Estrogen

Aka: Estrogen, Ethinyl Estradiol, Mestranol, Conjugated Estrogen

1. See Also
   1. Estrogen Replacement Therapy (Hormone Replacement)
   2. Oral Contraceptive
2. Symptoms: Excess Estrogen (e.g. Premenstrual Syndrome)
   1. Swollen or engorged Breast tenderness
   2. Water retention
   3. Irritability
   4. Headaches
   5. Visual disturbance
   6. Memory difficulty
   7. Sweet craving
3. Pharmacokinetics: Relative Potency
   1. Ethinyl Estradiol: 100
   2. Mestranol: 67
4. Precautions
   1. Mestranol is potentially a carcinogen (animal studies)
   2. MI, CVA, DVT, PE and Breast Cancer risk are all FDA Black box warnings
5. Preparations: Hormone Replacement Dosages (uncless otherwise noted)
   1. Ethinyl Estradiol
      1. Hormone Replacement: 0.005 to 0.02 mg/day
      2. Oral Contraceptive: 0.03 to 0.10 mg/day
   2. Micronized estradiol (1-2 mg/day)
   3. Estradiol Cypionate (2-5 mg every 3-4 weeks)
   4. Estradiol valerate (2-20 mg every other week)
   5. Estropipate (1.25-2.5 mg/day)
   6. Conjugated Estrogen (e.g. Premarin, Enjuvia)
      1. Oral (0.3-1.25 mg/day)
      2. Injectable (0.2-2 mg/day)
      3. Transdermal
   7. Diethylstilbestrol (0.1-0.5 mg/day)
   8. Quinestrol (0.1-0.2 mg/week)
   9. Chlorotrianisene (12-25 mg/day)
   10. Methallenestril (3-9 mg/day)
   11. Esterified Estrogen (Menest): 0.3 to 1.25 mg/day
6. Preparations: Native Estrogen with Selective Actions in Tissues (NEST)
   1. Background
      1. Native Estrogen with Selective Actions in Tissues (NEST) are plant-derived Estrogens (Phytoestrogens)
      2. Low potency and therefore 1000-fold higher doses are required (measured in mg NOT mcg)
         1. Nextstellis contains 14.2 mg of Estetrol, while most OCPs contain 20-30 mcg Ethinyl Estradiol
   2. Estetrol (E4)
      1. Estetrol is a new plant-derived Estrogen (E4) formulation available in 2021 as component of Nextstellis OCP
      2. Carries same Estrogen-related effects and contraindications
   3. References
      1. (2021) Presc Lett 28(7): 38