Conjugated estrogens and medroxyprogesterone is used in the treatment of typical menopausal symptoms, such as hot flashes of the moderate to severe variety and dryness in and around the vagina. Conjugated estrogens and medroxyprogesterone is also used to prevent the development of osteoporosis, or bone thinning, after menopause.
Menopause is a natural process in which women in their late 40s or early 50s see their menstrual cycles end. However, it can produce uncomfortable and distracting symptoms that prompt patients to seek a remedy. The medication is believed to work by decreasing receptors of nuclear estrogen, while suppressing epithelial DNA synthesis within the endometrial tissue. This helps curtail some of the effects of menopause.
Conjugated estrogens and medroxyprogesterone is usually effective in the treatment of menopausal and postmenopausal symptoms, providing relief to women afflicted by these issues. However, the drug also carries the potential for serious side effects, such as the increased risk of conditions such as breast cancer and dementia. Patients should inform their caregiver of any allergies or other conditions they suffer from before beginning treatment with conjugated estrogens and medroxyprogesterone.
Conjugated estrogens and medroxyprogesterone comes with the risk of certain side effects. If an allergic reaction occurs, a patient should seek medical help immediately, or call the poison control center at (1-800-222-1222). Additionally, medical attention should also be sought if any of the following reactions occur:
There are also less severe side effects that typically do not warrant immediate medical attention. As the patient's body adjusts to the medication, these effects may subside. Additionally, their caregiver may be able to instruct them on how to avoid the side effects or at least reduce them. Some of the less concerning reactions to conjugated estrogens and medroxyprogesterone include:
If any side effects other than the ones listed occur, the patient should notify their caregiver.
Conjugated estrogens and medroxyprogesterone is taken orally. Caregivers should prescribe the lowest effective dose and the duration of treatment should be as short as possible. The dosage depends on the drug's particular use for that patient.
For patients taking conjugated estrogens and medroxyprogesterone for the treatment of moderate to severe vasomotor symptoms, one 0.625 mg tablet of conjugated estrogens is taken for the first 14 days of treatment. The patient will then take a tablet composed of 0.625 mg conjugated estrogens and 5 mg of medroxyprogesterone acetate for days 15-27 of treatment.
For patients being treated for moderate to severe vaginal or vulvar atrophy, one 0.625mg tablet of conjugated estrogens is taken on days 1-14. For days 15-28, a tablet of 0.625 conjugated estrogens and 5 mg medroxyprogesterone is taken. Caregivers may also recommend the use of a topical vaginal medication in cases where vulvar or vaginal atrophy is the only condition being treated.
In cases when conjugated estrogens are being used to prevent osteoporosis, the patient takes the 0.625mg conjugated estrogens tablet once daily for days 1-14, while the 0.625mg conjugated estrogens and 5 mg medroxyprogesterone tablet is taken on days 15-28. Conjugated estrogens and medroxyprogesterone should be used for the sole purpose of preventing osteoporosis only if the patient is at significantly high risk for osteoporosis. Experts often recommend consideration of a non-estrogen medication in the prevention of osteoporosis.
Conjugated estrogens and medroxyprogesterone are metabolized by cytochrome P4503A4 (CYP384) and, as a result, drugs that induce or inhibit this cytochrome may have some effect on the metabolization of this medication. Drugs that induce the cytochrome, like carbamazepine, hypericum perforatum (better known as St. John's wart) and rifampin, can possibly reduce estrogen's plasma concentrations, risking a decrease in the effectiveness of conjugated estrogens and medroxyprogesterone and side effects. Conversely, medications that inhibit the cytochrome, such as clarithromycin, erythromycin, grapefruit juice, itraconazole, ketoconazole and ritonavir, increase estrogen plasma concentrations. This situation may also cause side effects.
Conjugated estrogens and medroxyprogesterone should never be taken with medications intended to reduce estrogen, for example cancer drugs like anti-aromotase agents. Birth control must be discontinued before beginning conjugated estrogens and medroxyprogesterone treatment. Some anticonvulsants (seizure medications) and antibiotics may cause noticeable effects when taken in conjunction with conjugate estrogens and medroxyprogesterone. A detailed list of major and moderate interactions is provided below.
Additionally, conjugated estrogens and medroxyprogesterone may have additional interactions with medications other than the ones listed above. If this occurs, the patient should notify their caregiver.
The use of conjugated estrogens and medroxyprogesterone has been linked to an increased risk of pulmonary embolism, deep vein thrombosis, stroke and heart attack. If any of these conditions occur, conjugated estrogens and medroxyprogesterone should be immediately discontinued.
Women in the 50-79 age range who took conjugated estrogens and medroxyprogesterone daily were found in a study to be at a significantly increased risk of stroke. If a stroke occurs, or the patient is showing signs of a stroke, conjugated estrogens and medroxyprogesterone should be discontinued immediately.
A study found of women receiving conjugated estrogens and medroxyprogesterone treatment found their increased risk of coronary heart disease was not statistically significant, but a significantly increased risk of venous thromboembolism (VTE) was reported in women taking a daily dose of the medication. Any occurrence of VTE related conditions should prompt immediate and permanent discontinuation of conjugated estrogens and medroxyprogesterone.
