Class Name(s):

• 68:16.04 Estrogens

Pronunciation:

• (ess' troe jen) (pro jes' tin)

Brand Name(s):

• Activella^® (as a combination product containing Estradiol, Norethindrone)
• Angeliq^® (as a combination product containing Drospirenone, Estradiol)
• Bijuva^® (as a combination product containing Estradiol, Progesterone)
• Jinteli^® (as a combination product containing Ethinyl Estradiol, Norethindrone)
• Mimvey^® (as a combination product containing Estradiol, Norethindrone)
• Premphase^® (as a combination product containing Conjugated Estrogens, Medroxyprogesterone)
• Prempro^® (as a combination product containing Conjugated Estrogens, Medroxyprogesterone)
• Fyavolv^®(as a combination product containing Ethinyl Estradiol, Norethindrone); also available generically

Other Name(s):

• HRT

WHY is this medicine prescribed?

Estrogen and progestin are used to treat certain symptoms of menopause. Estrogen also prevents thinning of the bones (osteoporosis) in menopausal women. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat (hot flashes), vaginal symptoms (itching, burning, and dryness) and difficulty with urination. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.

HOW should this medicine be used?

Hormone replacement therapy comes as a tablet or capsule to take by mouth. It is taken once a day. Take it around the same time every day.

Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medication without talking to your doctor.

Some estrogen and progesterone combination products come in a dispenser containing 28 tablets. Take one maroon tablet (containing only estrogen) once daily on days 1 to 14, and take one light-blue tablet (containing estrogen and progestin) once daily on days 15 to 28. Begin a new dispenser the day after you finish the last one.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Are there OTHER USES for this medication?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking hormone replacement therapy,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking hormone replacement therapy. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• you should know that the following nonprescription or herbal products may interact with estrogen and progestin: St. John's wort. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking estrogen and progestin. Do not start taking any of these medications while using estrogen and progestin without discussing with your healthcare provider.
• tell your doctor if you have had unusual vaginal bleeding, any type of cancer, or liver disease. Your doctor may tell you not to take estrogen and progestin.
• tell your doctor if you have had a hysterectomy (surgery to remove your uterus), and if you have or have ever had asthma; epilepsy (seizures); migraine headaches; endometriosis (condition in which tissue similar to the lining of the uterus grows outside the uterus); breast or ovarian cancer; bleeding disorder or blood clots; stroke; heart attack; high blood pressure; high cholesterol levels; heart disease; high levels of calcium in your blood, or gallbladder, thyroid, or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking this medication, call your doctor.
• tell your doctor if you use tobacco products. Cigarette smoking may increase the risk of side effects from this medication.
• this medication may not be recommended in people 65 years or older. There may be other treatment options that are safer or work better. Talk to your doctor about the risks and benefits of taking this medication.
• if you are having surgery, including dental surgery, tell the doctor or dentist you are taking hormone replacement therapy.
• tell your doctor if you use tobacco products. Smoking while taking this medication may increase your risk of serious side effects such as blood clots and stroke.

What SPECIAL DIETARY instructions should I follow?

Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medication.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Hormone replacement therapy may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• upset stomach
• vomiting
• stomach cramps, pain, or bloating
• diarrhea
• appetite and weight changes
• insomnia
• emotional changes or depression
• swelling of hands, feet, or lower legs (fluid retention)
• vaginal bleeding
• pain in the back or pelvic area
• breast pain or tenderness

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• hives, rash, itching, difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, and eyes
• itchy skin, dark urine, yellowing of your skin or eyes, flu-like symptoms pain in the upper right part of your stomach
• unusual vaginal bleeding
• sudden, severe headache; sudden, severe vomiting; speech problems; dizziness or faintness; sudden complete or partial loss of vision; double vision; weakness or numbness of an arm or a leg
• crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath
• breast lumps or other breast changes; discharge from nipples
• difficulty thinking clearly, remembering, or learning new things
• pain, tenderness, or redness in one leg

Hormone replacement therapy may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at http://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• nausea, vomiting, breast tenderness, abdominal pain, drowsiness and fatigue, or vaginal bleeding

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from heat and moisture (not in the bathroom).

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website http://goo.gl/c4Rm4p for more information.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location - one that is up and away and out of their sight and reach. http://www.upandaway.org

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including blood pressure measurements, breast exams, and a mammogram at least yearly. Follow your doctor's directions for examining your breasts; report any lumps immediately.

If you are taking hormone replacement therapy to treat symptoms of menopause, your doctor will check every 3 to 6 months to see if you still need this medication.

Before you have any laboratory tests, tell the laboratory personnel that you take hormone replacement therapy, because this medication may interfere with some laboratory tests.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™ Copyright, 2026. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: May 15, 2026.