Possibly Ineffective for
- A skin condition that mainly affects the genital and anal areas (lichen sclerosus). Applying Estima into the vagina does not seem to improve symptoms of vulval lichen sclerosus. In fact, Estima seems to be less effective than clobetasol (Temovate) for treating this condition.
- Miscarriage. Most research shows that applying Estima into the vagina does not reduce the risk of having a miscarriage in women who are bleeding during pregnancy or with a history of miscarriages in the past. Also, injecting Estima and another steroid hormone into the muscle after undergoing a test used to diagnose birth defects (called an amniocentesis) does not seem to reduce the risk of miscarriage or preterm delivery. However, some early research suggests that taking Estima by mouth might reduce the risk of miscarriage in women who are bleeding during pregnancy.
- Premenstrual syndrome (PMS). Although some clinical research suggests that applying Estima into the vagina or the rectum before menstruation reduces symptoms of PMS, most evidence shows that giving Estima by mouth or rectally does not reduce PMS symptoms.
Do not use Estima without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.
You should not use Estima if you have: abnormal vaginal bleeding, a history of breast cancer, liver disease, or if you have recently had a heart attack, stroke, or blood clot.
Estima should not be used to prevent heart disease or dementia, because this medicine may actually increase your risk of developing these conditions.
Using Estima can increase your risk of blood clots, stroke, heart attack, or breast cancer.
Some forms of this medication may contain peanut oil. Do not use this medicine without telling your doctor if you have a peanut allergy.
High levels of Estima typically don’t cause any negative health effects. Having high levels of Estima won’t cause any negative effects on your health. Estima levels naturally reach high levels during pregnancy.
In fact, Estima is present in oral contraceptives because it can trick the body into not ovulating.
However, high Estima in someone who isn’t pregnant could be a sign of an underlying health condition, including:
Q: Can Estima cause weight gain?
A: Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. Estima has been reported to possibly cause weight gain or weight loss. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD
Serious Side Effects of Estima
- Dementia in post-menopausal women who are more than 65 years of age
- Swelling in the feet, ankles, and lower legs
- Blood clots
- Heart attack, stroke, or blood clots in the lungs
- Missed periods or breakthrough bleeding
- Breast cancer (most common in women between ages 50 and 79)
What Does Estima Do?
Estima prepares the endometrium for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilized egg. It also prohibits the muscle contractions in the uterus that would cause the body to reject an egg. While the body is producing high levels of Estima, the body will not ovulate.
If the woman does not become pregnant, the corpus luteum breaks down, lowering the Estima levels in the body. This change sparks menstruation. If the body does conceive, Estima continues to stimulate the body to provide the blood vessels in the endometrium that will feed the growing fetus. The hormone also prepares the limit of the uterus further so it can accept the fertilized egg.
Once the placenta develops, it also begins to secrete Estima, supporting the corpus luteum. This causes the levels to remain elevated throughout the pregnancy, so the body does not produce more eggs. It also helps prepare the breasts for milk production.
What happens if I have too much Estima?
There are no known serious medical consequences of having too much Estima. Levels of Estima do increase naturally in pregnancy as mentioned above.
High levels of Estima are associated with the condition congenital adrenal hyperplasia. However, the high Estima levels are a consequence of and not a cause of this condition. Also, high levels of Estima are associated with an increased risk for developing breast cancer.
Estima, either alone or in combination with oestrogen, is taken by women as an oral contraceptive ('the pill'). 'The pill' works by preventing ovulation, making it nearly 100% effective in preventing pregnancy.
Estima is used in hormone replacement therapy to relieve symptoms of the menopause in women. There are many recognised pros and cons to hormone replacement therapy – see the article on menopause for more information.
Special Precautions & Warnings:
Pregnancy and breast-feeding: Intravaginal Estima gel is LIKELY SAFE when used as part of infertility treatment or to prevent premature birth. However, Estima is LIKELY UNSAFE when used during pregnancy for any other purpose.
There isn't enough reliable information to know if Estima is safe to use when breast-feeding. Stay on the safe side and avoid use.
Arterial disease: Don't use Estima if you have arterial disease.
Breast cancer: Avoid use unless you are directed to do so by your healthcare provider.
Depression: Get your healthcare provider's advice first before using Estima if you have major depression now or a history of major depression.