Conjugated estrogens and medroxyprogesterone has been found by a study to increase the risk of invasive breast cancer. The risk was shown to increase with the duration of treatment. Patients are advised to regularly perform breast self-examination, and schedule breast exams with their caregivers. Depending on the patient's age and risk factors, mammograms should also be scheduled.
Some cases of endometrial hyperplasia (a possible endometrial cancer warning sign) have occurred in patients taking conjugated estrogens and medroxyprogesterone. This condition often precedes endometrial cancer, the risk of which is increased with conjugated estrogens and medroxyprogesterone treatment. However, usage of estrogen treatments for less than one year does not carry an increased risk of endometrial cancer. The most significant risk occurs when estrogen therapies are used for 5-10 years or longer. It is important to monitor women for signs of endometrial cancer while they are being treated with conjugated estrogens and medroxyprogesterone. In cases of women with recurring or persistent abnormal genital bleeding while being treated with the drug, adequate diagnostic measures should be undertaken.
A slightly increased risk of ovarian cancer is associated with conjugated estrogens and medroxyprogesterone treatment.
Probable dementia is another risk of conjugated estrogens and medroxyprogesterone, as a study of women aged 65-79 being treated with the drug found that several of them were diagnosed with dementia four years after beginning treatment. It is unknown what the risk is among younger women.
Conjugated estrogens and medroxyprogesterone has been associated with an increase in gallbladder disease requiring surgery.
In women with breast cancer that has metastasized to the bones, an increased risk of severe hypercalcemia is present. In cases of hypercalcemia, conjugated estrogens and medroxyprogesterone treatment should be stopped immediately and the serum's calcium level should be reduced.
Conjugated estrogens and medroxyprogesterone has been associated with a possible risk of elevated blood pressure.
The drug is associated with an increased risk of pancreatitis in women with pre-existing hypertriglyceridemia, due to possible elevations of plasma triglycerides. If hypertriglyceridemia occurs, discontinuation of conjugated estrogens and medroxyprogesterone should be considered.
Care should be taken when women who have a history of cholestatic jaundice associated with pregnancy or past estrogen therapy are treated with conjugated estrogens and medroxyprogesterone. Women with impaired liver function may have trouble metabolizing conjugated estrogens and medroxyprogesterone. If conditions such as cholestatic jaundice recur, the medication should be discontinued.
Women who are dependant on thyroid replacement therapy will require an increased dose of this medication while being treated with cojugated estrogens and medroxyprogesterone. This is because estrogen increases thyroid-binding globulin levels. These women should receive close monitoring of their thyroid hormone during treatment, to ensure that function is within an acceptable range. Women whose thyroid function is normal can compensate by making more thyroid hormone.
Fluid retention is a possibility with conjugated estrogens and medroxyprogesterone treatment. If the patient has conditions such as renal and cardiac dysfunction, they should be carefully monitored during treatment.
Estrogen-induced hypocalcemia is a risk when conjugated estrogens and medroxyprogesterone is administered to women with hypoparathyroidism. These patients should be monitored carefully.
Anaphylaxis, requiring emergency medical treatment, has occurred in patients being treated with conjugated estrogens and medroxyprogesterone. Cases involved skin-related conditions (hives, swelling of lips, tongue, and face), the respiratory tract (trouble breathing) and gastrointestinal tract (nausea/vomiting/pain in abdomen).
Cases of angioedema, requiring medical attention and involving the face, feet, hands, larynx and tongue, have occurred with conjugated estrogens and medroxyprogesterone treatment. If the angioedema involves the tongue, glottis or larynx, obstruction of the airway is possible. Patients who develop an anaphylatic reaction, even without angioedema, should cease taking conjugated estrogens and medroxyprogesterone immediately.
Hereditary angioedema may be exacerbated by conjugated estrogens/medroxyproesterone.
Conjugated estrogens and medroxyprogesterone should be used with caution in women with the following conditions:
Women with any of the following conditions should not take conjugated estrogens and medroxyprogesterone:
Conjugated estrogens and medroxyprogesterone should not be used by pregnant women, women who are nursing (due to a decrease in milk quantity and quality) or children. Results of the drug, when used in geriatric populations, do not significantly differ from those found among younger patients.
An overdose of conjugated estrogens can cause the following symptoms:
Conjugated estrogens and medroxyprogesterone tablets should be stored in a closed container, at room temperature (68-77 degrees Fahrenheit). The medication should be kept out of the reach of children.
Conjugated estrogens and medroxyprogesterone can be an effective treatment for bothersome symptoms of menopause. Women taking the medication report positive results, and are often able to cede estrogen/progesterone therapy upon the conclusion of menopause. The drug can also be an effective tool in the prevention of osteoporosis, though some experts think it its best to avoid estrogen therapies in the treatment of this condition.
Use of conjugated estrogens and medroxyprogesterone does come with the risk of dangerous side effects, and can even cause major health conditions, such as stroke, breast cancer, and dementia. Therefore, the drug should be avoided by patients who have already had or been suspected to have certain conditions or are at high risk of allergic reactions. Hormone replacement therapies should always be handled with care.