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Precautions and Warnings With Estradiol Vaginal Tablets

Specific Precautions and Warnings With Estradiol Vaginal Tablets

Warnings and precautions to be aware of prior to using estradiol vaginal tablets include the following:
  • Studies have shown that estrogen hormone replacement therapy increases the risk of strokes and blood clots in the legs. These risks are probably quite low for estradiol vaginal tablets, as they are taken vaginally at a low dosage. However, your healthcare provider should make sure that you are appropriately treated for any risk factors for blood clots or heart disease before you take estradiol vaginal tablets. Risk factors include:
  • When possible, estrogen medications should be stopped at least four weeks before many surgeries in order to help prevent blood clots.
  • Let your healthcare provider know if you have abnormal vaginal bleeding (such as heavy bleeding or bleeding between periods) while taking estradiol vaginal tablets, 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 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, are recommended.
  • Women who take estrogens 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 tablets.
  • Estrogens can cause high blood pressure (hypertension) or high triglycerides in some women. Your healthcare provider should monitor you for these problems while you are using estradiol vaginal tablets.
  • Estradiol vaginal tablets can make uterine fibroids worse.
  • Care should be taken when inserting the applicator, especially in women who have irritated vaginal tissues.
  • Estrogens can cause fluid retention. This can be dangerous for people with certain medical conditions, such as congestive heart failure (CHF).
  • If you have had jaundice (yellowing of the whites of the eyes or skin) due to estrogens or pregnancy in the past, estradiol vaginal tablets could cause similar problems to recur. If this happens, your healthcare provider will probably advise you to stop taking the drug.
  • Estrogen medications may not be a good choice for women with liver disease, as the liver helps metabolize estrogens.
  • Giving estrogens to women with breast cancer that has spread to the bone can lead to dangerously high blood calcium levels (hypercalcemia).
  • Estradiol vaginal tablets may interact with a number of different medications (see Drug Interactions With Estradiol Vaginal Tablets).
  • Estradiol vaginal tablets should not be used during pregnancy (see Vagifem and Pregnancy).
  • The hormone in estradiol vaginal tablets enters the bloodstream and passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Vagifem and Breastfeeding).
Last reviewed by: Kristi Monson, PharmD
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