Estradiol and Levonorgestrel (Transdermal)

Overview

When women approach the menopause, their hormone levels tend to fluctuate before dropping to a fairly low level. Although this is expected, it can cause a number of unpleasant symptoms to occur. As the menopause can take place over a number of years, patients could be in pain or discomfort for a significant amount of time, without effective treatment.

As low hormone levels tend to cause the symptoms associated with menopause, they can be reduced by increasing the patient's hormone levels. This can be done in various ways and patients may opt to take hormones orally or apply them via a skin cream. Estradiol and Levonorgestrel skin patches, however, are simply applied to the skin and the body absorbs the hormones from them. Due to the ease of use and effectiveness of the medication, Estradiol and Levonorgestrel is a first-choice treatment for many patients.

Although estrogen is often considered to be the primary female hormone, it is not the only hormone which is affected by the menopause. Whilst some patients may respond to estrogen therapy, other patients benefit from additional hormone therapy. As Estradiol is a form of synthetic estrogen and Levonorgestrel is a type of synthetic progesterone, patients can benefit from both of these hormone levels increasing whilst using this medication.

As a result, patients may find that they get greater relief from symptoms and that an increasing number of symptoms are reduced. Hot flashes, headaches, night sweats, 'brain fog', fatigue, breast tenderness and palpitations are all symptoms of the menopause, for example, and can all be treated effectively with Estradiol and Levonorgestrel skin patches.

As well as managing symptoms of the menopause, Estradiol and Levonorgestrel skin patches can be used to treat patients who are suffering from low levels of estrogen. Even if the patient is not of typical menopausal age, there are a number of conditions or external factors which may cause estrogen levels to drop. In addition to causing uncomfortable symptoms to occur, a significant drop in hormone levels could even prompt the menopause to start much earlier than it normally would. By using Estradiol and Levonorgestrel skin patches, however, patients can maintain healthy hormone levels and avoid the symptoms associated with low levels of estrogen and/or progesterone.

Furthermore, Estradiol and Levonorgestrel skin patches can be used to prevent women from developing osteoporosis and similar conditions. As women age, their bone density reduces and, in many cases, they suffer from bone loss. As estrogen contributes to bone health, the degradation of the patient's bones can increase following the menopause. As well as causing bones to weaken, this can leave patients with an increased risk of suffering breaks and fractures in later life.

By prescribing Estradiol and Levonorgestrel skin patches, physicians can help to reduce the risk of patients developing these conditions and also reduce the chance of them suffering subsequent injuries. Whilst any type of hormone therapy requires thorough consideration, Estradiol and Levonorgestrel skin patches can reduce certain health risks and provide symptom relief for many patients.

Conditions Treated

Type Of Medicine

  • Hormone therapy

Side Effects

It's not unusual for patients to experience some side effects when using certain medications and this includes hormone therapy. Patients should discuss the treatment with their physician prior to applying the skin patches as this will give them an insight into the side effects they can expect to occur, if any.

Often, patients notice a reduction in side effects once they become used to the medication. This means that relatively mild side effects will often diminish or disappear completely once the patient has been using the Estradiol and Levonorgestrel skin patches for a few weeks or months. If the patient experiences the following side effects when using this medication, they may not require immediate medical assistance:

  • Back pain
  • Breast pain
  • Body pain or aches
  • Chills
  • Redness, itching, burning, swelling, rash on the skin or soreness at the application site
  • Ear congestion
  • Discouragement
  • Fever
  • Feeling empty or sad
  • Irritability
  • Pressure in stomach
  • Heavy non-menstrual vaginal bleeding
  • Loss of pleasure or interest
  • Swelling of the stomach and/or abdomen
  • Sneezing
  • Loss of voice
  • Sore throat
  • Nasal congestion
  • Tiredness
  • Runny nose
  • Difficulty concentrating
  • Bladder pain
  • Trouble sleeping
  • Cloudy or bloody urine
  • Cough producing mucus
  • Blurred vision
  • Diarrhea
  • Painful, difficult or burning urination
  • Dizziness
  • Difficulty with moving
  • Shivering
  • Excess gas or air in intestines or stomach
  • Pounding in the ears
  • Frequent urge to urinate
  • Passing gas
  • Pain in joints
  • General feeling of illness or discomfort
  • Pain in side or lower back
  • Itching of the genital area or vagina
  • Muscle pain and aching
  • Pain during sexual intercourse
  • Muscle stiffness or pain
  • Tenderness or pain in the cheekbones or around the eyes
  • Fast or slow heartbeat
  • Weight gain
  • Sweating
  • Thinning of the hair or hair loss

Whilst some of the symptoms above are more common than others, patients may not need medical assistance if their side effects are fairly mild. However, if patients are concerned about the presence of side effects or if side effects are debilitating, they should seek medical help straight away.

