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(ess' troe jen)Estrogen increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estrogen, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you may be given another medication called a progestin to take with vaginal estrogen. This may decrease your risk of developing endometrial cancer but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using vaginal estrogen, tell your doctor if you have or have ever had cancer and if you have unusual vaginal bleeding. Call your doctor immediately if you have abnormal or unusual vaginal bleeding during your treatment with vaginal estrogen. Your doctor will watch you closely to help ensure you do not develop endometrial cancer during or after your treatment. In a large study, women who took estrogen with progestins by mouth had a higher risk of heart attacks, strokes, blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Women who use vaginal estrogen alone or with progestins may also have a higher risk of developing these conditions. Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke in the past year, and if you or anyone in your family has or has ever had blood clots or breast cancer. Also tell your doctor if you have or have ever had high blood pressure, high blood levels of cholesterol or fats, diabetes, heart disease, lupus (a condition in which the body attacks its own tissues causing damage and swelling), breast lumps, or an abnormal mammogram (x-ray of the breasts used to find breast cancer). The following symptoms can be signs of the serious health conditions listed above. Call your doctor immediately if you experience any of the following symptoms while you are using vaginal estrogen: 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; difficulty thinking clearly, remembering, or learning new things; breast lumps or other breast changes; discharge from nipples; or pain, tenderness, or redness in one leg. You can take steps to decrease the risk that you will develop a serious health problem while you are using vaginal estrogen. Do not use vaginal estrogen alone or with a progestin to prevent heart disease, heart attacks, strokes, or dementia. Use the lowest dose of estrogen that controls your symptoms and only use vaginal estrogen as long as needed. Talk to your doctor every 3 to 6 months to decide if you should use a lower dose of estrogen or should stop using the medication. You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history. Tell your doctor if you are having surgery or will be on bed rest. Your doctor may tell you to stop using vaginal estrogen 4 to 6 weeks before the surgery or bed rest to decrease the risk that you will develop blood clots. Talk to your doctor regularly about the risks and benefits of using vaginal estrogen.