Zumenon

Zumenon® 2mg
estradiol

What you should know about Zumenon tablets
Read this leaflet before you take your medicine.
It gives you important information. Please keep this leaflet safe, because you may want to read it again. If you have any questions or are not sure about anything, ask your doctor or a pharmacist.

Unless you have had your womb removed, your doctor will prescribe another female hormone as well. This is called a progestogen. Your womb needs both estradiol and a progestogen to keep its natural balance of hormones. This type of treatment is called hormone replacement therapy, or HRT.

When not to take HRT
You should not take HRT if you:

have a blood clot in a vein in your leg or anywhere else (a deep vein thrombosis);
have a blood clot that has travelled to your lung or another part of your body (an embolus);
have had one of the above conditions in the past;
think you may be pregnant;
have any sort of cancer or a tumour (some cancers, especially cancer of the breast and womb, can be made worse by hormones);
have or have had a liver complaint;[*]have had a stroke;
have irregular or unusually heavy periods;
have severe heart or kidney disease;
suffer from Rotor syndrome or Dubin-Johnson syndrome;
are allergic to lactose (also found in dairy products) or any of the other ingredients; or
are breast-feeding.

What you should know before using HRT
Before giving you the prescription for this medication, your doctor will have taken details of your personal and family medical history. Depending on your medical history, your doctor will decide whether you need a physical examination.
The doctor will only examine your breasts or carry out a pelvic examination (an internal) if he or she thinks it is necessary.

You should take part in the national mammography and cervical smear screening programmes. In these schemes all women are automatically contacted to have regular smear tests (women age 20 to 64) and mammograms -breast X-rays- (every three years for women age 50 to 64). If you have questions about these schemes, please ask your doctor or nurse.

It is also important to be breast aware. This means noticing any changes in your breasts such as dimpling of the skin, changes in the nipple, or finding any lumps. You should tell your doctor or nurse immediately if you notice any changes.

All women have a small chance of having a blood clot in the veins of the leg, in the lung or other parts of the body whether or not they take HRT. For women who are not taking HRT, the chances of getting a blood clot are about 1 in 10,000 women each year. While taking HRT, the chances of getting a blood clot increase to 3 in 10,000 women each year.
You are more likely to have a blood clot whether or not you take HRT if:

you are very overweight;
you have had a blood clot in the veins or lungs before;
you have relatives who have suffered from these;
you are not able to move for long periods; or
you have a serious injury or a major operation.

If any of these apply to you, you should also talk to your doctor about whether you should take Zumenon.
If you know you will be having an operation that is likely to keep you off your feet for some time, you should talk to your doctor as you may need to stop taking Zumenon about a month before the operation.

Every woman is at risk of getting breast cancer, whether or not she takes HRT. There is a small increase in this risk for women who have been using HRT for more than 5 years compared with women of the same age who have never used HRT. It is not known whether the difference is caused by HRT.
It may be that women using HRT are examined more often so that breast cancer is noticed earlier. The longer that HRT has been used, the more chance there is of having breast cancer diagnosed. This increased chance of breast cancer is also found in women whose menopause is naturally late, without
taking HRT.
For women aged 50 who are not using HRT, about 45 in every 1,000 will have breast cancer diagnosed by the age of 70. For women who start using HRT at age 50, the extra number of breast cancers resulting from the use of HRT has been estimated as in the table below.

Length of time on HRT	Extra breast cancers found up to age 70 for every 1,000 women
5 years	2
10 years	6
15 years	12

If women stop taking HRT, the increased risk disappears by 5 years after stopping HRT and the chances of finding breast cancer are the same as for women who have never used HRT. Breast cancer seems less likely to have spread when found in women who have used HRT than in women who
have never used HRT.
If you are worried about the risk of breast cancer, discuss the risk compared to the benefits of HRT with your doctor.
Before you start Hormone Replacement Therapy (HRT), your doctor may give you a thorough examination and may suggest regular check-ups.
Some women get irregular bleeds when they start taking HRT.
If this does not settle after the first few weeks, tell your doctor.
If you have (or have had) any of the following, your doctor may want to watch your condition closely to make sure it does not get worse:

otosclerosis (a type of deafness);
multiple sclerosis;
systemic lupus erythematosus (SLE) (a disease which affects the skin and major organs);
Porphyria (an inherited blood disease);
melanoma (skin cancer);
epilepsy (fits);
migraine;
asthma;
blood disorders;
sugar diabetes;
liver disease;
endometriosis (the uterus lining building up in other parts of your body);
fibroids or breast lumps;
heart or kidney disease.

Zumenon is not a contraceptive pill. If there is a risk you could become pregnant, you should use a reliable non-hormonal contraceptive, such as a condom. If you become pregnant while taking these tablets, you should stop taking them immediately.
It is unlikely that Zumenon will affect your blood pressure, but your doctor will take your blood pressure at your regular check-ups, especially if you are being treated for high blood pressure.
There is a slightly increased risk of gall bladder disease inwomen taking HRT.

