Evamist

Estrogen Alone Tx Risk

Endometrial Cancer: unopposed estrogen use incr. endometrial CA risk in patients with intact uterus; adding progestogen may decr. risk of endometrial hyperplasia, a possible precursor to endometrial CA; use adequate diagnostic measures such as endometrial sampling to rule out malignancy if undiagnosed persistent or recurrent abnormal genital bleeding; Cardiovascular and Probable Dementia: do not use estrogen-alone tx for cardiovascular disease or dementia prevention; incr. risk of stroke and DVT in postmenopausal patients 50-79 yo (WHI estrogen-alone substudy regimen = conjugated estrogens 0.625 mg/day x7y); incr. risk of probable dementia in postmenopausal patients 65 yo and older (WHIMS estrogen-alone substudy regimen = conjugated estrogens 0.625 mg/day x5y); risk unknown in younger postmenopausal patients; other doses and routes of conjugated estrogens or other estrogen-alone products not studied, therefore adverse cardiovascular events and dementia relevance is unknown; weigh risk/benefit; use lowest effective estrogen dose, shortest duration based on individual tx goals and risks

Estrogen Plus Progestogen Tx Risk

Cardiovascular and Probable Dementia: do not use estrogen + progestogen tx for cardiovascular disease or dementia prevention; incr. risk of MI, stroke, and PE/DVT in postmenopausal patients 50-79 yo (WHI estrogen/progestogen substudy regimen = conjugated estrogens 0.625 mg/day with medroxyprogesterone 2.5 mg/day x6y); incr. risk of probable dementia in postmenopausal patients 65 yo and older (WHIMS estrogen/progestogen substudy regimen = conjugated estrogens 0.625 mg/day with medroxyprogesterone 2.5 mg/day x4y); risk unknown in younger postmenopausal patients; Breast CA: estrogen + progestogen tx may incr. risk of invasive breast CA in postmenopausal patients (WHI estrogen/progestogen substudy regimen = conjugated estrogens 0.625 mg/day with medroxyprogesterone 2.5 mg/day x6y); doses and routes of other estrogen progestogen combos not studied, therefore adverse cardiovascular events, dementia, and breast CA relevance is unknown; weigh risk/benefit; use lowest effective estrogen dose, shortest duration based on individual tx goals and risks

Secondary Exposure to Estrogen

children should avoid contact with application sites in patients using topical estrogen products due to reports of breast budding, breast masses, and gynecomastia after unintentional secondary exposure; topical estrogen use instructions should be followed