Overview: Transdermal estradiol is available as a patch, gel, or spray that is applied to the skin to increase estrogen levels. It is used after menopause to prevent osteoporosis or to reduce vaginal dryness, pain during sex, hot flashes, or night sweats. The most common side effects are headache and breast pain or tenderness. Talk with your healthcare provider right away about any unusual vaginal bleeding or vaginal discharge.
Uses
What is estradiol transdermal used for?
Estradiol transdermal is commonly used for the following.
- To help reduce postmenopausal vaginal dryness or pain during sex.
- To help reduce hot flashes and night sweats (vasomotor menopause symptoms)
- To help prevent osteoporosis after menopause
- To increase estrogen levels in people when they are not making enough on their own
Estradiol transdermal may also be used for other conditions as determined by your healthcare provider.
How does estradiol transdermal work (mechanism of action)?
Estrogen is an important hormone for the health of the vagina and bones. It also plays a role in temperature regulation. During menopause or when your body does not make enough natural estrogen, levels go down. When this happens, the vagina can become dry and irritated, bones can become weak and fragile, and you may have hot flashes or night sweats. Transdermal estradiol raises estrogen levels to reduce symptoms of menopause by improving vaginal health, reducing bone loss, and helping regulate body temperature.
How is estradiol transdermal supplied (dosage forms)?
Brands and other names
- Climara
- Divigel
- Dotti
- Elestrin
- EstroGel
- Evamist
- Lyllana
- Menostar
- Minivelle
- Vivelle-Dot
Dosage forms and strengths
- 0.06%, 0.1% transdermal gel
- 1.53 mg topical spray
- 0.014 mg, 0.025 mg, 0.0375 mg, 0.05 mg, 0.06 mg, 0.075 mg, 0.1 mg transdermal patch
How should I store estradiol transdermal?
Transdermal estradiol should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Only open the foil pouch when you are ready to put an estradiol patch on. Do not freeze estradiol spray.
Side Effects
What are the most common side effects of estradiol transdermal?
The most common side effects of transdermal estradiol are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Breast pain or tenderness
- Headache
- Pain in the arms, legs, or back
- Stomach pain, discomfort, cramps, bloating, nausea, or vomiting
- Fluid retention (edema)
- Flu-like symptoms
- Irregular vaginal bleeding or spotting
- Vaginal yeast infection
- Hair loss
- Skin redness and irritation at application site
There may be other side effects of transdermal estradiol that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of estradiol transdermal?
While less common, the most serious side effects of transdermal estradiol are described below, along with what to do if they happen.
Blood Clots. Transdermal estradiol may cause blood clots in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the back of the eye (retinal vein occlusion), in the lungs (pulmonary embolism), or deep venous thrombosis (DVT). Stop using transdermal estradiol and get emergency help if you have any of the following signs of blood clots.
- Chest pain or pressure
- Fast or abnormal heartbeat
- Trouble breathing
- Pain in your back, jaw, throat, or arm
- Sweating, upset stomach, vomiting, or dizziness
- Sudden weakness on one side of your body
- Sudden and severe headache
- Slurred speech or trouble understanding speech
- Pain, swelling, or tenderness in your arm or leg
- Vision loss
- Bulging eyes
- Double vision
Endometrial Cancer. You may be at higher risk for cancer in the lining of your uterus (endometrial cancer) if you use transdermal estradiol. Call your healthcare provider right away if you have any abnormal vaginal bleeding.
Breast Cancer. You may be at higher risk for breast cancer if you use transdermal estradiol. Call your healthcare provider right away if you have any of the following symptoms.
- New lump in your breast or armpit
- Changes in the size, shape, texture, or temperature of your breast
- Nipple changes
Ovarian Cancer. You may be at higher risk for cancer in your ovaries (ovarian cancer) if you use transdermal estradiol. Call your healthcare provider right away if you have any of the following symptoms.
