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Estradiol / levonorgestrel Side Effects

Medically reviewed by Last updated on Oct 8, 2020.

For the Consumer

Applies to estradiol/levonorgestrel: transdermal patch extended release


Transdermal route (Patch, Extended Release)

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia. Increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) have been reported. An increased risk of developing probable dementia in postmenopausal women 65 years of age or older has also been reported. Estrogens with progestins reduces the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman. Postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding should have adequate diagnostic tests, including directed or random endometrial sampling, to rule out malignancy.

Side effects requiring immediate medical attention

Along with its needed effects, estradiol / levonorgestrel may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking estradiol / levonorgestrel:

Incidence not known

  • Acid or sour stomach
  • anxiety
  • backache
  • belching
  • change in vaginal discharge
  • chest pain or discomfort
  • clear or bloody discharge from the nipple
  • confusion
  • cough
  • difficulty with speaking
  • difficulty with swallowing
  • dimpling of the breast skin
  • dizziness or lightheadedness
  • double vision
  • fainting
  • fast heartbeat
  • full or bloated feeling or pressure in the stomach
  • headache
  • heartburn
  • hives, itching, or rash
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • indigestion
  • inverted nipple
  • loss of appetite
  • lump in the breast or under the arm
  • nausea
  • pain or discomfort in the arms, jaw, back, or neck
  • pain or feeling of pressure in the pelvis
  • pain, redness, or swelling in the arm or leg
  • persistent crusting or scaling of the nipple
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness or swelling of the breast
  • slow speech
  • sore on the skin of the breast that does not heal
  • stomach discomfort, upset, or pain
  • sudden shortness of breath or troubled breathing
  • sweating
  • swelling of the abdominal or stomach area
  • tightness in the chest
  • unusual tiredness or weakness
  • vaginal bleeding
  • vomiting

Side effects not requiring immediate medical attention

Some side effects of estradiol / levonorgestrel may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Back pain
  • body aches or pain
  • breast pain
  • burning, itching, redness, skin rash, swelling, or soreness at the application site
  • chills
  • discouragement
  • ear congestion
  • feeling sad or empty
  • fever
  • heavy nonmenstrual vaginal bleeding
  • irritability
  • loss of interest or pleasure
  • loss of voice
  • nasal congestion
  • runny nose
  • sneezing
  • sore throat
  • tiredness
  • trouble concentrating
  • trouble sleeping

Less common

  • Bladder pain
  • bloody or cloudy urine
  • blurred vision
  • cough producing mucus
  • diarrhea
  • difficult, burning, or painful urination
  • difficulty with moving
  • dizziness
  • excess air or gas in the stomach or intestines
  • frequent urge to urinate
  • general feeling of discomfort or illness
  • itching of the vagina or genital area
  • joint pain
  • lower back or side pain
  • muscle aches and pains
  • muscle pain or stiffness
  • pain during sexual intercourse
  • pain or tenderness around the eyes and cheekbones
  • passing gas
  • pounding in the ears
  • shivering
  • slow or fast heartbeat
  • sweating
  • weight gain

Incidence not known

  • Hair loss or thinning of the hair
  • pressure in the stomach
  • swelling of the abdominal or stomach area

For Healthcare Professionals

Applies to estradiol / levonorgestrel: transdermal film extended release


The most common adverse events were application site reactions, which usually disappeared 2 to 3 days after patch removal.[Ref]


Cardiovascular disorders described as an increase risk of PE, DVT, stroke, and MI have been reported in the WHI (Women's Health Initiative) estrogen plus progestin substudy. Postmenopausal women 50 to 79 years of age receiving oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone (2.5 mg) showed an increased risk of stroke compared to placebo (33 versus 25 per 10,000 women-years); coronary heart disease defined as nonfatal MI, silent MI or coronary heart disease death (41 versus 34 per 10,000 women-years); venous thromboembolism (35 versus 17 per 10,000 women-years).[Ref]

Estrogen plus Progestin:

Frequency not reported: Cardiovascular disorders

Estradiol / levonorgestrel

Common (1% to 10%): Hypertension[Ref]


Estrogen plus Progestin:

Frequency not reported: Malignant neoplasms[Ref]

The Women's Health Initiative (WHI) has shown, after a mean follow-up of 5.6 years, estrogen (0.625 mg) plus progestin (2.5 mg) use increased risk of invasive breast cancer. The relative risk (RR) of invasive breast cancer was reported at 1.24 (absolute risk 41 versus 33 cases per 10,000 women-years) compared with placebo. For women with a prior history of hormone therapy, RR was 1.86 (absolute risk 46 versus 25 cases per 10,000 women-years) compared with placebo. In the same substudy, invasive breast cancers were larger, more likely to be node positive, and diagnosed at a more advanced stage.

Endometrial Cancer has been reported with the use of unopposed estrogen therapy in woman with a uterus; risk is about 2 to 12 times greater without progestin. Most studies show the greatest risk appears associated with prolonged use. Risk has been shown to persist for 8 to 15 years after estrogen therapy is discontinued. Adding a progestin to estrogen therapy in postmenopausal women has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer

A meta-analysis of 17 prospective and 35 retrospective epidemiology studies found that women using hormonal therapy for menopausal symptoms had an increased risk for ovarian cancer. Relative risks associated with current use was calculated at 1.41 (95% confidence interval [CI] 1.32 to 1.50). The relative risk associated with combined current and recent use (discontinued use within 5 years) were comparable and elevated risk was significant for both estrogen-alone and estrogen plus progestin products. It is not possible to determine the exact duration of hormone use associated with an increased risk of ovarian cancer.[Ref]

Nervous system

Uncommon (0.1% to 1%): Migraine

Postmarketing reports: Dizziness, headache[Ref]


Very common (10% or more): Application site reaction (40.6%)[Ref]


Common (1% to 10%): Rash

Postmarketing reports: Alopecia, night sweats, pruritus[Ref]


Common (1% to 10%): Abdominal pain, flatulence, nausea, vomiting

Uncommon (0.1% to 1%): Bloating, abdominal cramps

Postmarketing reports: Abdominal distension[Ref]


Very common (10% or more): Vaginal bleeding (36.8%)

Common (1% to 10%): Urinary tract infection, vaginitis, mastodynia

Uncommon (0.1% to 1%): Dysmenorrhea, endometrial hyperplasia

Rare (less than 0.1%): Increase in size of uterine fibrosis

Postmarketing reports: Changes in bleeding patterns[Ref]


Common (1% to 10%): Back pain, arthralgia

Uncommon (0.1% to 1%): Leg cramps[Ref]


Common (1% to 10%): Depression, increase/decrease in libido

Postmarketing reports: Insomnia[Ref]


Very common (10% or more): Upper respiratory infection (13.2%)

Common (1% to 10%): Sinusitis, bronchitis[Ref]


Uncommon (0.1% to 1%): Fluid retention

Postmarketing reports: Increased weight[Ref]


Postmarketing reports: Anaphylactic reaction[Ref]


Common (1% to 10%): Accidental injury, flu syndrome, pain, edema, weight gain

Uncommon (0.1% to 1%): Weight loss, fatigue

Postmarketing reports: Hot flush[Ref]


1. "Product Information. Climara Pro (estradiol-levonorgestrel)." Berlex Laboratories, Wayne, NJ.

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Further information

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

Some side effects may not be reported. You may report them to the FDA.