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[4] Systemic estradiol therapy is contraindicated in patients with unexplained vaginal bleeding, active or history of estrogen-dependent malignancies such as breast carcinoma, active deep-vein thrombosis or pulmonary embolism, and in those with known hereditary or acquired thrombophilias because of the heightened pro-coagulant milieu engendered by estrogen exposure

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Mushrooms and dairy products also contain high levels of L-carnitine

Patients who have endocrine conditions or rare thyroid conditions should consult their primary doctors before taking these medications, as they may be contraindicated for them