Estrogen

Estrogen is a hormone preparation that is used to treat a deficiency of the hormone estrogen in the body. Estrogen is usually used to relieve menopausal symptoms and prevent postmenopausal osteoporosis.

One type of estrogen available in Indonesia is conjugated estrogen. Conjugated estrogens are derivatives of the hormone estrogen, such as estradiol . Conjugated estrogens are made from a mixture of several types of estrogen hormones extracted from natural sources.

Conjugated estrogens work like the estrogen hormone produced by the body. By doing so, this drug can treat a variety of symptoms caused by decreased estrogen levels, such as vaginal atrophy , irregular menstruation, hot flashes , breast tenderness, depression, or fatigue.

This drug is also used in palliative therapy of prostate cancer and breast cancer.

Estrogen trademark: Esthero

What is Estrogen

Warning Before Taking Estrogen:

The following are some things you should pay attention to before taking conjugated estrogen:

• Do not take conjugated estrogens if you are allergic to this drug or to other estrogen derivatives. Tell your doctor about any history of allergies you have.
• Do not take conjugated estrogens if you are suffering from unexplained vaginal bleeding .
• Do not take conjugated estrogens if you have had or are currently having breast cancer, uterine cancer, cervical cancer , or vaginal cancer .
• Do not take conjugated estrogens if you have or are currently having liver disease , a tendency to develop blood clots, a heart attack , or stroke .
• Tell your doctor if you have or have ever had diabetes, edema , asthma, endometriosis , heart disease, epilepsy , hereditary angioedema , hypercalcemia, hypertension, high triglycerides , migraines, hypothyroidism , porphyria, lupus , gallbladder disease, or kidney disease .
• Tell your doctor if you have ever had a surgical removal of the uterus ( hysterectomy ).
• Tell your doctor if you are pregnant, breastfeeding or planning a pregnancy. Use the most effective contraceptive for you to prevent pregnancy while undergoing treatment with this medicine.
• Tell your doctor if you are taking other medications, including supplements and herbal products, in case of drug interactions.
• See your doctor immediately if you experience  a drug allergic reaction  or overdose after taking conjugated estrogens.

Dosage and Rules for Using Estrogen

The following are conjugated estrogen doses determined based on the goal of treatment:

1. Purpose: Prevent postmenopausal osteoporosis The
   dose is 0.3 mg, once a day. Treatment is generally given with a 25-day cycle of taking the drug without a break, then continuing with 5 days of not taking the drug.

2. Purpose: Relieves menopausal symptoms , including vaginal atrophy
   . Initial dose is 0.3 mg once daily. Dosage may be increased to 0.45–1.25 mg once daily. Dosage is determined based on the patient's condition and response to treatment. Treatment is generally given with a 25-day cycle of taking the drug without a break, then continuing with 5 days of not taking the drug.

3. Purpose: Overcoming low estrogen levels in hypogonadism
   . The dose is 0.3–0.625 mg, once a day. Dosage is adjusted based on the patient's condition and response to treatment. Treatment is generally given with a cycle of 3 weeks of taking the drug without a break, then continuing with 1 week of not taking the drug.

4. Purpose: Palliative therapy for prostate cancer
   . The dose is 1.25–2.5 mg, 3 times a day. Dosage is adjusted based on the patient's condition and response to treatment.

5. Purpose: Primary ovarian insufficiency The
   dose is 1.25 mg, once a day. Treatment is generally given with a cycle of 3 weeks of taking the drug without a break, then continuing with 1 week of not taking the drug. Dosage is adjusted based on the patient's condition and response to treatment.

How to Use Estrogen Properly

Always follow the doctor's recommendations and read the information on the drug packaging. Do not increase or decrease your dose without consulting your doctor first.

Conjugated estrogens can be taken before or after meals. If you have stomach ulcers, take this medicine after eating. Swallow the medicine whole with the help of a glass of water. Do not split, chew or crush the medication.

If you forget to take conjugated estrogens, take this medication as soon as it's not near your next scheduled time. If it is close, ignore the missed dose and do not double the next dose.

Long-term use of conjugated estrogens can increase the risk of uterine cancer and breast cancer.

To reduce the risk of uterine cancer, your doctor may also prescribe a progestin. Call your doctor right away if you experience vaginal bleeding. To anticipate the risk of developing breast cancer, you are advised to examine your breasts independently (check your own breasts or BSE ).

Apart from that, you also need to do gynecological examinations to the doctor regularly. Follow the control schedule that has been determined by the doctor.

Store this medication at room temperature, in a dry place, and avoid direct sunlight. Keep out of reach of children.

Estrogen Interactions with Drugs and Other Substances

Interactions that can occur if conjugated estrogens are used together with certain drugs are:

• Increased risk of blood clots when used with lenalidomide, thalidomide and tranexamic acid
• Increased risk of estrogen side effects when used with cimetidine , itraconazole, clarithromycin , quinidine, or erythromycin
• Decreased effectiveness of estrogen when used with rifampicin , carbamazepine or darunavir
• Decreased effectiveness of anticoagulants such as heparin , thus increasing the risk of blood clots and blocked arteries

Side Effects and Dangers of Estrogen

The following are side effects that can occur after consuming conjugated estrogens:

• The body looks swollen
• Hair loss
• Numb
• pins and needles
• Pain like burning
• back pain
• Leg cramps or pain
• Bloating or frequent bowel movements
• Heartburn
• Nausea or vomiting
• Stomach ache
• Dizziness or headache
• Pain in the breast
• Itchy or vaginal discharge
• Changes in menstrual periods
• Spots appear from the vagina

Check with your doctor if these side effects don't improve or get worse. See a doctor immediately if you experience serious side effects, such as:

• Low back pain and vaginal bleeding that occurs outside of menstruation
• A lump appears in the breast
• High calcium levels in the blood ( hypercalcemia ), which can be characterized by vomiting, constipation, increased frequency of urination, feeling very thirsty, muscle weakness, bone pain, or lack of energy
• Swelling all over the body followed by sudden weight gain
• Unusual behavior changes, confusion, or difficulty remembering
• Jaundice , which can be marked by yellowing of the eyes or skin

Seek immediate medical help or to the emergency room if you experience an allergic drug reaction or more serious side effects, including:

• Heart attack , which can be characterized by chest pressure, chest pain that spreads to the jaw or shoulder, and sweating
• Stroke , which can be characterized by visual disturbances, balance disorders, unclear speech, sudden severe headaches, or numbness or weakness in one side of the body
• Blood clots, which can be characterized by sudden loss of vision, stabbing chest pain, coughing up blood, or one or both legs feeling sore or hot