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Estrogens, Contraceptive Agents, Anti-menopausal Agents


Activelle, Aerodiol, Agofollin, Alpicort, Alora, Angeliq, Angemin, Armonil, Betatabs, Calidiol, Cetura, Clifemme, Climaston, Climara, Climen, Climodien, Cliovellan, Cliovelle, Cyclabil, Cyclo-Progynova, Delestrogen, Dermestril, Divigel, Divina, Duogestan, Duova, Epheilia, Epiestrol, Eptausa, Esclima, Estalis, Estraderm, Estradiolo, Estradot, Estradurin, Estrahexal, Estreva, Estring, Estrimax, Estroclim, Estrodose, Estrofem, Estrogel, Eviana, Evopad, Evorel, Fematab, Femsete Combi, FemSeven, Femanest®, Femanor®, Femasekvens®, Feminova, Femoston, Femphascyl, FemSeven, Femostonconti, Folivirin, Gelestra, Ginaikos, Gracial, Gynodian, Indivina, IOA, Juvinelle, Klaira, Kliane, Klimodien, Klimonorm, Kliogest, Lafamme, Lenzetto, Levelyn, Linoladiol, Lyrelle, Menorest, Merimono, Montadiol, Naemis, Neofolin, Noresmea, Novofem, Oesclim, Oestraclin, Oestring, Oestrodose, Oestrogel, Olaira, Pausogest, Prapanol, Progynon, Progynova, Provames, Qlaira, Sandrena, Sequidot, Sibilla, Sprediol, Systen, Thais, Theralgan, Totelle Sekvens, Triaklim, Trisekvens, Trisequense, Trivina, Tulita, Vagifem, Velbienne, Vivelle, Zerella, Zoely, Zumenon


estradiol, estradiol 3-acetate, estradiol hemihydrate, estradiol valerate

Generally refers to the 17-beta-isomer of estradiol, an aromatized C18 steroid with hydroxyl group at 3-beta- and 17-beta-position. Estradiol-17-beta is the most potent form of mammalian estrogenic steroids. In humans, it is produced primarily by the cyclic ovaries and the placenta. It is also produced by the adipose tissue of men and postmenopausal women. The 17-alpha-isomer of estradiol binds weakly to estrogen receptors (receptors, estrogen) and exhibits little estrogenic activity in estrogen-responsive tissues. Various isomers can be synthesized. [PubChem]

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Estradiol is on the EU list of substances whose concentrations in surface waters should be monitored in the Member States for environmental reasons. In addition to e.g. ethinyl estradiol and endogenous estrogen, estradiol contributes to the amount of estrogens in the environment. See also ethinyl estradiol.

Estradiol is included in the Stockholm County Council's table of pharmaceuticals with a negative environmental impact according to the environmental programme 2017-2021.

Estradiol is more easily degraded than ethinyl estradiol in the body, in the wastwater treatment plant, in the environment and is less potent in fish. An oral dose of 1.5 mg estradiol gives an excreeted dose in the urine of only 100 micrograms. Therefore, the risk is probably lower with estradiol despite the often higher dosage. 

Is recommended in The Wise List. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise List. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.

Suggestions on how to reduce the release of estradiol
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise List. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.

Concrete proposal for estradiol:
• Estradiol is recommended in the Wise List.
• Individual adaptation of contraceptives as well as pharmaceuticals for treatment of menopausal symptoms and symptomatic vaginal atrophy is important in order to optimize treatment and avoid side effects.
• For topical application of patches with estradiol (Estradot, recommended in the Wise List) for menopausal symptoms, the amount of pharmaceutical administered to an individual is significantly lower than the dose required to give the corresponding effect with estradiol tablets.
• Ensure that you, in your own business, discard leftover pharmaceuticals and used patches and vaginal inserts correctly, http://www.janusinfo.se/Rutiner/Hantering-av-lakemedel/ 
• Inform the patient about the importance of discarding leftover pharmaceuticals, as well as used patches and vaginal inserts, correctly. Order the folder for patients "Protect the Environment – Throw in the Right Way" http://janusinfo.se/Beslutsstod/Miljo-och-lakemedel/Dokument/Informationsmaterial/

The risk classification moderate, according to Fass.se, is based on total sold amount (kg) of the substance in Sweden during the year 2011 and the toxicity of the substance.


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