Estradiol Therapy Consent

PURPOSE OF TREATMENT

The purpose of estradiol therapy is to help restore estrogen levels in patients experiencing estrogen deficiency or hormone imbalance. This therapy aims to reduce or eliminate symptoms associated with hormonal decline due to perimenopause, menopause, surgical menopause, or hormonal dysregulation.

 

Expected Benefits:

Estradiol therapy is used to help treat symptoms related to estrogen deficiency, including hot flashes and night sweats, vaginal dryness, mood changes or irritability, insomnia or sleep disturbance, urinary incontinence, brain fog or memory decline, reduced risk of osteoporosis and bone loss, and potentially reduced risk of cardiovascular disease if initiated in early menopause.

Treatment may include oral estradiol, transdermal patches, intravaginal creams or tablets, or compounded formulations such as creams, capsules, lozenges, or injections.

 

Risks and Side Effects:

As with any hormone therapy, there are potential risks and side effects, which may include but are not limited to: breast tenderness, nausea, headache, fluid retention, mood swings, and spotting or breakthrough bleeding. There is a possible increased risk of blood clots, stroke, increased risk of endometrial cancer in women with an intact uterus who do not use progesterone, and breast cancer depending on individual health risk factors. Regular monitoring will be required.

 

Alternatives to Estrogen Replacement Therapy:

You may choose not to undergo estradiol therapy.

No Treatment: Choosing not to treat hormone deficiency may result in continued or worsening symptoms and increased risk for conditions associated with estrogen loss. (e.g., osteoporosis, cognitive decline).

Symptom-based Management: Using medications like SSRIs (antidepressants), sleep aids, herbal supplements, or other non-hormonal therapies.

Lifestyle Modification: Incorporating diet, weight management, stress reduction, exercise, yoga, or essential oils to alleviate symptoms.

Other Hormonal Options: Some estrogen therapies may be formulated synthetically or prescribed by other providers using different protocols. You may choose to consult with another provider for alternative views or approaches.

 

Off-Label Use and Informed Consent:

The use of bioidentical Estradiol, particularly compounded formulations, may be considered Off-Label by the FDA. Off-Label use refers to a legally prescribed medication for a use not specifically approved by the FDA. This includes the use of estradiol for treating symptoms in women who do not meet strict diagnostic criteria for menopause. This treatment plan is based on clinical judgment, medical literature, and symptomatology.

Please initial below to acknowledge the following:

I confirm that I have reviewed and understand the potential risks, benefits, alternatives, and the off-label nature of estradiol therapy.

AUTHORIZATION

I voluntarily request and give my informed consent for Alexander Medical, LLC and its healthcare providers to initiate or continue estradiol hormone therapy as described.

I authorize the providers to perform any additional tests, evaluations, or procedures reasonably necessary to support my care. I understand that this treatment is elective and that I may stop at any time by informing my provider.

 

ACKNOWLEDGMENT

I have read (or had read to me) this entire consent form. I have had the opportunity to ask questions and all questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives, and I consent to the use of estradiol hormone therapy.