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Estrace (Estradiol) Dosage and Side Effects
ESTRACE (estradiol) is an estrogen replacement hormone used to manage menopausal symptoms such as abnormal uterine bleeding, hot flashes, sweating, and chills.
Proper Use of this medication
Your dose of estradiol will depend on the condition that is being treated.
ESTRACE tablets in doses of 0.5 milligrams (mg), 1 mg, or 2 mg are typically given on a daily basis.
They can also be prescribed to be taken for three weeks, followed by one week of no medication.
The tablets can be taken more than once a day for some conditions.
The topical gel or emulsions are applied to the skin at the same time each day.
The vaginal ring is inserted in the vagina and left for three months at a time.
The patch should be applied to a dry, clean, hairless part of the trunk (but not the breasts). It should not be placed on irritated or damaged skin.
You should rotate the site of application, with at least one week between repeated applications to any one site.
Symptoms of an overdose include the following:
- Nausea or vomiting
- Heavy vaginal bleeding
- Tender breasts
- Discolored urine
If you suspect an overdose, you should contact a poison control center or emergency room immediately.
Missed Dose of Estradiol
If you miss a dose of oral estradiol, take it as soon as you remember.
However, if it's almost time for your next scheduled dose, skip the missed dose and continue on your regular schedule. Do not double up on doses.
If you forget a dose of estradiol gel but remember more than 12 hours before your next scheduled dose, apply the missed dose immediately.
However, if you remember less than 12 hours before your next dose, skip the missed dose and continue on your regular dosing schedule.
Do not apply extra gel to make up for a missed one.
If you forget to apply estradiol emulsion in the morning, apply it as soon as you remember.
Don't apply extra emulsion to make up for a missed dose.
Common Side Effects of Estradiol
You should tell your doctor if any of the following symptoms are severe or do not go away:
- Breast pain or tenderness
- Mood changes or depression
- Difficulty falling asleep or staying asleep
- Changes in sexual desire
- Back pain
- Runny nose, cough, or flu-like symptoms
- Hair loss or unwanted hair growth
- Darkening of facial skin
- Difficulty wearing contact lenses
- Vaginal discharge
- Swelling, redness, burning, irritation, or itching of the vagina
- Redness or irritation at the site of application
Estradiol and Weight Gain
Water retention that increases your weight is a common side effect.
Talk to your doctor about adjusting your dose of estradiol if weight gain becomes a problem.
Serious Side Effects of Estradiol
Contact your doctor immediately if you experience any of the following serious side effects:
- Sudden, severe headache
- Sudden, severe vomiting
- Speech problems
- Dizziness or fainting
- Sudden, complete or partial loss of vision or double vision
- Weakness or numbness of an arm or leg
- Crushing chest pain or chest heaviness
- Coughing up blood
- Sudden shortness of breath or difficulty breathing
- Breast lumps or other breast changes
- Nipple discharge
- Difficulty thinking clearly or remembering
- Pain, tenderness, or redness in one leg
- Bulging eyes
- Yellowing of the skin or eyes
- Loss of appetite
- Joint pain
- Stomach tenderness, pain, or swelling
- Hives, rash, or blisters
- Movements that are difficult to control
- Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
- Difficulty swallowing
Warnings and Precautions
Estradiol can increase the risk that you will develop endometrial cancer (cancer of the lining of the uterus). If you have not had a hysterectomy, you should take progestin along with estradiol to decrease this risk.
However, before taking these two medicines together, talk with your doctor about your risk for other health problems.
In one study, women who took estrogens (such as estradiol) by mouth with progestin had a higher risk of heart attacks, stroke, blood clots, breast cancer, and dementia.
Women who use topical estradiol alone or with progestin may also have a higher risk of developing these conditions.
Using topical estradiol may increase your risk of developing ovarian cancer and gallbladder disease. You should talk to your doctor about these risks.
Before taking estradiol, tell your doctor if you have or have ever had:
- A heart attack or stroke
- Heart disease
- Blood clots
- Any type of cancer
- Abnormal vaginal bleeding
- High blood pressure
- High cholesterol
- Gallbladder disease
- A thyroid disorder
- Epilepsy or another seizure disorder
- Liver disease
- Breast lumps or abnormal mammogram results
- Uterine fibroids
- Yellowing of the skin or eyes (jaundice)
- Migraine headaches
- Endometriosis (a condition where the type of tissue that lines the uterus grows in other areas of the body, usually the abdomen or pelvis)
- Low levels of calcium in your blood
- Porphyria (a condition where abnormal substances build up in the blood)
Also, tell your doctor if you smoke or use tobacco products.
You should use the lowest dose of estradiol for the shortest time possible to control your symptoms.
Talk with your doctor every three to six months to determine if you should lower your dose or stop using this medicine.
You should conduct a breast self-exam every month and have a mammogram and clinical breast exam (a breast exam by a health professional) every year to help detect breast cancer.
Tell your doctor if you are having surgery or will be on bed rest while taking estradiol. Your doctor may tell you to stop taking the medication to decrease the risk of blood clots.
The topical medicine may harm other people who touch your skin. You should not let anyone else touch the skin where you applied estradiol for one hour after application.
If someone does touch the area, he or she should wash his or her hands with soap and water immediately.
Pregnancy and Estradiol
Estradiol can harm an unborn baby or cause birth defects. You should not use this medication while pregnant.
Tell your doctor right away if you become pregnant or might become pregnant while taking this drug.
Since estradiol can also pass into breast milk, talk to your doctor before breastfeeding while taking the drug.
Interactions with this medication
You should tell your doctor about all prescription, non-prescription, over-the-counter (OTC), illegal or recreational drugs; herbal remedies; and nutritional or dietary supplements you're taking, especially:
- Antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral)
- St. John's wort
- Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
- Clarithromycin (Biaxin)
- Erythromycin (E.E.S, Erythrocin)
- Lovastatin (Alticor, Altoprev, Mevacor)
- Medications for thyroid disease
- Rifampin (Rifadin, Rimactane, Rifamate)
- Ritonavir (Norvir, in Kaletra)
Estradiol and Grapefruit
Grapefruit and grapefruit juice may interact with estradiol and cause unwanted side effects.
You should talk to your doctor before consuming any grapefruit products while taking estradiol.
Estradiol and Other Interactions
You should avoid unnecessary sun exposure while taking estradiol, since the gel may make your skin more sensitive to sunlight.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.