ZUMENON 1MG TABLETS
Active substance(s): ESTRADIOL / ESTRADIOL HEMIHYDRATE / ESTRADIOL / ESTRADIOL HEMIHYDRATE / ESTRADIOL / ESTRADIOL HEMIHYDRATE
Your medicine is known by either of the above names, but will be referred to
as Zumenon throughout this:
Patient Information Leaflet
Read all of this leaflet carefully before you start using this medicine.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others.
It may harm them, even if their symptoms are the same as yours.
• If any of the side effects gets serious, or if you notice any side effects
not listed in this leaflet, please tell your doctor or pharmacist.
In this leaflet:
1) What Zumenon is and what it is used for
2) Before you use Zumenon
3) How to use Zumenon
4) Possible side effects
5) How to store Zumenon
6) Further information
1) What Zumenon is and what it is used for
Zumenon is a Hormone Replacement Therapy (HRT).
It contains the female hormone oestrogen. Zumenon is used in
postmenopausal women with at least 6 months since their last natural
period and women switching from standard (cyclic or sequential) HRT on
the advice of their doctor.
Zumenon is used for:
Relief of symptoms occurring after menopause
During the menopause, the amount of the oestrogen produced by a
woman’s body drops. This can cause symptoms such as hot face, neck and
chest ("hot flushes"). Zumenon alleviates these symptoms after
You will only be prescribed Zumenon if your symptoms seriously hinder
your daily life.
2) Before you take Zumenon
Medical history and regular check-ups
The use of HRT carries risks which need to be considered when deciding
whether to start taking it, or whether to carry on taking it.
The experience in treating women with a premature menopause (due to
ovarian failure or surgery) is limited.
If you have a premature menopause the risks of using HRT may be
different. Please talk to your doctor. Before you start (or restart) HRT, your
doctor will ask about your own and your family’s medical history. Your
doctor may decide to perform a physical examination. This may include an
examination of your breasts and/or an internal examination, if necessary.
Once you have started on Zumenon you should see your doctor for regular
check-ups (at least once a year). At these check-ups, discuss with your
doctor the benefits and risks of continuing with Zumenon. Go for regular
breast screening, as recommended by your doctor.
Do not take Zumenon
If any of the following applies to you. If you are not sure about any of the
points below, talk to your doctor before taking Zumenon,
Do not take Zumenon
• If you have or have ever had breast cancer, or if you are suspected of
• If you have cancer which is sensitive to oestrogens, such as cancer of
the womb lining (endometrium), or if you are suspected of having it
• If you have any unexplained vaginal bleeding
• If you have excessive thickening of the womb lining (endometrial
hyperplasia) that is not being treated.
• If you have or have ever had a blood clot in a vein (thrombosis), such as
in the legs (deep venous thrombosis) or the lungs (pulmonary embolism)
• If you have a blood clotting disorder (such as protein C, protein S, or
• If you have or recently have had a disease caused by blood clots in the
arteries, such as a heart attack, stroke or angina
• If you have or have ever had a liver disease and your liver function tests
have not returned to normal
• If you have a rare blood problem called “porphyria” which is passed down
in families (inherited)
• If you are allergic (hypersensitive) to oestradial or any of the other
ingredients of Zumenon (listed in section 6 Further information)
• if you still have your womb and are not currently taking some form of
If any of the above conditions appear for the first time while taking
Zumenon, stop taking it at once and consult your doctor immediately.
When to take special care with Zumenon
Tell your doctor if you have ever had any of the following problems, before
you start the treatment, as these may return or become worse during
treatment with Zumenon. If so, you should see your doctor more often
• fibroids inside your womb
• growth of womb lining outside your womb (endometriosis) or a history of
excessive growth of the womb lining (endometrial hyperplasia)
• increased risk of developing blood clots (see “Blood clots in a vein
• increased risk of getting a oestrogen-sensitive cancer (such as having a
mother, sister or grandmother who has had breast cancer)
• high blood pressure.
• a liver disorder, such as a benign liver tumour
• migraine or severe headaches.
• a disease of the immune system that affects many organs of the body
(systemic lupus erythematosus, SLE)
• a disease affecting the eardrum and hearing (otosclerosis)
• a very high level of fat in your blood (triglycerides)
• fluid retention due to cardiac or kidney problems
Stop taking Zumenon and see a doctor immediately
If you notice any of the following when taking HRT:
- any of the conditions mentioned in the ‘DO NOT take Zumenon’ section
- yellowing of your skin or the whites of your eyes (jaundice). These may be
signs of a liver disease
- a large rise in your blood pressure (symptoms may be headache,
- migraine-like headaches which happen for the first time.
