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INTRODUCTION

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ESTRADIOL (es-tra-dye-ole)

Estrace, Gynodiol

estradiol acetate (es-tra-dye-ole as-e-tate)

Femtrace

estradiol cypionate (es-tra-dye-ole sip-ee-oh-nate)

depGynogen, Depo-Estradiol, Depogen, Dura-Estrin, E-Cypionate, Estragyn LA 5, Estro-Cyp, Estrofem, Estroject-LA, Estro-L.A

estradiol valerate (es-tra-dye-ole val-er-ate)

Clinagen LA, Delestrogen, Dioval, Duragen, Estra-L, Estro-Span, Femogex, Gynogen L.A, Menaval, Valergen

estradiol topical emulsion

Estrasorb

estradiol topical gel

Divigel, Elestrin, EstroGel

estradiol transdermal spray

EvaMist

estradiol transdermal system

Alora, Climara, Esclim, Estraderm, FemPatch, Menostar, Vivelle

estradiol vaginal tablet

Vagifem

estradiol vaginal ring

Femring, Estring

Classification

Therapeutic: hormones

Pharmacologic: estrogens

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Indications
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PO, IM, Topical, Transdermal: Replacement of estrogen (hormone replacement therapy, HRT) to diminish moderate-to-severe vasomotor symptoms of menopause and of various estrogen-deficiency states, including Female hypogonadism, Ovariectomy, Primary ovarian failure. Treatment and prevention of postmenopausal osteoporosis (not vaginal dose forms). PO: Inoperable metastatic postmenopausal breast or prostate carcinoma. Vaginal: Management of atrophic vaginitis that may occur with menopause (low dose), bothersome systemic symptoms of menopause (higher dose). Concurrent use of progestin is recommended during cyclical therapy to decrease the risk of endometrial carcinoma in patients with an intact uterus.

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Action
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Estrogens promote growth and development of female sex organs and the maintenance of secondary sex characteristics in women. Metabolic effects include reduced blood cholesterol, protein synthesis, and sodium and water retention. Therapeutic Effects: Restoration of hormonal balance in various deficiency states, including menopause. Treatment of hormone-sensitive tumors.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness, lethargy. EENT: intolerance to contact lenses, worsening of myopia or astigmatism. CV: MI, THROMBOEMBOLISM, edema, hypertension. GI: nausea, weight changes, anorexia, increased appetite, jaundice, vomiting. GU: womenamenorrhea, dysmenorrhea, breakthrough bleeding, cervical erosions, loss of libido, vaginal candidiasis; menerectile dysfunction, testicular atrophy. Derm: oily skin, acne, pigmentation, urticaria. Endo: gynecomastia (men), hyperglycemia. F and E: hypercalcemia, sodium and water retention. MS: leg cramps. Misc: breast tenderness.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of myocardial infarction, especially during exercise. Seek immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

  • Monitor signs of venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) to the physician.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of ...

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