Brief Answer:
Mixogen is associated with significant effects on long-term usage.

Detailed Answer:
Hello, XXXX.

I understand your concern.

Yes, certainly long term MIXOGEN can cause certain side effects as following.

Mixogen is a balanced combination of estradiol esters and testosterone esters, some with short and some with prolonged action.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS-

The following adverse reactions have been associated with either estrogen or androgen therapy or both:
1.Breast tenderness, pain, enlargement, secretion.

2.Gastro-intestinal tract-nausea, vomiting, cholelithiasis, cholestatic jaundice.
This can be the cause of her stomach pain.An ultrasound abdomen is highly recommended in her case.

3.Blood clot and elevation of blood pressure.

4.Skin rash and excessive body hair.

5.A headache, migraine, mood changes.

6. A Propensity to develop kidney damage and Diabetes.

7. Change in body mass, hoarseness or deepening of the voice.

8.Urogenital symptoms like Vaginal dryness, soreness, urinary frequency and urgency.

9.Case reports have been published of benign hepatic(LIVER) and tumours.Uterine cancers are reported in those with an intact uterus.

Baseline laboratory and imaging studies should be periodically done in those receiving HRT(hormone replacement therapy) It include the following:

1. Complete blood counts.
2. Urinalysis
3. Fasting lipid profile
4. Blood sugar levels
5. Serum estradiol and follicle-stimulating hormone (FSH) levels.
6. Ultrasonography of abdomen.
7. Electrocardiography and Echocardiography.
8. Mammography: Performed once every 2-3 years and annually after the age of 50 years.


For alternative forms of therapy-

I can guide you better if you can provide further info.

1.Indication for Uterus removal in her case? fibroids/cancer/endometriosis?
2.whether ovaries also removed?
3.Any history of diabetes and hypertension?
4.Any history of liver and lipid profile abnormalities?
5.Any history of bone, joint disorders or fractures?
6.How many side effects(from 1-9 above) she encountered so far?

I can formulate alternative regimen once I receive your answers.
Thank you.

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Brief Answer:
Please provide complete info.

Detailed Answer:
Hello, XXXX.

Thanks for your response.

You have not provided info regarding the indication for uterus and ovaries removal in her case.This is most important question I asked you.....For what disease, her uterus and ovaries were removed?Is it fibroids or Endometrial cancer or Something else?

Also, I would like to know if she had any bone or joint disorders in the past?

Please update me with the above.

Thank you.

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Brief Answer:
Low dose CEE is recommended as an alternative.

Detailed Answer:
Hello, XXXX.

I understand your concern.

Since your mother has reported problems 4,5,7,8 out of 9 it is advisable to stop Mixogen and get a complete set of all the investigations I mentioned.This is the most important step.

Low-dose estrogen particularly CEE-conjugated Ethinyl estradiol in a dose of 0.3mg/day is advisable in all women who had their uterus and ovaries removed.

Additionally vaginal creams of estrogen and progesterone may be used to combat the urogenital symptoms.

With the above regimen, side effects are largely reduced.

Please check with your physician if she shares my opinion and if can prescribe them to your mother.

Post your further queries if any.
Thank you.

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