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A few cases of malignant transformation of residual endometrial implants have been reported in women treated post-hysterectomy with estrogen-alone therapyFor women known to have residual endometriosis post-hysterectomythe addition of progestin should be considered.

The adverse reactions listed in the table are based on post-marketing spontaneousreporting rateclinical trials and class-effects.

Avoid smokingIt can greatly increase your risk of blood clotsstrokeor heart attack while using conjugated estrogens.

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A very serious allergic reaction to this product is rareHoweverget medical help right away if you notice any symptoms of a serious allergic reactionincludingrashitching/swellingespecially of the face/tongue/throatsevere dizzinesstrouble breathing.

Body system totals are not necessarily the sum of individual adverse eventssince a patient may report two or more different adverse reactions in the same body system.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effectsMany people using this medication do not have serious side effects.

If a tablet is forgottenit should be taken as soon as the patient rememberstherapy should then be continued as beforeIf more than one tablet has been forgotten only the most recent tablet should be takenthe patient should not take double the usual dose to make up for missed tablets.

Signs of a blood clotsudden vision lossstabbing chest painfeeling short of breathcoughing up bloodpain or warmth in one or both legs;

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Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

There is no evidence that the use of natural estrogens results in a different endometrial risk profile than synthetic estrogens of equivalent estrogen doseAdding a progestin to postmenopausal estrogen therapy has been shown to reduce the risk of endometrial hyperplasiawhich may be a precursor to endometrial cancer.

The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymesspecifically cytochrome P450 3A4CYP3A4enzymesThereforeinducers or inhibitors of CYP3A4 may affect estrogen drug metabolismInducers of CYP3A4such as StJohn’s wortHypericum perforatumpreparationsphenobarbitalphenytoincarbamazepinerifampicinrifabutinnevirapineefavirenz and dexamethasonemay reduce plasma concentrations of estrogenspossibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profileInhibitors of CYP3A4such as cimetidineerythromycinclarithromycinketoconazoleitraconazoleritonavirnelfinavir and grapefruit juicemay increase plasma concentrations of estrogens and may result in side effects.

In women who are not taking hormone replacement therapy or women who switch from a continuous combined hormone replacement therapy producttreatment may be started on any convenient dayIn women transferring from a sequential hormone replacement therapy regimentreatment should begin the day following completion of the prior regimen.

The WHI estrogen plus progestin substudy reported increased risks of DVTpulmonary embolismPEstroke and myocardial infarctionMIin postmenopausal women50 to 79 years of ageduring 5.6 years of treatment with daily oral CE0.625 mgcombined with medroxyprogesterone acetateMPA2.5 mgrelative to placebosee WARNINGS AND PRECAUTIONSand Clinical Studies

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