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The use of estrogen-containing medications, whether alone or combined with progestin, carries certain risks and necessitates careful consideration. Below are essential safety warnings and precautions for individuals considering or currently using such treatments. It is important to discuss these aspects with your healthcare provider to ensure safe and effective use.

• Cancer Risks: Estrogen therapies can increase the risk of uterine (endometrial) and breast cancer. For those with a healthy uterus, combining estrogen with progestin can help mitigate the risk of endometrial cancer. Regular monitoring and reporting of unusual vaginal bleeding or changes in breast appearance are crucial. Avoid estrogen therapies if you currently have or have had breast cancer.

• Cardiovascular Concerns: There is an elevated risk of developing blood clots, heart attacks, and strokes with estrogen use. This risk is heightened in individuals who smoke or have a history of cardiovascular issues. Immediate medical attention is required if you experience symptoms such as chest pain, severe headaches, or sudden vision changes.

• Dementia: Estrogen therapy may increase the risk of dementia, particularly in women over 65. Estrogen and progestin should not be used as a preventive measure against dementia.

• Gallbladder and Liver Issues: Estrogen use can lead to gallbladder problems and aggravate liver conditions. If you experience symptoms like persistent stomach pain or jaundice, contact your healthcare provider immediately. Those with a history of liver problems should avoid this medication.

• Metabolic Effects: Estrogens can elevate triglyceride levels, potentially leading to heart issues or pancreatitis. Regular blood tests may be necessary to monitor these levels.

• Thyroid and Calcium Levels: Estrogen can influence thyroid hormone and calcium levels in the blood. If you have thyroid issues or breast cancer that has spread to bones, consult your provider about potential risks.

• Fluid Retention and Other Conditions: Estrogen might cause fluid retention, potentially exacerbating heart or kidney problems. It may also worsen conditions such as high blood pressure, asthma, diabetes, migraines, and seizures. Discuss your full medical history with your healthcare provider before starting treatment.

• Contraindications: Do not use estrogen therapy if you have unexplained vaginal bleeding, a history of estrogen-dependent cancers, blood clots, or if you are currently pregnant.

In case of an overdose, seek emergency medical attention immediately. Regular consultations with your healthcare provider are advised to evaluate the need for continued use of hormone therapy. Always use the lowest effective dose for the shortest duration necessary.

Common side effects:

• nausea
• vomiting
• headache
• breast tenderness or growth
• bloating
• weight changes
• stomach cramps
• vaginal spotting or breakthrough bleeding
• dizziness
• high blood pressure
• melasma (dark patches on the skin)
• menstrual cramps
• mood changes
• trouble tolerating contact lenses

Less common but important to monitor:

• persistent unusual vaginal bleeding
• increased thirst or urination
• mental/mood changes
• breast lumps

Serious side effects:

• serious allergic reactions (rash, itching, swelling, severe dizziness, breathing difficulties)
• heart attack
• stroke
• deep vein thrombosis
• pulmonary embolism
• chest pain
• sudden severe headaches
• confusion
• trouble speaking
• pain/swelling in the legs
• liver or gallbladder issues (yellowing of the skin or eyes, dark urine, severe abdominal pain)