Estratest Side Effects: What to Expect and When to Call Your Doctor

Estratest (esterified estrogens/methyltestosterone) is an effective medication for managing moderate to severe menopausal hot flashes and night sweats — but like all hormone therapies, it comes with a set of potential side effects you should know about. Understanding what's normal, what's manageable, and what requires immediate attention is essential for anyone taking this medication.

Estratest is unique among hormone therapies because it contains both esterified estrogens (a form of estrogen) and methyltestosterone (a synthetic androgen/testosterone). This means its side effect profile includes effects from both components — some of which are different from standard estrogen-only therapies.

Boxed Warnings: The Most Serious Risks

Like all estrogen-containing hormone therapies, Estratest carries FDA boxed warnings — the most serious type of warning in drug labeling. These warn about:

Cardiovascular risks: Estrogens increase the risk of myocardial infarction (heart attack), stroke, and venous thromboembolism (blood clots in the legs or lungs). These risks are higher in women with existing cardiovascular risk factors.

Cancer risk: Estrogen without progestin increases the risk of endometrial cancer. Prolonged estrogen use may also be associated with increased breast cancer and ovarian cancer risk.

Dementia: Based on the Women's Health Initiative (WHI) study, estrogens (with or without progestins) in women 65 and older were associated with an increased risk of probable dementia.

These risks are managed by using the lowest effective dose for the shortest duration necessary and by regular monitoring with your prescriber.

Common Side Effects of Estratest

These side effects are seen in a meaningful percentage of patients and are usually manageable with dose adjustments or time:

Nausea and stomach discomfort (often improves by taking with food)

Headache

Breast tenderness or pain

Bloating and water retention (edema)

Acne

Weight changes

Changes in sex drive (may increase or decrease)

Dizziness

Depression or mood changes

Androgenic (Masculinizing) Side Effects from Methyltestosterone

Because Estratest contains methyltestosterone, women taking it may experience androgenic (masculinizing) side effects that are not typical with estrogen-only therapies. These include:

Voice changes (hoarseness or deepening): This can be permanent if it occurs — report it to your doctor immediately

Excess facial or body hair growth (hirsutism)

Male-pattern hair loss (androgenic alopecia)

Clitoral enlargement

Menstrual cycle changes (in women who still menstruate)

If caught early and the medication is stopped, many androgenic side effects will diminish. However, some effects — particularly voice deepening — can be permanent. Report any androgenic symptoms to your prescriber promptly.

Serious Side Effects: When to Get Immediate Medical Help

Call 911 or go to the emergency room immediately if you experience any of the following warning signs:

Signs of a blood clot: Swelling, pain, or warmth in the leg; sudden shortness of breath; chest pain; coughing up blood

Signs of a stroke: Sudden weakness or numbness on one side of the face or body; drooping face; slurred speech; sudden severe headache; vision changes

Signs of a heart attack: Chest pain or pressure spreading to arm, neck, or jaw; nausea; cold sweats; dizziness

Signs of liver damage: Yellowing of the skin or whites of the eyes (jaundice); dark urine; severe abdominal pain; loss of appetite; unusual fatigue

Unusual vaginal bleeding: Any unexpected or abnormal vaginal bleeding should be reported promptly — it can be a warning sign of endometrial changes

Gallbladder symptoms: Severe upper abdominal pain, nausea, fever — estrogens increase gallbladder disease risk

Who Should NOT Take Estratest

Estratest is contraindicated (should not be used) if you:

Are pregnant or may become pregnant (Category X — can cause serious birth defects)

Have known or suspected breast, uterine, or other hormone-sensitive cancers

Have a history of blood clots (DVT or pulmonary embolism), stroke, or heart attack

Have severe liver disease

Have undiagnosed abnormal vaginal bleeding

Monitoring While on Estratest

Your prescriber should monitor you regularly while on Estratest. Typical monitoring includes annual breast exams and mammograms, blood pressure checks, and periodic reassessment of whether continued treatment is still necessary. Liver function tests may also be ordered periodically since methyltestosterone can affect liver enzymes.

For information on drugs and substances that interact with Estratest, see our guide: Estratest Drug Interactions: What to Avoid.