esterified estrogens/methyltestosterone
Estratest (esterified estrogens / methyltestosterone) is a combination medication that has an estrogen and testosterone replacement. It helps treat vasomotor symptoms of menopause, like hot flashes and night sweats. This medication is used when estrogen therapy isn't enough by itself. Estratest (esterified estrogens / methyltestosterone) comes as a tablet that's taken by mouth every day in cycles (for example, 3 weeks on, 1 week off). Some side effects include nausea, headache, and breast tenderness.
What is Estratest (esterified estrogens / methyltestosterone)?
What is Estratest (esterified estrogens / methyltestosterone) used for?
Moderate-to-severe vasomotor symptoms of menopause, when estrogen therapy alone isn't enough
How Estratest (esterified estrogens / methyltestosterone) works
Estratest (esterified estrogens / methyltestosterone) has two ingredients that act like the sex hormones your body naturally makes. They balance hormonal changes that happen in your body during menopause.
Esterified estrogens is an estrogen replacement. It helps replace the natural estrogen that your body loses during menopause. This helps relieve menopause symptoms like hot flashes and night sweats.
Methyltestosterone is a testosterone replacement. It helps bring these hormone levels back up when they start to drop during menopause.
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What are the risks and warnings for Estratest (esterified estrogens / methyltestosterone)?
Estratest (esterified estrogens / methyltestosterone) 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.
Risk for blood clots and related complications (e.g., heart attack, stroke)
Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking tobacco | Considered obese | Systemic lupus erythematosus (SLE) | Taking high doses of Estratest (esterified estrogens / methyltestosterone)
Medications containing estrogen like Estratest can raise the risk of blood clots. These blood clots block blood flow to different parts of the body, like the leg, lungs, heart, or brain. Some clots can lead to dangerous complications, such as heart attack or stroke. What's more, the other ingredient in Estratest called methyltestosterone, can also raise this risk.
Before starting Estratest (esterified estrogens / methyltestosterone), ask your prescriber if it's safe for you. There are many things that can raise your risk for blood clots, like high blood pressure and high cholesterol.
Be sure you know the signs and symptoms of a blood clot, heart attack, and stroke.
Blood clot: swelling, pain, or tenderness in the arm or leg; skin that's warm to the touch; chest pain; cough; trouble breathing
Heart attack: chest pain traveling to the arm, neck, or jaw; shortness of breath; cold sweat; dizziness
Stroke: sudden weakness on one side of the body, drooping face, bad headache, changes in speech or vision, confusion
Stop taking Estratest (esterified estrogens / methyltestosterone) and get medical help right away if you have any signs or symptoms of a blood clot, heart attack, or stroke.
Risk for breast cancer
Risk factors: Personal or family history of breast cancer | Breast nodules | Abnormal mammograms (breast scans) | Taking Estratest (esterified estrogens / methyltestosterone) for a long period of time
It's not clear if taking estrogen therapy like Estratest (esterified estrogens / methyltestosterone) during menopause can raise the risk of breast cancer. But studies in animals suggest that the risk might go up if you take it for a long time.
To lower your risk, your prescriber will make sure you're taking the lowest dose for the shortest time needed to help with your symptoms. Regularly check your breasts often for any changes and get breast scans (mammograms) on time. Let your prescriber know if you notice anything unusual with the shape, size, or color of your breasts.
Risk for uterine cancer (also called endometrial cancer)
Risk factors: Taking estrogens without a progestin | People with a healthy uterus | Taking estrogen therapy for a long time | Higher estrogen dose
Estratest (esterified estrogens / methyltestosterone) is an estrogen medication. Estrogens can thicken and change the lining of your uterus, called the endometrium. If you have a healthy uterus, the lining can grow too much with estrogen therapy. This can lead to uterine cancer, or endometrial cancer. The risk is higher if you take estrogen therapy without another hormone called progestin to balance out the effect on the uterine lining.
