Major brand names of CEEs in combination with medroxyprogesterone acetate include Prempro and Premphase in the United States, Premplus in Canada, Premique in the United Kingdom and Ireland, Premia in Australia and New Zealand, and Premelle in South Africa. Prempak-C is a combination of CEEs and norgestrel which is used in the United Kingdom and Ireland, and Prempak N is a combination of CEEs and medrogestone which is used in South Africa. Many of the aforementioned brand names are also used in other, non-English-speaking countries. Availability
CEEs are marketed and available widely throughout the world. This includes in all English-speaking countries, throughout Europe, Latin America, Asia, and elsewhere in the world. Usage
Besides ethinylestradiol used in birth control pills, CEEs were the second most used estrogen in the U.S. in 2016, with 4.2 million total prescriptions filled. The first most used estrogen was estradiol, with 13.4 million total prescriptions filled. CEEs were the 206th most commonly prescribed medication in the U.S. that year. Health effects
Research starting in 1975 showed substantially increased risk of endometrial cancer. Since 1976 the drug has carried a label warning about the risk. As part of the Womens Health Initiative sponsored by the National Institutes of Health, a large-scale clinical trial of menopausal HRT showed that long-term use of estrogen and a progestin may increase the risk of strokes, heart attacks, blood clots, and breast cancer.
A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe causing it to be bent, resembling a hammer. In the early stage a flexible hammertoe is movable at the joints; a rigid hammertoe joint cannot be moved and usually requires surgery.Mallet toe is a similar condition affecting the distal interphalangeal joint.Claw toe is another similar condition, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint, combined with flexion of both the proximal and distal interphalangeal joints. Claw toe can affect the second, third, fourth, or fifth toes. Risk factors
Older people are more likely to develop hammer toes. Women are at higher risk, due to the construction of womens shoes. Injuries to the toes, and being born with a big toe that is short in comparison to the second toe, increase risk. Arthritis and diabetes may also increase the risk of foot deformities. Causes
Hammertoes and clawtoes have multiple causes. Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity.