Estrogens increase the risk of endometrial
cancer. Close clinical surveillance of all women taking estrogen
is important. Adequate diagnostic measures, including endometrial sampling
when indicated, should be undertaken to rule out malignancy in all cases
of undiagnosed persistent or recurring abnormal vaginal bleeding. There
is no evidence that the use of "natural" estrogens results in
a different endometrial risk profile than synthetic estrogens at equivalent
estrogenic doses. (see WARNINGS,
Malignant neoplasms, Endometrial cancer).
Cardiovascular and other risks. Estrogens with or without
progestins should not be used for the prevention of cardiovascular disease
or dementia. (see WARNINGS, Cardiovascular disorders and Dementia).
The Women's Health Initiative (WHI) study reported increased risks of
myocardial infarction, stroke, invasive breast cancer, pulmonary emboli,
and deep vein thrombosis in postmenopausal women (50 to 79 years of age)
during 5 years of treatment with oral conjugated estrogens (CE 0.625
mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to
placebo (see CLINICAL PHARMACOLOGY, Clinical Studies,
Warnings, Cardiovascular disorders and Malignant neoplasms, Breast cancer).
The Women's Health Initiative Memory Study (WHIMS), a substudy of WHI,
reported increased risk of developing probable dementia in postmenopausal
women 65 years of age or older during 4 years of treatment with oral
conjugated estrogens plus medroxyprogesterone acetate relative to placebo.
It is unknown whether or not this finding applies to younger postmenopausal
women. (See CLINICAL PHARMACOLOGY, Clinical Studies,
Warnings, Dementia and PRECAUTIONS, Geriatric Use). Other doses
of conjugated estrogens with medroxyprogesterone acetate, and other combinations
of estrogens and progestins were not studied in the WHI and, in the absence
of comparable data, these risks should be assumed to be similar. Because
of these risks, 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. |