What is Estrofem 

• Estrofem is a hormone replacement therapy (HRT) that is used for the short-term symptomatic treatment of women who have had their womb surgically removed (which is called hysterectomy) and who have signs and symptoms of oestrogen deficiency.
• A woman's last menstrual period is called the menopause and usually occurs between the ages of 45 and 55 years. Around the time of the menopause, the body slowly stops producing the two sex hormones called oestrogen and progesterone. Periods become irregular until they finally stop.
• If a woman has surgical or natural menopause the production of these hormones is diminished or stopped.
• Estrofem replaces the hormone called oestrogen which your body stops making after surgical or natural menopause.
• The falling or reduced hormone levels may cause you to experience uncomfortable symptoms such as hot flushes, night sweats, sleeplessness, dry vagina, urinary problems, headaches, mood swings, lack of concentration or loss of energy.
• The oestrogen in Estrofem relieves the symptoms caused by a lack of oestrogen.
• If you have not had a hysterectomy your doctor may prescribe another medicine (a progesterone type medicine) to be taken with Estrofem for 10-14 days of your 28 day cycle. It is very important to take both medications exactly the way your doctor has prescribed.

If you have any questions about the combination of the two medicines please talk to your doctor.

Your doctor may have prescribed Estrofem for another reason. Ask your doctor if you have any questions about why Estrofem has been prescribed for you.

Before you take Estrofem

Do not take Estrofem if:

• you are pregnant or suspect you may be pregnant, or you are breast-feeding
• you know or suspect you have, or you have had, a tumour which depends on hormones (e.g. cancer of the breast or the lining of the womb)
• you know or suspect you have, or you have had, breast cancer
• you have recently developed liver disease; or you have a history of liver disease where your blood test results have not returned to normal
• you have porphyria (a rare disease of blood pigments)
• you have any unexplained vaginal bleeding
• you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated
• you know that you are allergic to any of the ingredients in Estrofem
• you have or ever had any kind of blood clots
• you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• you have pain in your calf and your leg is swelling
• it is after the expiry date (Expiry) printed on the pack
• the packaging is torn or shows signs of tampering

Tell your doctor if:

• you have not had a hysterectomy, because another medicine may be more suitable for you
• you have previously taken oestrogen by itself for menopausal symptoms and have not had a hysterectomy. The long-term use of oestrogen without a progesterone can increase the risk of cancer of the lining of the womb
• you have a family history of blood clots
• you are to be hospitalised or undergoing surgery, particularly where you are or will be off your feet for a long time. You may need to stop taking Estrofem 4 to 6 weeks before your operation, to reduce the risk of a blood clot
• you have an intolerance to some specific sugars e.g. lactose (found in milk and milk products). Estrofem tablets contain lactose

Tell your doctor if you have or have had any medical conditions, especially the following:

• fibroids of the womb or endometriosis and you have not had a hysterectomy. Fibroids may increase in size while taking Estrofem and symptoms of endometriosis may worsen
• a history of excessive growth of the cells which line the womb
• family history of hormone-dependent cancer e.g. cancer of the breast or of the lining of the womb
• sudden blockage of your blood vessels, or risk factors for these events (e.g. you are seriously overweight, you have previously experienced one or more miscarriages, you have a family history of blood clots)
• high blood pressure
• inflammation of the pancreas due to high levels of blood fats (triglycerides)
• systemic lupus erythematosus (SLE)
• epilepsy, migraine, severe headache
• diabetes
• asthma
• gallstones
• liver disease
• heart disease
• kidney disease
• fluid retention (oedema)
• otosclerosis (hearing loss sometimes linked to pregnancy)

This is because you will need to be seen regularly by your doctor while you are taking Estrofem.

Unexpected bleeding

• You will have a bleed once a month (so-called withdrawal bleed) while taking Estrofem.

See your doctor as soon as possible if you have not had a hysterectomy and you have unexpected bleeding or drops of blood (spotting) besides your monthly bleeding, which:

• carries on for more than the first 6 months, or
• starts after you have been taking Estrofem more than 6 months, or
• carries on after you have stopped taking Estrofem.

Tell your doctor immediately if any of the following conditions occur (because you may be told to stop taking Estrofem):

• yellowing of your skin or eyes, or worsening of your liver function
• significant increase in your blood pressure
• migraine-like headache, and you have not previously had migraines
• sudden development of visual problems
• pregnancy
• If you have not told your doctor about any of the above, tell them before you take Estrofem. Estrofem should only be used to treat symptoms of the menopause that adversely affect your quality of life.

Taking other medicines

Tell your doctor if you are taking or plan to take other medicines, including:

• some medicines to help you sleep, including barbiturates
• some medicines for epilepsy e.g. phenytoin and carbamazepine
• some antibiotics and other anti-infective medicines e.g. rifampicin
• some anti-infectives such as ritonavir and nelfinavir, when used at the same time as steroid hormones
• St. John's Wort - used to treat depression
• Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop. The effect of Estrofem can be reduced by other medicines, and may affect your vaginal bleeding pattern.

