Before Using This Medicine
In deciding to use a medicine, the risks of taking the
medicine must be weighed against the good it will do. This is
a decision you and your doctor will make. For estrogens, the
following should be considered:
Allergies—Tell your doctor if you have ever had any unusual
or allergic reaction to estrogens. Also tell your health care
professional if you are allergic to any other substances, such
as foods, preservatives, or dyes.
Pregnancy—Estrogens are not recommended for use during
pregnancy or right after giving birth. Becoming pregnant or
maintaining a pregnancy is not likely to occur around the time
of menopause.
Certain estrogens have been shown to cause serious birth
defects in humans and animals. Some daughters of women who
took diethylstilbestrol (DES) during pregnancy have developed
reproductive (genital) tract problems and, rarely, cancer of
the vagina or cervix (opening to the uterus) when they reached
childbearing age. Some sons of women who took DES during
pregnancy have developed urinary-genital tract problems.
Breast-feeding—Use of this medicine is not recommended in
nursing mothers. Estrogens pass into the breast milk and their
possible effect on the baby is not known.
Children—Use of this medicine before puberty is not
recommended. Growth of bones can be stopped early. Girls and
boys may develop growth of breasts. Girls may have vaginal
changes, including vaginal bleeding.
Teenagers—This medicine may be used to start puberty in
teenagers with some types of delayed puberty.
Older adults—This medicine has been tested and has not been
shown to cause different side effects or problems in older
women than it does in younger women.
Other medicines—Although certain medicines should not be
used together at all, in other cases two different medicines
may be used together even if an interaction might occur. In
these cases, your doctor may want to change the dose, or other
precautions may be necessary. When you are taking estrogens,
it is especially important that your health care professional
know if you are taking any of the following:
* Acetaminophen (e.g., Tylenol) (with long-term, high-dose
use) or
* Amiodarone (e.g., Cordarone) or
* Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone
[e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol
[e.g., Winstrol]) or
* Androgens (male hormones) or
* Anti-infectives by mouth or by injection (medicine for
infection) or
* Antithyroid agents (medicine for overactive thyroid) or
* Carbamazepine (e.g., Tegretol) or
* Carmustine (e.g., BiCNU) or
* Chloroquine (e.g., Aralen) or
* Dantrolene (e.g., Dantrium) or
* Daunorubicin (e.g., Cerubidine) or
* Disulfiram (e.g., Antabuse) or
* Divalproex (e.g., Depakote) or
* Etretinate (e.g., Tegison) or
* Gold salts (medicine for arthritis) or
* Hydroxychloroquine (e.g., Plaquenil) or
* Isoniazid or
* Mercaptopurine (e.g., Purinethol) or
* Methotrexate (e.g., Mexate) or
* Methyldopa (e.g., Aldomet) or
* Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
* Oral contraceptives (birth control pills) containing
estrogen or
* Phenothiazines (acetophenazine [e.g., Tindal],
chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin],
mesoridazine [e.g., Serentil], perphenazine [e.g., Trilafon],
prochlorperazine [e.g., Compazine], promazine [e.g., Sparine],
promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril],
trifluoperazine [e.g., Stelazine], triflupromazine [e.g.,
Vesprin], trimeprazine [e.g., Temaril]) or
* Phenytoin (e.g., Dilantin) or
* Plicamycin (e.g., Mithracin) or
* Valproic acid (e.g., Depakene)—Use of these medicines with
estrogens may increase the chance of problems occurring that
affect the liver
* Cyclosporine (e.g., Sandimmune)—Estrogens can prevent
cyclosporine's removal from the body; this can lead to
cyclosporine causing kidney or liver problems
Other medical problems—The presence of other medical
problems may affect the use of estrogens. Make sure you tell
your doctor if you have any other medical problems,
especially:
* For all patients Blood clotting problems (or history of
during previous estrogen therapy)—Estrogens usually are not
used until blood clotting problems stop; using estrogens is
not a problem for most patients without a history of blood
clotting problems due to estrogen use
* Asthma or
* Calcium, too much or too little in blood or
* Diabetes mellitus (sugar diabetes)
* Epilepsy (seizures) or
* Heart problems or
* Kidney problems or
* Liver tumors, benign or
* Lupus erythematosus, systemic or
* Migraine headaches—Estrogens may worsen these conditions.
