Skip to Content

Estradiol / Levonorgestrel Dosage

Medically reviewed on December 15, 2017.

Applies to the following strengths: 0.045 mg-0.015 mg/24 hr

Usual Adult Dose for Postmenopausal Symptoms

Apply one patch once a week to the lower abdomen or upper quadrant of the buttock

Comments:
-Starting treatment:
--Not on estrogen containing therapy: start at any time.
--Currently on estrogen containing therapy: Complete cycle of current therapy before starting; if withdrawal bleeding occurs at completion of cycle, the first day of bleeding would be an appropriate time to start this medication.
-Start at the lowest effective dose for the shortest duration consistent with treatment goals.
-Attempts to discontinue this medication should be made at 3 to 6 month intervals.

Uses:
-Treatment of moderate to severe vasomotor symptoms due to menopause
-Prevention of postmenopausal osteoporosis

Usual Adult Dose for Prevention of Osteoporosis

Apply one patch once a week to the lower abdomen or upper quadrant of the buttock

Comments:
-Starting treatment:
--Not on estrogen containing therapy: start at any time.
--Currently on estrogen containing therapy: Complete cycle of current therapy before starting; if withdrawal bleeding occurs at completion of cycle, the first day of bleeding would be an appropriate time to start this medication.
-Start at the lowest effective dose for the shortest duration consistent with treatment goals.
-Attempts to discontinue this medication should be made at 3 to 6 month intervals.

Uses:
-Treatment of moderate to severe vasomotor symptoms due to menopause
-Prevention of postmenopausal osteoporosis

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Contraindicated

Precautions

US BOXED WARNING(S):
CARDIOVASCULAR DISORDERS, BREAST CANCER, ENDOMETRIAL CANCER, AND PROBABLE DEMENTIA
Estrogen Plus Progestin Therapy:
--Cardiovascular Disorders and Probable Dementia
-Estrogen plus progestin therapy should not be used for prevention of cardiovascular disease or dementia.
-The Women's Health Initiative (WHI) estrogen plus progestin substudy reported an increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and myocardial infarction (MI) in postmenopausal women (50 to 79 years old) taking conjugated estrogens (CE) (0.625 mg) combined with medroxyprogesterone acetate (MPA) (2.5 mg) for 5.6 years, compared to placebo.
-The WHI Memory Study (WHIMS) estrogen plus progestin ancillary study reported an increase of developing probable dementia in postmenopausal women over 65 years old treated with daily CE (0.625 mg) with MPA (2.5 mg) compared to placebo; it is unknown if this applies to younger postmenopausal women.

--Breast Cancer
-The WHI estrogen plus progestin substudy reported an increased risk of invasive breast cancer.
-Lacking comparable data, assume the risk is similar for other doses of CE and MPA doses, and other combinations and dosage forms of estrogens and progestins.

Estrogen Alone Therapy:
--Endometrial Cancer
-Endometrial cancer risk is increased in a woman with a uterus using unopposed estrogens.
-Adding a progestin to estrogen therapy reduces the risk of endometrial hyperplasia, which may be an endometrial cancer precursor.
-Perform diagnostic measures, including directed or random endometrial sampling when indicated, to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding.

--Cardiovascular Disorders and Probable Dementia
-Estrogen alone therapy should not be used for prevention of cardiovascular disease or dementia.
-The WHI estrogen-alone ancillary study reported increased risks of stroke and DVT in postmenopausal women (50 to 79 years old) taking daily CE (0.625 mg) for 7.1 years, relative to placebo.
-The WHIMS estrogen-alone ancillary study reported an increased risk of probable dementia in postmenopausal women over 65 taking daily CE (0.625 mg) for 5.2 years, relative to placebo; it is unknown if this applies to younger postmenopausal women.
-Lacking comparable data, assume the risk is similar for other doses and dosage forms of estrogens.

Recommendation:
-Estrogens, with or without progestins, should be prescribed at the lowest effective dose for the shortest duration consistent with treatment goals and risks.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis: No adjustment recommended.
-Patients with end stage renal disease receiving maintenance hemodialysis have higher total serum estradiol levels than normal patients after oral estradiol; estradiol levels may be excessive in these patients.
Peritoneal dialysis: Data not available

Other Comments

Administration advice:
-Do not apply on or near the breasts.
-Area of application should not be oily, damaged, or irritated.
-Avoid the waistline, as clothing may rub patch off or modify drug delivery.
-Avoid areas where sitting may dislodge patch.
-Rotate site of application, with at least a 1 week interval between applications to the same site.
-Press patch firmly in place for at least 10 seconds, making sure there is good contact, especially around the edges.
-If patch falls off, the same patch may be reapplied to another area of the lower abdomen.
-If patch cannot be reapplied, a new patch may be applied - continue on original treatment schedule.
-Only one patch should be worn at any time during the dosing interval.
-Effects of swimming, bathing, or using a sauna have not been studied; these activities may decrease patch adhesion and drug delivery.
-Remove patch carefully and slowly to avoid skin irritation.
-If adhesive remains on skin after removal, allow area to dry for 15 minutes, then gently rub area with an oil-based cream or lotion to remove adhesive residue.
-Used patches still contain active drug; fold patches carefully in half so that it sticks to itself before discarding.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide