Atrophy of the lower GUT related to estrogen deficiency Initially 0.5 mg daily for 1st few wk gradually reduce dosage based on relief of symptoms. Maintenance: 0.5 mg twice wkly. Pre- & post-op therapy in postmenopausal women undergoing vag surgery 2 wk before surgery: 0.5 mg/day. 2 wk after surgery: 0.5 mg twice a wk. Diagnostic aid in case of a doubtful atrophic cervical smear 0.5 mg on alternative days in the wk before taking the next smear.
Complete medical history (including pelvic & breast exam) should be taken before initiating hormone replacement therapy. Conditions that need supervision: Leiomyoma or endometriosis, history of thromboembolic disorders, 1st degree heredity for breast cancer, HTN, severe liver disorders; DM, cholelithiasis, migraine or severe headache, SLE, history of endometrial hyperplasia, epilepsy, asthma, otosclerosis. Discontinue use if jaundice or deterioration in liver function, significant increase in BP or new onset of migraine-type headache occur.
Barbiturates, carbamazepine, griseofulvin, hydantoins, rifampicin, nevirapine, efavirenz, St. John's wort may decrease effectiveness of estriol. Ritonavir, nelfinavir exhibit inducing properties when used w/ estriol. Estriol may increase effects of succinylcholine, theophylline & troleandomycin. Oral anticoagulants. Reduce dosage of corticosteroids if used concomitantly.
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