Estradiol and Levonorgestrel

Estradiol/levonorgestrel is a prescription medication used after menopause to reduce moderate to severe hot flashes and help reduce your chances of getting osteoporosis (thin weak bones). 

It is a single product containing two hormones, estradiol and levonorgestrel, and belongs to a group of drugs called estrogen and progestin combinations. Together these work as a hormone replacement to relieve issues caused by hormonal changes. 

It comes in a patch form and is usually applied to the skin once weekly. 

Common side effects of include reactions at the application site, vaginal bleeding, and breast pain. 

Estradiol and Levonorgestrel is part of the drug class:

• Progestogens and estrogens, fixed combinations

• Store at room temperature.
• Store in original container.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take estradiol and levonorgestrel or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to estradiol and levonorgestrel. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

Estrogens are poorly metabolized in women with hepatic dysfunction.

Refer to adult dosing.

Use is contraindicated in women with hepatic impairment or disease.

Transdermal patch: When initiating therapy, women not using a continuous estrogen or estrogen plus progestin may apply the patch at any time. Women already on hormonal therapy should complete their current cycle prior to initiating the patch. If bleeding occurs when the cycle is completed with the previous therapy, the first day of bleeding is an appropriate time to initiate the patch.

The patch should be applied immediately after taking out of pouch and removing the protective lining. Apply the adhesive side of the patch once weekly to a clean, dry, fold-free area of the lower abdomen or upper quadrant of buttock; avoid application to waistline or areas where sitting would dislodge the patch. Do not apply to irritated, oily, damaged or broken skin. Do not apply to breasts. Rotate site with each application; allow an interval of ≥1 week between applications to the same site. Avoid touching adhesive with fingers. Press patch in place for ≥10 seconds to ensure proper application, especially around the edges. If patch falls off, may reapply same patch or apply a new patch to another area of the lower abdomen and follow the original treatment schedule. If patch lifts, apply pressure to maintain adhesion. When taking off the patch, remove slowly to avoid irritating the skin. Allow skin to dry for 15 minutes, then gently rub area with an oil-based cream or lotion if needed to remove any remaining adhesive. Prior to discarding, fold patch so that it sticks to itself. Do not discard by flushing in the toilet.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience hair loss, back pain, cramps, bloating, edema, enlarged breasts, or dark patches on face. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes), signs of DVT (edema, warmth, numbness, change in color, or pain in the extremities), angina, shortness of breath, coughing up blood, severe headache, severe nausea, severe vomiting, severe dizziness, passing out, bulging eyes, vision changes, eye pain, severe eye irritation, contact lens discomfort, lump in breast, breast soreness or pain, nipple discharge, vaginitis, vaginal bleeding, depression, memory impairment, swelling of arms or legs, or severe skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.