Hormone replacement therapy for estrogen deficiency symptoms; treatment of climacteric syndrome associated with natural or artificial menopause, which testosterone enanthate 250 developed as a result of surgery.
- Increased sensitivity to estradiol and / or any other ingredient of the drug.
- Breast cancer (diagnosed, suspected or history).
- Diagnosed or suspected estrogen-dependent malignant tumors of the ovaries, the uterus, the endometrium.
- Benign neoplasms genitals and mammary glands (cervical and endometrial cancer, uterine cancer, vulvar cancer, ovarian cancer) in women under 60 years.
- Vaginal bleeding of unknown etiology and susceptibility to uterine bleeding.
- Endometrial hyperplasia.
- Tumors of the pituitary gland.
- Diffuse diseases of connective tissue.
- Pelvic inflammatory disease (oophoritis, endometritis).
- Hyperestrogenia stage of menopause.
- Spontaneous venous thromboembolic disease, including the anamnesis. Deep vein thrombosis, pulmonary embolism, including the anamnesis.
- Thrombophlebitis and acute thrombophlebitis, including history.
- Congenital hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson syndrome, Rotor).
- Liver tumors (hemangioma, liver cancer).
- Violations of cerebral blood flow (ischemic stroke, hemorrhagic stroke).
- Diabetes mellitus, retinopathy, angiopathy.
- Sickle-cell anemia.
- Disorders of lipid metabolism.
- Cholestatic jaundice or cholestatic pruritus strong (including the strengthening of their displays during a previous pregnancy or while taking steroids).
- Otosclerosis (including its aggravation during pregnancy).
should appoint Divigel in diseases such as bronchial asthma, migraine, epilepsy, hypertension, heart failure, ischemic heart disease, Skye, liver and / or kidney failure, edematous syndrome, endometriosis, fibrocystic breast disease, porphyria. The experience of women older than 65 years is limited.
Divigel should not be applied to the breasts, face, genital area, as well as on the irritated skin.
Dosing and Administration
Divigel – gel for transdermal administration. Divigel can be used for continuous and cyclical therapy. The usual starting dose is 1.0 mg estradiol (1.0 g gel, respectively) per day, but the selection of the starting dose may be based on the severity of symptoms. Depending on the clinical dose may be changed after 2-3 cycles individually from 0.5 g to 1.5 g per day, which corresponds to 0.5 to 1.5 mg of estradiol per day.
The patients with the “intact” (non-operated ) uterus during treatment Divigel recommended to prescribe a progestogen (for example – medroxyprogesterone acetate, norethisterone, nore-tisterona acetate or digidrogestron) for 10-12 days per cycle. After a course of progestogen should occur menstrualnopodobnoe bleeding. When extraordinary or prolonged uterine bleeding, be sure to establish the cause of their occurrence.
Patients in postmenopausal cycle time can be increased up to 3 months.
The gel is usually applied 1 time a day to clean skin on the lower part of the front wall of the abdomen, the lumbar region, shoulders, forearms, or turn to the right or the left buttock, alternating daily place of application. The area of application should be equal in size 1-2 palms. After applying the product, wait a few minutes until the gel is dry (2-3 minutes). Position of the gel should not be rinsed for 1 hour. Avoid accidental Divigel eyes. It is necessary to wash your hands immediately after applying the gel.
If the patient has forgotten to put the gel should do so as soon as possible, but no later than within 12 hours after applying the product on schedule. If more than 12 hours, Divigel application should be postponed until the next time. When the irregular use of the drug (missed doses) may occur menstrualnopodobnye uterine bleeding “breakthrough”.
Side effect On the part of the central and peripheral nervous system: headache, migraine, dizziness, depression, chorea, with the cardiovascular system: increased blood pressure, thrombosis, by pischevaritelnoi system: nausea, vomiting, stomach cramps, bloating, pain epigastric region; allergic reactions at the site of application: rash, skin irritation, redness of the skin at the site of application of the gel, contact dermatitis, on the part of the reproductive system: irregular vaginal bleeding (metrorrhagia) or scanty bleeding, increase in uterine leiomyoma size, hyperplasia of the endometrium (the appointment without combination with progesterone), endometrial carcinoma (in women with an intact uterus after menopause), ovarian sclerosis with prolonged use, changes in libido, with the endocrine system: bloating (voltage and / or increase) in the breast, weight gain, reduced tolerance to carbohydrates, disruption of the liver and biliary system: cholestatic jaundice, holeli-thiaz, porphyria attacks; by the water-salt metabolism: the delay of Na + , Ca 2+ and water (edema) during long-term use; Other: visual disturbances (changes in corneal curvature ), chloasma, melasma, vaginal candidiasis.
Overdose Symptoms: . Breast pain, bloating or pelvic region, anxiety, irritability, nausea, vomiting, and in some cases – metrorrhagia Treatment . – Symptomatic symptoms disappear with dose reduction or drug discontinuation.
Interaction with other drugs.
- increases the effectiveness of lipid-lowering agents;
- weakens the effect of the drugs of male sex hormones; hypoglycemic, diuretic, antihypertensive drugs and anticoagulants;
- reduces glucose tolerance (dose adjustment hypoglycemic agents).
Metabolism Estradiol is accelerated by concomitantly with barbiturates, tranquilizers (anxiolytics), narcotic analgesics, anesthetics, some antiepileptic drugs (karbamapzepin, phenytoin), inducers of microsomal liver enzymes; herbal preparations containing the herb Hypericum perforatum (St. John’s herb).
