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Clinical surveillance of all women taking estrogen/progestin combinations is importantsee PRECAUTIONSAdequate diagnostic measuresincluding endometrial sampling when indicatedshould be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal vaginal bleedingThere is no evidence that the use of natural estrogens results in a different endometrial risk profile than synthetic estrogens of equivalent estrogen doseAdding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasiawhich may be a precursor to endometrial cancer.

Estrogens act through binding to nuclear receptors in estrogen-responsive tissuesTo datetwo estrogen receptors have been identifiedThese vary in proportion from tissue to tissue.

ESTRACE vaginal cream should be used at the lowest dose possible for your treatment only as long as neededAlthough ESTRACE vaginal cream is only used in and around the vaginathe risks associated with oral estrogens should be taken into account.

Estrogen administration may lead to severe hypercalcemia in patients with breast cancer and bone metastasesIf hypercalcemia occursuse of the drug should be stopped and appropriate measures taken to reduce the serum calcium level.

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