CONJUGATED ESTROGENS (CON ju gate ed ESS troe jenz) relieves the symptoms of menopause, such as vaginal irritation, dryness, or pain during sex. It works by increasing levels of the hormone estrogen in the body. This medication is an estrogen hormone.

This medication is for use in the vagina only. Do not take by mouth. Follow the directions on the prescription label. Use at bedtime unless otherwise directed by your care team. Use the special applicator supplied with the cream. Wash hands before and after use. Fill the applicator with the cream and remove from the tube. Lie on your back, part and bend your knees. Insert the applicator into the vagina and push the plunger to expel the cream into the vagina. Wash the applicator with warm soapy water and rinse well. Use exactly as directed for the complete length of time prescribed. Do not stop using except on the advice of your care team.

Talk to your care team about the use of this medication in children. Special care may be needed.

A patient package insert for the product will be given with each prescription and refill. Read this sheet carefully each time. The sheet may change frequently.

Side effects that you should report to your care team as soon as possible:

• Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
• Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
• Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
• Gallbladder problems—severe stomach pain, nausea, vomiting, fever
• Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
• Heavy vaginal bleeding
• Increase in blood pressure
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
• Unusual vaginal discharge, itching, or odor

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Bloating
• Breast pain or tenderness
• Dark patches of skin on the face or other sun-exposed areas
• Hair loss
• Irregular menstrual cycles or spotting
• Nausea
• Stomach pain
• Swelling of the ankles, hands, or feet

Keep out of the reach of children and pets.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medication after the expiration date.

They need to know if you have any of these conditions:

• Abnormal vaginal bleeding
• Blood vessel disease or blood clots
• Breast, cervical, endometrial, or uterine cancer
• Dementia
• Diabetes
• Gallbladder disease
• Heart disease or recent heart attack
• High blood pressure
• High cholesterol
• High level of calcium in the blood
• Hysterectomy
• Kidney disease
• Liver disease
• Migraine headaches
• Protein C deficiency
• Protein S deficiency
• Stroke
• Systemic lupus erythematosus (SLE)
• Tobacco use
• An unusual or allergic reaction to estrogens other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

Do not take this medication with any of the following:

• Aromatase inhibitors, such as aminoglutethimide, anastrozole, exemestane, letrozole, testolactone

This medication may also interact with the following:

• Barbiturates used for inducing sleep or treating seizures
• Carbamazepine
• Certain antibiotics used to treat infections
• Grapefruit juice
• Medications for fungal infections, such as itraconazole and ketoconazole
• Raloxifene or tamoxifen
• Rifabutin
• Rifampin
• Rifapentine
• Ritonavir
• St. John's Wort
• Warfarin

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

Visit your care team for regular checks on your progress. You will need a regular breast and pelvic exam. You should also discuss the need for regular mammograms with your care team, and follow their guidelines.

This medication can make your body retain fluid, making your fingers, hands, or ankles swell. Your blood pressure can go up. Contact your care team if you feel you are retaining fluid.

If you have any reason to think you are pregnant; stop taking this medication at once and contact your care team.

Tobacco smoking increases the risk of getting a blood clot or having a stroke, especially if you are more than 35 years old. You are strongly advised not to smoke.

If you wear contact lenses and notice visual changes, or if the lenses begin to feel uncomfortable, consult your care team.

If you are going to have elective surgery, you may need to stop taking this medication beforehand. Consult your care team for advice prior to scheduling the surgery.