* Breast cancer or
* Bone cancer or
* Cancer of the uterus or
* Fibroid tumors of the uterus—Estrogens may interfere with
the treatment of breast or bone cancer or worsen cancer of the
uterus when these conditions are present
* Changes in genital or vaginal bleeding of unknown
causes—Use of estrogens may delay diagnosis or worsen
condition. The reason for the bleeding should be determined
before estrogens are used
* Endometriosis or
* High cholesterol or triglycerides (or history of) or
* Gallbladder disease or gallstones (or history of) or
* Liver disease (or history of) or
* Pancreatitis (inflammation of pancreas) or
* Porphyria—Estrogens may worsen these conditions. Although
estrogens can improve blood cholesterol, they can worsen blood
triglycerides for some people
* Hypothyroid (too little thyroid hormone)—Dose of thyroid
medicine may need to be increased.
* Vision changes, sudden onset including
* Bulging eyes or
* Double vision or
* Migraine headache or
* Vision loss, partial or complete—Estrogens may cause these
problems. Tell your doctor if you have had any of these
problems, especially while taking estrogen or oral
contraceptives (“birth control pills”).
* For males treated for breast or prostate cancer Blood
clots or
* Heart or circulation disease or
* Stroke—Males with these medical problems may be more likely
to have clotting problems while taking estrogens; the high
doses of estrogens used to treat male breast or prostate
cancer have been shown to increase the chances of heart
attack, phlebitis (inflamed veins) caused by a blood clot, or
blood clots in the lungs
Proper Use of This Medicine
Estrogens usually come with patient information or
directions. Read them carefully before taking this medicine.
Take this medicine only as directed by your doctor. Do not
take more of it and do not take or use it for a longer time
than your doctor ordered. For patients taking any of the
estrogens by mouth, try to take the medicine at the same time
each day to reduce the possibility of side effects and to
allow it to work better.
For patients taking any of the estrogens by mouth or by
injection:
* Nausea may occur during the first few weeks after you
start taking estrogens. This effect usually disappears with
continued use. If the nausea is bothersome, it can usually be
prevented or reduced by taking each dose with food or
immediately after food.
For patients using the transdermal (skin patch) form of
estradiol:
* Wash and dry your hands thoroughly before and after
handling the patch.
* Apply the patch to a clean, dry, nonoily skin area of your
lower abdomen, hips below the waist, or buttocks that has
little or no hair and is free of cuts or irritation. The
manufacturer of the 0.025-mg patch recommends that its patch
be applied to the buttocks only. Furthermore, each new patch
should be applied to a new site of application. For instance,
if the old patch is taken off the left buttock, then apply the
new patch to the right buttock.
* Do not apply to the breasts. Also, do not apply to the
waistline or anywhere else where tight clothes may rub the
patch loose.
* Press the patch firmly in place with the palm of your hand
for about 10 seconds. Make sure there is good contact,
especially around the edges.
* If a patch becomes loose or falls off, you may reapply it or
discard it and apply a new patch.
* Each dose is best applied to a different area of skin on
your lower abdomen, hips below the waist, or buttocks so that
at least 1 week goes by before the same area is used again.
This will help prevent skin irritation.
For patients using the topical emulsion (skin lotion) form
of estradiol:
* Washing and drying hands thoroughly before each
application.
* Apply while you are sitting comfortably. Apply one pouch to
each leg every morning.
* Apply the entire contents of one pouch to clean, dry skin on
the left thigh. Rub the emulsion into the entire thigh and
calf for 3 minutes until thoroughly absorbed.
* Apply entire contents of the second pouch to clean, dry skin
on the right thigh. Rub the emulsion into the entire thigh and
calf for 3 minutes until thoroughly absorbed.
* Rub any remaining emulsion on both hands on the buttocks.
* Washing and drying hands thoroughly after application.
* To avoid transfer to other individuals, allow the
application areas to dry completely before covering with
clothing.
Dosing—
The dose of these medicines will be different for different
patients. Follow your doctor's orders or the directions on the
label. The following information includes only the average
doses of these medicines. If your dose is different, do not
change it unless your doctor tells you to do so.
The number of tablets that you take or the amount of
injection you use depends on the strength of the medicine.
Also, the number of doses you take or use each day or patches
you apply each week, the time allowed between doses, and the
length of time you take or use the medicine depend on the
medical problem for which you are taking, using, or applying
estrogen.
* For conjugated estrogens For oral dosage form (tablets):
o For treating breast cancer in women after menopause and in
men:
+ Adults—10 milligrams (mg) three times a day for at least
three months.
