Uses
Use of estrogens alone in postmenopausal women generally is referred to as estrogen replacement therapy (ERT); use of estrogens in combination with progestins usually is referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy.
Estrogen Replacement Therapy
Management of moderate to severe vasomotor symptoms associated with menopause. Also used in fixed combination with testosterone cypionate for this indication; FDA is reevaluating this combination.
Management of vulvar and vaginal atrophy associated with menopause. If used solely for this indication, consider use of topical vaginal preparations.
Management of urogenital symptoms (urinary urgency and dysuria).
Osteoporosis
Prevention of postmenopausal osteoporosis. Used adjunctively with other measures (e.g., diet, calcium, vitamin D, weight-bearing exercise, physical therapy) to retard further bone loss and progression of osteoporosis in postmenopausal women.
Estrogens are effective for prevention of osteoporosis but are associated with a number of adverse effects. If prevention of postmenopausal osteoporosis is the sole indication for therapy, consider alternative therapy (e.g., alendronate, raloxifene, risedronate).
Has been effective in the treatment of osteoporosis in postmenopausal women. Formerly recommended as first-line therapy; however, recommendations on appropriate use of HRT have been revised based on WHI study findings. (See Boxed Warning.) Evaluate risks and benefits of long-term HRT use in the management of osteoporosis, taking into account the increased risk of breast cancer and cardiovascular disease, availability of other pharmacologic modalities (e.g., alendronate, calcitonin, calcium, raloxifene, risedronate, vitamin D), and life-style factors that can be modified.
Has been used in a limited number of anorexic women with chronic amenorrhea to reduce calcium loss† and, thereby, reduce risk of osteoporosis.
Corticosteroid-induced Osteoporosis
Has been used to prevent bone loss in postmenopausal women receiving low- to moderate-dose corticosteroid therapy†.
Hypoestrogenism
Treatment of hypoestrogenism secondary to hypogonadism, castration, or primary ovarian failure.
Metastatic Breast Carcinoma
Palliative treatment of metastatic breast cancer in selected women and men. One of several second-line agents.
Prostate Carcinoma
Palliative treatment of advanced androgen-dependent prostate carcinoma.
Cardiovascular Risk Reduction
ERT or HRT does not decrease the incidence of cardiovascular disease. AHA, American College of Obstetricians and Gynecologists, FDA, and manufacturers recommend that hormone therapy not be used to prevent heart disease in healthy women (primary prevention) or to protect women with preexisting heart disease (secondary prevention).†
Alzheimer’s Disease
Prior use of HRT, but not current HRT unless such use exceeds 10 years, associated with reduced risk of Alzheimer’s disease†. Estrogens have not been shown to prevent progression of Alzheimer’s disease; American Academy of Neurology recommends that estrogens not be used for treatment of Alzheimer’s disease.
Initiation of ERT or HRT in women ≥65 years of age not associated with an improvement in cognitive function. Some women receiving ERT or HRT (specifically conjugated estrogens 0.625 mg in conjunction with medroxyprogesterone acetate 2.5 mg daily or conjugated estrogens 0.625 mg daily) experience detrimental effects. Incidence of probable dementia in women receiving ERT or HRT was higher than that in women receiving placebo. Use of ERT or HRT to prevent dementia or cognitive decline in women ≥65 years of age is not recommended.
Postpartum Breast Engorgement
Used in the past for prevention of postpartum breast engorgement†; FDA has withdrawn approval of estrogen-containing drugs for this indication, since estrogens have not been shown to be safe for this use. (See Lactation under Cautions.)
Pregnancy
Not effective for any purpose during pregnancy; use contraindicated in pregnant women. (See Pregnancy under Cautions.)
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