Menest
Menest (esterified estrogens) is an estrogen hormone replacement used to relieve menopause symptoms like hot flashes and vaginal dryness. It's also used to treat low estrogen levels and certain advanced prostate and breast cancers. The tablet is taken by mouth, and dosage depends on why you're taking it. Menest (esterified estrogens) is only available as a brand-name medication since there is no generic version. Potential side effects include breast tenderness, nausea, and headache.
What is Menest (esterified estrogens)?
What is Menest (esterified estrogens) used for?
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
How Menest (esterified estrogens) works
Menest (esterified estrogens) replaces estrogen, a hormone that the body naturally produces.
During menopause, estrogen levels drop, leading to symptoms like hot flashes and night sweats. Menest (esterified estrogens) helps relieve these symptoms by restoring estrogen balance. It also helps people with low or no estrogen levels from other conditions by raising hormone levels and reducing symptoms.
For certain advanced breast and prostate cancer, Menest (esterified estrogens) can help to relieve symptoms by affecting hormone levels that might contribute to cancer growth.
Drug Facts
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What are the side effects of Menest (esterified estrogens)?
Common Side Effects
- Breast tenderness
- Nausea
- Headache
- Migraines
- Vomiting
- Stomach cramps
- Vaginal spotting/breakthrough bleeding
- Weight changes
Other Side Effects
- Dizziness
- High blood pressure
- Eye problems
- More vaginal discharge than usual
- Nipple pain
- Bloating
- Mood changes
Serious Side Effects
- Heart attack: chest pain or tightness, shortness or breath, sweating, nausea, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking or walking, numbness on one side of your body or face, severe headache, dizziness, confusion
- Blood clot: chest pain, shortness of breath, dizziness, fast heart rate, swelling, pain, or redness in the arms or legs
- Cancer: lumps, pain, swelling, or changes in the breasts; swollen lymph nodes, unusual or heavy vaginal bleeding, bloating, extreme tiredness, stomach-area pain
Source:Â DailyMed
The following side effects have also been reported
Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:
The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer.
Although the incidence is low, the use of estrogens may increase you chance of getting cancer of the breast. Breast cancer has been reported in men taking estrogens.
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.
The following side effects may be caused by blood clots, which could lead to stroke, heart attack, or death. These side effects occur rarely, and, when they do occur, they occur in men treated for cancer using high doses of estrogens.
Check with your doctor immediately if any of the following side effects occur:
More common
Breast pain (in females and males)
fast heartbeat
hoarseness
increased breast size (in females and males)
irritation of the skin
itching of the skin
joint pain, stiffness, or swelling
rash
redness of the skin
shortness of breath
swelling of the eyelids, face, lips, hands, or feet
swelling of the feet and lower legs
tightness in the chest
troubled breathing or swallowing
weight gain (rapid)
Less common or rare
Changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
chills
heavy non-menstrual vaginal bleeding
lumps in, or discharge from, breast (in females and males)
pains in the stomach, side, or abdomen
yellow eyes or skin
Rare
for males being treated for breast or prostate cancer only
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 the arm or leg
Incidence not known
Abdominal or stomach bloating
abdominal or stomach cramps
acid or sour stomach
backache
belching
blindness
blistering, peeling, or loosening of the skin
blue-yellow color blindness
blurred vision
change in vaginal discharge
changes in skin color
changes in vision
chest discomfort
clay-colored stools
clear or bloody discharge from nipple
confusion
convulsions
dark urine
decrease in the amount of urine
decreased vision
difficulty with breathing
difficulty with speaking
dimpling of the breast skin
dizziness
double vision
fainting
fluid-filled skin blisters
full feeling in upper abdomen or stomach
full or bloated feeling or pressure in the stomach
headache
inability to move the arms, legs, or facial muscles
inability to speak
incoherent speech
increased urination
indigestion
inverted nipple
irregular heartbeats
light-colored stools
lightheadedness
loss of appetite
loss of bladder control
lump under the arm
metallic taste
migraine headache
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
muscle spasm or jerking of all extremities
muscle weakness
noisy breathing
numbness or tingling of the hands, feet, or face
pain in the ankles or knees
pain or discomfort in the arms, jaw, back or neck
pain or feeling of pressure in the pelvis
pain, tenderness, swelling of the foot or leg
painful or tender cysts in the breasts
painful, red lumps under the skin, mostly on the legs
pains in the chest, groin, or legs, especially calves of the legs
