estradiol valerate
Estradiol valerate (Delestrogen) injection is a hormone replacement therapy (HRT). It's used to relieve certain menopause symptoms, such as hot flashes and vaginal dryness. It can also help raise estrogen levels in females with other conditions, such as hypogonadism and primary ovarian insufficiency (POI). Estradiol valerate (Delestrogen) injection is an injection that's given into the muscle every 1-4 weeks depending on the reason you're taking it. Potential side effects include vaginal spotting, breast tenderness, and headache.
What is Estradiol valerate (Delestrogen) injection?
What is Estradiol valerate (Delestrogen) injection used for?
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy from menopause, like vaginal dryness and irritation
Low estrogen level caused by female hypogonadism, primary ovarian insufficiency (POI), or castration
Palliative care for advanced androgen-dependent prostate cancer
How Estradiol valerate (Delestrogen) injection works
Estradiol valerate (Delestrogen) injection replaces estrogen hormones that your body loses during menopause or when your body can't make enough estrogen naturally. Replacing estrogen relieves symptoms of menopause, such as hot flashes and vaginal dryness.
Estradiol valerate (Delestrogen) injection can help lower androgen levels to help manage advanced prostate cancer.
Drug Facts
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What are the side effects of Estradiol valerate (Delestrogen) injection?
Common Side Effects
- Pain/tenderness where the medication is injected
- Breast tenderness or growth
- Nausea
- Headaches/migraines
- Vomiting
- Stomach cramps
- Vaginal spotting/breakthrough bleeding
- Weight changes
Other Side Effects
- Dizziness
- High blood pressure
- Melasma (dark patches of skin)
- Trouble tolerating contact lenses
- Menstrual cramps
- Nipple discharge
- Bloating
- Mood changes
Serious Side Effects
- Heart attack: chest pain, belly discomfort, sweating, nausea, dizziness
- Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Liver or gallbladder problems: yellowing of the skin or the whites of the eyes, tiredness, pain in the right upper stomach, dark urine
- Unusual vaginal bleeding, vaginal discharge, or pelvic pain
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heavy vaginal bleeding
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Estradiol valerate (Delestrogen) injection
Pros
Relieves multiple menopausal symptoms
Only injected once a month for most conditions
Available as a lower-cost generic
Cons
Injected into the muscles
Raises your risk of certain cancers, blood clots, and strokes
Can't use for people who have or have had breast cancer
Pharmacist tips for Estradiol valerate (Delestrogen) injection
Estradiol valerate (Delestrogen) injection can be given at home. Before using it, your healthcare professional will train you or a caregiver on how to inject this medication safely and properly.
Wash your hands with soap and water before giving estradiol valerate (Delestrogen) injection to prevent infection. Clean the area where you'll be injecting the medication with an alcohol wipe.
Make sure the needle and syringe you're using to draw up estradiol valerate (Delestrogen) injection are dry. Wet syringes can cause the medicine to look cloudy. If this does happen, the medication is still safe to use and will still be effective.
Use a new needle and syringe each time you give yourself estradiol valerate (Delestrogen) injection. Throw away the used syringes and needles in a protective (sharps) container. These containers might be given to you by your prescriber, but if not, they can be purchased at most pharmacies. Don't throw needles and syringes away in the regular trash.
Store estradiol valerate (Delestrogen) injection at room temperature, away from heat and direct light. Don’t let the medication get cold, as this can affect how well it works.
If you need to have any surgeries performed while you're taking estradiol valerate (Delestrogen) injection, ask your prescriber if you need to pause this medication. Estrogen-containing medications can raise your risk of blood clots during and after surgery.
Let your prescriber know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting estradiol valerate (Delestrogen) injection. These could be a sign of more serious side effects that are possible from this medication.
Frequently asked questions about Estradiol valerate (Delestrogen) injection
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What are the risks and warnings for Estradiol valerate (Delestrogen) injection?
