Estrogen And Progestin (Hormone Replacement Therapy)
Conditions Treated
Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat (hot flashes), vaginal symptoms (itching, burning, and dryness) and difficulty with urination, but it does not relieve other symptoms of menopause such as nervousness or depression. Estrogen also prevents thinning of the bones (osteoporosis) in menopausal women. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.
Possible Side Effects
What Side Effects Can This Cause?
Hormone replacement therapy may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- upset stomach
- vomiting
- stomach cramps or bloating
- diarrhea
- appetite and weight changes
- changes in sex drive or ability
- nervousness
- brown or black skin patches
- acne
- swelling of hands, feet, or lower legs (fluid retention)
- bleeding or spotting between menstrual periods
- changes in menstrual flow
- breast tenderness, enlargement, or discharge
- difficulty wearing contact lenses
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:
- double vision
- severe abdominal pain
- yellowing of the skin or eyes
- severe mental depression
- unusual bleeding
- loss of appetite
- rash
- extreme tiredness, weakness, or lack of energy
- fever
- dark-colored urine
- light-colored stool
Usage Instructions
How Should This Medication Be Used
Hormone replacement therapy comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take hormone replacement therapy, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medication without talking to your doctor. Activella, FemHrt, and Prempro come as tablets containing estrogen and progestin. Take one tablet every day. Ortho-Prefest comes in a blister card containing 30 tablets. Take one pink tablet (containing only estrogen) once daily for 3 days, then take one white tablet (containing estrogen and progestin) once daily for 3 days. Repeat this process until you finish all the tablets on the card. Begin a new blister card the day after you finish the last one. Premphase comes in a dispenser containing 28 tablets. Take one maroon tablet (containing only estrogen) once daily on days 1 to 14, and take one light-blue tablet (containing estrogen and progestin) once daily on days 15 to 28. Begin a new dispenser the day after you finish the last one. Before taking hormone replacement therapy, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient and read it carefully.
What Dietary Instructions Should I Follow
Ask your doctor about taking calcium supplements if you are taking this medication for prevention of osteoporosis. Follow all dietary and exercise recommendations, as both can help prevent bone disease.
Are There Any Special Instructions
Before taking hormone replacement therapy, tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetaminophen (Tylenol); anticoagulants ('blood thinners') such as warfarin (Coumadin); cyclosporine (Neoral, Sandimmune); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone) and prednisolone (Prelone); rifampin (Rifadin, Rimactane); salicylic acid; temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. in addition to the conditions listed in the IMPORTANT WARNING section, tell your doctor if you have had a hysterectomy and if you have or have ever had asthma; toxemia (high blood pressure during pregnancy); depression; epilepsy (seizures); migraine headaches; liver, heart, gallbladder, or kidney disease; jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle. if you are having surgery, including dental surgery, tell the doctor or dentist you are taking hormone replacement therapy. tell your doctor if you smoke cigarettes. Smoking while taking this medication may increase your risk of serious side effects such as blood clots and stroke. Smoking also may decrease the effectiveness of this medication. tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor.
Brand Names
Common Brand Names for This Medication
- Activella® (as a combination product containing Estradiol, Norethindrone)
- Angeliq® (as a combination product containing Drospirenone, Estradiol)
- FemHrt® (as a combination product containing Ethinyl Estradiol, Norethindrone)
- Mimvey® (as a combination product containing Estradiol, Norethindrone)
- Prefest® (as a combination product containing Estradiol, Norgestimate)
- Premphase® (as a combination product containing Conjugated/Equine Estrogens, Medroxyprogesterone)
- Prempro® (as a combination product containing Conjugated/Equine Estrogens, Medroxyprogesterone)
Overdose
What To Do In The Case of Emergency
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include:
- upset stomach
- vomiting
Forgotten Doses
What Should I Do If I Forget A Dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Additional Information
What Are the Storage Conditions for this Medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from heat and moisture (not in the bathroom). Throw way any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
What Other Information Should I Know?
Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctor's directions for examining your breasts; report any lumps immediately. If you are taking hormone replacement therapy to treat symptoms of menopause, your doctor will check every 3 to 6 months to see if you still need this medication. If you are taking this medication to prevent thinning of the bones (osteoporosis), you will take it for a longer period of time. Before you have any laboratory tests, tell the laboratory personnel that you take hormone replacement therapy, because this medication may interfere with some laboratory tests. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.