partial or complete loss of vision in the eye
pelvic pain
persistent crusting or scaling of nipple
pinpoint red or purple spots on the skin
prominent superficial veins over affected area
red, irritated eyes
redness or swelling of the breast
sensitivity to the sun
severe headaches of sudden onset
skin thinness
skin warmth
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 discomfort, upset, or pain
sudden loss of consciousness
sudden loss of coordination
sudden onset of shortness of breath for no apparent reason
sudden onset of slurred speech
sudden vision changes
swelling of the abdominal or stomach area
swelling of the fingers or hands
thirst
unpleasant breath odor
unusual tiredness or weakness
vomiting
vomiting of blood
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:
More common
Abnormal growth filled with fluid or semisolid material
accidental injury
bladder pain
bloated full feeling
bloody or cloudy urine
body aches or pain
coating or white patches on tongue
congestion
cough producing mucus
decrease in amount of urine
difficult, burning, or painful urination
discouragement
dryness of the throat
ear congestion or pain
excess air or gas in the stomach or intestines
fear
feeling of warmth
feeling sad or empty
frequent urge to urinate
general feeling of discomfort or illness
headache, severe and throbbing
increased clear or white vaginal discharge
irritability
itching of the vaginal, rectal or genital areas
lack of appetite
lack or loss of strength
loss of interest or pleasure
mild dizziness
neck pain
nervousness
pain during sexual intercourse
painful or difficult urination
pain or tenderness around the eyes and cheekbones
passing gas
redness of the face, neck, arms, and occasionally, upper chest
skin irritation or redness where skin patch was worn
shivering
sore mouth or tongue
sudden sweating
tender, swollen glands in the neck
thick, white vaginal discharge with no odor or with a mild odor
tiredness
trouble concentrating
trouble sleeping
unable to sleep
voice changes
Less common
Blemishes on the skin
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
burning or stinging of the skin
diarrhea (mild)
difficulty with moving
dizziness (mild)
increased hair growth, especially on the face
lower abdominal or stomach pain or pressure
mood or mental changes
muscle stiffness
painful cold sores or blisters on the lips, nose, eyes, or genitals
pounding in the ears
problems in wearing contact lenses
slow heartbeat
tooth or gum pain
unusual decrease in sexual desire (in males)
unusual increase in sexual desire (in females)
white or brownish vaginal discharge
Incidence not known
Abnormal turning out of cervix
changes in appetite
dull ache or feeling of pressure or heaviness in the legs
flushed, dry skin
fruit-like breath odor
increased hunger
irritability
large amount of triglyceride in the blood
leg cramps
patchy brown or dark brown discoloration of the skin
poor insight and judgment
problems with memory or speech
trouble recognizing objects
trouble thinking and planning
trouble walking
twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
unexpected or excess milk flow from the breasts
Also, many women who are taking estrogens with a progestin (another female hormone) will start having monthly vaginal bleeding, similar to menstrual periods, again. This effect will continue for as long as the medicine is taken. However, monthly bleeding will not occur in women who have had the uterus removed by surgery (total hysterectomy).
This medicine may cause loss or thinning of the scalp hair in some people.
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 Menest (esterified estrogens)
Pros
Relieves multiple menopause symptoms
Also treats low estrogen conditions and certain advanced cancers
Available in different strengths
Comes as a tablet that's taken by mouth
Cons
Common side effects include nausea, headache, breast tenderness
Raises your risk of serious blood clots
Taking the tablet in cycles can be hard to remember
Not safe for people with liver problems
Pharmacist tips for Menest (esterified estrogens)
You can take Menest (esterified estrogens) with or without food.
Follow the directions on your prescription label carefully. Many people take Menest (esterified estrogens) for a few weeks, then take a break before restarting. Speak with your prescriber or pharmacist if you're unsure about your schedule.
If you miss a dose of Menest (esterified estrogens), take it as soon as you remember. But if it's almost time for your next dose, skip it, and continue with your regular schedule. Never take 2 doses at the same time.
If you have a uterus, ask your prescriber about taking a progestin medication with Menest (esterified estrogens) to help lower the risk of uterine cancer.
If you're only taking Menest (esterified estrogens) for vaginal symptoms like dryness or irritation, ask your prescriber about alternatives with fewer side effects, like estrogen vaginal creams.
Let your prescriber know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting Menest (esterified estrogens). These aren't typical side effects and could be a sign of a more serious condition.
