Estropipate belongs to the class of medications known as estrogen replacement therapy. Estrogen is a hormone that is produced by the ovaries. Estropipate is a type of estrogen. Once menopause is reached, the ovaries produce less estrogen and progesterone, and symptoms of menopause can occur. This medication is an estrogen replacement hormone used to manage symptoms of menopause such as abnormal uterine bleeding, hot flashes, sweating, and chills.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The dose of estropipate should be adjusted to the minimum amount required to control symptoms. Usually the medication is taken for 21 to 25 days of the month, followed by 5 to 7 days of rest. Women who have had a hysterectomy (i.e., they have had their uterus removed) may take the tablets daily. Women who have not had a hysterectomy should take the medication along with a progestogen (such as progesterone or medroxyprogesterone acetate) for 12 to 14 days of each cycle to reduce the risk of endometrial (uterine) cancer.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Estropipate should not be taken by anyone who:

• is allergic to estropipate or to any of the ingredients of the medication
• is or may be pregnant
• has classical migraines
• has endometrial hyperplasia
• has had a stroke, a heart attack, or heart disease
• has had breast cancer or endometrial cancer, except in special circumstances
• has had diseases of circulation or clotting
• has liver dysfunction or liver disease
• has partial or complete loss of vision or double-vision from eye disease related to circulation problems
• has undiagnosed abnormal vaginal bleeding

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bloating of the stomach
• cramps of the lower stomach
• diarrhea (mild)
• dizziness (mild)
• headaches (mild)
• loss of appetite
• nausea
• problems with wearing contact lenses
• unusual decrease in sexual desire
• vomiting (usually with high doses)

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• breast pain
• changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
• increased breast size
• lumps in, or discharge from, the breast
• pains in the stomach, side, or abdomen
• swelling of the feet and lower legs
• symptoms of liver damage (such as yellow skin or eyes, abdominal pain, dark urine, clay coloured stools, loss of appetite, nausea and vomiting, or itching)
• weight gain (rapid)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• headache (sudden or severe)
• loss of coordination (sudden)
• loss of vision or change of vision (sudden)
• pains in the chest, groin, or leg, especially in the calf of leg
• shortness of breath (sudden and unexplained)
• slurring of speech (sudden)
• weakness or numbness in arm or leg

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breast cancer: Studies indicate an increased risk of breast cancer with long-term use of estrogen replacement therapy. Women who have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer should speak to their doctor about the use of estrogens. Women taking estrogens should have regular breast examinations and should be instructed in breast self-examination.

Blood pressure: Increased blood pressure is not uncommon in women using this medication. Blood pressure should be monitored with estrogen use, especially if high doses are used.

Blood problems:People with blood clotting or circulation disorders, varicose veins, severe obesity, and those on bedrest for 3 weeks or more should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Smoking can increase the risk of blood clots. Women who take estrogen are strongly advised not to smoke. Inform your doctor if you are planning an upcoming surgery, as there is an increased risk of blood clot formation when using this medication. If you experience sharp pain in the chest, pain in the calf, sudden shortness of breath, or are coughing blood, contact your doctor immediately, as these symptoms could indicate a possible blood clot.

Cholesterol: Oral estrogens can increase triglycerides in the blood. Your doctor may check your cholesterol while on estrogen.

Diabetes: Estrogens may affect blood glucose control. Anyone with diabetes should carefully monitor their blood glucose levels while taking any product containing estrogen.

Endometrial cancer: There is evidence from several studies that estrogens, when taken without progestogens, increase the risk of endometrial (uterine) cancer. Taking a progestogen appropriately along with the estrogen reduces this risk to the same level as that of a woman who does not take estrogen. For this reason, all women who have not had their uteruses removed should also take a progestogen if they use estrogens.

Fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Fluid retention: Estrogen may cause fluid retention. Women with heart or kidney dysfunction, epilepsy, or asthma should speak to their doctor about what signs and symptoms to watch for and monitor their condition closely.

Gallbladder disease: An increased risk of gallbladder disease has been reported in postmenopausal women taking estrogens.

Pregnancy: Estrogen should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor.

Breast-feeding: Estrogen is not safe for use during breast-feeding. A decision should be made whether to discontinue breast-feeding or to discontinue the estrogen, taking into account the importance of the medication to the mother.

Children: The safety and effectiveness of this medication have not been established for use by children.

There may be an interaction between estropipate and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.