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Estrogen HRT Cheat Sheet by

Estrogen therapy in the menopausal patient relieves hot flashes, also called vasomotor symptoms, and prevents atrophy of the vulva and vagina, as well as bone loss that can cause osteoporosis

Class: Hormone Replac­ement Therapy

Prototype Med
Conjugated Equine Estrogen
Other Meds
Transd­ermal Estradiol (Estra­derm)
Intrav­aginal Meds
Estradiol Intrav­aginal Tablets (Vagirem)
Estradiol Cream (Estrace Vag. Cream)
Action:Estrogen works by binding to estrogen receptors in target tissues such as the genital organs, breasts, hypoth­alamus, and pituitary gland to maintain the functions of reprod­uction and femini­zation.

Thera­peutic Use*

Relief of severe menopausal symptoms (vasom­otor) and vulvar and vaginal atrophy
Prevention of postme­nop­ausal osteop­orosis

Adverse Drug Reacti­ons

Thromb­oem­bolism: thromb­oph­leb­itis, pulmonary embolism, stroke, myocardial infarction
Endome­trial hyperp­lasia, endome­trial and ovarian cancer

Nursing Interv­entions

Inform clients that this effect diminishes with time.
Monitor for and report any indica­tions of deep vein thromb­osis, pulmo- nary embolism, myocardial infarc­tion, and cerebr­ova­scular accident.
Encourage clients who smoke to quit smoking.
Use HRT for no more than 3 to 4 years to treat vasomotor or genital symptoms of menopause.
Monitor blood pressure.
Monitor for vaginal bleeding.
Advise a yearly pelvic examin­ation
Check that clients who have an intact uterus are prescribed progester- one with their estrogen.

Patient Educat­ion

Take oral forms with food.
Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath.
Do not smoke.
Stop taking at least 4 weeks before any surgery that increases the risk of thromb­oem­bolic events.
Exercise regularly and follow a healthy, low-fat diet.
Take, apply, or instill at bedtime.
Obtain regular blood pressure checks.
Report persistent or recurrent vaginal bleeding.


Oral Capsules
Take according to the precise dosing schedule, typically contin­uously to avoid monthly bleeding. Take pills at the same time each day.
Transd­ermal estradiol patche
Apply patches at the recomm­ended interval, typically once or twice per week.
Apply to clean, dry, intact skin on the abdomen or trunk (not breasts or waistline) and press firmly for 10 seconds. Do not use the same site more than once per week.
Intrav­aginal estradiol hemihy­drate tablets (Vagifem) or vaginal cream (Estrace vaginal cream)
Use according to the precise dosing schedule, typically tablets are insert- ed once daily for 2 weeks, then twice per week. Insert tablet using provided applicator at bedtime.
Vaginal cream is applied using a reusable applicator to measure the precise dose; insert into vagina at bedtime.


History of or other risk for thromb­oem­bolic events
Suspected or confirmed breast, vaginal, cervical, or endome­trial cancer
Liver disease
Undiag­nosed vaginal bleeding


Hypert­ens­ion­/Heart Diseas­e/D­iabetes mellitus
Gallbl­adder diseas­e/K­idney Dysfun­ction


Rifampin, ritonavir (Norvir), phenob­arb­ital, carbam­azepine (Tegre­tol), primidone (Mysol­ine), phenytoin (Dilan­tin), and St. John’s wort can re- duce the effect­iveness of estrogens.
Estrogens can reduce the effects of warfarin (Coumadin) and hypoglyce- mic drugs.
Estrogens can increase levels of theoph­ylline (Theo-24), diazepam (Vali- um), chlord­iaz­epoxide (Librium), and tricyclic antide­pre­ssants.


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