• Estraderm TTS 25 containing 2 mg of estradiol. Your body will absorb about 25 micrograms of estradiol each day whilst you are wearing an Estraderm TTS 25 patch.
• Estraderm TTS 50 containing 4 mg of estradiol. Your body will absorb about 50 micrograms of estradiol each day whilst you are wearing an Estraderm TTS 50 patch.
• Estraderm TTS 100 containing 8 mg of estradiol. Your body will absorb about 100 micrograms of estradiol each day whilst you are wearing an Estraderm TTS 100 patch.

• Do you have or are you being treated for a blood clot in a vein in your leg or anywhere else (a “deep vein thrombosis”) or a blood clot that has travelled to your lung or another part of your body (an “embolus”)?
• Do you have problems with your circulation or with your blood clotting too easily (‘thrombosis’ or ‘embolism’) at the moment? You might notice swollen, sore, red areas over your veins, or pains in your legs or chest when you walk. You should not take ESTADERM TTS unless you are being treated with anticoagulant therapy (blood thinning medication) by your doctor.
• Do you have a previous experience of a blood clot anywhere in the body within the last 2 years?
• Do you suffer from known or suspected breast cancer?

• Have you ever had treatment for a breast lump, serious disease of the womb or any other estrogen dependent cancers?
• Do you, or your family, have a history, including during pregnancy, of any blood clotting disorders or of recurrent (i.e. occurring more than once) spontaneous abortion
• Do you have any liver, kidney or heart disease?
• Have you ever suffered from estrogen related jaundice or pruritus?
• Have you had any bleeding between periods or since your last period, if your periods have stopped?
• Is there any chance that you may be pregnant or are you breast-feeding?
• Are you allergic to any components of the patches (see “What’s in your medicine”)?
• Do you have porphyria?

• Do you have a family history of breast cancer?
• Do you have lumpy or painful breasts?
• Do you have fibroids?
• Do you suffer from endometriosis?
• Do you suffer from epilepsy (fits), migraine or asthma?
• Do you have diabetes?
• Do you suffer from high blood pressure (hypertension)?
• Do you suffer from gallstones?
• Have you ever suffered from hearing loss during pregnancy or when taking estrogens; for example, oral contraceptives?
• Have you ever suffered from high lipid levels in your blood?

• Barbiturates or meprobamate
• Hydantoins or anticonvulsants e.g. carbamazepine.
• Phenylbutazone
• Antibiotics e.g. rifampicin
• Activated charcoal
• Any other medicines which your doctor does not know about?

• You should not use Estraderm TTS it you are pregnant or breast feeding.
• Before giving you the prescription for this medication, your doctor will have taken details of your personal and family medical history.
• Depending on your medical history your doctor will decide whether you need a physical examination. Examination of your breasts and pelvic examination (internal examination) will only be carried out if your doctor considers it to be necessary.
• You are strongly encouraged to take part in the national mammography and cervical screening programmes. In these schemes all women are automatically contacted to have regular swear tests (women aged 20-64) and mammograms (every 3 years for women aged 50-64). If you have any questions about these schemes please ask your doctor or nurse.
• It is also important to be “breast aware”. This means noticing any changes in your breasts such as dimpling of the skin, changes in the nipple, or the finding of any lump. Any changes should be reported to your doctor or nurse without delay.
• If you suffer from epilepsy you should have regular check-ups with your doctor. If you notice your fits becoming more frequent you should discuss the continuation of this medication with your doctor.

Every woman is at risk of getting breast cancer, whether or not she takes HRT. There is a small increase in this risk for women who have been using HRT for more than 5 years compared with women of the same age who have never used HRT. It is not known whether the difference is caused by HRT. It may be that women using HRT are examined more often so that breast cancer is noticed earlier. The longer that HRT has been used, the more chance there is of having breast cancer diagnosed.
For women aged 50 who are not using HRT, about 45 in every 1,000 will have breast cancer diagnosed by the age of 70. For women who start using HRT at age 50, the extra number of breast cancers resulting from the use of HRT has been estimated as in the table below.
If women stop taking HRT, the increased risk disappears by 5 years after stopping HRT and then the chances of finding breast cancer are the same as for women who have never used HRT. Breast cancer seems less likely to have spread when found in women who have used HRT than in women who have never used HRT.
If you are concerned about the risk of breast cancer, discuss the risks compared to the benefits of HAT treatment with your doctor.

