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Estrogens act through binding to nuclear receptors in estrogen-responsive tissuesTo datetwo estrogen receptors have been identifiedThese vary in proportion from tissue to tissue.
The WHI estrogen-plus-progestin substudy demonstrated an increased risk of invasive breast cancer.
Because estrogens may cause some degree of fluid retentionpatients with conditions that might be influenced by this factorsuch as asthmaepilepsymigraineand cardiac or renal dysfunctionwarrant careful observation when estrogens are prescribed.
Use of ESTRACE alone or in combination with a progestinshould be limited to the shortest duration consistent with treatment goals and risks for the individual womanPostmenopausal women should reevaluate periodically as clinically appropriate to determine if treatment is still necessaryFor treatment of vulvar and vaginal atrophy associated with the menopausethe lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possibleFor women who have a uterusadequate diagnostic measuresincluding directed and random endometrial sampling when indicatedshould be undertaken to rule out malignancy in cases of undiagnosed persistent or recurring abnormal genital bleeding.
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