Estradiol valerate (Delestrogen) injection can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Uterine or endometrial cancer
Risk factors: Estrogen therapy without additional progestin | People with a healthy uterus | Using estrogen therapy for more than 1 year | High estrogen dose
Because estradiol valerate (Delestrogen) injection works like estrogen in your uterus, it can change the lining of your uterus (endometrium). Uncontrolled growth of the uterus lining can cause uterine or endometrial cancer in people with a healthy uterus. If you have a healthy uterus, your healthcare team will lower your risk of cancer by also prescribing a progestin to balance out estrogen's effect on the growth of the uterine lining. Let your healthcare team know right away if you have symptoms of uterine or endometrial cancer, such as unexpected vaginal bleeding; they can examine you and let you know if you need more medical attention.
Breast cancer
Risk factors: Personal or family history of breast cancer | Using estrogen and progestin together for more than one year
Estrogen HRTs, like estradiol valerate (Delestrogen) injection, can raise your risk of breast cancer. Your risk is higher if you're also taking a progestin medication. Don't use estradiol valerate (Delestrogen) injection if you currently have or have had breast cancer in the past. To lower your risk of breast cancer, your HCP will prescribe the lowest dose of estrogen for the shortest period of time possible. It's important that you regularly check your breasts for any changes and get breast scans (mammograms) done. Let your healthcare professional know if you notice any unusual changes in breast shape, size, or color.
Blood clots, heart attacks, and strokes
Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking | Larger body size | Systemic lupus erythematosus (SLE)
Estradiol valerate (Delestrogen) injection can raise your risk of blood clots. The clots can happen in any area of the body and can lead to serious conditions, like heart attack, stroke, or pulmonary embolism. Your risk for blood clots is higher if you smoke or have had blood clots in the past. Be sure to discuss all your past and present medical conditions with your prescriber before starting estradiol valerate (Delestrogen) injection. Call 911 or get medical help right away if you have pain in your legs or arms, chest pain, sudden severe headaches, trouble breathing, or sudden changes in your speech or vision.
Risk of dementia
Risk factor: Females 65 years of age and older
People taking estrogen/progestin combinations or estrogen-only therapy might be at greater risk for dementia. Your risk is higher if you start hormonal therapy after age 65. Estrogen/progestin combination and estrogen-only therapies shouldn't be used to prevent dementia. Early symptoms of dementia include new forgetfulness, confusion, getting lost, and wandering out into the neighborhood. If the risk of dementia worries you, talk to your HCP.
Gallbladder problems
Estradiol valerate (Delestrogen) injection can cause you to have problems with your gallbladder. Some people have even needed to have their gallbladder removed after starting this medication. If you experience stomach pain, nausea or vomiting that doesn't go away, fever, or a yellowing of the skin and eyes (jaundice), speak with your prescriber or get medical help right away.
Higher risk of side effects
Risk factors: History of or current liver problems
Estradiol valerate (Delestrogen) injection is processed (broken down) by the liver, so if your liver isn't working properly, you might experience more side effects from this medication. Because of this, if you have or have had any problems with your liver, including liver problems during a past pregnancy, you shouldn't use estradiol valerate (Delestrogen) injection.
High triglycerides
Risk factors: High levels of triglycerides
Estrogens can raise the amount of your body's blood fats (triglycerides), which can cause heart problems or inflammation of the pancreas. Your prescriber might order regular blood tests to watch for this while you're using estradiol valerate (Delestrogen) injection. If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or get medical care right away.
Vision problems
Although very rare, some people taking estrogens have had vision problems due to clot formation in the eyes. If you have sudden partial or complete vision loss, bulging eyes, double vision, or migraines, stop estradiol valerate (Delestrogen) injection and tell your HCP.
Changes in calcium levels in the blood
Risk factors: Breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Estrogen therapy can change the calcium levels in your blood. Females with breast cancer that has spread to the bones are at higher risk of extremely high calcium levels. Symptoms of high calcium levels include feeling tired and having muscle weakness, nausea, vomiting, or constipation.