In addition to the side effects listed above, there are other adverse effects which patients may notice when they're using Estradiol and Levonorgestrel skin patches. If patients exhibit any of the following side effects when using this medication, they should seek medical help:

  • Sour or acid stomach
  • Heartburn
  • Anxiety
  • Headache
  • Backache
  • Bloated or full feeling
  • Belching
  • Pressure in the stomach
  • Change in vaginal discharge
  • Fast heartbeat
  • Chest discomfort or pain
  • Fainting
  • Bloody or clear discharge from the nipple
  • Double vision
  • Confusion
  • Lightheadedness or dizziness
  • Cough
  • Dimpling of skin on the breast
  • Inverted nipple
  • Difficulty with speaking
  • Itching, rash or hives
  • Difficulty with swallowing
  • Inability to move the facial muscles, arms or legs
  • Loss of appetite
  • Inability to speak
  • Lump under the arm or in the breast
  • Indigestion
  • Slow speech
  • Nausea
  • Sweating
  • Sore on the skin of the breast which does not heal
  • Discomfort or pain in the back, neck, jaw or arms
  • Feeling of pressure or pain in the pelvis
  • Swelling, redness or pain in the leg or arm
  • Persistent scaling or crusting of the nipple
  • Swelling or puffiness around the eyes or of the eyelids, lips, face or tongue
  • Swelling or redness of the breast
  • Troubled breathing or sudden shortness of breath
  • Stomach pain, discomfort or upset
  • Vaginal Bleeding
  • Swelling of the stomach or abdominal area
  • Vomiting
  • Unusual weakness or tiredness
  • Chest tightness

Although there are a wide range of side effects which can occur when using Estradiol and Levonorgestrel skin patches, this doesn't mean that all patients will experience a significant number of adverse effects. In fact, many patients report no side effects at all when using Estradiol and Levonorgestrel hormone patches.

However, if patients notice any side effects which are not listed above, they should contact their physician for advice and/or treatment. In addition to this, patients can report the presence of additional side effects to the Food and Drug Administration on 1-800-FDA-1088.

Dosage

When patients are being treated for symptoms of the menopause or for post-menopausal bone loss, they are usually advised to apply one Estradiol and Levonorgestrel skin patch per week. Typically, each patch contains 0.045mg of Estradiol and 0.015mg of Levonorgestrel.

Although many patients find this dose to be effective, the patient's physician may alter their dose if necessary. Whilst this is a standard dose for the reduction of menopausal symptoms and bone loss prevention, each patient should follow the instructions given to them by their physician.

When applying the Estradiol and Levonorgestrel skin patch, most patients are advised to place the patch on their lower stomach or upper buttock area. However, the patch should not be applied to broken or irritated skin. If patients have skin conditions, birth marks and/or tattoos, they should also avoid placing the Estradiol and Levonorgestrel skin patch in these areas. If patients are unsure how to use the Estradiol and Levonorgestrel skin patches or where to apply them, they should seek advice from their physician.

Before applying the transdermal patch, patients should also make sure that the area is clean, dry and free from body lotions, powders or oils. These may prevent the patch from adhering to the skin properly and could prevent the patient from absorbing the appropriate amount of medication.

Patients will simply need to place the skin patch in the appropriate place and press it against their skin for approximately ten seconds. This should enable the skin patch to adhere to the skin properly. However, it's important that patients don't apply the skin patch to an area which is in appropriate. Putting the patch on the waistline is not recommended, for example, as clothes could easily cause the patch to come away from the skin. Similarly, patients should not apply the patch to the breast area or over any folds of skin.

When using Estradiol and Levonorgestrel skin patches, patients can swim, shower or take a bath without the patch being affected. If the patch becomes lose, patients can simply reapply it to a different area of their skin.

Although patients should wear the patch until it is time for a new patch to be used, they will need to avoid the patch being exposed to the sun for long periods of time. In addition to this, patients should not place the next patch in the same place as the previous one. In fact, patients should wait at least a week before using the same area of skin in which to apply the medication.

When patients are removing an Estradiol and Levonorgestrel skin patch, they should slowly peel the patch away from their skin. On some occasions, the patch may leave an adhesive residue on the skin once it has been removed. If so, patients should wait approximately fifteen minutes and then use lotion or oil to gently remove the adhesive.

If possible, patients should aim to change their Estradiol and Levonorgestrel skin patch on the same day each week as this ensures that patients get the appropriate amount of medication.

If a patch falls off, patients should attempt to reapply it to a different area of skin. If it will not stick, however, patients may apply a new patch but should then return to their original treatment schedule. When patients are discarding a used Estradiol and Levonorgestrel skin patch, they should do so responsibly. Skin patches should be thrown away in a child-proof container and should be kept away from children and/or pets. In addition to this, patients should not throw skin patches down the toilet in order to dispose of them.

