (Decadron, Medrol, Prednisone), and vitamins.
* tell your doctor if you have or have ever had asthma; epilepsy (seizures); migraine headaches; history of depression; liver, heart, gallbladder, or kidney disease; jaundice (yellowing of the skin or eyes); genital bleeding; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
* tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking estrogen, call your doctor immediately.
* if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking estrogen.
* tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this drug.
* tell your doctor and pharmacist if you wear contact lenses.
What special dietary instructions should I follow?
Follow all dietary and exercise recommendations, including those regarding calcium supplements, if you are taking estrogen to treat osteoporosis.
What should I do if I forget a dose?
If you forget to apply a skin patch, apply it as soon as you remember; note the date on the package, and adjust your schedule. If you miss a dose of tablets or vaginal cream, take it (or apply it) as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Estrogen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
* upset stomach
* stomach cramps
* bloating
* diarrhea
* appetite and weight changes
* glucose intolerance (increased blood sugar)
* brown or black skin patches
* acne
* swelling of the hands, feet, or lower legs (fluid retention)
* increased blood pressure
* bleeding or spotting between menstrual periods
* changes in menstrual flow
* painful or missed periods
* breast tenderness, enlargement, or secretion
* intolerance to contact lenses
Some side effects may be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:
* severe stomach pain
* yellowing of the skin or eyes
* severe mental depression
* unusual bleeding
* loss of appetite
Estrogen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
