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Endometriosis may be exacerbated with administration of estrogensA few cases of malignant transformation of residual endometrial implants have been reported in women treated post-hysterectomy with estrogen alone therapyFor patients known to have residual endometriosis post-hysterectomythe addition of progestin should be considered.

Treatment is usually initiated with a dose of 1 to 2 mg daily of estradioladjusted as necessary to control presenting symptomsthe minimal effective dose for maintenance therapy should be determined by titration.

Estrogen administration should be initiated at the lowest dose approved for the indication and then guided by clinical response rather than by serum hormone levelse.gestradiolFSHSee DOSAGE AND ADMINISTRATION section

The Women’s Health InitiativeWHIestrogen-alone substudy reported increased risks of stroke and deep vein thrombosisDVTin postmenopausal women with daily oral conjugated estrogensCEaloneThe WHI estrogen-plus-progestin substudy reported increased risks of DVTpulmonary embolismstrokeand myocardial infarction in postmenopausal women with daily oral CE combined with medroxyprogesterone acetateMPAIn the absence of comparable datathese risks should be assumed to be similar for other dosage forms of estrogens.

Retinal vascular thrombosis has been reported in patients receiving estrogensDiscontinue medication pending examination if there is sudden partial or complete loss of visionor a sudden onset of proptosisdiplopia or migraineIf examination reveals papilledema or retinal vascular lesionsestrogens should be permanently discontinued.

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postmenopausal women can use estrace not only as a hormone replacement, but to also prevent the onset of osteoporosis.