How to take Estrofem

Read carefully the instructions included in this leaflet, in order to correctly use the calendar pack.

Take one tablet a day, preferably at the same time each day, until all 28 tablets have been taken. Swallow each tablet with a glass of water. When you have finished each pack, start the next pack immediately.

If you are not on any other hormone replacement therapy and you have had a hysterectomy you can start taking Estrofem on any day that is convenient. If you are still experiencing bleeds, you should start using Estrofem on day 5.

Estrofem should not be taken by children, men, during pregnancy or while breast-feeding.

Duration of therapy:

• HRT should be prescribed at the lowest effective dose and for the shortest duration necessary. The continuation of the treatment should be re-evaluated annually. Women who have undergone a premature menopause (e.g. hysterectomy) may require longer term treatment.

If you forget to take it

• You can always see if you have taken your tablet by looking at the day on the calendar dial pack.
• If you forget to take a tablet at the usual time, take it as soon as you remember. If it is almost time for your next dose, throw away the tablet you missed and take your next dose when you are meant to.
• Do not take a double dose to make up for a forgotten tablet.

While you are taking Estrofem

• You can expect your symptoms to improve within a few months of starting Estrofem.
• If you get breakthrough bleeding or spotting, it is usually nothing to worry about, especially during the first few months of taking HRT.
• Estrofem can be stopped at any time. You should discuss this with your doctor.
• Estrofem is not a contraceptive and will not prevent pregnancy. Estrofem is only recommended for women who have signs and symptoms of oestrogen deficiency due to surgical or natural menopause and who have had a hysterectomy performed. After hysterectomy you cannot get pregnant.
• At your routine check-up, your doctor may reassess your continued need for Estrofem. Alternative HRT treatment may be given if troublesome symptoms remain.
• If you have any concerns about taking Estrofem, ask your doctor or pharmacist. If your doctor tells you to stop taking Estrofem, return any unused medicine to your pharmacist.

Side effects

All medicines can have side effects. Sometimes they are serious, most of the time they are not.

Tell your doctor or pharmacist if you experience any side effects while you are taking Estrofem (whether or not they are mentioned below). You may need medical treatment if you experience some of the side effects.

When you start taking Estrofem your body has to adjust to new hormone levels. You may experience the following side effects:

• abdominal (stomach) pain, feeling sick (nausea), vomiting, diarrhoea, bloating, flatulence, indigestion
• skin rash or itching, skin reactions, changes in hair growth
• headache, migraine, epilepsy, dizziness
• changes in libido, problems getting to sleep
• breast tenderness, enlargement or pain
• asthma, or worsening of asthma
• gall bladder problems
• leg cramps
• weight increase
• fluid retention (oedema)
• fungal infection of the vagina (thrush)

These side effects are usually temporary and disappear.

Tell your doctor if:

• you think you may be suffering from depression
• you are not feeling well or find any side effect too uncomfortable or unacceptable
• any side effect becomes worse
• you have not had a hysterectomy and vaginal bleeding or spotting suddenly becomes heavier

Tell your doctor immediately if any of the following conditions occur (because you may be told to stop taking Estrofem):

• pain in your calf and your leg is swelling
• any kind of blood clots
• yellow colouring of the skin and eyes (jaundice)
• migraine or sudden severe headache, and you have not previously had migraines
• problems with your eyesight which develop suddenly
• marked rise in blood pressure
• if you have not had a hysterectomy - vaginal bleeding or spotting occurring after you have been period-free for some time
• you can see or feel a lump in your breast, or you notice dimpling of the skin or changes in the nipple
• you know or suspect you are pregnant

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:

• skin rashes over a large part of the body
• shortness of breath, wheezing
• swelling of the face, lips or tongue
• fast pulse
• sweating

Storage

Keep all medicines out of reach of children.

Do not use Estrofem after the expiry date stated on the carton and label. The expiry date refers to the last day of that month.

Keep Estrofem in a cool dry dark place where the temperature stays below 25°C. Do not put Estrofem in the refrigerator.

Do not dispose of medicines down the sink or in your household rubbish. Ask you pharmacist how to dispose of medicines you no longer require. These measures will help to preserve the environment.

References:

https://pharmacybg.co.uk/en/product/420-estrofem-2-mg--28-tablets

https://www.hpra.ie/img/uploaded/swedocuments/2191933.PA0218_0

https://www.healthtranslations.vic.gov.au/bhcv2/bhcmed.nsf/

https://netdoktor.dk/interactive/medicin/Estrofem-id438.html

https://www.medicines.ie/medicines/estrofem-2mg-32072/smpc

https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol