Depo-Estradiol
Depo-Estradiol (estradiol cypionate) 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 raise estrogen levels in people who aren't making enough hormones. It's injected into the muscle about once every month. You can store Depo-Estradiol (estradiol cypionate) vials at room temperature, away from light. Some side effects of this medication include injection-site pain, headaches, and breast tenderness.
What is Depo-Estradiol (estradiol cypionate)?
What is Depo-Estradiol (estradiol cypionate) used for?
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Low estrogen level caused by hypogonadism
How Depo-Estradiol (estradiol cypionate) works
Depo-Estradiol (estradiol cypionate) 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.
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What are the side effects of Depo-Estradiol (estradiol cypionate)?
Common Side Effects
- Injection-site pain
- Breast tenderness or growth
- Nausea or vomiting
- Headaches
- Stomach cramps
- Vaginal spotting or irregular bleeding
Other Side Effects
- Dizziness
- High blood pressure
- Melasma (dark patches of skin)
- Trouble tolerating contact lenses
- Mood changes
- Swelling from fluids
- Hair loss
Serious Side Effects
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking, trouble walking, or numbness on one side of your body or face, severe headache
- 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
Pros and cons of Depo-Estradiol (estradiol cypionate)
Pros
Can be injected at home
Typically injected once every 3 to 4 weeks
Can be stored at room temperature
Cons
Given as an injection
Raises the risk of blood clots and strokes
If you have your uterus, you have to use Depo-Estradiol (estradiol cypionate) with another hormone called progestin to lower your risk of uterine cancer.
Pharmacist tips for Depo-Estradiol (estradiol cypionate)
Depo-Estradiol (estradiol cypionate) 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 Depo-Estradiol (estradiol cypionate) to prevent infection. Clean the area where you'll be injecting the medication with an alcohol wipe.
Shake the vial before drawing Depo-Estradiol (estradiol cypionate) into a syringe. This can help dissolve any crystals that might've formed during storage. Use a new needle and syringe each time you give yourself Depo-Estradiol (estradiol cypionate).
Throw away the used syringes and needles in a protective (sharps) container. Don't throw needles and syringes away in the regular trash to prevent needlestick injuries.
Store Depo-Estradiol (estradiol cypionate) at room temperature, away from heat and direct light. Don’t keep the medication in the fridge or freezer because this can affect how well it works. If it gets too cold, it can form crystals. These can be dissolved again by shaking and warming the vial in your hands.
Let your healthcare team know if you need surgery. They might ask you to stop using Depo-Estradiol (estradiol cypionate) temporarily, for about 4 to 6 weeks. Estrogen-containing medications can raise your risk of blood clots during and after surgery, especially if you're less mobile for an extended period of time during recovery.
Let your prescriber know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting Depo-Estradiol (estradiol cypionate). These are not typical side effects and could be a sign of more serious problems.
Frequently asked questions about Depo-Estradiol (estradiol cypionate)
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What are the risks and warnings for Depo-Estradiol (estradiol cypionate)?
Depo-Estradiol (estradiol cypionate) 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 Depo-Estradiol (estradiol cypionate) for more than 1 year | High estrogen dose
Because Depo-Estradiol (estradiol cypionate) injection works like estrogen, it can change the lining of the 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
There's a higher risk of developing breast cancer when taking estrogen medications, such as Depo-Estradiol (estradiol cypionate). To lower your risk of breast cancer, your prescriber 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)
Depo-Estradiol (estradiol cypionate) can raise your risk of blood clots, which can lead to a heart attack, stroke, or pulmonary embolism (life-threatening blood clot in the lungs). 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 Depo-Estradiol (estradiol cypionate). 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 factors: 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 such as Depo-Estradiol (estradiol cypionate) 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
Depo-Estradiol (estradiol cypionate) 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 attention.
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 very 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 Depo-Estradiol (estradiol cypionate).
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 Depo-Estradiol (estradiol cypionate) and tell your prescriber.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Depo-Estradiol (estradiol cypionate) 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
Depo-Estradiol (estradiol cypionate) 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.
Higher risk of side effects
Risk factors: History of or current liver problems
Depo-Estradiol (estradiol cypionate) 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 Depo-Estradiol (estradiol cypionate).
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 Depo-Estradiol (estradiol cypionate). 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.
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 Depo-Estradiol (estradiol cypionate), 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.
Depo-Estradiol (estradiol cypionate) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5ml of 5mg/ml | 1 vial | $249.48 | $249.48 |
Typical dosing for Depo-Estradiol (estradiol cypionate)
Your healthcare team will prescribe the lowest dose of Depo-Estradiol (estradiol cypionate) for the shortest period of time needed to treat your symptoms. They'll check in with you every 3 to 6 months to see if they can taper you off this medication.
Hot flashes: The typical dose ranges from 1 mg to 5 mg injected into a muscle every 3 to 4 weeks.
Low estrogen due to hypogonadism: The typical dose ranges from 1.5 mg to 2 mg injected into a muscle once a month.
How much does Depo-Estradiol (estradiol cypionate) cost?
Depo-Estradiol (estradiol cypionate) 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
Liver problems
Currently pregnant
What are alternatives to Depo-Estradiol (estradiol cypionate)?
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Low estrogen level caused by hypogonadism
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
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 Depo-Estradiol (estradiol cypionate)?
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.
Atkins, F. M., et al. (1988). Cottonseed hypersensitivity: new concerns over an old problem. The Journal of Allergy and Clinical Immunology.
MedlinePlus. (2022). Hypogonadism.
Pharmacia & Upjohn Company LLC. (2024). Depo-Estradiol- estradiol cypionate injection [package insert]. DailyMed.
Xiromed, LLC. (2024). Estradiol valerate injection [package insert]. DailyMed.
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