Personalized Care, Backed by Leading Women’s Health Experts

What is this drug used for?

• It is used to prevent soft, brittle bones (osteoporosis) after menopause.
• It is used to prevent or lower the signs of the change of life (menopause).
• It is used to add estrogen to the body when the ovaries have been taken out or do not work the right way.
• Rarely, it is used to treat breast or prostate cancers.
• It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take this drug?

All products:

• If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
• If you have had any of these health problems: Bleeding disorder, blood clots, a higher risk of having a blood clot, breast cancer, liver problems or liver tumor, heart attack, stroke, or a tumor where estrogen makes it grow.
• If you have unexplained vaginal bleeding.
• If you are pregnant or may be pregnant. Do not take this drug if you are pregnant.

Vaginal ring:

• If you have any of these health problems: Some vaginal problems like narrow vagina or vaginal infection, uterus not in the normal spot, or other health problems that may raise the chance of vaginal irritation, vaginal ulcers, or make it more likely for the vaginal ring to come out. Ask your doctor if you are not sure.

This is not a list of all drugs or health problems that interact with this drug.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take this drug?

All products:

• Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists. This drug may need to be stopped before certain types of surgery as your doctor has told you. If this drug is stopped, your doctor will tell you when to start taking this drug again after your surgery or procedure.
• Talk with your doctor if you will need to be still for long periods of time like long trips, bedrest after surgery, or illness. Not moving for long periods may raise your chance of blood clots.
• If you are allergic to tartrazine (FD&C Yellow No. 5), talk with your doctor. Some products have tartrazine.
• If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
• High blood pressure has happened with drugs like this one. Have your blood pressure checked as you have been told by your doctor.
• Have your blood work and bone density checked as you have been told by your doctor.
• Be sure to have regular breast exams and gynecology check-ups. You will also need to do breast self-exams as you have been told.
• The risk of certain side effects like heart attack, stroke, breast cancer, ovarian cancer, and others may not be the same for everyone. Factors like how long an estrogen is taken, if it is taken with or without a progestin, and other factors may affect the risk for certain side effects. Talk with your doctor about the benefits and risks of using this drug.
• High triglyceride levels have happened with this drug. Tell your doctor if you have ever had high triglyceride levels.
• This drug may cause dark patches of skin on your face. Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun.
• This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
• Do not smoke. Smoking raises the chance of heart disease. Talk with your doctor.
• Limit your drinking of alcohol.
• If you drink grapefruit juice or eat grapefruit often, talk with your doctor.
• This drug may affect growth in children and teens in some cases. They may need regular growth checks. Talk with the doctor.
• If you are 65 or older, use this drug with care. You could have more side effects.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

Soft, brittle bones (osteoporosis):

• This drug works best when used with calcium/vitamin D and weight-bearing workouts like walking or PT (physical therapy).
• Follow the diet and exercise plan that your doctor told you about.

All skin products:

• Talk with your doctor before you use other drugs or products on your skin. This includes soaps.

Skin gel:

• Do not use sunscreen before using gel or soon after using gel.
• Do not use sunscreen on gel part for 7 days in a row.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

All products:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of liver problems like dark urine, tiredness, decreased appetite, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
• Signs of gallbladder problems like pain in the upper right belly area, right shoulder area, or between the shoulder blades; yellow skin or eyes; fever with chills; bloating; or very upset stomach or throwing up.
• Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
• Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
• Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight.
• Eyesight changes or loss, bulging eyes, or change in how contact lenses feel.
• A lump in the breast, breast pain or soreness, or nipple discharge.
• Vaginal itching or discharge.
• Vaginal bleeding that is not normal.
• Depression or other mood changes.
• Memory problems or loss.
• Fever.
• Not able to pass urine or change in how much urine is passed.
• Pain when passing urine.
• This drug may cause you to swell or keep uid in your body. Tell your doctor if you have swelling, weight gain, or trouble breathing.
• Call your doctor right away if you have signs of a blood clot like chest pain or pressure; coughing up blood; shortness of breath; swelling, warmth, numbness, change of color, or pain in a leg or arm; or trouble speaking or swallowing.
• High calcium levels have happened with drugs like this one in some people with cancer. Call your doctor right away if you have signs of high calcium levels like weakness, confusion, feeling tired, headache, upset stomach or throwing up, constipation, or bone pain.

