Indications: menopausal symptoms, senile vaginitis and pruritis vulvae, dysfunctional uterine bleeding, prostatic carcinoma, functional amenorrhoea, hypogenitalism.

Cautions: increase the risk of developing endometrial hyperplasia that may lead to cancer of the lining of the uterus. Taking progestins, with conjugated estrogens lowers the risk of developing this condition. Treatment with conjugated estrogens may increase the risk of heart attack, stroke, breast cancer, and blood clots in the lungs or legs. Because of these risks, conjugated estrogens should be prescribed at the lowest effective dose, for the shortest amount of time necessary.

Contra-indications: Pregnancy; estrogen dependent cancer; history of breast cancer; active thrombophlebitis; active or recent thromboembolic disease; liver disease; untreated endometrial hyperplasia; undiagnosed vaginal bleeding, breast feeding.

Side Effects: nausea, vomiting; abdominal cramps and blotting; weight changes, breast enlargement and tenderness, premenstrual like syndrome; sodium & fluid retention; cholestatic jaundice, glucose intolerance, altered blood lipids- may lead to pancreatitis, rashes & chloasma, changes in libido, depression, mood changes, headache, migraine, dizziness, leg cramps, vaginal candidiasis, contact lenses may irritate.

Drug Interactions: Decrease the effects of warfarin, Rifampin, barbiturates, carbamazepine, griseofulvin phenytoin all increase the elimination of estrogen by enhancing the liver's ability to eliminate estrogens. Use of any of these medications with estrogens may result in a reduction of the beneficial effects of estrogens.

Conversely, drugs such as erythromycin, ketoconazole, itraconazole, and ritonavir, may reduce the elimination of estrogens by the liver as and lead to increased levels of estrogens in the blood.

Dose: menopausal symptoms, postmenopausal osteoporosis, 0.625-1.25 mg daily for 21 days from 5th day of cycle, repeated after 7 days if necessary, reduced to maintenance dose, and if necessary continued on a cyclical basis with a progestogen for 12-14 days per cycle if uterus intact.

Primary amenorrhoea, 1.25-3.75 mg daily in divided doses for 21 days, with a progestogen from 15th to 21 st day.