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), or symptoms
of menopause:
+ Adults—0.3 to 1.25 mg a day. Your doctor may want you to
take the medicine each day or only on certain days of the
month.
o To prevent loss of bone (osteoporosis):
+ Adults—0.625 mg a day. Your doctor may want you to take the
medicine each day or only on certain days of the month.
o For treating ovary problems (female hypogonadism or for
starting puberty):
+ Adults and teenagers—0.3 to 0.625 mg a day. Your doctor may
want you to take the medicine only on certain days of the
month.
o For treating ovary problems (failure or removal of both
ovaries):
+ Adults—1.25 mg a day. Your doctor may want you to take the
medicine each day or only on certain days of the month.
o For treating prostate cancer:
+ Adults—1.25 to 2.5 mg three times a day.
* For injection dosage form:
o For controlling abnormal bleeding of the uterus:
+ Adults—25 mg injected into a muscle or vein. This may be
repeated in six to twelve hours if needed.
* For diethylstilbestrol For oral dosage form (tablets):
o For treating prostate cancer:
+ Adults—At first, 1 to 3 milligrams (mg) a day. Later, your
doctor may decrease your dose to 1 mg a day.
* For diethylstilbestrol diphosphate For oral dosage form
(tablets):
o For treating prostate cancer:
+ Adults—50 to 200 milligrams (mg) three times a day.
* For injection dosage form:
o For treating prostate cancer:
+ Adults—At first, 500 mg is mixed in solution with sodium
chloride or dextrose injection and injected slowly into a
vein. Your doctor may increase your dose to 1 gram a day for
five or more straight days as needed. Then, your doctor may
lower your dose to between 250 and 500 mg one or two times a
week.
* For esterified estrogens For oral dosage form (tablets):
o For treating breast cancer in women after menopause and in
men:
+ Adults—10 milligrams (mg) three times a day for at least
three months.
o For treating a genital skin condition (vulvar atrophy) or
inflammation of the vagina (atrophic vaginitis), or to prevent
loss of bone (osteoporosis):
+ Adults—0.3 to 1.25 mg a day. Your doctor may want you to
take the medicine each day or only on certain days of the
month.
o For treating ovary problems (failure or removal of both
ovaries):
+ Adults—1.25 mg a day. Your doctor may want you to take the
medicine each day or only on certain days of the month.
o For treating ovary problems (female hypogonadism):
+ Adults—2.5 to 7.5 mg a day. This dose may be divided up and
taken in smaller doses. Your doctor may want you to take the
medicine each day or only on certain days of the month.
o For treating symptoms of menopause:
+ Adults—0.625 to 1.25 mg a day. Your doctor may want you to
take the medicine each day or only on certain days of the
month.
o For treating prostate cancer:
+ Adults—1.25 to 2.5 mg three times a day.
* For estradiol For oral dosage form (tablets):
o For treating breast cancer in women after menopause and in
men:
+ Adults—10 milligrams (mg) three times a day for at least
three months.
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), ovary
problems (female hypogonadism or failure or removal of both
ovaries), or symptoms of menopause:
+ Adults—0.5 to 2 mg a day. Your doctor may want you to take
the medicine each day or only on certain days of the month.
o For treating prostate cancer:
+ Adults—1 to 2 mg three times a day.
o To prevent loss of bone (osteoporosis):
+ Adults—0.5 mg a day. Your doctor may want you to take the
medicine each day or only on certain days of the month.
* For topical emulsion dosage form (skin lotion):
o For treating symptoms of menopause:
+ Adults—1.74 grams (one pouch) applied to the skin of each
leg (thigh and calf) once a day in the morning.
* For transdermal dosage form (skin patches):
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), symptoms of
menopause, ovary problems (female hypogonadism or failure or
removal of both ovaries), or to prevent loss of bone
(osteoporosis):
+ For the Climara patches Adults—0.025 to 0.1 milligram (mg)
(one patch) applied to the skin and worn for one week. Then,
remove that patch and apply a new one. A new patch should be
applied once a week for three weeks. During the fourth week,
you may or may not wear a patch. Your health care professional
will tell you what you should do for this fourth week. After
the fourth week, you will repeat the cycle.
+ For the Alora, Estraderm, Estradot, Vivelle, or Vivelle-Dot
patches Adults—0.025 to 0.1 mg (one patch) applied to the skin
and worn for one half of a week. Then, remove that patch and
apply and wear a new patch for the rest of the week. A new
patch should be applied two times a week for three weeks.
During the fourth week, you may or may not apply new patches.
