Estropipate

INTRODUCTION

Indications

PO: As part of HRT in the treatment of vasomotor symptoms of menopause. Treatment of various estrogen-deficiency states, including Female hypogonadism, Ovariectomy, Primary ovarian failure. Adjunctive therapy of postmenopausal osteoporosis.

Vaginal: Management of atrophic vaginitis. Concurrent use of progestin is recommended during cyclical therapy to decrease the risk of endometrial carcinoma in patients with an intact uterus.

Action

Estrogens promote the 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.

Adverse Reactions/Side Effects

(systemic use)

CNS: headache, dizziness, lethargy, mental depression. 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: women—amenorrhea, breakthrough bleeding, dysmenorrhea, cervical erosion, loss of libido, vaginal candidiasis; men—erectile dysfunction, testicular atrophy. Derm: acne, oily skin, pigmentation, urticaria. Endo: gynecomastia (men), hyperglycemia. F and E: hypercalcemia, sodium and water retention. MS: leg cramps. Misc: breast tenderness.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of myocardial infarction (MI), 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 high calcium levels (hypercalcemia), including muscle pain, cramps, weakness, joint pain, confusion, and lethargy. Notify physician because severe cases can lead to stupor and coma.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• If treating menopausal symptoms, monitor severity and frequency of vasomotor symptoms (hot flashes) and other symptoms (vaginal/vulvular itching and irritation) to help determine drug efficacy.

• Assess dizziness that might affect gait, balance, and other ...