Be aware of the warning signs of uterine cancer, like vaginal bleeding that doesn't go away or keeps coming back. Tell your prescriber if you notice any unusual vaginal bleeding. If you're worried about uterine cancer, ask your prescriber if you need to take another medication called a progestin to help lower your risk.
Harm to an unborn baby
Don't take estrogen therapy like Estratest (esterified estrogens / methyltestosterone) if you're pregnant or could be pregnant. This medication can harm an unborn baby if taken during pregnancy. For example, there's a small chance of birth defects. And baby girls might be at higher risk of vaginal or cervical cancer later in life. The methyltestosterone can also cause baby girls to develop male-like genital features. If you become pregnant while taking this medication, tell your prescriber right away.
Liver or gallbladder problems
Risk factors: History of liver problems or jaundice | High doses of methyltestosterone
Estrogens can raise the risk of liver damage and gallbladder problems. And taking methyltestosterone for a long time can lead to serious liver problems. Tell your prescriber if you've had jaundice (yellowing of your skin or eyes) before to make sure Estratest (esterified estrogens / methyltestosterone) is safe for you.
Stop taking this medication and talk to your prescriber if you have jaundice, stomach pain, light-colored stool, or dark urine. These can be signs of liver damage or gallbladder disease.
Buildup of fluids in the body (fluid retention)
Risk factors: Heart failure | Kidney or liver problems
Estratest (esterified estrogens / methyltestosterone) can make your body hold extra fluid. This can cause swelling in your hands, ankles, or feet. The risk of problems from fluid retention is higher if you have heart failure or certain kidney or liver conditions. Fluid retention can also make some health problems worse. These can include seizures, migraines, and certain heart or kidney conditions. Tell your prescriber if you notice swelling in the hands or feet while taking Estratest (esterified estrogens / methyltestosterone).
High calcium levels
Risk factors: Breast cancer | Cancer that has spread to the bones | Kidney problems
Estratest (esterified estrogens / methyltestosterone) can cause you to have high calcium levels. The risk for severely high calcium is higher if you have breast cancer or cancer that's spread to the bones.
Tell your prescriber if you have constipation, feel more thirsty, urinate more, have weak muscles, feel tired, or have bone pain. These can be signs of high calcium levels. Your prescriber will probably check your calcium levels through blood tests. If your levels are too high, you might need to stop this medication.
Use with caution in people with diabetes
Estratest (esterified estrogens / methyltestosterone) might affect how your body processes sugars. Let your prescriber know if you have diabetes. And tell your diabetes care team you're taking this medication. Ask them how often you should check your blood sugar at home. If you take diabetes medications, your prescriber might adjust your doses to help keep your sugar under control.
What are the side effects of Estratest (esterified estrogens / methyltestosterone)?
Common Side Effects
- Change in menstrual bleeding patterns, including spotting
- Breast tenderness
- Breast enlargement
- Deepening of the voice
- Voice hoarseness
- Acne
- Nausea
- Stomach cramps
- Bloating
- Headache or migraine
- Dizziness
Other Side Effects
- Vomiting
- Hair loss
- Excessive hair growth (e.g., more hair on the face)
- Depression
- Anxiety
- Swelling in the feet or ankles
- Changes in weight
- Changes in sex drive
- Patches of darkened skin on the face
Serious Side Effects
- Blood clots: trouble breathing, leg pain or swelling, skin that's warm to the touch
- Heart attack: chest pain, arm pain, shortness of breath, cold sweat, lightheadedness
- Stroke: sudden weakness on one side of your body, drooping face, changes in your speech or vision, confusion, headache
- Breast lumps or pain: breast pain or soreness, swelling, rash
- High calcium levels: tiredness, muscle weakness, nausea, vomiting, constipation, frequent urination, thirst, blood in the urine
- Unusual vaginal bleeding
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Absent, missed, or irregular menstrual periods
acne or oily skin
decreased breast size
enlarging clitoris
hoarseness or deepening of the voice
menstrual changes
stopping of menstrual bleeding
unnatural hair growth or loss