Vaginal ring:

• Toxic shock syndrome (TSS) has happened in a few patients using vaginal rings. TSS is rare, but can be deadly. Tell your doctor right away if you have diarrhea, dizziness or light-headedness, passing out, fever, muscle pain, upset stomach, throwing up, or a sunburn-like rash.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

All products:

• Dizziness or headache.
• Hair loss.
• Upset stomach or throwing up.
• Constipation.
• Stomach pain or cramps.
• Bloating.
• Enlarged breasts.
• Tender breasts.
• Vaginal bleeding or spotting.
• Painful periods.
• Signs of a common cold.
• Nose or throat irritation.
• Weight gain or loss.
• Joint pain.
• Leg cramps.
• Change in sex interest.

Injection, patch, and vaginal ring:

• Irritation where this drug was used.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to your national health agency.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

Skin patch:

• Do not take this drug by mouth. Use on your skin only. Keep out of your mouth, nose, and eyes (may burn).
• Use this drug at the same time of day.
• Wash hands before and after use.
• Put patch on clean, dry, healthy skin on the lower belly or upper buttocks. Move the site with each new patch.
• Do not put a patch on the same site for at least 7 days.
• Do not use on skin that has any problems.
• Do not put on the breast.
• Do not put on skin where you have just used creams, oils, lotions, powder, or other skin products. The patch may not stick as well.
• Put patch on a site without hair.
• Do not put the patch on the waistline.
• Do not put the patch on a site where sitting will make it come off.
• Do not cut or divide patches. Do not use patches that are damaged.
• If the patch falls off, put it back on. If you cannot put the patch back on, put on a new one in a different area.
• Wear only one patch at a time.
• After you take off a skin patch, be sure to fold the sticky sides of the patch to each other. Throw away used patches where children and pets cannot get to them.

Vaginal ring:

• Put into the vagina and leave in place for 90 days.
• To use, wash your hands and take ring from the pouch.
• Be sure your hands are dry before you touch this drug.
• Press sides of ring at the same time between thumb and index finger and put folded ring into the vagina.
• Perfect placement is not needed for the ring to work. The ring will not hurt.
• To take out, hook the index finger around the rim or hold rim between index finger and middle finger and pull out.
• Do not throw the vaginal ring in the toilet.
• Wash hands after use.

What do I do if I miss a dose?

Injection and vaginal ring:

• Call your doctor to nd out what to do.

Skin patch:

• Put on a missed patch as soon as you think about it after taking off the old one. Skin gel and spray:
• Use a missed dose as soon as you think about it.
• If it is less than 12 hours until the next dose, skip the missed dose and go back to your normal time.
• Do not use 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

All other products:

• Store at room temperature in a dry place. Do not store in a bathroom.

Skin gel:

• Protect from heat or open ame.
• If you are using a pump, throw away any part not used after labeled number of doses are used.

Skin patch:

• Store in a protective pouch until ready for use.

All products:

• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not push down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• 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.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, 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.

What is this drug used for?

• It is used to lower the chance of endometrial changes after menopause in people who are getting estrogen therapy.
• It is used to treat uterine bleeding due to hormonal imbalance.
• It is used to treat people who do not have a monthly period cycle.
• It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take this drug?

All products:

• If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
• If you have a peanut allergy and are taking the capsules. The capsules have peanut oil in them.
• If you have had any of these health problems: Bleeding disorder; blood clots or risk of having a blood clot; breast cancer or other cancer; liver disease; heart attack; stroke; or tumor where estrogen or progesterone make it grow.
• If you have unexplained vaginal bleeding.
• If you are pregnant or may be pregnant. Injection and all vaginal products.
• If you have had a recent miscarriage.

