Generic name: EstradiolBrand names: Estraderm, Vivelle, Vivelle-Dot, Climara, Esclim, Estrogen Patches, Alora
All of these products are used to reduce symptoms of menopause, including feelings of warmth in the face, neck, and chest; the sudden intense episodes of heat and sweating known as "hot flashes"; dry, itchy external genitals; and vaginal irritation. They are also prescribed for other conditions that cause low levels of estrogen, and some doctors prescribe them for teenagers who fail to mature at the usual rate.
Along with diet, calcium supplements, and exercise, Alora, Climara, Estraderm, Vivelle, and Vivelle-Dot are prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken.
Because estrogens have been linked with an increased risk of breast, uterine, and endometrial cancer (cancer in the lining of the uterus), it is essential to have regular mammograms and checkups. Report any unusual vaginal bleeding to your doctor immediately.
Hormone replacement therapy using estrogens, with or without progestin, should not be used to prevent heart disease. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous blood clots among women taking estrogen or estrogen combinations for 5 years. Blood clots can lead to phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels serving the eye, and other serious disorders. Because of these risks, hormone replacement therapy should be given at the lowest effective dose for the shortest possible time. Your doctor will determine the dosage that is best for you.
Each patch is individually sealed in a protective pouch and is applied directly to the skin.
A stiff protective liner covers the adhesive side of the patch. Remove the liner by sliding it sideways between your thumb and index finger. Holding the patch at one edge, remove the protective liner and discard it. Try to avoid touching the adhesive. Use immediately after removing the liner. If you are using Alora, Vivelle, or Vivelle-Dot peel off one side of the protective liner and discard it. Use the other half of the liner as a handle until you have applied the sticky area, then fold back the remaining side of the patch, pull off the rest of the liner, and smooth the second half of the patch onto your skin.
Apply the adhesive side to a clean, dry area of your skin on the trunk of your body (including the buttocks and abdomen). Do not apply to your breasts or waist. Firmly press the patch in place with the palm of your hand for about 10 seconds, to make sure the edges are flat against your skin. When first using Alora, start on the lower abdomen. Climara is applied only to the abdomen or upper buttock, and is pressed in place with the fingers.
Remove the patch slowly and carefully to avoid irritating your skin. If any adhesive remains, let it dry for 15 minutes then gently rub the area with an oil-based cream or lotion to remove the adhesive residue. The used patch still contains active hormone. To dispose of it properly, fold it in half so it sticks to itself before throwing it away.
Contact with water during bathing, swimming, or showering will not affect the patch.
The application site must be rotated. Allow an interval of at least 1 week between applications to a particular site.
Alora, Esclim, Estraderm, Vivelle, and Vivelle-Dot patches should be replaced twice a week; Climara once weekly.
Side effects cannot be anticipated. If any develop or change in intensity, notify your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using the estrogen patch.
Estrogen patches should not be used during pregnancy. You should also avoid this product if you have:
Estrogen has the potential of causing clot-related disorders, including heart attack and stroke, pulmonary embolism (a clot in the lungs), and thrombophlebitis (a clot in the veins). A complete medical and family history should be taken by your doctor before starting any estrogen therapy, especially if you have a history of deep vein thrombosis (a clot in the legs) or a history of thrombosis in your family. The chance of developing a clot-related problem can be reduced by using the lowest dose of estrogen that still proves effective. If a problem surfaces anyway, you'll have to stop using the patch. Likewise, you should discontinue the patch and call your doctor immediately if you suffer a loss of vision, any other eye problems, or a migraine headache.
Some experts suspect that high doses of estrogen, with or without a progestin, may increase the risk of ovarian, breast, and endometrial cancer. The risk may increase with prolonged use.
Hormone therapy occasionally causes a rise in blood pressure. If you have a blood pressure problem, use the patch with caution and have your pressure checked regularly.
If you suffer from liver problems or liver disease you may not be able to use hormone therapy.
If you are on hormone therapy you may need to have your thyroid medication adjusted and your thyroid tested more frequently.
Hormones also tend to cause fluid retention. If you have a condition that could be aggravated by excess fluid, such as asthma, epilepsy, migraine headaches, heart disease, or kidney problems, use the patch with caution.
If you suffer from endometriosis, a condition where the endometrium (the lining of the uterus) doesn't shed properly and attaches to the outside of the uterus or other areas such as the ovaries or bowels, hormone therapy may cause a worsening of this condition.
Because estrogen can increase triglyceride levels, you'll need to be closely monitored if your triglycerides tend to be high. If you have diabetes, estrogen may also affect your blood sugar levels.
Estrogen therapy occasionally causes abnormal uterine bleeding or breast pain. In view of concerns about cancer, you should have these symptoms checked by your doctor. In general, you should not take estrogen for more than 1 year without a follow-up physical exam. Ideally, you should have a checkup every 3 to 6 months.
Women who take oral estrogen after menopause face a two- to fourfold increase in the odds of gallbladder disease.
In elderly women, estrogen therapy could increase the risk of dementia, including Alzheimer's disease. Talk with your doctor about the risks and benefits of using Vivelle-Dot.
For teenagers who fail to mature at the usual rate, large doses of estrogen taken for an extended period may affect growth. In girls, it may cause the early start of menstruation or early breast development.
While taking estrogen, get in touch with your doctor right away if you notice any of the following:Abdominal pain, tenderness, or swellingAbnormal bleeding of the vaginaBreast lumpsCoughing up bloodDifficulty with speechPain in your chest or calvesSevere headache, dizziness, or faintnessSkin irritation, redness, or rashSudden shortness of breathVision changesWeakness or numbness of an arm or legYellowing of the skin or eyes
If you take certain other drugs while using estrogen, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before taking the following:AlcoholBarbiturates such as phenobarbital and secobarbitalBlood thinners such as warfarinCimetidineClarithromycinDantroleneEpilepsy drugs such as carbamazepine and phenytoinErythromycinGrapefruit juiceItraconazoleKetoconazoleRifampinRitonavirSt. John's wortSteroids such as prednisoneTricyclic antidepressants such as amitriptyline and imipramine
Estrogens should not be used during pregnancy or immediately after childbirth. Use of estrogens during pregnancy has been linked to reproductive tract problems in the children. If you are pregnant or plan to become pregnant, notify your doctor immediately. Estrogens decrease the quantity and quality of breast milk. If Vivelle-Dot is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.
If you are a postmenopausal woman with a uterus, progestin may be prescribed as well in order to reduce the risk of endometrial cancer. Your doctor will determine the dosage that is right for you. Typically, hormone replacement therapy should be started at the lowest possible dose and for the shortest duration needed to relieve your symptoms. You should be evaluated every 3 to 6 months.
ALORA AND ESTRADERM
The usual starting dose is one 0.05-milligram patch applied to the skin 2 times a week. (For osteoporosis the doctor may prescribe a 0.025-milligram patch.)
The usual starting dose is one 0.025-milligram patch applied to the skin once a week. (For osteoporosis, the doctor may prescribe a 0.025-milligram patch.)
The usual starting dose is one 0.025-milligram patch applied to the skin 2 times a week.
VIVELLE AND VIVELLE-DOT
The usual starting dose to relieve symptoms of menopause is one 0.0375-milligram patch applied to the skin 2 times a week. (For osteoporosis, the doctor may prescribe a 0.025-milligram patch.) The patch may be used continuously, or left off every fourth week.
Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.