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Drug Profile

Do NOT stop taking this or any drug without the advice of your physician. Some drugs can cause severe adverse effects when they are stopped suddenly.

Do Not Use [what does this mean?]
Generic drug name: esterified estrogens with methyltestosterone (ess TERR i fyed ESS tro jenz with METH yl tes TOSS ter one)
Brand name(s): ESTRATEST, ESTRATEST HS
GENERIC: not available FAMILY: Hormone Combinations
Find the drug label by searching at DailyMed.

Alternative Treatment [top]

Safety Warnings For This Drug [top]

FDA BLACK BOX WARNINGS

1. Estrogens have been reported to increase the risk of endometrial carcinoma.
Three independent case control studies have reported an increased risk of endometrial cancer in postmenopausal women exposed to exogenous estrogens for prolonged periods.[1],[2],[3] This risk was independent of the other known risk factors for endometrial cancer. These studies are further supported by the finding that incidence rates of endometrial cancer have increased sharply since 1969 in eight different areas of the United States with population-based cancer reporting systems, an increase which may be related to the rapidly expanding use of estrogens during the last decade.[4]

The three case control studies reported that the risk of endometrial cancer in estrogen users was about 4.5 to 13.9 times greater than in nonusers. The risk appears to depend on both duration of treatment[3] and on estrogen dose.[1] In view of these findings, when estrogens are used for the treatment of menopausal symptoms, the lowest dose that will control symptoms should be utilized and medication should be discontinued as soon as possible. When prolonged treatment is medically indicated, the patient should be reassessed on at least a semiannual basis to determine the need for continued therapy. Although the evidence must be considered preliminary, one study suggests that cyclic administration of low doses of estrogen may carry less risk than continuous administration;[1] it therefore appears prudent to utilize such a regimen.

Close clinical surveillance of all women taking estrogens is important. In all cases of undiagnosed persistent or recurring abnormal vaginal bleeding, adequate diagnostic measures should be undertaken to rule out malignancy. There is no evidence at present that “natural” estrogens are more or less hazardous than “synthetic” estrogens at equiestrogenic doses.

2. Estrogens should not be used during pregnancy.
The use of female sex hormones, both estrogens and progestogens, during early pregnancy may seriously damage the offspring. It has been shown that females exposed in utero to diethylstilbestrol, a non-steroidal estrogen, have an increased risk of developing in later life a form of vaginal or cervical cancer that is ordinarily extremely rare.[5],[6] This risk has been estimated as not greater than 4 per 1000 exposures.[7] Furthermore, a high percentage of such exposed women (from 30 to 90 percent) have been found to have vaginal adenosis,[8],[9],[10],[11] epithelial changes of the vagina and cervix. Although these changes are histologically benign, it is not known whether they are precursors of malignancy. Although similar data are not available with the use of other estrogens, it cannot be presumed they would not induce similar changes.

Several reports suggest an association between intrauterine exposure to female sex hormones and congenital anomalies, including congenital heart defects and limb reduction defects.[12],[13],[14],[15] One case control study[13] estimated a 4.7-fold increased risk of limb reduction defects in infants exposed in utero to sex hormones (oral contraceptives, hormone withdrawal tests for pregnancy, or attempted treatment for threatened abortion). Some of these exposures were very short and involved only a few days of treatment. The data suggest that the risk of limb reduction defects in exposed fetuses is somewhat less than 1 per 1000.

In the past, female sex hormones have been used during pregnancy in an attempt to treat threatened or habitual abortion. There is considerable evidence that estrogens are ineffective for these indications, and there is no evidence from well controlled studies that progestogens are effective for these uses.

If ESTRATEST or ESTRATEST H.S. is used during pregnancy, or if the patient becomes pregnant while taking this drug, she should be apprised of the potential risks to the fetus, and the advisability of pregnancy continuation.

3. Cardiovascular and other risks.
ESTRATEST® and ESTRATEST® H.S. Tablets do not contain a progestin. ESTRATEST® and ESTRATEST® H.S. Tablets are an Estrogen/Androgen product.
Estrogens with or without progestins should not be used for the prevention of cardiovascular disease.

The Women’s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women during 5 years of treatment with conjugated equine estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to placebo. Other doses of conjugated estrogens with medroxyprogesterone and other combinations of estrogens and progestins were not studied in the WHI and, in the absence of comparable data, these risks should be assumed to be similar. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

Facts About This Drug [top]

On April 10, 2003, the FDA announced that it was beginning legal procedures to remove the marketing authorizations for combination drug products containing estrogen and androgen, female and male hormones, respectively. Estrogen and androgen combination products had been approved for the treatment of moderate to severe “hot flashes” (vasomotor symptoms) associated with menopause in women whose symptoms were not improved by estrogen alone.

The only estrogen-androgen combination product...

On April 10, 2003, the FDA announced that it was beginning legal procedures to remove the marketing authorizations for combination drug products containing estrogen and androgen, female and male hormones, respectively. Estrogen and androgen combination products had been approved for the treatment of moderate to severe “hot flashes” (vasomotor symptoms) associated with menopause in women whose symptoms were not improved by estrogen alone.

The only estrogen-androgen combination product remaining on the U.S. market is esterified estrogens with methyltestosterone (ESTRATEST, ESTRATEST H.S.).

Estrogen-only drugs are approved for the treatment of moderate to severe hot flashes associated with menopause. The FDA is taking this action because it no longer believes that there is substantial evidence that androgens contribute to the effectiveness of these combination products in treating hot flashes in menopausal women who do not find relief from these symptoms when using estrogens alone.

The legal standard for approving a drug in the United States is substantial evidence that the drug is safe and effective for its intended use. The standard used for approving combination products is that the combination must be shown to be more effective than the individual ingredients. The weight of the evidence now shows that estrogen-androgen combination drugs are not superior to estrogen in reducing the vasomotor symptoms of menopause.

If the androgen in estrogen-androgen combination products does not result in a benefit for women, then all that is left from the androgen are its risks, and these risks are significant. The FDA’s thinking at this time is that androgen can reverse the favorable impact of estrogen on cholesterol and triglycerides (fats in the blood). Androgen also is associated with abnormal hairiness, acne, deepening of the voice, and hair loss in women.

We agree with the FDA’s decision to remove the marketing authorizations for combination drug products containing estrogen and androgen; however, the issue over the effectiveness of these combinations goes back for decades, and this action by the FDA is long overdue.

The FDA has had a long-standing policy to allow the continued marketing of drug products while matters such as these are being resolved, provided there is no documented serious public health or safety issue associated with such products. In our opinion this policy is irresponsible. It is probusiness, not pro–public health and safety. There is no justification for leaving products on the market when there are questions of effectiveness, as with the estrogen-androgen combinations.

You should consult your physician if you are now using an estrogen-androgen combination product to control the vasomotor symptoms of menopause.

Do not succumb to promotions of compounding pharmacists, and the physicians that work with them, who claim the estrogen and androgen products they prepare in their back rooms are effective and without adverse effects.

In 2019, Lancet published a study showing that the longer the use of all types of hormone therapy (except vaginal estrogen, such as estradiol vaginal cream [ESTRACE]), the higher the risk of invasive breast cancer (breast cancer that spreads into surrounding breast tissue). It also found that combination hormone therapy is associated with a higher breast cancer risk than estrogen-only therapy.[16]

last reviewed April 30, 2021