Menest (esterified estrogens) can interact with many medications. Tell your prescriber about all medications you take, including prescription, over-the-counter (OTC), and supplements, to make sure it's safe for you.
Use Menest (esterified estrogens) for the shortest time needed at the lowest appropriate dose. Talk to your prescriber every 3 to 6 months to see if you still need this medication.
Frequently asked questions about Menest (esterified estrogens)
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What are the risks and warnings for Menest (esterified estrogens)?
Menest (esterified estrogens) 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 (endometrial) cancer
Risk factors: Using Menest (esterified estrogens) without progestin for people with a uterus | Long-term use of Menest (esterified estrogens)
Vaginal bleeding after menopause can be a warning sign of uterine (endometrial) cancer, so tell your prescriber if you notice any unusual bleeding. Taking estrogen replacement medications like Menest (esterified estrogens) for more than a year can raise your risk of this. If you still have your uterus, taking a progestin along with Menest (esterified estrogens) can help lower your risk by balancing estrogen's effects and slowing the growth of your uterine lining.
Breast cancer
Risk factors: Personal or family history of breast cancer | Using Menest (esterified estrogens) and progestin together | Long-term use of Menest (esterified estrogens)
Taking Menest (esterified estrogens) with a progestin might raise the risk of breast cancer, especially with long-term use. The longer you take this combination, the higher the risk becomes. To lower your risk, use Menest (esterified estrogens) for the shortest time needed at the lowest appropriate dose. Contact your care team if you notice lumps, pain, swelling, or any unusual changes in your breasts. To stay safe, get yearly breast exams with your OB-GYN and do monthly breast self-checks at home.
Blood clots and stroke
Risk factors: History of blood clots or stroke | Postmenopausal females using estrogen products | Using Menest (esterified estrogens) with or without progestin | Obesity | History of lupus | Inactivity
Menest (esterified estrogens) can raise your risk of blood clots. This can be very dangerous and lead to a stroke, pulmonary embolism (blood clot in the lungs), or deep vein thrombosis (blood clot in the legs). If you're having major surgery or expect to be on bed rest for a long time, your prescriber might ask you to stop taking Menest (esterified estrogens) at least 4 to 6 weeks before to lower the risk of blood clots. Be sure to discuss all your past and present medical conditions with your provider before starting Menest (esterified estrogens) to lower your risk of a blood clot. Call 911 or seek immediate medical attention if you experience leg or arm pain, chest pain, sudden severe headaches, trouble breathing, or sudden changes in your speech or vision.
Heart disease and heart attacks
Risk factors: History of heart attack | Heart disease | High blood pressure | High cholesterol | Diabetes | Obesity | Smoking tobacco
Menest (esterified estrogens) should never be used alone or with a progestin to lower the risk of heart disease. In fact, using estrogens like Menest (esterified estrogens), can raise your risk of a heart attack. If you have any signs of a heart attack, such as chest pain, chest tightness, trouble breathing, nausea, vomiting, dizziness, sweating, or a fast heartbeat, get emergency help right away.
Dementia
Risk factors: Age over 65
In clinical studies, postmenopausal women aged 65 and older taking medications with estrogen, such as Menest (esterified estrogens), might have a higher risk of developing dementia. It’s unclear if this risk applies to younger postmenopausal women or to those taking estrogen alone. If you’re worried about memory changes or dementia risk while taking Menest (esterified estrogens), talk to your prescriber.
Gallbladder and liver problems
Risk factors: History of or current liver problems | Postmenopausal women
Taking estrogens, like Menest (esterified estrogens), after menopause can raise your risk of gallbladder problems, sometimes leading to surgery. If you have stomach pain, nausea or vomiting that doesn't go away, fever with chills, or a yellowing of the skin and eyes (jaundice), speak with your prescriber or get medical help.
Menest (esterified estrogens) is broken down by the liver, so if your liver isn't working properly, you might have more side effects from this medication. If you have or have had liver problems, including liver issues during a past pregnancy, you shouldn't use this medication.
Vision problems
A blood clot in the eye, known as retinal vascular thrombosis, can happen in people using estrogen products like Menest (esterified estrogens). If you suddenly lose vision in one or both eyes, or experience bulging eyes, double vision, or migraines, stop using Menest (esterified estrogens) and call your prescriber right away.
