Estrogen (Topical)

Within a few weeks to months, you may notice:

• Relief from hot flashes, night sweats, and vaginal dryness
• Better sleep, mood, and mental clarity
• More stable energy and improved focus
• Improved urinary health and sexual function

With continued use, hormone therapy may help support:

• Heart and brain health
• Bone strength and prevention of osteoporosis
• Cognitive function and reduced dementia risk
• Weight and metabolic balance

These are usually temporary and dose-related:

• Headaches, breast tenderness, or bloating
• Mood changes or sleep disturbances
• Spotting or menstrual changes
• Skin irritation or mild swelling

Call your doctor if you experience strong or persistent symptoms like severe abdominal pain, unusual vaginal bleeding, breast lumps, or signs of a blood clot (swelling, chest pain, shortness of breath).

Call your doctor right away if you experience any of the following while on estrogen therapy:

• Unusual vaginal bleeding or spotting
• Breast lumps or new breast pain
• Severe headaches or migraines
• Vision changes or blurred vision
• Chest pain or shortness of breath
• Swelling, redness, or pain in the legs (possible blood clot)
• Yellowing of the skin or eyes (possible liver issue)
• Severe abdominal pain or persistent nausea
• Signs of allergic reaction (rash, itching, swelling)

These could signal a serious side effect or the need to adjust your dose.

Estrogen Black Box Warning

1. Endometrial Cancer

   • Using estrogen without a progestogen in women with a uterus increases the risk of endometrial (uterine) cancer.
   • To reduce this risk, a progestogen is typically prescribed alongside estrogen in women who still have a uterus.

2. Cardiovascular Risks

   • Estrogen therapy may increase the risk of stroke, deep vein thrombosis (DVT), pulmonary embolism, and heart attack, especially in postmenopausal women over 50.

3. Breast Cancer

   • Estrogen, especially when combined with a progestin, may increase the risk of invasive breast cancer.

4. Use for Shortest Duration

   • Hormone therapy should be used at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Note: These warnings are based primarily on oral, synthetic hormone therapies used in large studies like the Women’s Health Initiative (WHI). Bioidentical and transdermal therapies may carry different risk profiles, but are still subject to the same FDA labeling requirements.

• Use as indicated by your doctor.

For more instruction on how to use your medication, select the device you recevied:

• Syringe
• Megapump
• Topiclick

• Wait 3–4 hours after applying the cream before your blood draw, or as instructed by your doctor.
• Do not draw from areas where the cream was applied.
• Lab testing is usually done at baseline, 1–3 months in, and then every 3-6 months.
• Common labs: Estradiol and/or Estrone, Progesterone, Testosterone, SHBG, FSH/LH