Vaginitis
Conjugated Estrogen cream is indicated in the following indications-
- Moderate-to-severe vasomotor symptoms associated with estrogen deficiency.
- Prevention and management of osteoporosis associated with estrogen deficiency.
- Atrophic vaginitis and Kraurosis Vulvae.
- Female hypoestrogenism.
- Treatment of moderate to severe Dyspareunia.
Osteoporosis associated with estrogen deficiency: Estrogen replacement therapy is the most effective single modality for the prevention of osteoporosis (loss of bone mass) in postmenopausal women. Estrogen reduces bone resorption and retards or halts postmenopausal bone loss. One clinical study demonstrated that even when estrogen was started as late as fifteen years after menopause, further loss of bone mass was prevented but no restoration of bone mass was observed. The effect on bone mass conservation is sustained only as long as conjugated estrogen therapy is continued. Different ethnic groups are at different risk for osteoporosis.
Atrophic vaginitis and Kraurosis Vulvae: Atrophic vaginitis and Kraurosis Vulvae associated with estrogen deficiency. In the absence of estrogen stimulation, the vulvar and vaginal tissues shrink, the vaginal walls become thin and dry, and rugal folds disappear. Tenderness and pruritus, with resulting dysuria and dyspareunia, may occur. Fissures and ulcerations of tissue with spotting or bleeding may result from coitus. These changes are reversible with the administration of estrogen replacement therapy.
Female Hypoestrogenism: Estrogen replacement therapy is indicated in hypoestrogenism related to female hypogonadism or primary ovarian failure. Primary ovarian failure starting early in life will lead to delayed closure of the epiphyses and retarded bone maturation. Long term estrogen deficiency in any age group will usually lead to osteoporosis (for efficacy with estrogen replacement therapy see osteoporosis). Estrogen therapy is associated with the appearance of female characteristics in these patients.
The most serious adverse reactions associated with the use of estrogen are indicated under Warnings and Precautions. The following additional adverse reactions have been reported with estrogenic therapy.
- Genitourinary System: Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea.
- Breasts: Tenderness, enlargement, secretion.
- Gastrointestinal: Nausea, vomiting, abdominal cramps, bloating, cholestatic jaundice.
- Skin: Chloasma or melasma which may persist when drug is discontinued, alopecia, rash.
- Eyes: Steepening of the corneal curvature; intolerance to contact lenses.
- Central Nervous System: Headache, migraine, dizziness; chorea.
- Miscellaneous: Increase or decrease in weight; edema; changes in libido, aggravation of porphyria.
Common side effects include Headache, Breast pain, Irregular vaginal bleeding or spotting, stomach or abdominal cramps, bloating, Nausea and vomiting, Hair loss, Fluid retention, Vaginal yeast infection, Reactions from inserting Conjugated Estrogen Vaginal Cream, such as vaginal burning, irritation and itching.
Uncommon side Effects Heart attack, Stroke, Blood clots, Dementia, Breast cancer, Cancer of the lining of the uterus (womb), Cancer of the ovary, High blood pressure, High blood sugar, Gallbladder disease, Enlargement of benign tumors of the uterus
(fibroids), Severe allergic reaction.
As a general principle, the administration of any drug to nursing mothers should be done only when clearly necessary since many drugs are excreted in human milk.
A complete medical and family history should be obtained prior to the initiation of any estrogen therapy. The pretreatment and periodic physical examinations should include special reference to blood pressure, breasts, abdomen, and pelvic organs, and should include a Papanicolaou smear. Where no pathologic cause is found for abnormal vaginal bleeding, dose reduction of cycling may be indicated. Women on estrogen replacement therapy have not been reported to have an increased risk of thrombophlebitis and/or thromboembolic disease. However, there is insufficient information regarding women who have a history of thromboembolic disease to determine risk. Estrogen may be poorly metabolized in patients with impaired liver function and they should be administered with caution in such patients.