- if you become pregnant
- if you notice signs of a blood clot, such as:
- painful swelling and redness of the legs
- sudden chest pain
- difficulty in breathing
For more information, see ‘Blood clots in a vein (thrombosis)’
Note: Zumenon is not a contraceptive. If it is less than 12 months since
your last menstrual period or you are under 50 years old, you may still need
to use additional contraception to prevent pregnancy. Speak to your doctor
HRT and cancer
Excessive thickening of the lining of the womb (endometrial
hyperplasia) and cancer of the lining of the womb (endometrial
Taking oestrogen-only HRT will increase the risk of excessive thickening of
the lining of the womb (endometrial hyperplasia) and cancer of the womb
lining (endometrial cancer).
Taking a progestogen in addition to the oestrogen for at least 12 days of
each 28 day cycle protects you from this extra risk. So your doctor will
prescribe a progestogen separately if you still have your womb. If you have
had your womb removed (a hysterectomy), discuss with your doctor
whether you can safely take this product without a progestogen.
In women who still have a womb and who are not taking HRT, on average,
5 in 1000 will be diagnosed with endometrial cancer between the ages of 50
For women aged 50 to 65 who still have a womb and who take oestrogenonly HRT, between 10 and 60 women in 1000 will be diagnosed with
endometrial cancer (i.e. between 5 and 55 extra cases), depending on the
dose and for how long it is taken.
You will have a bleed once a month (so-called withdrawal bleed) while
taking Zumenon. But, if you have unexpected bleeding or drops of blood
(spotting) besides your monthly bleeding, which:
• carries on for more than the first 6 months
• starts after you have been taking Zumenon more than 6 months
• carries on after you have stopped taking Zumenon
see your doctor as soon as possible
Evidence suggests that taking combined oestrogen-progestogen and
possibly also oestrogen-only HRT increases the risk of breast cancer. The
extra risk depends on how long you take HRT. The additional risk becomes
clear within a few years. However, it returns to normal within a few years (at
most 5) after stopping treatment.
For women who have had their womb removed and who are using
oestrogen-only HRT for 5 years, little or no increase in breast cancer risk is
Women aged 50 to 79 who are not taking HRT, on average, 9 to 17 in 1000
will be diagnosed with breast cancer over a 5-year period. For women aged
50 to 79 who are taking oestrogen-progestogen HRT over 5 years, there will
be 13 to 23 cases in 1000 users (i.e. an extra 4 to 6 cases).
• Regularly check your breasts. See your doctor if you notice any
changes such as:
• dimpling of the skin
• changes in the nipple
• any lumps you can see or feel
Ovarian cancer is rare much rarer than breast cancer. The use of
oestrogen-only or combined oestrogen-progestagen HRT has been
associated with a slightly increased risk of ovarian cancer. The risk of
ovarian cancer varies with age. For example in women aged 50 to 54 who
are not taking HRT, on average about 2 women in 2000 will be diagnosed
with ovarian cancer over a 5-year period. For women who have been taking
HRT for 5 years, there will be about 3 cases per 2000 users (i.e. about 1
Effect of HRT on heart and circulation
Blood clots in a vein (thrombosis)
The risk of blood clots in the veins is about 1.3 to 3- times higher in HRT
users than in non-users, especially during the first year of taking it.
Blood clots can be serious, and if one travels to the lungs, it can cause
chest pain, breathlessness, fainting or even death.
You are more likely to get a blood clot in your veins as you get older and if
any of the following applies to you.
Inform your doctor if any of these situations applies to you:
• you are unable to walk for a long time because of major surgery, injury or
illness (see also section 3, If you need to have surgery)
• you are seriously overweight (BMI >30 kg/m2)
• you have any blood clotting problem that needs long-term treatment with
a medicine used to prevent blood clots
• if any of your close relatives has ever had a blood clot in the leg, lung or
• you have systemic lupus erythematosus (SLE)
• you have cancer.
For signs of a blood clot, see “Stop taking Zumenon and see a doctor
Looking at women in their 50s who are not taking HRT, on average, over a
5-year period, 4 to 7 in 1000 would be expected to get a blood clot in a vein.
For women in their 50s who have been taking oestrogen-progestogen
HRT for over 5 years, there will be 9 to 12 cases in 1000 users (i.e. an extra
For women in their 50s who have had their womb removed and have been
taking oestrogen-only HRT for over 5 years, there will be 5 to 8 cases in
1000 users (i.e. 1 extra case).
Heart disease (heart attack)
There is no evidence that HRT will prevent a heart attack.
Women over the age of 60 years who use oestrogen-progestogen HRT are
slightly more likely to develop heart disease than those not taking any HRT.
For women who have had their womb removed and are taking oestrogenonly therapy there is no increased risk of developing a heart disease.