Rare
Continuing nausea
dark-colored urine
difficulty with swallowing
dizziness
fast heartbeat
light-colored stools
loss of appetite
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
purple or red-colored spots on the body or inside the mouth or nose
shortness of breath
skin rash
tightness in the chest
unusual tiredness or weakness
vomiting
Incidence not known
Abdominal or stomach bloating, cramps, or pain
bleeding from gums or nose
blistering, peeling, or loosening of the skin
bloody or cloudy urine
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in vaginal discharge
changes in skin color, pain, or tenderness
chest pain or discomfort
chills
clay-colored stools
clear or bloody discharge from nipple
confusion
convulsions
darkening of urine
decrease in amount of urine
difficult, burning, or painful urination
difficulty with breathing
difficulty with moving
difficulty with speaking
dimpling of the breast skin
dizziness or lightheadedness
double vision
fainting
fluid-filled skin blisters
frequent urge to urinate
headache
inability to move the arms, legs, or facial muscles
inability to speak
indigestion
inverted nipple
irregular heartbeats
itching of the vagina or genital area
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
loss of appetite
lump in the breast or under the arm
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
muscle pain or stiffness
noisy, rattling breathing
numbness and tingling around the mouth, fingertips, or feet
pain during sexual intercourse
pain in the ankles or knees
pain or discomfort in the arms, jaw, back, or neck
pain or feeling of pressure in pelvis
painful, red lumps under the skin, mostly on the legs
pains in the stomach, side, or abdomen, possibly radiating to the back
pelvic pain
persistent crusting or scaling of the nipple
pinpoint red or purple spots on the skin
poor insight and judgment problems with memory or speech
red, irritated eyes
redness or swelling of the breast
ringing in the ears
sensitivity to the sun
shortness of breath
skin thinness
slow speech
sore on the skin of the breast that does not heal
sores, ulcers, or white spots in the mouth or on the lips
stomach pain
sudden shortness of breath or troubled breathing
sweating
swelling
swelling of the fingers, hands, feet, or lower legs
tenderness of the breast
thick, white curd-like vaginal discharge without odor or with mild odor
tiredness
trouble recognizing objects
trouble thinking and planning
trouble walking
troubled breathing at rest
unexpected or excess milk flow from breasts
unpleasant breath odor
vaginal bleeding
vision changes
vomiting of blood
weakness
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Blemishes on the skin
brown, blotchy spots on the exposed skin
decreased interest in sexual intercourse
headache, severe and throbbing
inability to have or keep an erection
increase or decrease in weight
increased hair growth, especially on the face
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
irritability
leg cramps
loss in sexual ability, desire, drive, or performance
loss of hair
mental depression
redness of the skin
swelling or inflammation of the mouth
twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Estratest (esterified estrogens / methyltestosterone)
Pros
An option to help with hot flashes and night sweats from menopause if estrogen therapy alone isn't enough
Cons
Is a controlled substance, so there might be special requirements to get the medication filled
Might need to take another medication called a progestin to help lower your risk of endometrial cancer
Pharmacist tips for Estratest (esterified estrogens / methyltestosterone)
Take Estratest (esterified estrogens / methyltestosterone) at the same time every day for 3 weeks. Then, stop taking it for 1 week. After the break, start the cycle again. It can help to keep track of when to take your medication and when your break weeks are so you don't forget.
Check in with your prescriber regularly, like every 3 to 6 months, about how well Estratest (esterified estrogens / methyltestosterone) is helping with your menopause symptoms. This medication has many side effects and risks. So it's important to take it for the shortest time needed to help your symptoms.
You might notice your voice getting deeper, acne, and more hair on your face and body while you're taking Estratest (esterified estrogens / methyltestosterone). If you see these changes, stop taking the medication and tell your prescriber right away. Talk to them if you're worried about this side effect.
