Hormone replacement therapy (HRT), estrogen deficiency symptoms and progesterone.
- hypersensitivity to any component of the drug;
- thromboembolic testosterone enanthate half life disorders, now or in history;
- the presence of current or a history of jaundice or severe liver disease, including the presence of liver tumors in the present or in history;
- diagnosed or suspected breast cancer in anamnesis;
- congenital hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome);
- hormone-dependent tumors of the endometrium and breast or other organs;
- acute hepatitis;
- uterine bleeding of unknown etiology;
- sickle cell anemia;
- thrombophlebitis of deep veins of the lower extremities;
- pituitary tumors;
- pregnancy (known or suspected);
Precautions : multiple sclerosis, lupus syndrome, epilepsy, epileptic syndrome, diabetes with vascular complications, benign tumors of the breast, hypertension (resistant to treatment), chronic renal failure, chronic heart failure, asthma, porphyria, otosclerosis with complications during during previous pregnancy, estrogen-dependent tumors in the history of cholelithiasis, severe obesity (including history), migraine, herpes infection history.
Dosage and administration:
1 tablet per day (preferably – in the evening) for 21 days, followed by a 7-day break, during which bleeding occurs menstrualnopodobnoe, and then re-start reception. During the first 11 dne1 take white tablets containing estrogen only, and then for 10 days – blue tablets containing a combination of estrogen with progesterone. The drug may be started at any time, if the normal menstrual cycle is stopped, or if it is irregular, and also on the 5th day after the start of menstruation. Menstrualnopodobnoe bleeding starts during the week, free admission Divina. The menopause can be marked differences in the length of the menstrual cycle. Bleeding may begin during a reception blue tablets (in this case, the reception should be immediately stopped, and after the arrest of bleeding can be renewed reception white tablets).
In the case of missed pills should be taken within 12 hours and continue to take the drug in the usual manner .
Side effect On the part of the nervous system : headache; mood changes including anxiety and depressed mood; dizziness; migraine; sleep disturbances. From the digestive system : nausea, abdominal pain, dyspepsia, vomiting, flatulence, cholecystitis, cholelithiasis, diarrhea or constipation. Cardio-vascular system : increased blood pressure, rarely – thrombosis, palpitations. From the endocrine : alopecia, hirsutism, breast engorgement, increase in fibroids. Allergic reactions : rash, pruritus, erythema multiforme exudative, nodular erythema. Other : uterine bleeding, vaginal candidiasis, fluctuations in body weight, peripheral edema, changes in libido, muscle cramps lower limbs, blurred vision, blood plasma, increase in liver transaminases (ALT and ACT), alkaline phosphatase, gamma-glutamyltransferase, lupus syndrome.
Symptoms of overdose include nausea, headache and uterine bleeding. No specific antidote. Treatment – symptomatic.
Interaction with other drugs
estrogenic effect Divina can be reduced while receiving with antihypertensive drugs, indirect anticoagulants, oral hypoglycemic agents; baobituratami, hydantoins, rifampicin, ampicillin, tetracycline, as well as with the drugs-inducers of microsomal oxidation (including phenytoin, antiepileptic drugs, griseofulvin).
estrogenic effect Divina can be increased at the same time taking with drugs depressing microsomal oxidation (ketoconazole, cyclosporine ).
Before starting or re-appointment of HRT should provide a complete personal and family history, as well as to conduct a thorough general and gynecological examination in order testosterone enanthate half life to identify possible contraindications and complying with the necessary precautions while taking the drug. Before treatment to rule out a pregnancy. If the pregnancy during treatment, the drug should be immediately repealed.Divina can not be used for contraception.
In the course of treatment is also recommended to carry out further tests.
The frequency of inspections and methods used are determined for each individual patient individually. Breast examination and mammography is conducted in accordance with accepted standards.
Breakthrough vaginal bleeding and pronounced menstrualnopodobnye bleeding may occur during the first months of treatment. If, despite dose adjustments like bleeding does not stop, the drug should be withdrawn to determine the cause of bleeding. If the bleeding recurs after a period of amenorrhea or persists after discontinuation of treatment should be to establish its etiology. This may require a biopsy of the endometrium.
Particular care is necessary to weigh the benefits of treatment and the possible risk of it, if there are, there were ever before and / or occurred during pregnancy or preceded rates state of hormonal therapy, described in the “Precautions”. In these cases, the patient should be closely monitored.
Under special supervision must be in patients with heart failure and dysfunction, as Estrogens may cause fluid retention. Patients in end stage renal disease require particularly careful observation is expected since raising Divina active substances in the blood.
In some patients, receiving estrogen / progestogen therapy may experience changes in glucose tolerance. Diabetic patients should carefully monitor the level of blood glucose in the first months of HRT.
Data from epidemiological studies suggest that hormone replacement therapy is associated with a relatively high risk of developing deep vein thrombosis of the lower limbs or pulmonary vessels. Risk factors for the development of thromboembolic diseases are: their presence in the personal and family history, severe obesity (body mass index> 30 kg / m 2 ) and systemic lupus erythematosus. There is no consensus about the possible role of varicose veins is not.
HRT patients with recurrent or with established thrombosis of deep veins in history, receiving anticoagulant therapy requires careful assessment of risks and benefits of HRT. To eliminate the predisposition to thrombosis should be carefully examined for the presence of a history of recurrent thrombosis, or recurrent spontaneous abortion. Before setting the above diagnosis or anticoagulant therapy, HRT should be considered contraindicated.
The risk of developing deep vein thrombosis may be temporarily increased with prolonged immobilization, major trauma or “big” surgery. All postoperative patients attention should be paid to preventive measures aimed at the prevention of thromboembolic complications after surgery. Where prolonged immobilization is needed after surgery, particularly after abdominal surgery and surgery of the lower limbs bodies should consider the possibility of temporary cessation of HRT for 4-6 weeks prior to surgery. The decision to resume HRT taken individually for each case.
If thrombosis developed after initiation of HRT, Divino should be abolished. Patients should be instructed on the need for immediate treatment to the doctor if any of the following symptoms:. Pain and swelling of the lower limbs, the sudden chest pain, shortness of breath
These epidemiological studies have shown a slight increase in women’s likelihood of developing breast cancer treated previously or are currently receiving HRT. Detection of breast cancer may be due to earlier diagnosis, biological effects of HRT, or a combination of both factors. The probability of diagnosing breast cancer increases with duration of treatment and returned to normal five years after cessation of HRT. In postmenopausal women receiving estrogens increases the risk of confirmed cholelithiasis. When HRT also increases the risk of SLE.
The use of estrogen may influence the results of certain laboratory parameters (activity of liver transaminases ALT and ACT, alkaline phosphatase, gamma-glutamyltransferase).
Estrogen therapy may lead to increased levels of plasma triglycerides, which in some cases contribute to development of pancreatitis and other complications in patients with congenital defects in lipoprotein metabolism. Experience of treating testosterone enanthate half life women older than 65 years is limited.
Effects on ability to drive and other mechanisms
21 tablets in a blister (11 white and 10 blue). By 1 or 3 blisters in a carton box with instructions for medical use).
At a temperature of 15 to 25 ° C in the original packaging of the reach of children.
Do not use after the date printed on the packaging!