The concentration of estradiol in the blood are also reduced by the simultaneous use of phenylbutazone and certain antibiotics (ampicillin, rifampicin, rifabutin, testosterone enanthate 250 nevirapine, efavirenz). Associated with changes in the intestinal microflora.
The action of estradiol increased the intake of folic acid, and thyroid medication.
Before the start or re-appointment of hormone replacement therapy is necessary to assemble a complete personal and family history. It is necessary to carry out a medical examination in order to identify possible contraindications and complying with the necessary precautions while taking the drug (including pelvic organs and breasts). In the course of treatment is recommended to carry out periodic surveys, the frequency and number of methods included in it, are determined for each case individually. Investigations, including mammography, should be carried out in accordance with accepted standards and adapted to the individual clinical needs of each individual case. During the reception, the patient hormone replacement therapy should be carried out a thorough evaluation of all the benefits vs. risks.Conditions which require monitoring. If any of the following conditions are present, have met earlier and / or exacerbated during pregnancy or previous hormone treatment, the patient should be under constant supervision physician. It will be appreciated that these conditions may, in rare cases, recur or worsen during treatment Divige-lem, in particular: leiomyoma (uterine fibroids) or endometriosis; thromboembolic disease history or risk factors for them; risk factors for estrogen-dependent tumors (1st degree heredity for breast cancer); arterial hypertension; liver function disorders (adenoma); diabetes with vascular lesions or without; cholelithiasis; migraine and / or (severe) headache; systemic lupus erythematosus; endometrial hyperplasia in history; epilepsy; bronchial asthma; . otosclerosis Reasons for immediate discontinuation of therapy Therapy should be discontinued if found contraindications and / or in the following situations: jaundice or deterioration in liver function; marked increase in blood pressure; new onset migraine headaches; pregnancy. Endometrial hyperplasia. risk of endometrial hyperplasia and carcinoma is increased by estrogens over time. For the degree of risk reduction must be combined with estrogen therapy in women with unremoved uterus progesterone for at least 12 days per cycle of treatment. In the case of the observation of bleeding “breakthrough” and / or scant bleeding after a few months of taking Divigel, studies must be conducted to identify the causes incurred. Studies may include endometrial biopsy (to rule out malignancy of the endometrium). Women with hysterectomy because of endometriosis (especially in cases of residual endometriosis) recommended the addition of progesterone to estrogen therapy due premalignantnoy or malignantnoy transformation of endometriosis at Oestrich-gene stimulation. Breast cancer. The risk of developing breast cancer increases with long-term use of hormone replacement therapy. According to epidemiological studies, among women aged 50 to 70 years in 45 cases diagnosed in 1000 with breast cancer. It is estimated that among women taking or have recently taken hormone replacement therapy, the total number of additional cases of breast cancer in the same period would be 1-3 (mean = 2) extra cases per 1000 for taking HRT for 5 years, 3-9 ( mean = 6) per 1000 for taking HRT for 10 years and 5-20 cases (mean = 12) per 1000 women taking HRT for 15 years. This increased risk was found mainly in women lean or normal body build. Women have a full body (high predisposition for breast cancer), hormone replacement therapy does not increase further the risk of developing breast cancer. The additional risk of breast cancer increases with the duration of receiving hormone replacement therapy and returned to baseline for about 5 years after stopping treatment.Combined estrogen-progestogen hormone replacement therapy provides similar or greater risk compared to estrogen therapy. thrombophlebitis. In women receiving hormone replacement therapy have a higher risk of thromboembolic venous disease (deep vein thrombosis of the lower extremities and pulmonary veins), compared with women not receiving HRT, 2-3. The probability is higher in the first year of HRT than in subsequent years. The main risk factors are: personal or family history, severe obesity (body mass index over 30 kg / m 2 ), systemic lupus erythematosus. Patients with a history of thromboembolic events or recent spontaneous abortions, more research is needed in order to avoid predisposition to thrombophlebitis. The use of hormone replacement therapy in this case should be initiated after a thorough evaluation of thrombophlebitis factors and early anticoagulation. The risk increases with prolonged immobilization, testosterone enanthate 250 major trauma or major surgical interventions. Receiving hormone replacement therapy should be discontinued for 4-6 weeks before the planned surgeries on abdominal or orthopedic surgery of the lower limbs. Treatment may be resumed after the full recovery of motor abilities. With the development of thromboembolic symptoms (sudden pain in the chest, dyspnea), you must immediately contact your doctor, hormone replacement therapy may be canceled. Renal impairment. Estrogen causes fluid retention in the body. Patients with renal failure periodic should be under constant medical supervision due to increased levels of estradiol and its metabolites in blood. Diabetes. Estrogens increase sensitivity to insulin and increase its excretion. Patients with diabetes in the first months of hormone replacement therapy shows continuous monitoring of blood glucose levels. Gallstone disease. Estrogens Reception increases the risk of surgically confirmed gallstone disease. Hypertriglyceridemia. Rare cases of a sharp increase in the level of triglycerides in the blood in patients receiving estrogens may lead to the development of pancreatitis. thyroid disease. Estrogens increase the level of thyroid-binding globulin, increasing the level of the circulating amount of thyroid hormones. Avoid getting gel on mammary glands and mucous membranes of the vulva and vagina. stanozolol for sale