Your health care professional will tell you what you should do
for this fourth week. After the fourth week, you will repeat
the cycle.
* For estradiol cypionate For injection dosage form:
o For treating ovary problems (female hypogonadism):
+ Adults—1.5 to 2 milligrams (mg) injected into a muscle once
a month.
o For treating symptoms of menopause:
+ Adults—1 to 5 mg injected into a muscle every three to four
weeks.
* For estradiol valerate For injection dosage form:
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), symptoms of
menopause, or ovary problems (female hypogonadism or failure
or removal of both ovaries):
+ Adults—10 to 20 milligrams (mg) injected into a muscle every
four weeks as needed.
o For treating prostate cancer:
+ Adults—30 mg injected into a muscle every one or two weeks.
* For estrone For injection dosage form:
o For controlling abnormal bleeding of the uterus:
+ Adults—2 to 5 milligrams (mg) a day, injected into a muscle
for several days.
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), or symptoms
of menopause:
+ Adults—0.1 to 0.5 mg injected into a muscle two or three
times a week. Your doctor may want you to receive the medicine
each week or only during certain weeks of the month.
o For treating ovary problems (female hypogonadism or failure
or removal of both ovaries):
+ Adults—0.1 to 1 mg a week. This is injected into a muscle as
a single dose or divided into more than one dose. Your doctor
may want you to receive the medicine each week or only during
certain weeks of the month.
o For treating prostate cancer:
+ Adults—2 to 4 mg injected into a muscle two or three times a
week.
* For estropipate For oral dosage form (tablets):
o For treating a genital skin condition (vulvar atrophy),
inflammation of the vagina (atrophic vaginitis), or symptoms
of menopause:
+ Adults—0.75 to 6 milligrams (mg) a day. Your doctor may want
you to take the medicine each day or only on certain days of
the month.
o For treating ovary problems (female hypogonadism or failure
or removal of both ovaries):
+ Adults—1.5 to 9 mg a day. Your doctor may want you to take
the medicine each day or only on certain days of the month.
o To prevent loss of bone (osteoporosis):
+ Adults—0.75 mg a day. Your doctor may want you to take the
medicine each day for twenty-five days of a thirty-one–day
cycle.
* For ethinyl estradiol For oral dosage form (tablets):
o For treating breast cancer in women after menopause and in
men:
+ Adults—1 milligram (mg) three times a day.
o For treating ovary problems (female hypogonadism or failure
or removal of both ovaries):
+ Adults—0.05 mg one to three times a day for three to six
months. Your doctor may want you to take the medicine each day
or only on certain days of the month.
o For treating prostate cancer:
+ Adults—0.15 to 3 mg a day.
o For treating symptoms of menopause:
+ Adults—0.02 to 0.05 mg a day. Your doctor may want you to
take the medicine each day or only on certain days of the
month.
* For ethinyl estradiol and norethindrone For oral dosage
form (tablets):
o For treating symptoms of menopause:
+ Adults—1 tablet (5 mcg ethinyl estradiol and 1 mg of
norethindrone) each day
o To prevent loss of bone (osteoporosis):
+ Adults—1 tablet (5 mcg ethinyl estradiol and 1 mg of
norethindrone) each day
Missed dose—
* For patients taking any of the estrogens by mouth: If you
miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the
missed dose and go back to your regular dosing schedule. Do
not double doses.
* For patients using the topical emulsion (skin lotion) form
of estradiol: If you forget to apply the emulsion when you are
suppose to, apply it as soon as possible. However, if it is
almost time for the next dose, skip the missed one and go back
to your regular schedule. Do not apply more than once a day.
* For patients using the transdermal (skin patch) form of
estradiol: If you forget to apply a new patch when you are
supposed to, apply it as soon as possible. However, if it is
almost time for the next patch, skip the missed one and go
back to your regular schedule. Always remove the old patch
before applying a new one. Do not apply more than one patch at
a time.
Storage—
To store this medicine:
* Keep out of the reach of children.
* Store away from heat and direct light.
* Do not store in the bathroom medicine cabinet because the
heat or moisture may cause the medicine to break down.
* Keep the injection form of this medicine from freezing.
* Do not keep outdated medicine or medicine no longer needed.
Be sure that any discarded medicine is out of the reach of
children.
Precautions While Using This Medicine
It is very important that your doctor check your progress
at regular visits to make sure this medicine does not cause
unwanted effects . These visits will usually be every year,
but some doctors require them more often.
