Estrogen Therapy and Warnings

Estrogen therapy is common practice these days and is prescribed regularly for the treatment of menopausal symptoms such as hot flashes, mood swings and vaginal dryness.  In this particular discussion, I don't necessarily want to discuss all of the specific indications of estrogen therapy, or even the pros and cons of whether someone should use estrogen treatment.  My goal in this specific blog is to bring to light the warnings that are associated with these medications.  I feel that the cautions and warnings accompanied with the estrogen category of medications are sometimes glossed over because the immediate benefit of therapy is so great.

Estrogens are to be taken in the lowest effective dose for the shortest duration of time for your particular situation.  Please contact your doctor at least every 6 months so you may discuss how you are doing at your current dose and to evaluate if the dose needs to be adjusted or if you still need to continue taking your estrogen therapy.  While you are taking your estrogen therapy, please make sure you receive a complete physical exam with your doctor at least once a year.

It is important to note that if you are using estrogen therapy for the treatment of atrophy, burring or dryness in and around the vagina; and these are the only symptoms you are treating, it is recommended to talk with your doctor about a vaginal cream, vaginal tablet or vaginal insert.  Taking a systemic medication that needs to circulate through your blood system, such as a tablet, patch or injection may significantly increase your chance of estrogen related side effects.

Estrogen therapy is also prescribed to help prevent bone loss in women after menopause; however, if bone loss is the only issue, there are other medications that are safer to take and are just as effective at maintaining bone structure. 

In my opinion, the Black Box Warnings written for the estrogen medications are very complicated.  I took some time arranging them so they may be a little easier to understand and digest.  These warnings are divided into two categories and I have listed them below. 

If you take, or may be taking estrogen therapy in the future, please take the time to read these warnings.  It is important that you discuss this issue with your physician before you begin on estrogen therapy.

Black Box Warning

Warning#1 Endometrial Cancer (cancer of the uterus)

-There is an increased risk of cancer in the uterus in women who use estrogen without also taking a progestin.  Adding a progestin to the therapy may reduce the likelihood of the cascade of events that leads to uterine cancer.  If you are postmenopausal and taking estrogen and are having undiagnosed genital bleeding, please seek medical attention.

Warning#2 Cardiovascular and other Risks

-Estrogen therapy given by itself has been associated with an increased risk of stroke and serious blood clots in the legs.
-Estrogen therapy given in conjunction with progestin therapy has been associated with an increased risk of heart attack, stroke, blood clots in the legs or lungs, and increased risk of breast cancer.
-Estrogen therapy, with or without progestin, has been shown to increase the incidence of heart disease and dementia and should not be used for the treatment of either of these two disease states  
-Estrogens, with or without progestin, should be prescribed in the lowest effective dose for the shortest duration of therapy, consistent with the treatment goals for each individual patient.

Thanks for reading and pass this on to someone who may be interested in learning about this information.

To listen to Medication Specific Counseling Sessions on different types of estrogen therapy, please visit  Once you register and become a member, you will have full access to all of the estrogen counseling sessions, as well as all of the other Medication Specific Counseling Sessions.


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