- Unusual vaginal discharge
- Belly or back pain
- Need to pee more often or urgently
Gallbladder Problems. Using transdermal estradiol may cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your healthcare provider right away if you have any of the following symptoms.
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
- Fever
- Pain in your upper stomach area
- Stool (poop) that is clay-colored
Memory Problems. Using transdermal estradiol may increase your risk for memory problems (dementia), especially if you are 65 or older. Call your healthcare provider if you or friends or family notice that you are having trouble with your memory.
Increased Blood Pressure (Hypertension). Transdermal estradiol may increase your blood pressure or worsen it if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while using this medicine.
If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea or vomiting
- Blurry or other changes to the vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heart beats
Severe Allergic Reactions. Transdermal estradiol may cause allergic reactions, which can be serious. Stop using transdermal estradiol and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat (angioedema)
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Warnings & Precautions
Who should not use estradiol transdermal?
Allergies to Ingredients. People who are allergic to any of the following should not use transdermal estradiol products.
- Estradiol
- Climara
- Divigel
- Dotti
- Elestrin
- EstroGel
- Evamist
- Lyllana
- Menostar
- Minivelle
- Vivelle-Dot
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific transdermal estradiol products they stock.
Blood Clots. Transdermal estradiol should not be used if you have now or have a history of blood clots in your veins, such as a deep venous thrombosis (DVT), or your lungs, such as a pulmonary embolism (PE).
Breast Cancer. Transdermal estradiol should not be used if you have, are being evaluated to see if you have, or have previously had breast cancer.
Estrogen Dependent Cancer. Transdermal estradiol should not be used if you have cancer that needs estrogen to grow. Examples of these cancers include ovarian cancer and endometrial or uterine cancer.
Stroke or Heart Attack. Transdermal estradiol should not be used if you have had a stroke or heart attack.
Unusual Vaginal Bleeding. Transdermal estradiol should not be used if you have abnormal bleeding from your vagina that has not been diagnosed by a healthcare provider.
Thrombophilia. Transdermal estradiol should not be used if you have low blood levels of protein C, protein S, or antithrombin, or if you have a condition that increases your risk of developing a blood clot.
Liver Problems. Transdermal estradiol should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your healthcare provider may do tests to determine if it is working well enough to use this medicine.
What should I know about estradiol transdermal before using it?
If you have a uterus, talk to your healthcare provider about whether adding a progestin is right for you.
Ask your pharmacist or other healthcare provider to show you how to correctly use transdermal estradiol. Follow the “Instructions for Use” that comes with your transdermal estradiol when using it for the first time.
Be sure your skin is clean and dry before applying transdermal estradiol. It is important to rotate where you apply transdermal estradiol. This reduces the risk of skin irritation because you are not using the same area of skin over and over.
Not all transdermal estradiol products are used daily. Consider using a calendar or app to help you remember when to use it next. Ask your pharmacist if you have any questions about how often you should use transdermal estradiol.
Do not use transdermal estradiol unless it has been prescribed to you by a healthcare provider. Use it as prescribed.
Do not share transdermal estradiol with other people, even if they have the same condition as you. It may harm them.
Keep transdermal estradiol out of the reach of children.
If an estradiol patch falls off before it is time to put a new one on, try to put the old patch back on. If you are not able to get the old patch to stick, you can use a new patch. Whether the old or a new patch is used, a new application site should be used and the old schedule should continue to be followed.
Safely throw away used transdermal estradiol patches by folding them in half so the sticky sides touch, and placing them in a child-proof container before putting them in the trash. Do not flush them down the toilet.
Transdermal estradiol gel and liquid are flammable. Avoid open flames or smoking while using them or until your skin dries after applying it.
To limit exposing others to any estradiol gel or spray, allow the area to dry completely after applying it and limit exposing others to that area by covering with clothing when possible. If someone is exposed to the application area before the estradiol dries, the part of their body that touched the application area should be washed with soap and water as soon as possible. Wash your hands after applying estradiol gel.