If patients forget to change a patch, they should put a new skin patch on as soon as they remember to do so. If it is almost time for the next patch to be applied, however, patients should skip the missed patch and simply continue with their normal schedule. Patients should not apply an extra patch, even if they have forgotten to apply an Estradiol and Levonorgestrel patch previously.

When patients are unsure how to use Estradiol and Levonorgestrel skin patches or don't know how to proceed with treatment, they should seek advice from their physician or pharmacist.

Potential Drug Interactions

Due to the possibility of an interaction occurring, patients are not normally prescribed Estradiol and Levonorgestrel skin patches if they are already taking:

  • Tranexamic Acid

Furthermore, treatment with Estradiol and Levonorgestrel is not usually recommended if patients are taking any of the following medications:

  • Bupropion
  • Ulipristal
  • Carbamazepine
  • Tizanidine
  • Ceritinib
  • Theophylline
  • Conivaptan
  • Sugammadex
  • Dabrafenib
  • Pixantrone
  • Darunavir
  • Lixisenatide
  • Donepezil
  • Lesinurad
  • Eliglustat
  • Lumacaftor
  • Idelalisib
  • Pitolisant
  • Isotretinoin

Although Estradiol and Levonorgestrel could interact with the medicines listed above, doctors may feel it is appropriate to prescribe Estradiol and Levonorgestrel alongside one of the medications listed above, in some cases. If so, the patient's dose may be altered to prevent an interaction occurring.

If patients use Estradiol and Levonorgestrel skin patches whilst taking or using any of the following medications, it may increase the risk of side effects occurring:

  • Acitretin
  • Delavirdine
  • Alprazolam
  • Colesevelam
  • Amprenavir
  • Cyclosporine
  • Aprepitant
  • Efavirenz
  • Atazanavir
  • Clarithromycin
  • Bacampicillin
  • Ketoconazole
  • Betamethasone
  • Etravirine
  • Bexarotene
  • Fosaprepitant
  • Bosentan
  • Griseofulvin
  • Eslicarbazepine Acetate
  • Fosamprenavir
  • Ginseng
  • Phenobarbital
  • Fosphenytoin
  • Lamotrigine
  • Prednisolone
  • Levothyroxine
  • Perampanel
  • Licorice
  • Phenytoin
  • Modafinil
  • Oxcarbazepine
  • Mycophenolate Mofetil
  • Nelfinavir
  • Mycophenolic Acid
  • Telaprevir
  • Primidone
  • Rifabutin
  • Tipranavir
  • Rifampin
  • Topiramate
  • Rifapentine
  • Voriconazole
  • Ritonavir
  • Warfarin
  • Rosuvastatin
  • Troleandomycin
  • Rufinamide
  • Troglitazone
  • Selegiline
  • Tacrine
  • St John's Wort

Although the risk of some side effects may be increased if patients use Estradiol and Levonorgestrel in conjunction with the above medicines, it doesn't necessarily mean that patients will not be prescribed Estradiol and Levonorgestrel skin patches if they are already taking one of the medicines listed above. Instead, physicians may adjust the patient's dose to reduce the risk of adverse effects occurring. In addition to this, doctors may prescribe additional medications to reduce particular side effects, if they do occur.

Patients should also be aware that over-the-counter medicines, herbal supplements, vitamins and some foods and drinks can interact with prescription medicines. Patients should not consume the following food or drink when using this medication:

  • Grapefruit, grapefruit juice and/or grapefruit derivatives

The following substance, in particular, many increase the patient's risk of side effects:

  • Caffeine

Due to this, patients should reduce their caffeine consumption or cut caffeine out of their diet altogether when they are being treated with Estradiol and Levonorgestrel.

In addition to this, patients should seek medical advice before using over-the-counter medicines, supplements and/or vitamins whilst they are using Estradiol and Levonorgestrel skin patches.

Warnings

Before using Estradiol and Levonorgestrel skin patches, patients will need to discuss their medical history with their physician. There are some conditions which may affect the use of Estradiol and Levonorgestrel skin patches. These include:

  • Kidney disease
  • Systemic lupus erythematosus
  • Cancer
  • Asthma
  • Diabetes
  • Porphyria
  • Headaches or migraines
  • Liver disease
  • Liver tumor
  • Body swelling or fluid retention (edema)
  • Epilepsy
  • Seizures
  • Gallbladder disease
  • Endometriosis
  • Hereditary angioedema
  • Heart disease
  • Jaundice from using hormone therapies previously or during pregnancy
  • Underactive thyroid (Hypothyroidism)
  • Low levels of calcium in the blood (Hypocalcemia)
  • High levels of calcium in the blood (Hypercalcemia)
  • High fats or triglycerides in the blood (Hypertriglyceridemia)
  • High blood pressure (Hypertension)
  • Angioedema, particularly in response to previous hormone therapies
  • Anaphylaxis, particularly in response to previous hormone therapies
  • Estrogen-dependent tumors
  • Unusual or abnormal vaginal bleeding
  • Breast cancer
  • Blood clots
  • Heart attack
  • Stroke
  • Protein S or C deficiency or other blood clotting disorders
  • Surgery or significant period of inactivity

Using Estradiol and Levonorgestrel skin patches could worsen or exacerbate some of these conditions so caution should be used. Patients are advised to disclose any previous, current or suspected conditions so that physicians can determine whether treatment with Estradiol and Levonorgestrel is right for them.

