Estradiol Effective For Hot Flashes Linked Menopause

Armen Hareyan's picture
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Medical specialists from around the country will gather this week to discuss the latest research in obstetrics and gynecology, and menopause and estrogen therapy will be among the information presented.

"Estrogen therapy continues to be the gold standard for the management of hot flashes, the most common physical sign of menopause," said Dr. Ricki Pollycove, fellow, American College of Obstetrics and Gynecology and clinical faculty member, University of California, San Francisco. "However, because of misconceptions that still exist today due to the influx of conflicting information that has emerged since the Women's Health Initiative Study, women may not be aware that advances in low-dose hormone therapies exist."

In June 2007, the U.S. Food and Drug Administration (FDA) approved Divigel (estradiol gel) 0.1 percent, the lowest approved dose of estradiol available for the treatment of moderate to severe hot flashes associated with menopause. Guidelines from the North American Menopause Society (NAMS) indicate that estrogen hormone therapy should be used at the lowest effective dose for the shortest amount of time.

"Transdermal estrogen therapies, such as Divigel, are emerging as an effective and safe mode of treatment," said Dr. Pollycove.

The estrogen in Divigel is derived from plant sources and is bioidentical to the primary estrogen produced by a woman's ovaries before menopause. Certain older oral estrogen therapies contain conjugated estrogens derived from the urine of pregnant mares. Divigel is a quick-drying gel that is odorless when dry, and is available in convenient, individual-use packets. One packet of gel is applied daily to an area that measures approximately 5 x 7 inches on the thigh, the smallest application area compared to all other available gel or lotion estrogen products. After the gel is applied, it absorbs directly into the bloodstream without having to pass through the liver. Divigel also offers dosing flexibility with three different strengths (0.25 mg estradiol/day, 0.5 mg estradiol/day and 1.0 mg estradiol/day) to individualize treatment for each woman.

Important Safety Information for Patients

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The following are not all the possible risks for Divigel. Please read the full Patient Information leaflet and talk to your healthcare provider.

Estrogens increase the chance of getting cancer of the uterus. Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause. In general, the addition of a progestin is recommended for women with a uterus to reduce the chance of getting cancer of the uterus.

Do not use estrogens, with or without progestins, to prevent heart disease, heart attacks, or strokes. Using estrogens, with or without progestins, may increase your chance of getting heart attacks, strokes, breast cancer, and blood clots.

Do not use estrogens, with or without progestins, to prevent dementia. Using estrogens, with or without progestins, may increase your risk of dementia.

Do not use estrogen products, including Divigel, if you have unusual vaginal bleeding, currently have or have had certain cancers, had a stroke or heart attack in the past year, currently have or have had blood clots, currently have or have had liver problems, are allergic to any Divigel ingredients, or think you may be pregnant.

The most common side effects for all estrogen products are headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps and bloating, nausea and vomiting, and hair loss. Less common but serious side effects include breast cancer, cancer of the uterus, stroke, heart attack, blood clots, dementia, gallbladder disease and ovarian cancer.

In Divigel clinical trials, the most common side effects were inflammation of the nasal passages and pharynx, upper respiratory tract infection, vaginal yeast infection, breast tenderness and vaginal bleeding. Call your healthcare provider right away if you have any symptoms that concern you.

Estrogen products should be used at the lowest dose possible for your treatment and only as long as needed. You and your healthcare provider should talk regularly about whether you still need treatment with Divigel.

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