The risk of getting stroke is about 1.5 times higher in HRT users than in
non-users. The number of extra cases of stroke due to use of HRT will
increase with age.
Looking at women in their 50s who are not taking HRT, on average, 8 in
1000 would be expected to have a stroke over a 5-year period. For women
in their 50s who are taking HRT, there will be 11 cases in 1000 users, over
5 years (i.e. an extra 3 cases).
• HRT will not prevent memory loss. There is some evidence of a higher
risk of memory loss in women who start using HRT after the age of 65.
Speak to your doctor for advice.
Using other medicines
Some medicines may interfere with the effect of Zumenon. This might lead
to irregular bleeding. This applies to the following medicines:
• Medicines for epilepsy (such as phenobarbital, phenytoin and
• Medicines for tuberculosis (such as rifampicin, rifabutin)
• Medicines for HIV infection (such as nevirapine, efavirenz, ritonavir and
• Herbal remedies containing St John’s Wort (Hypericum perforatum).
Problems due to high levels of the following medicines may occur when you
take Zumenon so careful drug monitoring and dose decrease may become
• tacrolimus and cyclosporin – used, for example, for organ transplants
• fentanyl – a painkiller
• theophylline – used for asthma and other breathing problems
Please tell your doctor or pharmacist if you are taking or have recently
taken any other medicines including medicines obtained without a
prescription, herbal medicines or other natural products.
If you need a blood test, tell your doctor or the laboratory staff that you are
taking Zumenon, because this medicine can affect the results of some tests.
Pregnancy and breast-feeding
Zumenon is for use in peri and postmenopausal women only. If you become
pregnant, stop taking Zumenon and contact your doctor.
Important information about some of the ingredients of Zumenon
Zumenon tablets contain milk sugar (lactose). If you have been told by your
doctor that you have an intolerance to some sugars, contact your doctor
before taking this medicinal product.
3) How to take Zumenon
Always take Zumenon exactly as your doctor has told you. You should
check with your doctor or pharmacist if you are not sure.
Take one tablet every day, without a break between packs. Swallow the
tablet with water, with or without food.
In women with a uterus, a progestagen should normally be added to
Zumenon for 12 - 14 days of each month. If you are having regular periods
you should start taking Zumenon on day one of bleeding.
If you are not having regular periods and are not taking any other HRT
preparations, or you are switching from a combined continuous HRT
product, you can start taking Zumenon on any convenient day.
If you are currently using a ‘cyclic’ or ‘sequential’ HRT preparation (which
involves taking an oestrogen tablet or patch for part of the month, followed
by both oestrogen and progestagen tablet or patch for up to 14 days) start
taking Zumenon the day after you finish the pack i.e. at the end of the
Your doctor will aim to prescribe the lowest dose to treat your symptom for
as short as necessary. Speak to your doctor if you think this dose is too
strong or not strong enough.
You may experience some irregular bleeding or light bleeding (spotting)
during your first few months of taking Zumenon. If the bleeding is
troublesome, or continues beyond the first few months of treatment you
should discuss this with your doctor.
If you take more Zumenon than you should
If you or somebody else takes too many Zumenon tablets, they are unlikely
to come to any harm. Nausea (feeling sick), vomiting, sleepiness, dizziness
and withdrawal bleeding may occur. No treatment is necessary, but if you
are worried contact your doctor for advice.
If you forget to take Zumenon
Take the missed tablet as soon as you remember. If it is more than 12
hours since you took the last one, take the next dose without taking the
forgotten tablet. Do not take a double dose. Bleeding or spotting may occur
if you miss a dose.
If you need to have surgery
If you are going to have surgery, tell the surgeon that you are taking
Zumenon. You may need to stop taking Zumenon about 4 to 6 weeks
before the operation to reduce the risk of a blood clot (see section 2, Blood
clots in a vein). Ask your doctor when you can start taking Zumenon again.
If you stop taking Zumenon
Do not stop taking Zumenon without first talking to your doctor.
If you have any further questions on the use of this product, ask your doctor
4) Possible side effects
Like all medicines, Zumenon can cause side effects, although not
everybody gets them.