In some patients using estrogens, tenderness, swelling, or
bleeding of the gums may occur. Brushing and flossing your
teeth carefully and regularly and massaging your gums may help
prevent this. See your dentist regularly to have your teeth
cleaned. Check with your medical doctor or dentist if you have
any questions about how to take care of your teeth and gums,
or if you notice any tenderness, swelling, or bleeding of your
gums.
It is not yet known whether the use of estrogens increases
the risk of breast cancer in women. Therefore, it is very
important that you regularly check your breasts for any
unusual lumps or discharge. Report any problems to your
doctor. You should also have a mammogram (x-ray pictures of
the breasts) done if your doctor recommends it. Because breast
cancer has occurred in men taking estrogens, regular breast
self-exams and exams by your doctor for any unusual lumps or
discharge should be done.
If your menstrual periods have stopped, they may start
again. This effect will continue for as long as the medicine
is taken. However, if taking the continuous treatment (0.625
mg conjugated estrogens and 2.5 mg medroxyprogesterone once a
day), monthly bleeding usually stops within 10 months.
Also, vaginal bleeding between your regular menstrual
periods may occur during the first 3 months of use. Do not
stop taking your medicine. Check with your doctor if bleeding
continues for an unusually long time, if your period has not
started within 45 days of your last period, or if you think
you are pregnant.
Tell the doctor in charge that you are taking this medicine
before having any laboratory test because some results may be
affected.
Side Effects of This Medicine
Side Effects of This MedicineWomen rarely have severe side
effects from taking estrogens to replace estrogen. Discuss
these possible effects with your doctor:
* The prolonged use of estrogens has been reported to
increase the risk of endometrial cancer (cancer of the lining
of the uterus) in women after menopause. This risk seems to
increase as the dose and the length of use increase. When
estrogens are used in low doses for less than 1 year, there is
less risk. The risk is also reduced if a progestin (another
female hormone) is added to, or replaces part of, your
estrogen dose. If the uterus has been removed by surgery
(total hysterectomy), there is no risk of endometrial cancer.
* It is not yet known whether the use of estrogens
increases the risk of breast cancer in women. Although some
large studies show an increased risk, most studies and
information gathered to date do not support this idea. Breast
cancer has been reported in men taking estrogens.
The following side effects may be caused by blood clots,
which could lead to stroke, heart attack, or death. These side
effects occur rarely, and, when they do occur, they occur in
men treated for cancer using high doses of estrogens. Get
emergency help immediately if any of the following side
effects occur:
* Rare—for males being treated for breast or prostate
cancer only
o Headache (sudden or severe); loss of coordination (sudden);
loss of vision or change of vision (sudden); pains in chest,
groin, or leg, especially in calf of leg; shortness of breath
(sudden and unexplained) ; slurring of speech (sudden);
weakness or numbness in arm or leg
Also, check with your doctor as soon as possible if any of
the following side effects occur:
* More common
o Breast pain (in females and males); fast heartbeat; fever;
hives; hoarseness; increased breast size (in females and
males); irritation of skin; itching of skin; joint pain,
stiffness or swelling; rash; redness of skin; shortness of
breath ; swelling of eyelids, face, lips, hands, or feet ;
swelling of feet and lower legs; tightness in chest; troubled
breathing or swallowing ; weight gain (rapid); wheezing
* Less common or rare
o Changes in vaginal bleeding (spotting, breakthrough
bleeding, prolonged or heavier bleeding, or complete stoppage
of bleeding); chest pain; chills; cough; heavy nonmenstrual
vaginal bleeding; lumps in, or discharge from, breast (in
females and males); pains in stomach, side, or abdomen; yellow
eyes or skin
* Frequency not determined
o Abdominal bloating; abdominal cramps ; acid or sour stomach;
anxiety; backache; belching ; blindness; blistering, peeling,
loosening of skin; blue-yellow color blindness ; blurred
vision; change in vaginal discharge; changes in vision;
changes in skin color; chest discomfort ; clay-colored stools;
clear or bloody discharge from nipple; confusion ;
constipation; convulsions ; dark urine; decrease in amount of
urine; decreased vision; depression; diarrhea; difficulty
breathing; difficulty in speaking; dimpling of breast skin;
dizziness; double vision; dry mouth; eye pain; fainting;
fluid-filled skin blisters; full feeling in upper abdomen;
full or bloated feeling or pressure in the stomach; headache;