Using your medicine

• Always use your patches as instructed by your doctor.
• To reduce menopausal symptoms, treatment is usually started with Estraderm TTS 50. Your doctor will change the dose it necessary to suit you.
• To prevent bone loss, Estraderm TTS 50 is used.
• Most women using Estraderm TTS will have had a hysterectomy (an operation to remove the womb). If you have not had a hysterectomy, you will need to take another hormone called progestogen for 12 days each month. You will probably have a ‘period’ each month towards the end of the course of progestogen. This is quite normal.

• Remove the sachet from the box and tear it open at the notch. Use your fingers because cutting with scissors might damage the patch inside. You must never cut or tear your patches in any way.
• Take Out the transparent patch and loosen the backing by rubbing the edge of the patch between your thumb and forefinger. The stiff protective liner will peel away from the flexible, sticky patch.
• Stick the patch onto a hairless area of skin below the waist. Most patients find that the buttock is the best place and that skin irritation is less likely to occur at this site. You could also try the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. Choose a clean, dry area of skin. Avoid skin which is red or irritated. Never powder or oil your skin before putting on a patch as it may not stick properly. Do not expose the patch to direct sunlight.
• Place the sticky patch on the area of skin you have chosen and press it firmly into position with the palm of your hand. Pressing for 10-20 seconds or so will make it stick securely. Run your finger around the edge of the patch to make sure that the edges stick. Provided that you have applied the patch correctly, can bath, shower or swim with little risk of the patch coming off.
• If the patch does come off in the bath or shower, just shake it to remove any water, dry the skin thoroughly and put it on again in the usual way.
• When the time comes to change your patch, take off the old one, fold it in half with the sticky side inwards, and throw it away carefully out of the reach of children. Remember, it will still contain some medication.
• Always place your new patch on a fresh area of skin. Wait a week before using the same area again.
• If you forget to change the patch at the right time, you should change it as soon as possible. Then change to your next patch on the normal day.
• Because of the way Estraderm TTS is administered, an overdose is unlikely to occur. If an overdose is administered seek medical advice promptly.

• Difficulty in breathing.
• Tender or painful calves, thighs or chest.

• General swelling or itching occurring outside the site of patch application.
• Yellowing of your skin or eyes.

• Headaches, nausea or breast tenderness
• Cramping pains in calf or abdomen
• Feeling slightly bloated
• Increase in varicose veins
• Slight redness and itching of the skin where a patch has been. This usually disappears within 3-4 days of taking off the patch
• Irregular or unusual vaginal bleeding or constant spoiling?
• Dizziness
• Unusual weight changes or fluid retention
• Increase in blood pressure or rapid pulse
• Monthly irritability or moodiness.

• You are very overweight (body mass index > 30kg/m²)
• You have had a blood clot in the veins or lungs before
• You have relatives who have suffered from these
• You are unable to move for long periods
• You have a serious injury or a major operation.
• You suffer from systemic lupus erythematosus (SLE — an inflammatory condition that includes rash).

• Coughing blood
• Unusual pains or swelling of your arms or legs
• Sudden shortness of breath
• Fainting.

• The expiry date for this medicine is given on the carton. Do not use after this date.
• Store your medicine in a cool place (below 25°C). Do not store in the refrigerator Store out of the reach of children before and after use. Return any unused medicine to your pharmacist.

• Sunbathing - always make sure your patch is covered by clothing.
• Using a sun bed - either cover up your patch as above or take it off and put it back on after your shower when your skin is completely cool and dry.
• Swimming - you can wear your patch beneath your swimming costume during swimming.
• Never stick on a patch straight after a hot bath or shower Wait a while for the skin to become completely cool and dry.
• It a patch comes off and will not stick back on, apply a new patch in the usual way. Remember to apply your next patch at the normal time. It you have run out of patches, contact your doctor straight away.