From the FDA Drug Label
Estrogens increase the chances of getting cancer of the uterus. Report any unusual vaginal bleeding right away while you are taking estrogens. Unusual vaginal bleeding can be a warning sign of cancer of the uterus, especially if it happens after menopause. Common side effects include: ... Irregular vaginal bleeding or spotting
The patient may bleed on Estrofem because estrogens can cause irregular vaginal bleeding or spotting, and it is recommended to report any unusual vaginal bleeding right away. Starting the treatment at day 2 of her period may not be the cause of the bleeding, but rather the estrogen hormone itself. It is essential to monitor and report any unusual vaginal bleeding to the healthcare provider to rule out any serious conditions, such as cancer of the uterus 1.
From the Research
A patient may experience bleeding while taking Estrofem (estradiol) when started on day 2 of her period because the medication is being introduced during active menstrual bleeding, which can temporarily disrupt the normal shedding process of the endometrium. This is generally considered normal and should resolve within 1-2 cycles as the body adjusts to the hormone therapy. If the bleeding becomes heavy, prolonged (more than 7 days), or occurs repeatedly between cycles, the patient should contact her healthcare provider. The dosing of Estrofem typically starts at 1-2 mg daily, and adjustments may be needed based on symptoms and response. To minimize bleeding issues, some providers prefer starting hormone therapy after menstruation has completed, but starting on day 2 is also an acceptable approach that allows for a smoother hormonal transition in many women. According to a study published in 2007 2, unopposed estradiol therapy in postmenopausal women can lead to endometrial hyperplasia and bleeding episodes, highlighting the importance of monitoring and adjusting hormone therapy as needed. Key points to consider include:
- The patient's symptoms and response to the medication
- The need for adjustments to the dosing or type of hormone therapy
- The importance of monitoring for signs of endometrial hyperplasia or other complications
- The potential for bleeding episodes, especially in obese patients 2 It is essential to weigh the benefits and risks of hormone therapy and to individualize treatment based on each patient's needs and medical history. In terms of monitoring, transvaginal ultrasonography can be used to evaluate endometrial thickness and detect potential abnormalities 3, 4, but it is crucial to consider the limitations and potential false negatives of this method. Ultimately, the decision to start hormone therapy on day 2 of a patient's period should be made on a case-by-case basis, taking into account the patient's individual needs and medical history.