Systemic Estrogen Therapy : Side Effects

“So-called NATURAL therapies are not without risk.”

Potential adverse side effects of systemic estrogen therapy are listed below.

• Uterine bleeding (starting or returning)
• Breast tenderness or pain (increased density and sometimes enlargement)
• Nausea
• Abdominal bloating
• Fluid retention in extremities
• Changes in the shape of the cornea of the eye (sometimes leading to contact lens intolerance)
• Headache (sometimes migraine)
• Dizziness
• Hair loss

Low-dose local vaginal estrogen therapy has a similar set of possible side effects, and each type (cream, tablet, or ring) differs slightly.

With all, the most often reported complaints include uterine bleeding, vulvovaginal discomfort, vaginal discharge or itching, breast tenderness, and nausea—which imply that these hormones might be initially systemically absorbed or too high a dose was used. A few women may be allergic to the plastic in the ring products. Some vaginal leakage may be noticed with the cream.

Progestogen Side Effects

Potential progestogen side effects include uterine bleeding and some effects similar to those of PMS, including fluid retention, headache, breast tenderness, and mood changes, particularly with the synthetic progestins.

Systemic ET/EPT does not cause weight gain. However, some women do experience temporary weight gain from the side effect of water retention in the hands and feet. Systemic ET can also cause abdominal bloating with gaseous bowel distension, making the waist temporarily larger.

Progestogen and Hot Flashes

There is one “side effect” issue that is important to keep in mind when systemic ET/EPT is to be discontinued: stopping all at once often results in hot flashes. Gradually tapering the dose may be helpful, although this has not been proven. Experts don’t agree on the best way to stop ET/EPT. Local vaginal ET may be discontinued abruptly without any adverse effects.

Dealing with ET/EPT side effects. There are various strategies that women and their clinicians often use to deal with unwanted side effects of ET or EPT. However, in general, they have not been evaluated in clinical trials. Many side effects of therapy are temporary until a woman adjusts to the hormonal changes. Unless side effects are severe, a trial of 3 months of any hormone therapy is advised to see if they resolve. One strategy is appropriate for any side effect—stop hormones to see if hormones are the cause.

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