The following diseases are reported more often in women using HRT
compared to women not using HRT:
• breast cancer
• abnormal growth or cancer of the lining of the womb (endometrial
hyperplasia or cancer)
• ovarian cancer
• blood clots in the veins of the legs or lungs (venous thromboembolism)
• heart disease
• probable memory loss if HRT is started over the age of 65
painful reddish skin nodules (erythema nodosum)
vaginal thrush (a vaginal infection due to a fungus called Candida
symptoms of cystitis
high blood pressure
swelling of the ankles, feet or fingers (peripheral oedema)
water retention (oedema)
peripheral vascular disease
blood clots in the veins of the legs or lungs (venous thromboembolism)
fibroids get bigger (growths in the womb increase)
changes in the cervix (the lower end of the womb)
problems with your sight
faster heart beat (palpitations)
breast pain or tenderness
Rare (in less than 1 in 1,000, but more than 1 in 10,000 patients
- liver disorders, which may include jaundice (yellowing of the skin),
asthenia (feeling weak) or general malaise, and abdominal pain
- change in the surface of the eye
- intolerance to contact lenses
- pre-menstrual tension (PMT)
- feeling anxious
- feeling bloated
- excessive hair growth
- muscle cramps
- vaginal discharge
- feeling tired
- swelling of the breasts
- change in sex drive
Very rare (in less than 1 in 10,000 patients treated, not known (cannot
be estimated from the available data)):
- reduction in red blood cells which can make the skin pale and cause
weakness or breathlessness (anaemia)
- chorea (muscle twitches)
- skin discolouration (purpura)
- worsening of porphyria (a metabolic disease)
- rash with target-shaped reddening or sores (erythema multiforme)
- discoloration of the skin especially of the face or neck known as
“pregnancy patches” (chloasma or melasma)
If unscheduled bleeding occurs after some time on HRT, you should contact
your doctor. If unscheduled bleeding continues after stopping HRT, it may
be necessary to perform tests to exclude disease of the endometrium (the
lining of the uterus).
Changes can occur in the levels of certain proteins and hormones in the
blood. The action of the hormones in the body is not affected. You should
tell your doctor that you are taking HRT if you are to have a blood test.
The following side effects have been reported with other HRTs:
• a disease where the immune system abnormally attacks many organs of
the body (systemic lupus erythematosus)
• change in metabolism of sugars and starches (carbohydrate)
• high levels of certain blood fats (hypertriglyceridemia)
• worsening of fits (epilepsy)
• blood clots in the arteries (arterial thromboembolism)
• inflammation of the pancreas (pancreatitis) in women with pre-existing
high levels of certain blood fats (hypertriglyceridemia)
• a condition where gastric juices, containing acid, travel back from the
stomach into the oesophagus (gastrooesophageal reflux disease)
symptoms include heartburn
• urinary incontinence
• painful/lumpy breasts (fibrocystic breast disease)
• increased total thyroid hormones
Reporting side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This
includes any possible side effects not listed in this leaflet. You can also
report side effects directly via the Yellow Card Scheme at:
www.mhra.gov.uk/yellowcard. By reporting side effects you can help
provide more information on the safety of this medicine.
5) How to store Zumenon
Keep all medicines out of the sight and reach of children.
Do not take the tablets after the expiry date shown on the pack.
Do not store above 30°C.
If your medicine is not used, take it back to your pharmacist.
Medicines should not be disposed of via wastewater or household waste.
Ask your pharmacist how to dispose of medicines no longer required.
These measures will help to protect the environment.
6) Further information
For more information about these side effects, see Section 2.
The following serious side effects may occur during treatment with
- swelling of the skin around the face and neck. This may cause difficulty
- heart attack
- heavy, irregular or painful bleeds
If any of these side effects occur you should stop treatment
immediately and contact your doctor.
The following side effects may occur during treatment:
Common (in less than 1 in 10, but more than 1 in 100 patients treated):
- feeling sick
- leg cramps
- abdominal pain
- pelvic pain
- unscheduled bleeding or spotting
- wind (flatulence)
- feeling weak (asthenia)
- weight changes
- rash or itching
Uncommon (in less than 1 in 100, but more than 1 in 1,000 patients
- hypersensitivity (allergic) reaction such as skin rash, itching, skin redness
What Zumenon contains:
Each film-coated tablet contains 1 mg estradiol (as the hemihydrate).
The estradiol in the tablets is made from plant materials. The tablets also
contain: lactose monohydrate, hypromellose, maize starch, colloidal
anhydrous silica, magnesium stearate, OPADRY Y-1-7000 White
(hypromellose, titanium dioxide (E171) and macrogol 400).
What Zumenon looks like and contents of the pack
The tablets are, round, white, film-coated and imprinted with ‘379’ on one
side, and plain on the other side.
Zumenon is available as calendar blister pack of 28 tablets, which is
marked with the days of the week to help you remember to take your
Zumenon 1mg Tablets/ Oromone 1mg Tablets
Who makes and repackages your medicine?
Your medicine is manufactured by Abbott Biologicals BV, Veerweg 12, 8121
AA Olst, The Netherlands. Procured from within the EU and repackaged by
the Product Licence Holder: Primecrown Ltd, 4/5 Northolt Trading Estate,
Belvue Road, Northolt, Middlesex, UB5 5QS.
Leaflet date: 16.06.2016
Zumenon® and Oromone® are registered trademarks of BGP Products B.V.,
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.