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Clinical surveillance of all women using estrogen-alone or estrogen plus progestin therapy is importantAdequate diagnostic measuresincluding directed or random endometrial sampling when indicatedshould be undertaken to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding.

Serum follicle stimulating hormoneFSHand estradiol levels have not been shown to be useful in the management of moderate to severe symptoms of vulvar and vaginal atrophy.

Estrogens may be poorly metabolized in women with impaired liver functionFor women with a history of cholestatic jaundice associated with past estrogen use or with pregnancycaution should be exercisedand in the case of recurrencemedication should be discontinued.

14.Women with pre-existing hypertriglyceridemia should be followed closely during estrogen replacement or hormone replacement therapysince rare cases of large increases of plasma triglycerides leading to pancreatitis have been reported with estrogen therapy in this condition.

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