Sunscreen may affect how transdermal estradiol your body absorbs. Read and follow any specific instructions about using sunscreen that come in the patient information with your transdermal estradiol.
Do not apply transdermal estradiol to your breasts or vagina. You should also avoid injured, burnt, or irritated skin, or areas with skin conditions (such as birth marks, tattoos, or an area that is very hairy).
People who are aged 65 or older can be at greater risk for some side effects from transdermal estradiol. Talk to your healthcare provider about your risks if you are in this age group.
It is best to use the lowest dose of transdermal estradiol that works for the shortest length of time. Ask your healthcare provider how much and for how long you should use transdermal estradiol.
Keep all scheduled appointments for breast exams, vaginal exams, and mammograms while using transdermal estradiol.
What should I tell my healthcare provider before using estradiol transdermal?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if transdermal estradiol is right for you.
In particular, make sure that you discuss any of the following.
Surgery or Bedrest. Tell your healthcare provider about any bedrest or upcoming surgery that will require you to be immoble or not be able to get up and walk around normally. Follow any instructions from your healthcare provider about when to stop and restart using transdermal estradiol.
Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- Heart problems
- Blood clots
- Unusual vaginal bleeding
- Cancer
- Stroke
- Diabetes
- Kidney problems
- Liver problems, including growth of abnormal blood vessels in the liver (hemangioma)
- Cancer
- Systemic lupus erythematosus
- Asthma
- Migraines
- Porphyria
- Seizures
- Thyroid or parathyroid problems
- Vision problems
- Hereditary angioedema
- Smoking
- High blood calcium levels
- Gallbladder problems with estrogen use or during pregnancy
Other Medicines and Supplements. Transdermal estradiol may interact with other medicines and supplements. Before using transdermal estradiol, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
High Triglyceride Levels. If you have high triglyceride levels, transdermal estradiol may make your triglycerides even higher. Very high triglyceride levels can lead to inflammation of the pancreas, which is called pancreatitis. Tell your healthcare provider if you have high triglyceride levels.
Pregnancy. People who can become pregnant are not usually prescribed transdermal estradiol. Tell your healthcare provider if you are or plan to become pregnant.
Breastfeeding. Transdermal estradiol passes into breast milk and using this medicine while breastfeeding can reduce breast milk production. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use transdermal estradiol while breastfeeding.
Interactions
Does estradiol transdermal interact with foods or drinks?
Do not drink grapefruit juice while using transdermal estradiol. Grapefruit juice may increase the estradiol levels in your blood and cause serious side effects.
Limit the amount of alcohol you drink while using transdermal estradiol. There may be an increased risk for liver damage if you drink large amounts of alcohol.
Does estradiol transdermal interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before using transdermal estradiol.
- St. John’s wort, which is a supplement that may be used to treat depression
- Phenobarbital or carbamazepine (Carbatrol, Tegretol, and others), which is a medicine to control seizures
- Rifampin, which is a medicine used to treat an infection called tuberculosis
- Erythromycin (Ery-Tab and others) or clarithromycin, which is a medicine used for bacterial infections
- Ketoconazole or itraconazole (Sporanox, Tolsura), which is a medicine used for fungal infections
- Ritonavir, which is a medicine commonly used to treat HIV
Some other medicines may alter the blood levels of transdermal estradiol. Tell your healthcare provider about all medicines that you take or have recently taken.
This may not be a complete list of medicines that can interact with transdermal estradiol. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much estradiol transdermal?
If you or someone else has used too much transdermal estradiol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of estradiol transdermal?
If you miss a dose of estradiol spray or gel, use it as soon as you remember. If it is almost time for your next dose (for example, if it is within 12 hours of your next dose), skip the missed dose and only use the next dose. Do not use double or extra doses.
Estradiol patches are left on the skin for multiple days in a row. If you forget to remove a patch and put a patch on, do so as soon as you remember. Continue to follow the old dosing schedule. Do not use more than one patch at a time.
Are you currently using Estradiol transdermal?
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