1. Health

Estrogens & Progestins - Can I Stop Taking Them?

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Updated December 19, 2003

21. Are the estrogens and progestins in birth control pills (oral contraceptives) the same as those in Prempro and Premarin? Do they have the same risks?

Oral contraceptives also contain estrogens and progestins, but different types and doses. All estrogens have similar side effects. However, the risks of particular side effects may differ since oral contraceptives are used in younger women with different health status compared to postmenopausal women.

As with all estrogens, the use of oral contraceptives is also associated with increased risks of several serious conditions including heart attack, blood clots, stroke, liver tumors, and gallbladder disease. These risks are higher in women with underlying risk factors such as high blood pressure, high cholesterol, and diabetes, and in those who smoke cigarettes.

22. Will other estrogen and progestin products carry the same warnings?

The FDA believes that the new findings regarding estrogens and progestins are very significant and have a major public health impact for postmenopausal women. We believe that all health care providers who prescribe estrogen and progestin drug products for postmenopausal women, and all postmenopausal women who use these drugs, need to know about the new risk information. Thus, the FDA is requesting all manufacturers who have estrogen and progestin products approved for treatment of menopausal signs and symptoms to include the new information for their products. The FDA will also reissue its guidance for labeling these products, including revised recommendations for patient information.

23. Are estrogens in patches or vaginal creams or vaginal rings safer than tablet forms?

We do not know if the other forms are safer than the tablets. Estrogens are available in a variety of forms including transdermal patches, estrogen gels, and vaginal creams and rings. Most of the data on the long-term health effects of estrogens come from studies involving estrogen and progestin oral tablets. Unless there are data to say otherwise, postmenopausal women who take estrogen and progestin in other dosage forms should be similarly warned about risks.

The amount of estrogen that enters the blood stream from estrogen-containing vaginal creams and rings can vary depending on the specific product, how it is used, and on factors that vary from woman to woman. FDA encourages manufacturers to provide drug blood level information in the physician prescribing information. However, it is important to realize that little is known about the relationship between blood levels of estrogens and potential health risks.

24. If a woman wants to stop taking estrogens, what should she do?

Women are advised to discuss this issue with their health care provider -before stopping their medication. .

25. If estrogens are stopped will that change a woman's sex drive?
In what way?

Estrogen, and estrogen plus progestin drug products have been shown to be effective in treating vaginal dryness, itching, and burning, which can cause discomfort with intercourse. By stopping estrogen and progestin, symptoms such as discomfort during sexual intercourse may return. Women are advised to discuss their symptoms off estrogens and options with their health care provider.

26. Does estrogen protect against aging, wrinkles, and Alzheimer's?

Researchers are investigating the benefits of estrogen and estrogen plus progestin in offering protection from a number of conditions and diseases such as Alzheimer's disease and macular degeneration, a serious condition that can lead to blindness. At this time there are no convincing studies to support these claims.

27. What can be done to lower the risks of side effects such as heart attack, stroke, blood clots or breast cancer while taking estrogen or estrogen plus progestin?

The safety and effectiveness of medicines are increased when they are used as directed. Here are some points for women to consider:
  • Talk with a health care provider periodically about whether estrogens should be continued and how to monitor for side effects.

  • If unusual vaginal bleeding develops, see a health care provider right away.

  • Do a self-breast examination regularly and have a breast exam by a health care provider and mammogram (breast X-ray) regularly.

  • High blood pressure, high cholesterol (fat in the blood), diabetes, tobacco use, and being overweight increase the chances for getting heart disease. A health care provider can advise on how to lower the chances for getting heart disease.

Adapted from the Women's Health Initiative (WHI) and National Institutes of Health (NIH)

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