Conjugated Estrogen

Molecule Description

Conjugated estrogens are mixture of estrogen hormones from different sources an

d are used in the treatment of age related conditions in women of menopause (terminated menstrual periods) and related symptoms. This medicine belongs to a class of medicines known as ‘hormone replacement therapy’.

Uses

Contraindications

Side effects

Precautions and Warnings

Uses of Conjugated Estrogen

Treatment of
Symptoms of estrogen deficiency in women after reaching menopause (post-menopausal
women) – such as hot flashes (redness of skin), usually on face, neck and chest; breast pain,
headaches, mood swings etc.
Prevention of
Bone thinning and bone loss which is common in estrogen deficient or post-menopausal
women (osteoporosis). This condition will increase the risk of bone weakening and fractures.

Contraindications of Conjugated Estrogen

When should one not use Conjugated Estrogen

Allergy to Conjugated estrogens or any components used in the medicine
History of breast cancer or the lining of uterus (endometrial cancer) or any other estrogen
related cancers
History of or tendency for blood clot formation e.g. in the legs (deep venous thrombosis) or the
lungs (pulmonary embolism), or any other clotting disorders
An inherited diseases that causes defective red cell production and purple patches on the skin
(porphyria)
Liver disease

Side effects of Conjugated Estrogen

Common side effects of this drug are:

Cancers of the breast and ovary
Formation of blood clots in the veins of lungs or legs
Thickening or growths in the lining of uterus (endometriosis or cancer)
Heart diseases, brain stroke, loss of memory
Unexplained uterine or vaginal bleeding, irregular bleeding or spotting, pain in the pelvic region
(below stomach), irritation and discharge from vagina, breast pain and swelling, discharge from
nipples, feeling sick (nausea), stomach pain, mood swings, anxiety, depression, leg cramps,
weight loss or gain, increased cholesterol, tremors, memory loss, worsening of asthma, gall
bladder disease or irritation of the intestines causing blood in the stools (less common)
Severe allergic reactions causing swelling of the body, face, lips and throat and swallowing and
breathing difficulty with or without rashes, itching, skin peeling, especially in women (serious,
but rare).

Precautions and Warnings of Conjugated Estrogen

Pregnancy

Can I take Conjugated Estrogen during pregnancy?

You should not Conjugated estrogens during pregnancy as increased estrogen levels may harm the baby.

Breast Feeding

Can I take Conjugated Estrogen while breastfeeding?

Conjugated estrogens should not be given in breast-feeding women because they suppress production of milk (lactation).

Driving

Can I drive if I have consumed Conjugated Estrogen?

It is unknown if Conjugated estrogens can affect your ability to drive.

Alcohol

Can I consume alcohol with Conjugated Estrogen?

Alcohol can increase estrogen levels and increase the risk of cancers. It is recommended not to consume alcohol while on Conjugated estrogens.

Other General Warnings

Talk to your doctor if

Inform your doctor if you have a history of or develop:
Thickness or growths in the lining of uterus (endometriosis or uterine fibroids)
Risk or tendency of developing blood clots
Heart, liver or kidney disease, high blood pressure
Any family history of estrogen dependent cancers
Swelling of hands and feet, diabetes, seizures, migraine, asthma, gall bladder disease, ear
problems, high fats or low calcium in the blood
Inform the doctor about all the products you are using (including prescription medicines, non-
prescription medicines, and herbal products)

Mode of Action of Conjugated Estrogen

How Does It Work?

Conjugated estrogens are derived from natural sources such as humans, animals and plants (commonly from urine of pregnant women and horses) and perform the functions of estrogen hormone which become...

Interactions of Conjugated Estrogen

Interactions with other medicines

Use the following medicines with caution
Anti-seizure medications (carbamazepine, phenytoin, phenobarbital)
Certain anti-infective medicines – to treat TB (rifampicin, rifabutin), HIV (nevirapine, efavirenz,
ritonavir), antibiotics (erythromycin, clarithromycin), antifungals (ketoconazole, itraconazole)
Metyrapone (used to treat problems of adrenal glands present on top of the kidneys),
cimetidine (reduces stomach acids), dexamethasone (suppresses immune response) or st.john’s
wort (a herbal preparation used for depression).

Interactions with food items

Conjugated estrogens can be used with or without food.

Dietary Restrictions of Conjugated Estrogen

Avoid grapefruit juice.

Dosage of Conjugated Estrogen

Overdose

Occasional overdose with Conjugated estrogens may not be harmful. But consult the doctor in the presence of any symptoms such as - nausea, vomiting, dizziness, breast pain, stomach pain, vaginal ble...

If you missed any dose take it as early as you remember. If it is time for the next dose, skip the
missed dose and continue your regular dosing schedule. Do not take a higher or a double dose
of medicine to compensate for the missed dose.
It is advised not to miss any doses with Conjugated estrogens it may cause irregular bleeding.

Frequently Asked Questions (FAQs)

Q: What is the difference between estradiol and Conjugated estrogens?

Estradiol (E2) is naturally occurring form of estrogen, which is produced outside the human
body from one of the many sources, such as estrone – another form of estrogen that is
produced in ovaries, placenta and some other tissues, or from a substance called disogenin
found in soya and yams.
E2 (estradiol) is available in tablet, cream, gel, patches and ring forms.
Conjugated estrogens (CE) are made from different types of estrogens – such as from human,
animal and plant sources. The main source of CE is urine of pregnant women and mares
(horses) and is available in tablet and cream forms.
There is one more form of estrogen that is commonly used in birth control pills –
Ethinylestradiol (EE), which is artificially prepared from plants. The chemical form of EE is 17-
alpha-ethinylestradiol and is available only as a tablet.
While E2 (estradiol) and conjugated estrogens (CE) are considered to be natural estrogens,
ethinylestradiol (EE) is an artificial and most potent of all the 3 varieties.
Both the formulations are used in estrogen deficiency symptoms such as menopause (age-
related termination of menstrual periods) and prevention of bone loos and thinning
(osteoporosis) in such patients, while ethinyl estradiol (EE) is used in birth control pills.
This is because EE is very strong (has high estrogenic activity), due to which it suppresses the
ovarian function required for fertility. 10 micro grams of EE is equivalent to 1.25 milli grams of
conjugated estrogens.
Among estradiol (E2) and conjugated estrogens (CE), E2 has a better safety profile, but is
absorbed quickly, very little is available to exert any actions and is ideal for patients with mild
and responsive symptoms. While CEE, stays for a longer time in the blood, due to presence of
multiple estrogens, and is usually given when the symptoms are difficult to manage.

Q: Is there anything else I need to know before taking Conjugated estrogens?

Inform the doctor in case of premature menopause (menopause achieved earlier than
expected), as the treatment in these type of patients may vary.
Before starting treatment with Conjugated estrogens, a complete physical examination,
including that of the breasts and genital organs is necessary. Make sure you get this done.
Regular check-up and breast examination (or screening) would be required through the
treatment.
Inform your doctor if you notice any changes in or near the nipple, dimpling of the skin or any
lumps or hard swellings in the breast.
Conjugated estrogens should be taken in the exact dose as advised by the physician
Do not take more than the recommended dose of this medicine.
Overdose of conjugated estrogens can cause serious heart problems
The medicines are sometimes given in cycles – for e.g. 3 weeks medicines, 1 week off. - It can
be taken with or without meals

References

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Last Updated on: 05 Oct 2020 | 10:47 PM (IST)

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