Your blood pressure might get higher while taking Estratest (esterified estrogens / methyltestosterone). Your prescriber might check your blood pressure before starting treatment to make sure it's safe for you. And they might ask you to check at home as well. If your blood pressure stays higher than usual, tell your prescriber.
Tell your prescriber at least 4 to 6 weeks before any surgeries, bedrest, or other situations where you need to sit still or lie down for a long time. They'll let you know if you should stop taking Estratest (esterified estrogens / methyltestosterone) before and when to restart it after your procedure. This helps lower your risk for blood clots.
Estratest (esterified estrogens / methyltestosterone) can cause changes to the thyroid hormone levels in your body. Tell your prescriber if you have any conditions that affect your thyroid hormone levels. They can make sure your hormone levels stay in a normal range.
Frequently asked questions about Estratest (esterified estrogens / methyltestosterone)
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Estratest (esterified estrogens / methyltestosterone) dosage forms
Typical dosing for Estratest (esterified estrogens / methyltestosterone)
The typical dose is 0.625 mg/1.25 mg or 1.25 mg/2.5 mg (esterified estrogens/methyltestosterone) by mouth once a day. Take the medication every day for 3 weeks, then stop for 1 week. After the 1-week break, start the cycle again until your prescriber tells you to stop.
Interactions between Estratest (esterified estrogens / methyltestosterone) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ginseng
- Levothyroxine
- Licorice
- Tipranavir
- Warfarin
How much does Estratest (esterified estrogens / methyltestosterone) cost?
Estratest (esterified estrogens / methyltestosterone) contraindications
Breast cancer (except in certain people with metastatic cancer, or cancer that's spread to other parts of the body)
Estrogen-sensitive cancer or tumor
Abnormal vaginal bleeding that hasn't been diagnosed
Conditions that cause blood clots
History of blood clot or problems from a blood clot when using estrogen therapy in the past
Severe liver damage
Currently pregnant
Currently breastfeeding
What are alternatives to Estratest (esterified estrogens / methyltestosterone)?
Moderate-to-severe vasomotor symptoms of menopause, when estrogen therapy alone isn't enough
Hot flashes and night sweats due to menopause
Vaginal itching, dryness, and burning due to menopause
Low estrogen levels
Breast cancer or prostate cancer in certain people
To prevent bone loss (osteoporosis) after menopause
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy, like vaginal dryness
Prevention of osteoporosis in females who've reached menopause
Estratest (esterified estrogens / methyltestosterone) images
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References
Best studies we foundBrzozowska, M., et al. (2020). Changes of androgens levels in menopausal women. Menopause Review.
Endocrine Society. (2019). Compounded bioidentical hormone therapy.
Furness, S., et al. (2012). Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. The Cochrane Database of Systematic Reviews.
Kabat, G. C., et al. (2014). Combined conjugated esterified estrogen plus methyltestosterone supplementation and risk of breast cancer in postmenopausal women. Maturitas.
Kim, J. J., et al. (2010). Role of progesterone in endometrial cancer. Seminars in Reproductive Medicine.
Lobo, R. A., et al. (2003). Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Menopause.
Meadows, M. (2006). Promoting safe and effective drugs for 100 years. U.S. Food and Drug Administration.
MedlinePlus. (2016). Gallbladder diseases.
MedlinePlus. (2024). Hypercalcemia.
Method Pharmaceuticals. (2025). Estratest FS- esterified estrogens and methyltestosterone tablet; Estratest HS- esterified estrogens and methyltestosterone tablet [package insert]. DailyMed.
Shepherd, M. D., et al. (2003). Prescription drugs marketed in the United States should be approved by the FDA. Journal of Managed Care Pharmacy.
Sood, R., et al. (2011). Counseling postmenopausal women about bioidentical hormones: Ten discussion points for practicing physicians. Journal of the American Board of Family Medicine.
U.S. Food and Drug Administration. (2003). Certain estrogen-androgen combination drugs; drugs for human use; drug efficacy study implementation; Amendment and opportunity for hearing. Federal Register.
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