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Oestrogen

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Benefits

  • reduces the severity and frequency of hot flushes by around 85%
  • improves vaginal dryness
  • by reducing menopausal symptoms, oestrogen may improve sleep and quality of life
  • reduces the risk of post-menopausal bone fracture, including hip fracture
  • not associated with weight gain
  • may decrease the rsik of coronary heart disease

Side effects

  • breast enlargement and tenderness
  • nausea
  • usually temporary
  • may be dose related
  • exacerbation of hormonally-sensitive migraine headache (only with oral)

Risks

  • increased risk of blood clots (venous thromboembolism)
  • increased risk of stroke 
  • increased risk of gallbladder inflammation (cholecystitis)

Unopposed oestrogen

  • Oestrogen stimulates the release of eggs from your ovaries and causes the cells of the womb lining to divide
  • Progesterone gets the lining of your uterus ready to receive the egg from the ovaries
  • The levels of oestrogen and progesterone in your body are usually balanced
  • If oestrogen is not kept in check by progesterone, it can increase
  • This is called unopposed oestrogen
  • This unopposed oestrogen causes the cells of the endometrium (the lining of the uterus) to divide resulting in endometrial hyperplasia
  • Endometrial hyperplasia is a condition in which the endometrium becomes abnormally thick.
  • Although endometrial hyperplasia is not cancer, it can lead to uterine or womb cancer in some women
  • Combining progestogen with oestrogen substantially reduces the risk of atypical endometrial hyperplasia
  • Therefore, all patients with an intact uterus must be prescribed progesterone
  • Approximately 20% of women given unopposed oestrogen for one year develop endometrial hyperplasia
  • The risk persists for many years after oestrogen treatment has been stopped

 Oestrogen prescribing choices

  • These formulations contain oestrogen only and are for patients with no uterus
 Formulation  Brand, strength & dose Pros Cons
 Oral
  • Elleste solo (oestradiol) 1mg & 2mg daily
  • Premarin - (Conjugated oestrogens) - a mixture of oestrogen hormones
  • Patients may find this easier to take especially if taking other tablets
  • Oral is not recommended as first line
  • VTE risk
  • Increases sex hormone binding globulin (SHBG) so reduces free androgen index (lowers libido even more)
  • Less reliable absorption
  • More contraindications (for example obesity, diabetes, gallbladder disease, migraine and so on)

 

Patches

  • Evorel 25 / 50 / 75 / 100mcg patches
    twice a week
  • Estradot 25 / 50 / 75 / 100mcg patches
    twice a week (smaller in size)
  • Elleste 40 / 80mcg patches twice a week
  • Usually stick well and easy to use
  • Can swim, shower, bath, swim with them on
  • Constant level given so can be better in women with migraines
  • Can use more than one which is useful for women with early menopause / primary ovarian insufficiency (POI)
  • Some women do not like to have something stuck to their skin
  • Can lead to local irritation
  • Some women find they do not stick on well or they crinkle (therefore reduced absorption)
  • Some women find they have high absorption in hot climates
  • Plaster mark on bottom – can be removed with baby oil and dry flannel!
Gel
  • Oestrogel 2-4 pumps a day
    (young women often higher doses)
  • Sandrena sachets 0.5-1mg daily
  • Easy to alter dose so women have more control
  • Usually absorb really easily
  • Can be used with patches to ‘top up’
  • Women with cyclical symptoms (including PMS) can use more on the days with worse symptoms. 
  • Young women needing higher doses need to use large quantities
  • Harder to remember as needed once or twice a day
  • Sachets can be hard to open

Vaginal oestrogen to treat genitourinary syndrome of menopause can be prescribed alone or in addition to systemic HRT and does not require a progestogen for endometrial protection to be prescribed simultaneously.

 

https://jamanetwork.com/journals/jama/article-abstract/192323

https://jcp.bmj.com/content/54/6/435

https://www.nhs.uk/conditions/womb-cancer/causes/

 

 

 

 

Elleste Premarin Evore Estradot Oestrogel Sandrena

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