Estradiol and norethindrone transdermal (skin patch) is a combination medicine used to treat menopause symptoms such as hot flashes and vaginal changes. This medicine is also used before menopause to treat a lack of estrogen caused by conditions such as hypogonadism, primary ovarian failure, or surgical removal of the ovaries.

Estradiol and norethindrone may also be used for purposes not listed in this medication guide.

You should not use this medicine if you are allergic to estradiol or norethindrone, or if you have:

• unusual vaginal bleeding that has not been checked by a doctor;
• liver disease;
• a bleeding disorder;
• a history of heart attack, stroke, or blood clot; or
• a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina.

Do not use estradiol and norethindrone if you have had your uterus (womb) removed.

Do not use estradiol and norethindrone if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

Using this medicine can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke.

Estradiol and norethindrone should not be used to prevent heart disease, stroke, or dementia, because this medicine may actually increase your risk of developing these conditions.

Tell your doctor if you have ever had:

• heart disease;
• liver problems;
• kidney disease;
• angioedema (swelling of face and tongue);
• lupus;
• asthma;
• diabetes;
• epilepsy or other seizure disorder;
• migraines;
• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);
• gallbladder disease;
• endometriosis;
• high levels of calcium levels in your blood;
• a thyroid disorder; or
• if you have any unusual vaginal bleeding.

Using estradiol and norethindrone may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.

Ask a doctor if it is safe to breastfeed while using this medicine.

Use Estradiol And Norethindrone (Transdermal)(Transdermal) exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Remove the skin patch and call your doctor at once if you have:

• heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
• increased blood pressure--severe headache, blurred vision, pounding in your neck or ears, anxiety, nosebleed;
• signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;
• signs of a blood clot--sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;
• swelling or tenderness in your stomach;
• jaundice (yellowing of the skin or eyes);
• unusual vaginal bleeding, pelvic pain;
• a breast lump;
• memory problems, confusion, unusual behavior; or
• high levels of calcium in your blood--nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, lack of energy.

Common side effects may include:

• nausea, vomiting, stomach cramps;
• bloating, swelling, weight gain;
• breast pain;
• light vaginal bleeding or spotting;
• vaginal itching or discharge;
• headache;
• thinning scalp hair; or
• redness or irritation where the patch is worn.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Avoid smoking. It can greatly increase your risk of blood clots, stroke, or heart attack while using estradiol and norethindrone.

Grapefruit may interact with estradiol and lead to unwanted side effects. Avoid the use of grapefruit products.

Avoid using creams, lotions, or powders on the skin where you apply the patch, or it may not stick to your skin.