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Estrace (estradiol) is a form of estrogen. Estrogen is a female sex hormone necessary for many processes in the body. Estradiol is used to treat symptoms of menopause such as hot flashes, and vaginal dryness, burning, and irritation. It is also used to prevent osteoporosis in women and men. Estradiol is sometimes used as part of cancer treatment in women and men.

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Uses

1. Treatment of moderate to severe vasomotor symptoms associated with the menopause. There is no adequate evidence that estrogens are effective for nervous symptoms or depression which might occur during menopause and they should not be used to treat these conditions.
2. Treatment of vulval and vaginal atrophy.
3. Treatment of hypoestrogenism due to hypogonadism, castration or primary ovarian failure.
4. Treatment of breast cancer (for palliation only) in appropriately selected women and men with metastatic disease.
5. Treatment of advanced androgen-dependent carcinoma of the prostate (for palliation only).
6. Prevention of osteoporosis.

How to take

Estradiol tablets are generally prescribed once daily. In some patients, a so-called cyclic regimen is used, wherein estradiol is given daily for 23 consecutive days, followed by 5 days of no medication, after which the cycle resumes

Side effects

Among the most common endocrine side effects are break-through bleeding or spotting, loss of periods or excessively prolonged periods, breast pain, breast enlargement and changes in sexuality (increase or decrease in libido). Abdominal pain may indicate the development of gallstones or occasionally hepatitis. Migraine headaches have been associated with estrogen therapy. Estrogens can cause sodium and fluid retention. Melasma, tan or brown patches, may develop on the forehead, cheeks, or temples. These may persist even after the estrogen is stopped. Conjugated estrogens may cause an increase in the curvature of the cornea. Patients with contact lenses may develop intolerance to their lenses.
Blood clots are an occasional but serious adverse effect and are dose-related. (The higher the dose, the more likely the clots.) Cigarette smokers are at a higher risk for clots, and, therefore, patients requiring estrogen therapy are strongly encouraged to quit smoking.
Estrogens can promote a buildup of the uterine lining (endometrial hyperplasia) and increase the risk of endometrial carcinoma. At diagnosis, endometrial cancers in estrogen recipients are generally of an earlier stage and a lower grade. Survival is also is better in women exposed to estrogens than in those not exposed to estrogens. The addition of a progestin to estrogen therapy prevents endometrial carcinoma.
Conflicting data exists on the association between estrogens and breast cancer. There may be a small increase in risk. The effect of concomitant progestin therapy on the risk of estrogen-induced breast carcinoma is unclear.

Precaution

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: undiagnosed abnormal vaginal bleeding, cancer (e.g., breast cancer - also see USES section), blood clots, active/recent stroke or heart attack, liver disease. Before using this medication, tell your doctor or pharmacist your medical history, especially of: family medical history (especially breast lumps and cancer), asthma, diabetes, seizures, migraine headaches, heart disease (high blood pressure, heart attacks, congestive heart failure), kidney disease, low thyroid hormone (hypothyroidism), abnormal calcium level in the blood, depression, high blood pressure during pregnancy (toxemia), yellowing of skin and eyes (cholestatic jaundice) during pregnancy or with past estrogen use, womb problems (e.g., uterine fibroids endometriosis), cholesterol or lipid problems, gallbladder disease, excessive weight gain, certain blood disorder (porphyria), any allergies - especially to tartrazine (a yellow dye) or aspirin. If you will be having surgery or will be confined to a chair or bed for a long period of time (e.g., a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking this drug. This drug may make you dizzy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. This drug may cause a patchy darkening of the skin on the face (melasma). Sunlight may intensify this darkening and you may need to avoid prolonged sun exposure and sunlamps. Consult your doctor regarding use of sunscreens and protective clothing. Cigarette smoking can increase the chance of blood clots while taking this medication (especially in women over the age of 35). If this medicine is used in children, their growth pattern should be monitored as this drug might stunt their growth. This medication must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. This medication may pass into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding while using this medication is not recommended.

Drug interactions

Estrogens can inhibit the metabolism of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels are not elevated.
Estrogens appear to increase the risk of liver disease in patients receiving dantrolene through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk.
Estrogens increase the liver's ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is added when warfarin is already being taken.
Rifampin, barbiturates, carbamazepine (Tegretol), griseofulvin, phenytoin (Dilantin) and primidone, can all increase the elimination of estrogen by enhancing the liver's ability to metabolize it. Concurrent use may result in reduction of the beneficial effects of estrogens.

Missed dose

If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Storage

Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight. Do not store in the bathroom. Keep away from children and pets.