On the other hand, females with low parathyroid hormone levels from the parathyroid gland are at higher risk of low calcium levels during estrogen therapy. Symptoms of low calcium levels include muscle spasms or twitching and numbness and tingling in your fingers, toes, or around your mouth.
Let your HCP know if you notice any of these symptoms. You might need regular blood tests done so that your HCP can check your calcium levels while you're taking estradiol valerate (Delestrogen) injection.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Estradiol valerate (Delestrogen) injection can affect thyroid hormone levels in your blood. If you take medications for low thyroid hormone levels, you might require higher doses of thyroid replacement therapy. Your prescriber might have you perform regular blood tests to check your thyroid hormone levels.
Fluid Retention
Risk factors: History of heart or kidney problems
Estradiol valerate (Delestrogen) injection might cause some fluid retention, or edema. This could worsen symptoms of certain conditions, like heart conditions (e.g., congestive heart failure) or kidney problems. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your prescriber know.
Worsening of other medical conditions
Taking estrogen-containing medications can worsen certain medical conditions. These include high blood pressure, hereditary angioedema, asthma, diabetes, migraine, and seizures. Before you start estradiol valerate (Delestrogen) injection let your healthcare team know about your past medical history so they can talk with you about the risks and benefits of taking this medication.
Estradiol valerate (Delestrogen) injection dosage forms
Typical dosing for Estradiol valerate (Delestrogen) injection
Menopausal symptoms: The typical dose is to inject 10 mg to 20 mg into the gluteal muscle (buttocks) every 4 weeks. If you have a healthy uterus, your healthcare team will also prescribe a progestin medication at the same time. Your care team will check in with you every 3 to 6 months to see if it's appropriate to lower the dose of or stop estradiol valerate (Delestrogen) injection.
Low-estrogen conditions: The typical dose is to inject 10 mg to 20 mg into the gluteal muscle (buttocks) every 4 weeks.
Prostate cancer: The typical dose is to inject 30 mg into the gluteal muscle (buttocks) every 1 to 2 weeks.
How much does Estradiol valerate (Delestrogen) injection cost?
Estradiol valerate (Delestrogen) injection contraindications
Abnormal vaginal bleeding that your gynecologist doesn’t know about or you haven’t gone to them about
Currently have or have had breast cancer
Estrogen-dependent cancers (e.g., endometrial cancer, ovarian cancer)
High risk for developing a blood clot
History of blood clots, stroke, or heart attack
Have a bleeding disorder
Kidney problems
Liver problems
Currently pregnant
What are alternatives to Estradiol valerate (Delestrogen) injection?
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy from menopause, like vaginal dryness and irritation
Low estrogen level caused by female hypogonadism, primary ovarian insufficiency (POI), or castration
Palliative care for advanced androgen-dependent prostate cancer
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Low estrogen level caused by hypogonadism
Hot flashes, night sweats, and flushes from menopause
Vaginal dryness and irritation from menopause
Low estrogen from hypogonadism
Low estrogen from castration (removal of the ovaries)
Primary ovarian failure (ovaries stop working before age 40)
Certain advanced breast cancers
Certain advanced advanced prostate cancers
What is the latest news about Estradiol valerate (Delestrogen) injection?
Estradiol valerate (Delestrogen) injection images
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.
Bosland, M. C. (2005). The role of estrogens in prostate carcinogenesis: A rationale for chemoprevention. Reviews in Urology.
ENDO USA, Inc. (2024). Delestrogen- estradiol valerate injection [package insert]. DailyMed.
Hembree, W. C., et al. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society Clinical Practice Guideline.
Kundakovic, M., et al. (2022). Sex hormone fluctuation and increased female risk for depression and anxiety disorders: From clinical evidence to molecular mechanisms. Frontiers in Neuroendocrinology.
MedlinePlus. (2022). Hypogonadism.
MedlinePlus. (2024). Primary ovarian insufficiency.
National Cancer Institute. (2024). Hormone therapy for prostate cancer.
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