High triglycerides
Risk factors: High levels of triglycerides
Estrogens can raise the amount of fat in your blood (triglycerides), which can lead to heart problems or pancreatitis (inflammation of the pancreas). Your prescriber might order regular blood tests to watch for this while you're taking Menest (esterified estrogens). If you have sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or get medical care right away.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Menest (esterified estrogens) can affect your thyroid hormone levels. If you take medications for low thyroid levels, you might need higher doses of the thyroid replacement therapy. Your prescriber might check your thyroid levels regularly to make sure they stay in a healthy range.
Fluid Retention
Risk factors: History of heart or kidney problems
Estrogen products, like Menest (esterified estrogens), can cause your body to hold on to extra fluid and cause edema. If you have heart or kidney problems, this could make your condition worse. 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.
Changes in calcium levels in the blood
Risk factors: History of breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Taking Menest (esterified estrogens) can cause high calcium in people with breast cancer that's spread to the bones. If your calcium is too high, you might feel thirsty, have 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 the medication.
Use Menest (esterified estrogens) carefully if you have low parathyroid hormone levels (hypoparathyroidism), a condition that lowers calcium levels 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.
Worsening of other health conditions
Risk factors: Endometriosis | History of asthma or diabetes | History of lupus | History of seizures or migraines | Taking other medications that can cause seizures
If you have certain health conditions, such as asthma or diabetes, endometriosis, talk to your prescriber before using Menest (esterified estrogens) because estrogen can make your condition worse.
Menest (esterified estrogens) dosage forms
Typical dosing for Menest (esterified estrogens)
Hot flashes and night sweats due to menopause: The typical dose is 1.25 mg by mouth once a day for 3 weeks, then take no tablets for 1 week. Repeat this cycle.
Vaginal dryness due to menopause: The typical dose is 0.3 mg to 1.25 mg by mouth once a day for 3 weeks, then take no tablets for 1 week. Repeat this cycle. Your prescriber might adjust your dose depending on your symptoms.
Low estrogen from hypogonadism: The typical dose is 2.5 mg to 7.5 mg by mouth daily (in divided doses) for 20 days, then take no tablets for 10 days. If you don't have a period during the 10 day break, repeat the cycle. If you get a period before the 10-day break ends, take Menest (esterified estrogens) for 20 days and add a progestin medication for the last 5 days.
Low estrogen from primary ovarian failure and castration: The typical dose is 1.25 mg by mouth once a day for 3 weeks, then take no tablets for 1 week. Repeat this cycle. Your prescriber might adjust your dose based on how well it works and if you have side effects.
Breast cancer: The typical dose is 10 mg by mouth 3 times a day for at least 3 months.
Prostate cancer: The typical dose is 1.25 mg to 2.5 mg by mouth 3 times a day.
Interactions between Menest (esterified estrogens) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Dasabuvir
- Ombitasvir
- Paritaprevir
- Ritonavir
- Tranexamic Acid
Using medicines in this class 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.
- Abametapir
- Amifampridine
- Amoxicillin
- Ampicillin
- Amprenavir
- Anagrelide
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Boceprevir
- Bosentan
- Brigatinib
- Bupropion
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Conivaptan
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Fostemsavir
- Glecaprevir
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Netupitant
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Paclitaxel
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Pixantrone
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Troglitazone
- Ulipristal
- Valproic Acid
How much does Menest (esterified estrogens) cost?
Menest (esterified estrogens) contraindications
Undiagnosed abnormal vaginal bleeding
History of breast cancer
Cancer that depends on estrogen for growth
Blood clots or blood clotting conditions
History of stroke or heart attack
Liver problems
Currently pregnant
What are alternatives to Menest (esterified estrogens)?
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
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
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness caused by menopause
Low estrogen levels due to certain conditions
Certain advanced stages of breast cancer
Certain advanced stages of prostate cancer
Prevention of bone loss (osteoporosis) after menopause
What is the latest news about Menest (esterified estrogens)?
Menest (esterified estrogens) images
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References
Best studies we foundMason, J. B., et al. (2022). The interrelationship between female reproductive aging and survival. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.
MedlinePlus. (2024). Hypogonadism.
MedlinePlus. (2024). Primary ovarian insufficiency.
Pfizer Laboratories Div Pfizer Inc. (2024). Menest-esterified estrogens tablet, film coated [package insert]. DailyMed.Â
Smith, N. L., et al. (2006). Conjugated equine estrogen, esterified estrogen, prothrombotic variants, and the risk of venous thrombosis in postmenopausal women. Atherosclerosis, Thrombosis, and Vascular Biology.
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