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USP) Moderale-to-severe vasomotor symptoms associated with the menopause (There is no evidence that estrogens are ettective lor nervous symptoms or depression without associated vasomotor symptoms and they should not be used to treat such conditions ) Osteoporosis (abnormally low bone mass) Atrophic vaginitis Kraurosis vulvae Female castration PREMARIN (conjugated estrogens) Vaginal Cream is indicated in the treatment ol atrophic vaginitis and PREMARIN HAS NOT BEEN SHOWN TO BE EFFECTIVE FOR ANY PURPOSE DURING PREGNANCY AND ITS USE MAY CAUSE SEVERE HARM TO THE FETUS (SEE BOXED WARNING) Concomitant Progestin Use: The lowest effective dose appropriate tor Ihe specific indication should be reported a lowered incidence of endometrial hyperplasia Morphological and biochemical studies ot the endometrium and to eliminate any hyperplastic changes Whether this will provide protection from endometrial carcinoma has not been clearly established There are possible additional risks which may be associated with the inclusion of progestin in estrogen replacement regimens (See PRECAUTIONS ) The choice of progestin and dosage may be important, product labeling should be reviewed to minimize possible adverse effects CONTRAINDICATIONS: Estrogens should nol be used in women (or men) with any ot the following conditions estrogen use (except when used in treatment ol breast or prostatic malignancy) WARNINGS: Estrogens have been reported lo increase the risk ot endometrial carcinoma (see Boxed Warning) However, a recent large case-controlled study indicated no increase in risk of breast cancer in poslmenopausal in women receiving postmenopausal estrogens Adverse effects ol oral contraceptives may "herbal viagra that works in australia" be expected at the larger doses ot estrogen used to treat prostatic or breast cancer or postpartum breast engorgement, it has been shown that there is an increased risk of thrombosis in men receiving estrogens for prostatic cancer and women for postpartum breast engorgement Users ol oral contraceptives have an increased risk ol diseases, such as thrombophlebitis, pulmonary embolism, stroke, and myocardial intarction Cases of retinal thrombosis, mesenteric thrombosis, and optic neuritis have been reported in oral contraceptive users An increased risk of postsurgery thromboembolic complications has also been surgery of the type associated with an increased risk ol thromboembolism, or during periods ol prolonged immobilization Estrogens should not be used in persons with active thrombophlebitis thromboembolic disorders, or in persons with a history ot such disorders in association with estrogen use They should be used estrogens per day), comparable to those used to treat cancer ol Ihe prostate and breasl, have been shown lo increase the risk of nonlatal myocardial intarction, pulmonary embolism, and thrombophlebitis When doses ol this size are used, any ol the thromboembolic and thrombotic adverse ettects should be considered a clear risk Benign hepatic adenomas should be considered in estrogen users having abdominal pain and tenderness, abdominal mass, or hypovolemic shock Hepatocellular carcinoma has been reported in women taking estrogencontaining oral contraceptives Increased blood pressure may occur with use of estrogens in the menopause and blood pressure should be monitored with estrogen use A worsening of glucose tolerance has been observed in patients on estrogen-containing oral contraceptives For this reason, diabetic patients should be carefully observed Estrogens may lead lo severe hypercalcemia in patients with breast cancer and bone metastases PRECAUTIONS: Physical examination and a complete medical and family history should be taken prior to the initiation of any estrogen therapy with special reference to blood pressure, breasts, abdomen, and pelvic organs, and should include a Papanicolaou smear As a general rule, estrogen should not be prescribed for longer than one year without another physical examination being performed Conditions influenced by fluid retention, such as asthma, epilepsy, migraine, and cardiac or renal dysfunction, require careful observation Certain patients may develop manifestations ol excessive estrogenic stimulation, such as abnormal or excessive uterine bleeding, mastodyma, etc Prolonged administration ol unopposed estrogen therapy has been reported to increase the risk of endometrial hyperplasia in some patients Oral contraceptives appear to be associated with an increased incidence ol mental depression Patients with a history of depression should be carefully observed Pre-existing uterine leiomyomata may increase in size during estrogen use The pathologist should be advised ol estrogen therapy when relevant specimens are submitted It jaundice develops in any patient receiving estrogen, the medication should be discontinued while the cause is investigated Estrogens should be used with care in patients with impaired liver function, renal insufficiency, metabolic bone diseases associated with hypercalcemia, or in young patients in whom bone growth is not yet complete II concomitant progestin therapy is used, potential risks may include adverse etlects on carbohydrate and lipid metabolism The following changes may be expected with larger doses of estrogen c Increased thyroid binding globulin (TBG) leading to increased circulating total thyroid hormone, as t Reduced response lo melyrapone test g Reduced serum tolate concentration h Increased serum triglyceride and phospholipid concentration As a general principle, the administration of any drug lo nursing mothers should be done only when clearly necessary since many drugs are excreted in human milk Long-term, continuous administration ol natural and synthetic estrogens in certain animal species increases Ihe Irequency ot carcinomas ot the breasl, cervix, vagina, and liver However, in a recent, large case-controlled study ol poslmenopausal women there was no increase in risk ol breasl cancer with use ot conjugated estrogens ADVERSE REACTIONS: The following have been reported with estrogenic therapy, including oral contraceptives breakthrough bleeding, spotting, change in menstrual How, dysmenorrhea, premenstrual-like syndrome, amenorrhea during and after treatment, increase in size ol uterine fibromyomata. 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