Estrogen and Progestin Combination (Ovarian hormone therapy)

Overview

When taken as an oral medication, estrogens and progestin is primarily prescribed to alleviate the symptoms of menopause. It is very effective for this purpose because estrogen and progestin are naturally occurring female hormones that are necessary for the development of the female body and regulation of menstrual cycles throughout a woman's life. However, as women get older and the body produces less estrogen from the ovaries this medication can help to maintain the hormonal balance that prevents menopause debilitating symptoms. Women in the throes of menopause can feel weaker or faint and experience symptoms such as hot flashes, profuse sweating, and dizziness. The estrogen in this medication alleviates these symptoms while the progestins regulate the infusion of the estrogens.

There are many reasons why a doctor might prescribe a woman estrogen therapy. While it may be to compensate for the body not producing enough of the hormone on its own it can also be a method of treating vaginal or vulvar atrophy. As post-menopausal women can experience osteoporosis this therapy can be prescribed as a preventative measure to prevent the weakening of bones. However, it is important to note that estrogen is not proven to maintain youthful appearance or to have any impact on the health of the skin. They are also not effective in the treatment of emotional or nervous disorders that are not directly connected to menopause. This medication is normally taken as either tablets or chewable tablets that are only available with a doctor's prescription.

Conditions Treated

  • Menopause
  • Osteoproris

Type Of Medicine

  • Female Hormone

Side Effects

As estrogens are a naturally occurring hormone in the body it is very rare to have severe side effects as a result of taking this medication. However, these side effects are not completely unheard of. Before beginning hormone therapy, the possibility of side effect should be discussed. The most important consideration should be the link between prolonged use of estrogen therapy and an increase in instances of endometrial cancer. This cancer in the lining of the uterus can be potentially life-threatening and the risk appears to increase the longer that this therapy is used. Low doses used for less than a year is considered a safe time frame, but the dose of progestin in this medication is intended to reduce the risk as well. Naturally, this risk factor does not apply to women who have had a total hysterectomy and this medication is unlikely to be necessary in that case. It is unknown whether or not the use of estrogens increases the risk of breast cancer as some studies support this assertion while others show conflicting data.

While side effects are rare, some of them can be quite serious. Immediate medical care should be sought if any of the following side effects occur while taking this medication:

  • Breast pain or tenderness
  • Dizziness or light-headedness
  • Headache
  • Rapid weight gain
  • Swelling of feet and lower legs
  • Vaginal bleeding
  • Breast lumps
  • Change in vaginal discharge
  • Discharge from nipple
  • Nausea and vomiting
  • Pains in chest, groin, or leg, especially calf
  • Pains in stomach, side, or abdomen
  • Pain or feeling of pressure in pelvis
  • Severe or sudden headache
  • Sudden and unexplained shortness of breath
  • Sudden loss of coordination
  • Sudden slurred speech
  • Sudden vision changes
  • Weakness or numbness in arm or leg
  • Yellow eyes or skin

Not all side effect symptoms experiences while taking estrogen and progestin are as serious, however. Some side effects are considered routine and temporary in nature as they subside as the body adjusts to the hormones. There also may be certain methods of alleviating these symptoms until they disappear so the patient should check with their healthcare provider regarding remedies. If these symptoms continue longer than expected or are more intense then the doctor should be informed because this may be an indication of a more serious medical condition.

Routine or temporary side-effects include:

  • Back pain
  • Bloating or gas
  • Dizziness
  • General feeling of tiredness
  • Flu-like symptoms
  • Mental depression
  • Muscle aches
  • Nausea'taking tablet with food may decrease
  • Vaginitis
  • Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Dosage

Patients who are taking estrogens and progestins should carefully read care instructions that come with the prescription prior to taking the medication. This is a medication that should only be used exactly as directed and taking more than prescribed or for a longer period of time than indicated could have profound consequences. Taking this medication at the same time each day will help the medication work better for the purpose it was prescribed for and reduce the chance that side effects will be experienced. Patients taking oral tablets of estrogens and progestins may experience nausea during the first few weeks of the dosage. This temporary effect can be reduced if the medication is taken during a mealtime and taking it with food will not affect the potency of the medication.

