Oestrogen HRT estradiol, conjugated oestrogens

About oestrogen HRT

If you have had your womb (uterus) removed by hysterectomy, you can experience the symptoms women often develop during the menopause, or 'change'. Oestrogen is a female sex hormone that is prescribed to treat a variety of women's health problems, including menopausal symptoms.

After hysterectomy, or during the menopause, your female hormone levels begin to fall. Hormone replacement therapy (HRT) replaces these hormones. This helps to relieve some of the problems associated with the menopause, such as hot flushes, night sweats and vaginal dryness. HRT can also protect against 'thinning' of the bones (osteoporosis), although other treatments are usually preferred for this. Most HRT is a combination of two female hormones, an oestrogen and a progestogen. However, if you have had your womb removed then it is likely that you only need to take oestrogen HRT therapy.

Different types of natural oestrogen are used in HRT preparations. These include conjugated oestrogens and estradiol. HRT is available in several different forms, such as tablets, skin patches and gels. Your doctor will discuss the pros and cons of each formulation with you so that you can make an informed choice about which formulation to use. There are several brands of each of these types of HRT - all deliver a set dose of oestrogen into your bloodstream.

If you have not had your womb removed, it is important that you receive HRT which contains both an oestrogen and a progestogen. Some of the brands mentioned in this leaflet can be prescribed for women with a womb, as long as a progestogen is also prescribed for a number of days each month. Please see the separate medicine leaflet called Oestrogen and progestogen for HRT for more information about this.

Before taking/using oestrogen HRT

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start oestrogen HRT, it is important that your doctor knows:

• If you have migraine-like headaches.
• If you have any unexplained vaginal bleeding.
• If you have had breast cancer or any lumps in your breast, or if a close family member has had breast cancer.
• If you or a close family member have ever had a blood clot in the legs or lungs.
• If you have varicose veins, or any swelling of your veins.
• If you have too much sugar in your blood (diabetes mellitus).
• If you have any problems with the way your liver works.
• If you get angina chest pain, or if you have had a heart attack.
• If you have a rare inherited blood disorder called porphyria.
• If you have ever had an allergic reaction to a medicine.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take/use oestrogen HRT

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about the specific brand of oestrogen you have been given, and will provide you with a full list of the side-effects which you could experience.
• If you have been prescribed tablets: take one tablet every day. Take your doses at the same time of day, each day. If you forget to take a tablet, read the advice in the manufacturer's leaflet and follow the instructions it gives. You can take the tablets either before or after meals. There are several different brands and strengths of tablet, so each time you collect a new supply from your pharmacy, it's a good idea to check that the tablets are the same as you have had before. If they are different, speak with your pharmacist who will advise you about what to do.
• If you have been prescribed patches: some patches are applied and left on for a whole week (such as FemSeven® and Progynova® TS), whereas other patches are applied twice a week and removed after 3-4 days. Make sure you are clear how often to use the patches you have been prescribed - the instructions for how to use them will be on the label of the pack. Apply the patch to a clean, dry, unbroken area of your skin, preferably to an area below your waist. You should never apply the patches near to your breasts. Each time you use a patch, apply it to a different area so that your skin doesn't become irritated. There are several different strengths of patches, so it is a good idea to check the strength each time you collect a prescription.
• If you have been prescribed gel: the instructions for how much gel to use will be on the label of the pack. Apply the required amount once every day, and allow it to dry for a few minutes before you put on clothes. It is recommended that you apply Oestrogel® to your arms, shoulders or inner thighs, and Sandrena® to an area of skin below your waist, such as your thighs. Never apply the gel to your breasts. You should wash your hands after applying the gel so you do not pass it on accidentally, but do not wash the area you have applied it to for at least one hour, to give it time to work. If you forget to use the gel but it is still within 12 hours of your usual time, apply it as usual and then carry on as before. If it is more than 12 hours since you should have applied the gel then just wait and apply the next dose when it is due.

Getting the most from your treatment

• Please keep your regular appointments with your doctor. This is so your doctor can check on your progress. Report to your doctor any changes in your well-being and lifestyle, and remember to check your breasts regularly for any lumps. You will also be invited to go for regular breast screening and cervical smear tests - it is important that you attend these sessions.
• If you are due to have an operation, please let the person carrying out the surgery know in advance that you are taking HRT. It is likely that you will be advised to stop taking the HRT a few weeks before any major surgery, especially if you are likely to be on bed rest afterwards.
• There are some risks which are associated with HRT - your doctor will discuss the benefits and risks of the treatment with you before you start. The risks are low when small doses of HRT are used for short periods of time, so the benefits of short-term HRT usually outweigh any problems. If used for longer periods of time, the incidence of blood clots, breast cancer, ovarian cancer and possibly heart disease increases. Because of this, the decision to continue HRT needs to be made individually and your progress should be reviewed at least once a year. If you have any concerns at any time, make an appointment to discuss them with your doctor.
• Travelling that involves periods of immobility (more than three hours) can increase the risk of unwanted blood clots, particularly in the legs or lungs. Taking appropriate exercise during long journeys and wearing flight socks (elastic hosiery) can reduce this risk. If you would like more advice about this, speak with your doctor or pharmacist.
• Before you buy any medicines, check with a pharmacist which medicines are safe for you to take alongside oestrogen HRT.
• Please note: HRT treatments are not suitable for preventing pregnancy.

Can oestrogen HRT cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the ones associated with oestrogen HRT. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you develop any of the following symptoms, please stop taking/using the HRT and contact your doctor for advice straightaway:

• Sudden chest pain.
• Sudden breathlessness, or if you cough up blood.
• Swelling or pain in a leg.
• Severe stomach ache.
• An unusually severe headache.
• Any yellowing of your skin or the whites of your eyes (jaundice).

If you experience any other symptoms which you think may be due to the treatment, please speak with your doctor or pharmacist for further advice.

How to store oestrogen HRT

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines