Brand Names:

• Activella
• Alora
• Angeliq
• Clinagen LA 40
• Depo-Estradiol
• Estinyl
• Femring
• Loestrin 1/20
• Lunelle Monthly Contraceptive
• Mircette
• Ortho-Novum
• Prefest
• Premphase
• Triphasil
• Alti-Mpa

Dosage Forms:

• Tablet
• Tablet, Chewable

Uses of This Medicine:

Conjugated estrogens and medroxyprogesterone are estrogen and progestin hormones. Along with other effects, estrogens help females develop sexually at puberty and regulate the menstrual cycle. Progestin lowers the effect of estrogen on the uterus and keeps estrogen-related problems from developing.

Around the time of menopause, the ovaries produce less estrogen. Estrogens are given to:

• Relieve the signs of menopause (vasomotor symptoms of menopause), such as hot flashes and unusual sweating, chills, faintness, or dizziness.
• Treat inflammation of the vagina (atrophic vaginitis) and of the genital area (atrophy of the vulva) by keeping these areas from becoming too dry, itchy, or painful.
• Prevent the loss of bone that begins at the time of menopause. Keeping bones strong decreases the chance of developing weak bones that easily break (osteoporosis). Estrogen use is most effective when it is taken for more than 7 years while you are getting regular exercise and extra calcium. Protection from bone loss can then last for many years after you stop taking the medicine.

There is no medical evidence to support the belief that the use of estrogens will keep the patient feeling young, keep the skin soft, or delay the appearance of wrinkles. Nor has it been proven that the use of estrogens during menopause will relieve emotional and nervous symptoms, unless these symptoms are related to the menopausal symptoms, such as hot flashes.

Progestins are not needed if the uterus has been removed (by a surgical method called hysterectomy). In that case, it may be better to receive estrogens alone without the progestin.

Conjugated estrogens and medroxyprogesterone are available only with your doctor's prescription.

Before Using This Medicine:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Older adults—

Conjugated estrogens and medroxyprogesterone may increase your chance of having a stroke, memory problems, or breast cancer that spreads to other parts of your body.

Pregnancy—

Conjugated estrogens and medroxyprogesterone are not recommended for use during pregnancy. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause. Tell your doctor right away if you suspect you are pregnant.

Breast-feeding—

Conjugated estrogens and medroxyprogesterone pass into the breast milk. This medicine is not recommended for use during breast-feeding.

Other medicines—

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Felbamate
• Isotretinoin
• Paclitaxel
• Paclitaxel Protein-Bound
• Theophylline
• Tizanidine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems—

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Asthma or
• Epilepsy or
• Heart problems or
• High blood pressure or
• Kidney problems, severe or
• Migraine headaches—Rarely, water retention caused by conjugated estrogens or medroxyprogesterone may worsen these conditions; on the other hand, blood pressure and some heart or blood vessel problems can improve for most patients.

• Blood clotting problems (or history of during previous estrogen therapy)—Estrogens usually are not used until blood clotting problems stop; using estrogens is usually not a problem for most patients without a history of blood clotting problems due to estrogen use.

• Bone cancer or
• Breast cancer or
• Cancer of the uterus (active or suspected) or
• Fibroid tumors of the uterus—Estrogens may interfere with the treatment of breast or bone cancer, worsen cancer of the uterus, or increase the size of fibroid tumors.

• Changes in genital or vaginal bleeding of unknown causes—Estrogens may make these conditions worse; some irregular vaginal bleeding may be a sign that the lining of the uterus may be growing too much or is a sign of cancer of the uterus lining.

• Changes in vision—This medicine may make cause changes in vision; your medicine may need to be stopped if these conditions become worse.

• Diabetes mellitus (sugar diabetes)—Conjugated estrogens or medroxyprogesterone may slightly change the amount of blood sugar for some patients, but for most patients with sugar diabetes, there is no change in blood sugar.

• Endometriosis or
• Gallbladder disease or gallstones (or history of) or
• High cholesterol or triglycerides (or family history of) or
• Jaundice (yellow skin) or
• Liver disease, including jaundice (or history of) or
• Pancreatitis (inflammation of pancreas) or
• Porphyria (liver problem)—Conjugated estrogens or medroxyprogesterone may worsen these conditions; using estrogens can lower blood cholesterol in many patients with high cholesterol.

• Low blood calcium, severe—Estrogens should be used with caution in patients with this condition.

• Underactive thyroid—A change in dose of thyroid medication may be needed. Your doctor will watch for this.

Proper Use of This Medicine:

Conjugated estrogens and medroxyprogesterone usually come with patient directions. Read them carefully before taking this medicine.

Take this medicine only as directed by your doctor. Do not take more of it and do not take it for a longer period of time than your doctor ordered. The length of time you take the medicine will depend on the medical problem for which you are taking conjugated estrogens and medroxyprogesterone. Discuss with your doctor how long you will need to take these medicines.

If you are taking the estrogen or progestin hormones in a certain order (i.e., conjugated estrogens tablets followed by conjugated estrogens and medroxyprogesterone tablets), be sure you know in which order you need to take the medicines. If you have questions about this, ask your health care professional.