The manufacturer of this medication has indicated average doses that are safest for patients. However, the dosage will vary based on personal health, age, and a number of other factors such as the exact condition for which the medication is prescribed. If prescribed a different dose than indicated by these guidelines the prescription should be followed as it has taken these factors into consideration. Do not alter dosage without a doctor's advice.

Dosage of this medication may depend upon the specific brand. When taking estradiol and norgestimate for menopause, vaginal or vulvar atrophy or any other genital skin condition 1mg estradiol tablets should be taken once daily for three days followed by 0.09mg tablets of norgestimate for three days. This cycle should be continued without interruption to ensure the effectiveness of the treatment. When prescribed for prevention of osteoporosis, the same guidelines apply and the cycle needs to be maintained in order to effectively prevent bone loss.

Patients taking ethinyl estradiol and norethindrone tablets for vasomotor symptoms of menopause will take 2.5mcg tablets of ethinyl estradiol and a 0.5mg norethindrone tablets together once per day. When treating vaginal or vulvar atrophy 1mg of estradiol and 0.5mg of norethindrone will be taken once per day. This dosage also applies to patients taking this medication for the prevention of osteoporosis.

It is very important to maintain the dosing schedule when using this medication as missed doses can significantly affect the treatment plan. However, if a dose is missed it should be taken as soon as possible. Do not take a double dose to make up for a missed dose and if a dose needs to be taken later in the day than usual then take the next dose at roughly the same time of day the following day.

Interactions

Although estrogen and progestin are naturally occurring hormones in the body, they still may interact with other medicines and products that you are exposed to. Certain medications may not be able to be used at all while a patient is using this treatment, but others may be used together even if there is a risk of potential drug interactions. If you have any questions about what medications can be taken while using estrogen and progestin combination therapy ask your physician and make sure that they are aware of all prescription and nonprescription medication that is being taken.

The following medications have a notable interaction with estrogen and progestin and using them together is not recommended.

  • Boceprevir
  • Dasabuvir
  • Ombitasvir
  • Paritaprevir
  • Ritonavir
  • Tranexamic Acid

The following medications are usually not recommended but in certain circumstances may be deemed medically necessary. If these medications are prescribed at the same time as estrogen and progestin combination treatment then the patient should proceed with caution and the doctor may take steps such as staggering medication times or altering dosages to avoid the consequences of drug interactions.

  • Anagrelide
  • Boceprevir
  • Bupropion
  • Carbamazepine
  • Ceritinib
  • Clozapine
  • Conivaptan
  • Dabrafenib
  • Darunavir
  • Dasabuvir
  • Donepezil
  • Eliglustat
  • Idelalisib
  • Isotretinoin
  • Lesinurad
  • Lixisenatide
  • Lumacaftor
  • Paclitaxel
  • Paclitaxel Protein-Bound
  • Piperaquine
  • Pirfenidone
  • Pitolisant
  • Pixantrone
  • Sugammadex
  • Theophylline
  • Tizanidine
  • Ulipristal
  • In addition to drug interactions, there is a possibility that consuming certain foods, drink, alcohol, and use of tobacco products could have an effect of the effectiveness of this treatment or make side effects more likely to occur. These possibilities should be discussed with the prescribing physician before beginning an estrogen and progestin regimen.

Other medical problems that a patient may be experiencing may also affect the use of estrogen and progestin combination as an effective treatment for menopause or osteoporosis prevention. Your doctor should be fully informed of your medical history so that they know if you have these conditions or have experienced them in the past. In some cases, these conditions will reduce the effectiveness of hormone therapy or the medication will make the conditions worse.

