EstroGel

• Risk factors: People ages 50 years and older| High blood pressure | People identified as obese | High cholesterol | Diabetes | History of smoking cigarettes | Recent surgery or bedrest

Estrogens like estradiol gel (EstroGel) can raise the risk of serious blood clots. Higher estrogen levels can raise blood proteins that promote clot formation. These clots can form anywhere in the body and might be life-threatening. Get medical attention right away if you have any signs or symptoms of a blood clot:

• Brain (e.g., stroke): weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion
• Eyes (e.g., retinal thrombosis): trouble seeing, bulging eye, double vision
• Heart (e.g., heart attack): chest pain, sweating, nausea, or dizziness
• Lungs (e.g., pulmonary embolism or PE): trouble breathing, chest pain, or cough
• Legs (e.g., deep vein thrombosis or DVT): cramps, swelling, pain, or muscle tightness

Your risk of blood clots is higher if you're older, smoke cigarettes, or have certain medical conditions. It's also higher if you're on bedrest after surgery. Your gynecologist might temporarily stop estradiol gel (EstroGel) for 4-6 weeks before surgery. Talk with your gynecologist if you have any questions regarding your risk of blood clots.

• Risk factors: Estrogen therapy without additional progestin | Using estrogen therapy for more than 1 year

Estrogens like estradiol gel (EstroGel) can thicken and change the lining of your uterus (endometrium). This can lead to uncontrolled growth, which might cause uterine (endometrial) cancer. To reduce this risk, it's generally recommended to take progestin, another hormone, along with estrogen. Progestin helps slow the growth of the uterine lining. Watch for warning signs of uterine cancer, such as vaginal bleeding that doesn’t stop or keeps coming back. Contact your prescriber right away if you notice any unusual vaginal bleeding.

• Risk factors: Personal or family history of breast cancer | Long-term use of estrogen and progestin together

There's a higher risk of developing breast cancer when taking estrogen, such as estradiol gel (EstroGel), and progestin medications together. The longer you take this combination, the higher your risk is. That's why it's best to use estradiol gel (EstroGel) only for the shortest amount of time needed. Make sure to check your breasts regularly for changes and get breast scans (mammograms). Let your prescriber know if you notice any unusual changes in breast shape, size, or color.

• Risk factors: Age 65 years or older

People using estrogen therapy like estradiol gel (EstroGel) may have a higher risk of dementia, especially if treatment begins after age 65. Early symptoms of dementia include new forgetfulness, confusion, getting lost, or wandering. If you’re concerned about this risk, talk to your prescriber.

• Risk factors: History of or current liver problems

Estradiol gel (EstroGel) can cause problems with your gallbladder, and some people have needed gallbladder surgery 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 right away.

The estrogen in estradiol gel (EstroGel) is processed by the liver. So if your liver isn't working properly, you might have more side effects from this medication. If you currently have or have had any liver problems, including issues during a past pregnancy, you shouldn't use estradiol gel (EstroGel).

• Risk factors: Breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels

Taking estrogens like estradiol gel (EstroGel) can lead to severely high calcium levels in people with breast cancer that has spread to their bones. High calcium can cause symptoms like thirst, stomach pain, nausea, vomiting, constipation, bone pain, muscle weakness, or confusion. Tell your prescriber if you have any of these symptoms because you might have to stop taking estradiol gel (EstroGel).

Use estradiol gel (EstroGel) carefully if you have low parathyroid hormone levels (hypoparathyroidism), which can lead to low calcium in your body. Let your prescriber know if you have signs of low calcium such as burning or tingling of your fingers, toes, or lips, muscle pain and cramps, or confusion.

Although very rare, some people taking estrogens have experienced vision problems caused by a blood clot in the eyes. If you have sudden partial or complete vision loss, bulging eyes, double vision, or migraines, stop taking estradiol gel (EstroGel) and tell your prescriber right away.

• Risk factors: High levels of triglycerides

Estrogens can raise the amount of fats in your blood (triglycerides), which can lead to heart problems or pancreatitis, a serious inflammation of the pancreas. Your prescriber might recommend regular blood tests to watch for this while you're taking estradiol gel (EstroGel). If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or seek medical care right away.

• Risk factors: Low thyroid hormone levels

Estradiol gel (EstroGel) can affect thyroid hormone levels in your blood. If you're taking medications for low thyroid hormone levels, you might need a higher dose of your thyroid replacement therapy. Your prescriber might recommend regular blood tests to check your thyroid hormone levels while you're taking this medication.

• Risk factors: History of heart or kidney problems

Estrogen products like estradiol gel (EstroGel) can cause some fluid retention or edema, especially in people with heart conditions, like 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 care team know.

• Risk factors: History of asthma or diabetes | History of lupus | History of seizures or migraines | History endometriosis

Taking estrogen-containing medications like estradiol gel (EstroGel) can worsen certain medical conditions. These include endometriosis, hereditary angioedema, asthma, diabetes, migraine, and seizures. Before you start estradiol gel (EstroGel) 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.

There's a chance that estradiol gel (EstroGel) could transfer to someone else through skin-to-skin contact with the application site. To avoid this, make sure the gel is completely dry before allowing others to touch the area. Once the gel is dry, cover the application site with clothing.