Nausea may occur during the first few weeks after you start taking estrogens. This effect usually disappears with continued use. If the nausea is bothersome, it can usually be prevented or reduced by taking each dose with food or immediately after food.

Dosing—

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • To prevent loss of bone (osteoporosis) or for treating itching or dryness of the genital area (atrophy of the vulva), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
    • Adults—One tablet (containing 0.625 mg conjugated estrogens) once a day on Days 1 through 14; then, one tablet (containing 0.625 mg conjugated estrogens and 5 mg medroxyprogesterone) once a day on Days 15 through 28. Repeat cycle.

• For oral dosage form (tablets):
  • To prevent loss of bone (osteoporosis) or for treating itching or dryness of the genital area (atrophy of the vulva), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
    • Adults—One tablet (containing 0.3 mg conjugated estrogens and 1.5 mg medroxyprogesterone) once a day for twenty-eight days. Repeat cycle. If vaginal bleeding or spotting continues and it is undesired, your doctor may increase your dose to the next highest strength tablet (0.45 mg conjugated estrogens and 1.5 mg medroxyprogesterone). It should be taken once a day for twenty-eight days. Repeat cycle.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects. Plan on going to see your doctor every year, but some doctors require visits more often.

Although the risk for developing breast problems or breast cancer is low, it is still important that you regularly check your breasts for any unusual lumps or discharge, and report any problems to your doctor. You should also have a mammogram (x-ray pictures of the breasts) and breast examination done by your doctor whenever your doctor recommends it.

If your menstrual periods have stopped, they may start again once you begin taking this medicine. This effect will continue for as long as the medicine is taken. However, if taking the continuous treatment (0.625 mg conjugated estrogens and 2.5 mg medroxyprogesterone once a day), monthly bleeding usually stops within 10 months.

Also, vaginal bleeding between your regular menstrual periods may occur during the first 3 months of use. Do not stop taking your medicine. Check with your doctor if bleeding continues for an unusually long time, if your period has not started within 45 days of your last period, or if you think you are pregnant.

Tell the doctor in charge that you are taking this medicine before having any laboratory test, because some test results may be affected.

You may need to stop taking this medicine before having some kinds of surgery or while your doctor has ordered a long period of bedrest. Talk with your doctor about this.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Healthy women rarely have severe side effects from taking conjugated estrogens or medroxyprogesterone to replace estrogen.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Itching of the vagina or genital area

menstrual periods beginning again, including changing menstrual bleeding pattern for up to 6 months (spotting, breakthrough bleeding, prolonged or heavier vaginal bleeding, or vaginal bleeding completely stopping by 10 months)

pain during sexual intercourse

thick, white vaginal discharge

Less common

Blurred vision

breast lumps

chest pain

discharge from breast

dizziness

feeling faint, dizzy, or light-headed

feeling of warmth or heat

flushing or redness of skin, especially on face and neck

headache

heavy nonmenstrual vaginal bleeding

pounding in the ears

severe cramping of the uterus

slow or fast heartbeat

sweating

Rare

Change in vaginal discharge

pain or feeling of pressure in pelvis

pain or tenderness in stomach, side, or abdomen

yellow eyes or skin

Incidence not known

Abdominal bloating

acid or sour stomach

belching

backache

full or bloated feeling or pressure in the stomach

heartburn

indigestion

loss of appetite

pelvic pain

stomach discomfort, upset or pain

stomach pain

swelling of abdominal or stomach are

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Abdominal cramps

back pain

body aches or pain

breast pain or tenderness

congestion

chills

cough

crying

depersonalization

diarrhea

dryness or soreness of throat

dysphoria

enlarged breasts

euphoria

feeling faint, dizzy, or light-headedness

feeling of warmth or heat

fever

flushing or redness of skin, especially on face and neck

general feeling of discomfort or illness

headache, severe and throbbing

hoarseness

increase in amount of clear vaginal discharge

itching

joint pain

lack or loss of strength

mental depression

muscle aches and pains

nausea

pain

pain or tenderness around eyes and cheekbones

painful menstrual periods

painful or difficult urination

paranoia

passing of gas

quick to react or overreact emotionally

rapidly changing moods

runny nose

shivering

shortness of breath or troubled breathing

sneezing

sore throat

stuffy nose

stomach discomfort following meals

tender, swollen glands in neck

tightness of chest or wheezing

trouble sleeping

trouble in swallowing

unusual tiredness

voice changes

vomiting

Less common

Acne

bloating or swelling of face, ankles, or feet

cervix disorder

crying

depersonalization

dysphoria

euphoria

increase in sexual desire

leg cramps

mental depression

paranoia

quick to react or overreact emotionally

rapidly changing moods

sleeplessness

tense muscles

trouble sleeping

unable to sleep

unusual weight gain or loss

Incidence not known

Abdominal cramping

bloody or cloudy urine

bloody vaginal discharge

difficult, burning, or painful urination

frequent urge to urinate

light vaginal bleeding between periods and after intercourse

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.