heartburn ; inability to move arms, legs, or facial muscles ;
inability to speak; incoherent speech; increased urination;
indigestion; inverted nipple; irregular heartbeats;
light-colored stools; lightheadedness; loss of appetite; loss
of bladder control; lump under the arm; metallic taste;
migraine headache; mood or mental changes; muscle cramps in
hands, arms, feet, legs, or face; muscle pain; muscle spasm or
jerking of all extremities; muscle weakness; nausea; noisy
breathing; numbness or tingling of hands, feet, or face; pain
in ankles or knees; pains in chest, groin, or legs, especially
calves of legs; pain or discomfort in arms, jaw, back or neck;
pain or feeling of pressure in pelvis; painful or tender cysts
in the breasts ; painful, red lumps under the skin, mostly on
the legs; pain; tenderness; swelling of foot or leg; partial
or complete loss of vision in eye; pelvic pain; persistent
crusting or scaling of nipple ; pinpoint red or purple spots
on skin; prominent superficial veins over affected area; red,
irritated eyes; redness or swelling of breast; sensitivity to
the sun; severe headaches of sudden onset; skin thinness; skin
warmth; slow speech; sore on the skin of the breast that does
not heal; sore throat; sores, ulcers, or white spots in mouth
or on lips; stomach discomfort, upset or pain; sudden loss of
consciousness; sudden loss of coordination; sudden onset of
shortness of breath for no apparent reason; sudden onset of
slurred speech; sudden vision changes ; sweating; swelling of
abdominal or stomach area; swelling of fingers or hands;
thirst; tremor; unpleasant breath odor; unusual tiredness or
weakness; vomiting; vomiting of blood; weight loss
Other side effects may occur that usually do not need
medical attention. These side effects may go away during
treatment as your body adjusts to the medicine. However, check
with your doctor if any of the following side effects continue
or are bothersome:
* More common
o Abnormal growth filled with fluid or semisolid material;
accidental injury; bladder pain; bloated full feeling; bloody
or cloudy urine; body aches or pain; coating or white patches
on tongue; congestion; cough producing mucus; decrease in
amount of urine; difficult, burning, or painful urination ;
discouragement; dryness of throat; ear congestion or pain;
excess air or gas in stomach or intestines; fear ; feeling of
warmth; feeling sad or empty; frequent urge to urinate;
general feeling of discomfort or illness; headache, severe and
throbbing; increased clear or white vaginal discharge;
irritability; itching of the vaginal, rectal or genital areas;
lack of appetite; lack or loss of strength ; loss of interest
or pleasure; mild dizziness; neck pain; nervousness; pain;
pain during sexual intercourse; painful or difficult urination
; pain or tenderness around eyes and cheekbones; passing gas;
redness of the face, neck, arms and occasionally, upper chest;
runny nose; skin irritation or redness where skin patch was
worn; shivering; sleeplessness; sneezing; sore mouth or
tongue; stuffy nose; sudden sweating; tender, swollen glands
in neck; thick, white vaginal discharge with no odor or with a
mild odor; tiredness; trouble concentrating; trouble sleeping;
unable to sleep; voice changes
* Less common
o Blemishes on the skin; burning, crawling, itching, numbness,
prickling, "pins and needles" , or tingling feelings; burning
or stinging of skin; diarrhea (mild); dizziness (mild);
increased hair growth, especially on the face; lower abdominal
pain or pressure; mood or mental changes ; muscle stiffness;
difficulty in moving; painful cold sores or blisters on lips,
nose, eyes, or genitals; pimples; pounding in the ears; slow
heartbeat; problems in wearing contact lenses; tooth or gum
pain; unusual decrease in sexual desire (in males); unusual
increase in sexual desire (in females); white or brownish
vaginal discharge
* Frequency not determined
o abdominal pain; abnormal turning out of cervix; changes in
appetite; dull ache or feeling of pressure or heaviness in
legs; fatigue; flushed, dry skin; fruit-like breath odor;
increased hunger; irritability; large amount of triglyceride
in the blood; leg cramps; patchy brown or dark brown
discoloration of skin; twitching, uncontrolled movements of
tongue, lips, face, arms, or legs; unexpected or excess milk
flow from breasts
Also, many women who are taking estrogens with a progestin
(another female hormone) will start having monthly vaginal
bleeding, similar to menstrual periods, again. This effect
will continue for as long as the medicine is taken. However,
monthly bleeding will not occur in women who have had the
uterus removed by surgery (total hysterectomy).
This medicine may cause loss or thinning of scalp hair in
some people.
Other side effects not listed above may also occur in some
patients. If you notice any other effects, check with your
doctor.
