It should also not be used in liver disease, breast or genital cancer, blood clots or history thereof, otosclerosis, breast cancer, genital cancer, undiagnosed vaginal bleeding or sickle cell anaemia.
A pre-treatment gynaecological and general examination is essential and piperazine oestrone should be used in conjunction with a progestogen if still menstruating.
Side effects may include abnormal uterine bleeding, vaginal thrush, nausea, fluid retention, weight gain and breast tenderness. Unusual side effects may include a rash, blurred vision, vomiting, bloating, intestinal cramps, pigmentation of skin on face and rarely blood clots, calf or chest pain and yellow skin (jaundice).
Piperazine oestrone may interact with other sex hormones, warfarin, anticonvulsants (treat epilepsy), hypoglycaemics (treat diabetes), pethidine, theophylline, beta-blockers, phenothiazines, thyroxine, tricyclic antidepressants, cyclosporin, bromocriptine and caffeine. Smoking increases the risk of serious side effects.