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Precautions and Warnings With Estradiol Vaginal Cream

Specific Warnings and Precautions for Estradiol Vaginal Cream

Some of the warnings and precautions to be aware of prior to using estradiol vaginal cream include the following:
  • It is important to understand that even though estradiol vaginal cream is applied vaginally, the estrogen hormone in the cream is absorbed into the bloodstream. This means that any of the risks associated with oral estrogen hormone replacement therapy also apply to estradiol vaginal cream. Although the risks are thought to be lower with estradiol vaginal cream (since the body is exposed to less of the hormone), the risk is not eliminated.
  • Studies have shown that estrogen hormone replacement therapy (such as estradiol vaginal cream) increases the risk of strokes and blood clots in the legs. Your healthcare provider should make sure that you are appropriately treated for any risk factors for heart disease (such as high blood pressure, high cholesterol, diabetes, obesity, or smoking) or blood clots before you use estradiol vaginal cream.
  • When possible, estradiol vaginal cream should be stopped four to six weeks before many surgeries in order to help prevent blood clots.
  • Let your healthcare provider know if you have abnormal vaginal bleeding (such as very heavy bleeding or bleeding between periods) while taking estradiol vaginal cream, as this may be a sign of precancerous or cancerous changes in the uterus. Your healthcare provider can perform the necessary tests to rule out cancer. Of course, if you have had a hysterectomy, you are not at risk for uterine cancer.
  • Estrogen drugs (such as estradiol vaginal cream) may increase the risk of breast cancer. Proper screening and monitoring (as determined by your healthcare provider), such as yearly mammograms and monthly self breast exams, is recommended.
  • Estrogen drugs (such as estradiol vaginal cream) seem to increase the risk of dementia. In no case should estradiol vaginal cream be used to prevent or treat dementia (it is not effective for this use).
  • Women who take estrogens (such as estradiol vaginal cream) have an increased risk for gallbladder disease.
  • Let your healthcare provider know right away if you notice any vision changes. This can signal a blood clot in the retina, a possible side effect of estradiol vaginal cream.
  • Estradiol vaginal cream can cause high blood pressure (hypertension) or high triglycerides in some women. Your healthcare provider should monitor you for these problems.
  • If you have had jaundice (yellowing of the whites of the eyes or skin) due to estrogens or pregnancy in the past, it is possible that estradiol vaginal cream will cause similar problems to recur. If this happens, your healthcare provider will probably advise you to stop taking estradiol vaginal cream.
  • If you have an underactive thyroid (hypothyroidism), estradiol vaginal cream may increase your body's requirement for thyroid hormones. Your healthcare provider should monitor you and adjust the dose of your thyroid medications as necessary.
  • Estradiol vaginal cream can cause fluid retention. This can cause problems for people with congestive heart failure (CHF) or kidney problems.
  • Estradiol vaginal cream should be used with caution in people who have low calcium levels in the blood (known medically as hypocalcemia).
  • It is not clear whether estradiol vaginal cream increases the risk of ovarian cancer. Some studies have shown an increased risk, while others have not.
  • Estradiol vaginal cream can make endometriosis symptoms worse.
  • Estradiol vaginal cream can interact with a number of different medications (see Drug Interactions With Estradiol Vaginal Cream for more information).
  • Estradiol vaginal cream should not be used during pregnancy (see Estrace Vaginal Cream and Pregnancy).
  • The hormone in estradiol vaginal cream enters the bloodstream and passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, discuss this with your healthcare provider prior to using the product (see Estrace Vaginal Cream and Breastfeeding).
Last reviewed by: Kristi Monson, PharmD
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