Oestrogens for HRT

Indications & Dose:

Hormone replacement therapy. Oestrogens in oral contraception, post-menopausal symptoms, senile vaginitis, kraurosis vulvae, dysmenorrhoea, acne, hirsutism, dysfunctional uterine bleeding, osteoporosis, suppression of postpartum lactation. 

Contraindications:

Thromboembolic disorders, severe impairment of liver function, undiagnosed vaginal bleeding, jaundice, hypertension. Endometrial hyperplasia, suspected oestrogen dependent tumours, hyperlipoprotinaemia, Rotor syndrome, Dubin Johnson syndrome, porphyria, sickle cell anaemia. Pregnancy & breast-feeding.

Side Effects:

Nausea, anorexia with large dose, vomiting which resembles morning sickness, mild diarrhoea, thromboembolism, weight gain, breast tenderness, withdrawal bleeding, sodium retention and oedema, jaundice, headache, skin rash. Endometrial carcinoma in postmenopausal women.

WITHDRAWAL BLEEDING. Cyclical HRT (where a progestogen is taken for 10-14 days of each 28days oestrogen treatment cycle) usually results in a regular withdrawal bleed towards the end of the progestogen. The aim of continuous combined HRT (where a combination of oestrogen and progestogen is taken, usually in a single tablet, throughout each 28-day treatment cycle) is to avoid bleeding, but irregular bleeding may occur during the early treatment stages (if it continues endometrial abnormality should be excluded and consideration given to cycli-cal HRT instead)

DOSE

See under Brands Available with Cost

Women with Uterus

Preparations contain a progestogen as well as an oestrogen  are  suitable for a woman with an intact uterus; they are not suitable for use as (or with) hormonal contraceptives 

Women without uterus

The following preparations do not contain a progestogen; if the uterus is intact they need to be given with a progestogen in which case packs incorporating a suitable progestogen tablet are preferred (see above)

Cautions:

Prolong exposure to unopposed oestrogens may increase risk of development of endometrial cancer; migraine (or migraine-like headaches);  history of breast nodules —closely monitor breast status (risk of breast cancer, pre-existing uterine fibroids may increase in size, symptoms of endometriosis may be exacerbated; predisposing factors to thromboembolism, increased risk of gall bladder disease reported; porphyria .

OTHER CONDITIONS. Hypertension, cardiac or renal disease, diabetes, asthma, epilepsy, sicklecell disease, melanoma, otosclerosis,  multiple sclerosis and systemic lupus erythematosus. Evidence for caution in these conditions in unsatisfactory and many women with these conditions may stand to benefit from HRT.

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Lactations:

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