Are you taking any of these other medicines?

Barbiturates
Phenytoin or carbamazepine (usually prescribed for epilepsy)
Rifampicin (an antibiotic).

If you are not sure, ask your doctor ar a pharmacist. These other medicines may stop Zumenon working properly.
HRT could affect some medical tests. If you visit a hospital or clinic for any medical tests, tell the doctor or nurse that you are on HRT.

How to take your medicine
For menopausal symptoms (hot flushes, night sweats), the usual starting dose is one tablet daily of Zumenon 1 mg. Your doctor may increase this to 2 mg daily. The usual dose for prevention of osteoporosis is one tablet daily of Zumenon 2 mg.
If you have had a hysterectomy (your womb taken out) or you have been through the menopause (change of life), you may start taking the tablets on any day that suits you.
If you have regular periods, you should start taking Zumenon on the fifth day of bleeding. You should keep taking the tablets until your doctor tells you to stop.
You should see your doctor at least every 6 to 12 months while you are on oestrogen treatment.
Swallow the tablet with a glass of water. You do not have to take the tablet with food.

If you forget to take a dose, take the next one as soon as you remember. If you don't remember until it is time to take the next dose, just take one dose. Do not take two doses to make up for the one you missed. If you miss several doses, you may have
irregular bleeding. If this happens, you should see your doctor.
If you, or someone else, takes too many Zumenon tablets, they are unlikely to make you ill, but you should contact your doctor.

Possible side effects
Some women may have side effects when taking Zumenon, but they usually disappear after the first few months.
Possible side effects of oestrogen replacement therapy are:

irregular bleeds, spotting, period pains, pre-menstrual tension (PMT), breakthrough bleeding (bleeding between periods), absence of periods, increase in the size of uterine fibroids, changes in the cervix;
thrush, vaginal discharge and urinary;
infections such as cystitis;
swollen, tender breasts, breast secretions;
feeling or being sick, a feeling of being bloated, stomach cramps, cholestatic jaundice (yellowing of the skin and eyes);[*]rashes or discoloration, swellings or red patches on the skin;
minor eye changes which may cause difficulties if you wear contact lenses;
headaches, migraine, dizzinesss, mood changes, muscular twitches;
weight changes, changes in appetite;
changes in sex drive (libido);
leg cramps;[*]worsening of porphyria;
oedema (swelling).

Usually, side effects are not common and do not usually last long. If any of these side effects do last for a long time or you notice any other side effects, please contact your doctor or a pharmacist for advice.
If you develop a very severe headache or migraine, jaundice, or sudden problems with your vision, contact your doctor immediately.
If you get a blood clot while you are taking Zumenon you should stop taking it immediately and contact your doctor.
Warning signs to look out for are:

coughing blood;
unusual pains or swellings of your arms or legs;
pains or feeling of heaviness in your chest;
sudden shortness of breath; or
fainting.

How to store your medicine
Do not store above 30°C. Keep container in outer carton.
Do not use it after the expiry date shown on the carton.
Store your medicine where children cannot see or reach it.
Take any tablets you do not use back to a pharmacist.
This leaflet was revised in April 2003.

More information on the menopause
What is the menopause?
You usually get menopausal symptoms a few years before your last period. These symptoms last for about five years after your last period. Around the age of 45, your ovaries make less oestrogen and progesterone. These female hormones are responsible for your periods. Your periods
become irregular and the fall in oestrogen levels leads to menopausal symptoms.
Your periods will usually end when you are about 52.
Menopausal symptoms can last for many years. Usually they begin with hot flushes, sweating, tiredness, sleeplessness, feelings of depression, headaches and aching muscles and joints. Another symptom can be sudden increases in your heart beat (palpitations). These symptoms can vary from woman to woman.

Later many women can experience incontinence.
The vagina’s delicate lining can become irritated leading to pain during intercourse.
In the longer term, lack of oestrogen can cause your bones to thin (osteoporosis). This increases the risk of you breaking your bones. Hormone replacement therapy can help stop your bones thinning.

Oestrogens are thought to be good for your circulation, as they act directly on blood vessels and cut down the amount of fat (cholesterol) in the blood. When your oestrogen levels fall, there
may be an increased risk of you developing heart disease.
If you would like more information on osteoporosis and the menopause, the following organisations can help:

National Osteoporosis Society
PO Box 10
Radstock
Bath BA3 3YB

Phone: 01761 471771

The Amarant Helpline
Phone: 01293 413000

Lines are open from 12 noon to 7 pm, Monday to Friday.
Calls are answered personally by nurses.

Remember
This medicine is for you.
Please do not offer it to your family and friends,
even if they have the same symptoms as you.