BMA Concise Guide to Medicine & Drugs

Estradiol

Brand names Aerodiol, Climaval, Elleste, Estraderm, FemSeven, Oestrogel, Progynova, Zumenon, and others

Used in the following combined preparations Angeliq, Climagest, Climesse, Femapak, Trisequens, and others

QUICK REFERENCE

Drug group Female sex hormone

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Estradiol is a naturally occurring oestrogen (female sex hormone). It is used mainly as hormone replacement therapy (HRT) for menopausal and post menopausal symptoms. Estradiol is often given with a progestogen, either as separate drugs or as a combined product. In certain cases, treatment is for a specific number of days each month. Taken alone, estradiol is associated with an increased risk of cancer of the uterus. For this reason, it is usually combined with a progestogen to reduce the risk; it is usually used alone in women who have had a hysterectomy. HRT is usually only advised for short-term use around the menopause.

Estradiol is available in a variety of forms, including implants and skin gel and patches. Skin patches of the drug may cause local rash and itching.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, implants, pessaries, vaginal rings, skin gel, patches.

Frequency and timing of doses Once daily (tablets, gel); every 1–7 days (skin patches); every 4–8 months (implants); every 1–7 days (pessaries); every 3 months (vaginal ring).

Adult dosage range 1–2mg daily (tablets); 2–4 measures daily (skin gel); 25–100mcg daily (skin patches); 25–100mg per dose (implants); 25mcg per dose (pessaries); 7.5mcg daily (vaginal ring).

Onset of effect 10–20 days.

Duration of action Up to 24 hours; some effects may be longer lasting.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next daily treatment is due within 4 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

The most common adverse effects of estradiol are similar to symptoms of early pregnancy and generally diminish with time. They include nausea, vomiting, breast swelling or tenderness, and weight gain. Headaches and depression may also occur. Discuss with your doctor if you experience breast symptoms or depression, or if any of the other symptoms are severe. Sudden, sharp pain in the chest, groin, or legs may indicate a blood clot; if you experience such pain, stop taking the drug and seek urgent medical help.

INTERACTIONS

Tobacco smoking This increases the risk of serious adverse effects on the heart and circulation with estradiol.

Anticonvulsants The effects of estradiol are reduced by topiramate, carbamazepine, phenytoin, and phenobarbital; estradiol reduces the effects of lamotrigine.

Anticoagulant drugs The effects of these drugs are reduced by estradiol.

St John’s wort may reduce the effects of estradiol.

Rifampicin This drug may reduce the effects of estradiol.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a long-term liver problem or gallstones.

· You have heart or circulation problems.

· You have porphyria.

· You have had blood clots or a stroke.

· You have diabetes.

· You are a smoker.

· You suffer from migraine or epilepsy.

· You are taking other medicines.

Pregnancy Not prescribed.

Breast-feeding Not prescribed. The drug passes into breast milk and may inhibit its flow. Discuss with your doctor.

Infants and children Not usually prescribed.

Over 60 No special problems.

Driving and hazardous work No problems expected.

Alcohol No known problems.

Surgery and general anaesthetics You may need to stop taking estradiol several weeks before having major surgery. Discuss this with your doctor.

PROLONGED USE

As part of HRT, estradiol is usually only advised for short-term use around the menopause and is not normally recommended for long-term use or for treatment of osteoporosis. Long-term use increases the risk of breast cancer, venous thrombosis, heart attack, and stroke.

Monitoring Blood pressure checks and physical examinations, including regular mammograms, may be performed.