Although older patients may be prescribed Estradiol and Levonorgestrel skin patches, age-related conditions may affect their treatment. Age-related heart, kidney or liver problems may slow down the processing of medications, for example, so a lower dose of Estradiol and Levonorgestrel may be advisable.

When patients are using Estradiol and Levonorgestrel skin patches, they should have regular consultations with their doctor. Patients may also need to undergo regular breast exams, mammograms and pelvic exams to ensure the medication is not having any potentially harmful effects.

Using Estradiol and Levonorgestrel skin patches may increase the patient's risk of developing dementia. This is particularly relevant to patients who are over the age of 65. Patients should discuss this with their physician prior to using Estradiol and Levonorgestrel skin patches.

Using Estradiol and Levonorgestrel transdermal patches can also increase the patient's risk of suffering a heart attack, stroke or blood clot. The risk may be increased further if the patient has diabetes, high cholesterol, high blood pressure, is overweight and/or smokes cigarettes. If patients experience any of the following symptoms whilst using Estradiol and Levonorgestrel skin patches, they should seek immediate medical help:

  • Inability to speak
  • Headaches
  • Inability to move legs, arms or facial muscles
  • Double vision
  • Difficulty speaking
  • Confusion

If patients use Estradiol and Levonorgestrel skin patches over a long period of time, if may increase their risk of developing certain cancers, such as uterine, breast or endometrial cancer. Patients should contact their physician immediately if they have unusual vaginal bleeding whilst being treated with Estradiol and Levonorgestrel. If patients still have their womb, they should also ask their physician if they would benefit from progestin treatment as well.

If patients experience sudden headaches or eye problems when using Estradiol and Levonorgestrel skin patches, they should seek urgent medical help. Sudden loss of vision or changes to the patient's vision also warrants medical attention and patients may be referred to an ophthalmologist for an in-depth assessment.

Patients should inform the relevant medical practitioners that they are using Estradiol and Levonorgestrel skin patches if they are due to undergo any medical procedures, including dental procedures. Similarly, if patients are due to undergo medical tests, they should notify their doctor or nurse that they are being treated with Estradiol and Levonorgestrel.

Once women have been through the menopause, it is unlikely that they will become pregnant. However, patients should be aware that using Estradiol and Levonorgestrel skin patches whilst pregnant could cause harm to the unborn baby. Due to this, patients should seek immediate medical advice if they become pregnant whilst using this medicine.

Similarly, it is unusual for post-menopausal women to breastfeed but patients should be aware that using Estradiol and Levonorgestrel skin patches can affect the amount of breastmilk produced and the consistency of the milk. As Estradiol and Levonorgestrel can be passed to an infant via breastfeeding, patients are normally advised not to breastfeed whilst using this medication. If relevant, patients should discuss this with their physician before using this medication.

If patients experience an allergic reaction whilst using Estradiol and Levonorgestrel skin patches, they will need urgent medical assistance. Anaphylaxis can be life-threatening and may be characterized by the following symptoms:

  • Wheezing
  • Itching
  • Hives
  • Trouble breathing
  • Difficulty swallowing
  • Hoarseness
  • Swelling of the lips, throat, mouth, tongue and/or face

Storage

Patients should follow the manufacturer's guidelines when storing Estradiol and Levonorgestrel skin patches at home. In most cases, however, the patches can be kept at room temperature, providing they are in a location which is free from heat, moisture and direct light.

Estradiol and Levonorgestrel skin patches should be kept in a closed or locked container, however, and patients should ensure that children and/or pets cannot access the medication.

Summary

During the menopause, patients can suffer a wide range of debilitating symptoms. As well as relatively short-term symptoms, such as hot flashes and breast tenderness, patients can experience long-term complications, such as bone loss and osteoporosis.

By using hormone therapies, however, patients can obtain relief from these symptoms and reduce the risk of developing bone problems in later life. Although hormone therapies can increase the risk of other conditions, a thorough assessment of the patient's medical history will be used to determine whether the treatment is appropriate for them. If so, Estradiol and Levonorgestrel skin patches can be used to obtain relief from menopausal symptoms and to slow the reduction of bone mineral density.