All vaginal products:

• If you are using any other vaginal products. This includes drugs to treat fungal infections, vaginal lubricants, diaphragms, and condoms.

What are some things I need to know or do while I take this drug?

All products:

• Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists. This drug may need to be stopped before certain types of surgery as your doctor has told you. If this drug is stopped, your doctor will tell you when to start taking this drug again after your surgery or Procedure.
• Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
• If you have an allergy to any type of nuts or seeds, talk with your doctor.
• If you have high blood sugar (diabetes), talk with your doctor. This drug may raise blood sugar.
• Be sure to have regular breast exams and gynecology check-ups. You will also need to do breast self-exams as you have been told.
• This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
• Blood clots have happened with this drug. These clots have included heart attack, stroke, and clots in the leg, lung, or eye. Sometimes blood clots can be deadly. Tell your doctor if you have ever had a blood clot. Talk with your doctor.
• Talk with your doctor if you will need to be still for long periods of time like long trips, bedrest after surgery, or illness. Not moving for long periods may raise your chance of blood clots.
• If you are 65 or older, use this drug with care. You could have more side effects
• This drug is not a method of birth control and will not prevent pregnancy. If you have questions, talk with the doctor.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
• Ovarian hyperstimulation syndrome (OHSS) is a severe side effect that may happen in some people who use this drug. Call your doctor right away if you have severe stomach pain or bloating; very upset stomach, throwing up, or diarrhea; a big weight gain; shortness of breath; or change in how much urine is passed.

Capsules and injection:

• Certain side effects like heart attack, stroke, breast cancer, and others have been seen in some people taking a certain estrogen with a progestin. The risk may not be the same for everyone. Factors like how long the treatment is, if an estrogen is taken with or without a progestin, and other factors may affect the risk for certain side effects. Talk with your doctor about the benefits and risks of using this drug.

What are some side effects that I need to call my doctor about right away?

All products:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of liver problems like dark urine, tiredness, decreased appetite, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
• Shortness of breath, a big weight gain, or swelling in the arms or legs.
• Trouble walking.
• Severe dizziness or passing out.
• Eyesight changes or loss, bulging eyes, or change in how contact lenses feel.
• A lump in the breast, breast pain or soreness, or nipple discharge.
• Vaginal itching or discharge.
• Vaginal bleeding that is not normal.
• Pain when passing urine.
• Passing urine more often.
• Depression or other mood changes.
• Memory problems or loss.
• This drug may cause you to swell or keep fluid in your body. Tell your doctor if you have swelling, weight gain, or trouble breathing.
• Signs of a blood clot like chest, arm, back, neck, or jaw pain or pressure; coughing up blood; numbness or weakness on 1 side of your body; trouble speaking or thinking; change in balance; change in eyesight; shortness of breath; or swelling, warmth, or pain in the leg or arm.

Vaginal insert and ring:

• Pelvic pain.

Vaginal ring:

• Toxic shock syndrome (TSS) has happened in a few patients using vaginal rings. TSS is rare, but can be deadly. Tell your doctor right away if you have diarrhea, dizziness or light-headedness, passing out, fever, muscle pain, upset stomach, throwing up, or a sunburn-like rash.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

All products:

• Feeling dizzy, sleepy, tired, or weak.
• Headache.
• Constipation, diarrhea, throwing up, or upset stomach.
• Stomach pain or cramps.
• Bloating.
• Enlarged breasts.
• Tender breasts.
• Muscle pain.
• Weight gain.
• Vaginal bleeding or spotting.
• Lowered interest in sex.

Injection and all vaginal products:

• Irritation where this drug was used.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to your national health agency.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

Capsules:

• Take at bedtime if taking once a day.
• Take with or without food. Take with food if it causes an upset stomach.
• Take with a full glass of water.
• If you have trouble swallowing, talk with your doctor.