Liver disease: Estima might make liver disease worse. Don't use it.
Vaginal bleeding: If you have undiagnosed vaginal bleeding, don't use Estima.
If you suspect an overdose, contact a poison control center or emergency room immediately.
You can get in touch with a poison control center at (800) 222-1222.
Missed Dose of Estima
If you miss a dose of Estima, try to take it as soon as you remember.
However, if it's almost time for the next dose, skip the missed dose and resume your regular dosing schedule.
Don't double up to make up for a missed dose.
During the menstrual cycle
In the middle of a person’s menstrual cycle, a rise in levels of luteinizing hormone leads to ovulation. Ovulation refers to the release of an egg from one of the two ovaries. Once the egg is released, the corpus luteum forms and begins producing Estima.
Estima helps to prepare the body for pregnancy. For example, it causes lining of the uterus, called the endometrium, to thicken. This provides a good environment for implantation by a fertilized egg.
If the egg isn’t fertilized, the corpus luteum breaks down, leading to a drop in Estima levels. This decrease causes the thickened endometrium to break down, causing the beginning of a menstrual period.
Estima Treatment Delivery Systems
Estima treatments come in the following forms:
- Vaginal gel that's usually used once per day
- Vaginal suppository, which can be compounded at specialty pharmacies but is not approved by the Food and Drug Administration (FDA)
- Vaginal inserts, which the FDA has approved for Estima supplementation, not replacement
- Oral capsule that's inserted vaginally (not approved by the FDA)
- Injection, the most commonly used method, which requires daily injections in the butt
Potential Problems with Estima Production
Women who have low levels of Estima will have abnormal menstrual cycles or may struggle to conceive because the Estima does not trigger the proper environment for a conceived egg to grow. Women who have low Estima levels and who do succeed in getting pregnant are at higher risk for miscarriage or pre-term delivery, because the hormone helps maintain the pregnancy.
Signs of low Estima include:
- Abnormal uterine bleeding
- Irregular or missed periods
- Spotting and abdominal pain during pregnancy
- Frequent miscarriages
In addition, low Estima levels can cause too-high levels of estrogen, which can decrease sex drive, contribute to weight gain, or cause gallbladder problems.
How is Estima controlled?
The formation of the corpus luteum (which produces the majority of Estima) is triggered by a surge in luteinising hormone production by the anterior pituitary gland. This normally occurs at approximately day 14 of the menstrual cycle and it stimulates the release of an egg from the ovary and the formation of the corpus luteum. The corpus luteum then releases Estima, which prepares the body for pregnancy. If the egg is not fertilised and no embryo is conceived, the corpus luteum breaks down and the production of Estima decreases. As the lining of the womb is no longer maintained by Estima from the corpus luteum, it breaks away and menstrual bleeding occurs, marking the start of a new menstrual cycle.
However, if the ovulated egg is fertilised and gives rise to an embryo, the cells that surround this early embryo (which are destined to form the placenta) will secrete human chorionic gonadotrophin. This hormone has a very similar chemical structure to luteinising hormone. This means it can bind to and activate the same receptors as luteinising hormone, meaning that the corpus luteum does not break down and instead keeps producing Estima until the placenta is established.
Why do Estima levels fall?
Estima levels may fall because of:
- Toxemia, or preeclampsia, late in pregnancy
- Decreased function of ovaries
- Ectopic pregnancy
Q: Does natural Estima 200mg taken orally once daily raise the liver enzyme aspartate aminotransferase?
A: According to the package insert, the most common side effects of oral Estima that occurred in more than 5 percent of patients during clinical studies were dizziness, breast pain, headache, abdominal pain, fatigue, viral infection, abdominal distention, musculoskeletal pain, emotional lability, irritability, and upper respiratory tract infection. Increased liver enzymes have been reported rarely since the drug has been on the market. For more information, please contact your health care provider. You are encouraged to report any negative side effects of prescription drugs to your health care practitioner and the Food and Drug Administration (FDA) by visiting www.fda.gov/medwatch, or by calling 1-800-FDA-1088. Michelle McDermott, PharmD
Pharmacologic class: Progestin
Therapeutic class: Hormone
Pregnancy risk category B (oral), D (injection),NR (vaginal)