Conditions with a chance of detrimental interactions with estrogen and progestin combination include:

  • Asthma
  • High or low calcium levels
  • Diabetes mellitus
  • Epilepsy
  • Seizures
  • Heart problems
  • Kidney problems
  • Liver tumors
  • Lupus erythematosus
  • Migraine headaches
  • Porphyria
  • Blood clotting problems
  • Breast cancer
  • Bone cancer
  • Cancer of the uterus
  • Fibroid tumors of the uterus
  • Changes in genital or vaginal bleeding of unknown causes
  • Endometriosis
  • Gallbladder disease or gallstones
  • High cholesterol or triglycerides
  • Liver disease
  • Pancreatitis
  • Hypothyroid
  • Vision changes
  • Bulging eyes
  • Double vision
  • Migraine headache
  • Vision loss

If any of these problems have been previously experienced while taking oral contraceptives then a doctor should be informed as this may affect the decision to prescribe estrogen and progestin.

Warnings

When on a regimen of estrogen and progestin it is crucial that the patient attend regular examinations to monitor the progress of the treatment and to ensure that there are no side effects as a result of the hormone therapy. While these examinations will usually be scheduled annually there may be reasons to perform them more frequently. As using these medications for more than a year may carry certain risk factors, prescriptions may not be renewed if these examinations are not attended.

When using this medication it is very important that precautions be taken including regular breast self-exams and other monitoring in the early detection of breast cancer. While there is no consensus regarding whether or nor estrogen hormone therapy causes breast cancer some studies have indicated that there is a correlation. Breasts should be examined for unusual lumps or discharge from the nipple. If recommended by a doctor a mammogram may be a necessary precaution. If anything unusual is found during a self-examination schedule an examination by a doctor for a full range of testing.

If a patient has experienced blood clotting problems in the past it may be unsafe to use estrogens. If blood clotting problems are currently being experienced it may be necessary to delay hormone treatments until the problems are no longer occurring. Patients with an inflammation of the pancreas may have the condition significantly worsened by using this medication. In some cases, doses of estrogen will alter blood chemistry and patients will experience an improvement in cholesterol but a significantly worse volume of triglycerides in the blood. If a patient is currently being treated for cancer of the breasts or bones this medication can make those conditions worse or make it more likely that the patient will develop cancer of the uterus. If there is a history of unknown vaginal bleeding not associated with menstruation then the use of estrogen may make this condition worse. The reason for this unexplained bleeding should be determined before hormone therapy is used.

This medication may affect the results of laboratory tests and a doctor should be informed that you are taking estrogen and progestin before any such tests are performed.

Storage

This medication should be stored in a closed and secure container and kept out of the reach of children. As with most medications in capsule form, it should be kept away from sources of heat that might melt it or sources of cold temperatures that may cause it to freeze. Ideally, it should be stored at room temperature and away from direct sunlight or sources of bright electric light. Do not keep expired medication on hand or maintain the prescription longer than indicated by your doctor. Promptly dispose of this medication in accordance with guidelines concerning disposal of medical waste in your area.

Summary

The effects of menopause can be miserable for older women and produce many debilitating symptoms that can only be treated by restoring the balance of hormones as they were during child-bearing years. Estrogen and progestin combination therapy is very effective for this purpose as it is virtually a natural way of restoring hormone balance and combating menopause. For women struggling with this condition, hormone therapy can have a significant effect on their health, wellness, and emotional state. However, as with all medical treatments, it is not without certain risks that should be taken into consideration before prescribing this regimen. Patients should be fully appraised of all of these risks before attempting hormone therapy, including the potential for developing cancer as a result of use or misuse of this medication.

Despite potential risks posed by the use of estrogen and progestin therapy, there are certain conditions where the potential gains in health far outstrip the risks. For example, there is a very low risk of side effects from this medication in relation to other medications that may be used for the prevention of osteoporosis in older women, making it a generally safer alternative therapy. The effectiveness of this medication in preventing osteoporosis may have the potential to be life-saving for some patients. Falls resulting in broken hips are one of the most life-threatening problems older women face and any preventative steps that can be taken should be taken. However, it is important that patients understand that hormone therapy is best for short periods of time and is not a method for combating all of the conditions that the body experiences as it ages including changes to appearance, vigor, or emotional states. So long as this medication is used properly and for the time frame that it is safe to use it can be very beneficial to most patients.