Estradiol
Brand: Estrace (tablets discontinued; Estrace cream still marketed)
Boxed warning
Endometrial cancer (with estrogen alone in a woman with a uterus), cardiovascular disorders, breast cancer, and probable dementia; use the lowest dose for the shortest time.
- Caution
- Contraindicated with undiagnosed vaginal bleeding, a history of breast cancer, active clots, stroke, or liver disease; smoking raises clot risk.
- Pregnancy
- Contraindicated in pregnancy: no indication and possible fetal harm.
Common side effects
- Nausea
- Breast tenderness
- Headache
- Bloating
- Spotting
Key interactions
- Smoking raises clot and stroke risk
- CYP3A4 inducers (rifampin, carbamazepine, phenobarbital, St. John's wort) lower its levels
Counseling points
- Take at the same time each day
- Report leg pain, chest pain, or shortness of breath
- Do not smoke
- Report unusual vaginal bleeding
- Attend regular check-ups
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