When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use if you had an allergic reaction to estradiol, are pregnant, or have a blood clotting disorder, liver disease, or a history of heart attack or stroke. Tell your doctor if you have a history of cancer.

How to Use This Medicine:
Patch

• Your doctor will tell you how many patches to use, where to apply them, and how often to apply them. Do not use more patches or apply them more often than your doctor tells you to.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Wash your hands with soap and water before and after applying a patch.
• Leave the patch in its sealed wrapper until you are ready to put it on. Tear the wrapper open carefully. NEVER CUT the wrapper or the patch with scissors. Do not use any patch that has been cut by accident.
• The patient instructions will show the body areas where you can wear the patch. When putting on each new patch, choose a different place within these areas. Do not put the new patch on the same place you wore the last one. Be sure to remove the old patch before applying a new one.
• Place the patch on a clean, dry area of your lower stomach or upper buttock area, where there is no oil, lotion, or powder. Do not apply the patch on or near your breasts, over cut or broken skin, or in a spot where it might rub off (such as at the waistline).
• Press the patch firmly in place with your hand for about 10 seconds.
• Change your patch on the same days of each week, to help you remember.
• If you have any adhesive left on your skin after you remove the patch, allow it to dry for 15 minutes. Then gently rub the sticky area with oil or lotion to remove the adhesive.
• You may take a bath, shower, or swim while wearing a patch.
• Fold the used patch in half with the sticky side together. Place it in a sturdy childproof container and throw away, out of the reach of children and pets. Do not flush the patch down the toilet.
• Missed dose: If you forget to wear or change a patch, put one on as soon as you can. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Do not apply extra patches to make up for a missed dose.
• If a patch falls off, just put it back on a different area. If the patch does not stick completely, put on a new patch, but continue to follow your original schedule for changing to a new one.
• Store the patches at room temperature in a closed container, away from heat, moisture, and direct light. Do not open the pouch until you are ready to use the patch.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some foods and medicines can affect how estradiol works. Tell your doctor if you are using St John's wort, carbamazepine, clarithromycin, erythromycin, itraconazole, ketoconazole, phenobarbital, rifampin, ritonavir, thyroid medicine, or a blood thinner (such as warfarin).
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

• Pregnancy after menopause is not likely, but if you think you could be pregnant, tell your doctor. This medicine could harm an unborn baby.
• Tell your doctor if you are breastfeeding, or if you have kidney disease, liver disease, asthma, diabetes, endometriosis, epilepsy, migraine headaches, porphyria, lupus, thyroid problems, heart disease, high blood pressure, high cholesterol or triglycerides, or a history of cancer. Tell your doctor if you had liver problems caused by pregnancy or estrogen.
• This medicine may cause the following problems:
  
  • Higher risk of heart attack, stroke, or blood clots
  • Higher risk of endometrial cancer, breast cancer, or uterine cancer
  • Higher risk of dementia, especially in women 65 years of age and older
  • Gallbladder disease
  • Vision problems
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results. You may need to stop using this medicine before and after you have surgery or if you need to stay in bed for a long time.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments. Have regular exams and mammograms as directed by your doctor.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Breast lump
• Chest pain, trouble breathing, or coughing up blood
• Chest pain that may spread, trouble breathing, nausea, unusual sweating, fainting
• Numbness or weakness on one side of your body, sudden or severe headache, problems with vision, speech, or walking
• Swelling in your hands, ankles, or feet
• Unusual vaginal bleeding or heavy bleeding
• Vision changes

If you notice these less serious side effects, talk with your doctor:

• Headache
• Mild nausea, vomiting, gas
• Runny or stuffy nose
• Skin redness or itching where the patch is placed
• Swollen or tender breasts

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088