Restogen

Indications

Conjugated Oestrogens are a mixture of female hormones (oestrogens). Tablets are used as hormone replacement therapy (HRT) to relieve moderate to severe menopause symptoms such as hot flushes and night sweats, to prevent bone thinning (osteoporosis) after menopause in women who cannot use other treatments, and for low oestrogen caused by certain ovary problems. The vaginal cream is used for vaginal dryness, itching and pain during sex caused by thinning of the vaginal tissue after menopause.

How It Works

After menopause the ovaries make much less oestrogen, which causes hot flushes, vaginal dryness and faster bone loss. Conjugated oestrogens replace some of this missing hormone. They act on oestrogen receptors in the brain, vagina, bones and other tissues, easing symptoms and slowing bone loss.

Dosage and Administration

The dose and length of treatment are decided by your doctor and should be the lowest dose that controls symptoms, for the shortest time needed. Use exactly as prescribed. Women who still have a womb (uterus) usually also need a progestogen to protect the womb lining. Tablets are taken once a day at the same time. The vaginal cream is inserted with the applicator as prescribed, usually daily at first and then less often. Treatment should be reviewed by your doctor at least once a year.

Interactions

Medicines that speed up liver enzymes, such as Rifampicin, Carbamazepine, Phenytoin and St John's Wort, can reduce its effect. Erythromycin, Clarithromycin, Ketoconazole and grapefruit juice can increase levels. Oestrogens can change the effect of thyroid hormone (Levothyroxine), Warfarin, diabetes medicines and Lamotrigine. Tell your doctor about all your medicines.

Contraindications

Do not use if you have or have had breast cancer or another oestrogen-dependent cancer, unexplained vaginal bleeding, a blood clot in the legs or lungs, a stroke or heart attack, active liver disease, porphyria, a known clotting disorder, untreated thickening of the womb lining, if you are pregnant, or if you are allergic to the product.

Side Effects

Common side effects include breast tenderness, headache, nausea, bloating, leg cramps, spotting or vaginal bleeding, vaginal discharge and mood changes. Long-term use is linked to a higher risk of blood clots, stroke, gallbladder disease, and cancer of the breast, ovary and womb lining (especially without a progestogen).

Get urgent medical help if you have pain or swelling in one leg, sudden chest pain or breathlessness, coughing up blood, sudden severe headache, weakness or numbness on one side, trouble speaking or seeing, yellow skin or eyes, a breast lump, or unexpected heavy vaginal bleeding.

Pregnancy and Lactation

Conjugated oestrogens must not be used during pregnancy; stop and see your doctor if you become pregnant. They are not recommended while breastfeeding because they can reduce milk supply and pass into milk.

Precautions and Warnings

HRT does not prevent heart disease or dementia and should not be used for that purpose. Have regular check-ups, including breast checks and screening as advised. Tell your doctor if you have high blood pressure, diabetes, migraine, epilepsy, asthma, endometriosis, fibroids, liver or gallbladder disease, or a history of blood clots. Stop treatment and inform the surgeon before planned surgery or long immobility, as advised. The vaginal cream can weaken latex condoms and diaphragms.

Overdose

Overdose may cause nausea, vomiting, breast tenderness, drowsiness and vaginal bleeding. Serious problems are unlikely, but seek medical advice if a large amount is taken, especially by a child.

Therapeutic Class

Sex hormone, oestrogen (hormone replacement therapy).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.