General
Description & Use
Treats the lack of estrogen from menopause or removal of the ovaries.
Also used to treat osteoporosis (bone loss). Also popular for
M2F transsexuals
in gender reassignment. Estraderm TTS patches contain the active
ingredient estradiol (previously spelt oestradiol in the UK),
which is a naturally occuring form of the main female sex hormone,
oestrogen.
About
Estraderm Patches
Womens’
ovaries gradually produce less and less oestrogen in the period
up to the menopause, and oestrogen blood levels decline as a result.
The declining levels of oestrogen can cause distressing symptoms,
such as irregular periods, hot flushes, night sweats, mood swings
and vaginal dryness or itching. Oestrogen (in this case in the
form of estradiol) can be given as a supplement to replace the
falling levels in the body and help reduce these distressing symptoms
of the menopause. This is known as hormone replacement therapy
(HRT). HRT is usually only required for short-term relief from
menopausal symptoms and its use should be reviewed at least once
a year with your doctor. Estraderm TTS patches are a continuous,
oestrogen-only form of HRT. They release estradiol through the
skin into the bloodstream at a constant rate and are designed
to be changed twice a week, ie a patch is worn for three to four
days and then replaced with a new one. As
they only contain oestrogen, Estraderm TTS patches are most suitable
for women who have had a hysterectomy. Women who have not had
a hysterectomy should also be prescribed a progestogen medicine
to take with this medicine for the last 12 days of each monthly
cycle. This is because oestrogen stimulates the growth of the
womb lining (endometrium), which can lead to endometrial cancer
if the growth is unopposed. A progestogen is given to oppose oestrogen's
effect on the womb lining and reduce the risk of cancer, though
it does not eliminate this risk entirely. This is known as combined
HRT. If a woman has had her womb surgically removed (a hysterectomy),
endometrial cancer is not a risk, and a progestogen is not necessary
as part of HRT (unless the woman has a history of endometriosis).
HRT is also sometimes used to prevent osteoporosis
in postmenopausal women. The declining level of oestrogen at menopause
can affect the bones, causing them to become thinner and more
prone to breaking. Oestrogen supplements help prevent bone loss
and fractures that may occur in women in the years after menopause.
However,
in December 2003, a review of the available evidence on the risks
and benefits of HRT by the Medicines and Healthcare products Regulatory
Agency (MHRA) and the Committee on Safety of Medicines (CSM) in
the UK, concluded that the risks of using HRT long-term to prevent
osteoporosis in women aged over 50 years exceed the benefits.
As a result this medicine should not be used as a first-line option
for preventing postmenopausal osteoporosis in women over 50. However,
it may be used as a second-line option for women at high risk
of fractures who cannot take other medicines that are licensed
for this purpose. Only the Estraderm TTS 50 strength is licensed
for preventing osteoporosis.
Women considered to be at risk of developing fractures
following the menopause include those who have had an early menopause,
those with a family history of osteoporosis, those who have had
recent prolonged corticosteroid therapy (eg prednisolone), those
with a small thin frame, and smokers.
You can read more about the risks and benefits
of HRT and other medicines for preventing osteoporosis in the
factsheets about menopause and osteoporosis linked below.
What
is it used for?
Transdermal hormone replacement therapy to relieve symptoms of
the menopause. Transdermal applied HRT (eg: hormones absorbed
through the skin) are less stressful upon the liver than orally
taken HRT.
Second-line
option for preventing osteoporosis in postmenopausal women who
are at high risk of fractures and cannot take other medicines
licensed for preventing osteoporosis (Estraderm TTS 50 only).
Hormone
treatment in male-to-female
transsexuals
Also
see Estrofem® Estradiol
and Progynova
(non synthetic and plant extracted estradiol) and a complete
list of hormone related
products
Warning!
Follow the instructions provided with your patches carefully.
One Estraderm TTS patch should be applied to a clean, dry, unbroken,
non-irritated area of skin below the waist, eg the buttocks. Don't
apply creams, lotions or other oily products before applying the
patch as they will stop it sticking. The patch should be replaced
with a new one twice a week. Each fresh patch should be applied
to a slightly different area to avoid irritating the skin. Leave
at least a week before applying a patch to the same site. Patches
should NOT be applied on or near the breasts. They should not
be exposed to sunlight.
You can shower and bath without removing the patch.
If a patch falls off before you are due to change it, for example
because you have been doing vigorous exercise, sweating excessively,
or wearing clothes that rub the patch, you should replace it with
a new one. Change this new patch on your normal patch change day.
Women using any form of HRT should have regular
medical and gynaecological check-ups. Your need for continued
HRT should be reviewed with your doctor at least once a year.
It is important to be aware that all women using
HRT have an increased risk of being diagnosed with breast cancer
compared with women who don't use HRT. This risk needs to be weighed
against the personal benefits to you of using HRT. There is more
detailed information about the risks and benefits associated with
HRT in the factsheet about the menopause linked above. You should
discuss these with your doctor before starting HRT. Women on HRT
should have regular breast examinations and mammograms and should
examine their own breasts regularly. Report any changes in your
breasts to your doctor or nurse.
It is important to be aware that women using HRT
have a slightly increased risk of stroke and of blood clots forming
in the veins (eg deep vein thrombosis/pulmonary embolism) compared
with women who don't use HRT. The risk is higher if you have existing
risk factors (eg personal or family history, smoking, obesity,
certain blood disorders - see cautions below) and needs to be
weighed against the personal benefits to you of taking HRT. There
is more detailed information about the risks and benefits associated
with HRT in the factsheet about the menopause linked above. Discuss
these with your doctor before starting treatment.
The risk of blood clots forming in the veins (thromboembolism)
while using HRT may be temporarily increased if you experience
major trauma, have surgery, or are immobile for prolonged periods
of time (this includes travelling for over five hours). For this
reason, your doctor may recommend that you stop using HRT for
a period of time (usually four to six weeks) prior to any planned
surgery, particularly abdominal surgery or orthopaedic surgery
on the lower limbs, or if you are to be immobile for long periods.
The risk of blood clots during long journeys may be reduced by
appropriate exercise during the journey and possibly by wearing
elastic hosiery. Discuss this with your doctor.
Stop using this medicine and inform your doctor
immediately if you experience any of the following symptoms while
using this medicine: stabbing pains or swelling in one leg; pain
on breathing or coughing; coughing up blood; breathlessness; sudden
chest pain; sudden numbness affecting one side or part of the
body; fainting; worsening of epilepsy; migraine or severe headaches;
visual disturbances; severe abdominal complaints; increased blood
pressure; itching of the whole body; yellowing of the skin or
eyes (jaundice); or severe depression.
This medicine will not usually cause a monthly
withdrawal bleed, unless you are also prescribed progestogen tablets
to take for the last few days of each month. However, you may
experience spotting or breakthrough bleeding during the first
few months of treatment. Spotting or breakthrough bleeding is
more likely if you forget to change a patch on schedule. If any
bleeding continues after a few months of using the medicine, or
after stopping treatment, you should consult your doctor.
A woman is considered fertile for two years after
her last menstrual period if she is under 50, or for one year
if over 50. HRT does not provide contraception for women who fall
within this group. If a potentially fertile women is taking HRT
but also requires contraception, a non-hormonal method (eg condoms
or contraceptive foam) should be used.
