Angeliq
Angeliq (drospirenone / estradiol) is a combination hormone replacement therapy (HRT). It's used to relieve certain menopause symptoms, such as hot flashes and vaginal dryness. It contains 2 active ingredients: drospirenone (a progestin) and estradiol (an estrogen). Angeliq (drospirenone / estradiol) comes as a tablet that's taken by mouth once daily. Some side effects of this medication include breast pain, vaginal bleeding, belly ache, and weight gain. Angeliq (drospirenone / estradiol) is only available as a brand-name medication, not generic.
What is Angeliq (drospirenone / estradiol)?
What is Angeliq (drospirenone / estradiol) used for?
In females who have a healthy uterus:
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy, like vaginal dryness and irritation
How Angeliq (drospirenone / estradiol) works
Your ovaries make estrogen and progesterone, which are important hormones that help control your menstrual cycles. As the body ages and goes through menopause, your ovaries make less and less of these hormones. This can lead to certain symptoms, including hot flashes and night sweats.
Angeliq (drospirenone / estradiol) is hormone replacement therapy (HRT) that replaces estrogen and progesterone hormones during menopause:
Estradiol replaces the estrogen that your body loses during menopause, which lessens the symptoms of vaginal dryness and hot flashes.
Drospirenone is a progestin. It acts like progesterone and helps balance the effect of estrogen on the growth of your uterine lining.
Drug Facts
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What are the side effects of Angeliq (drospirenone / estradiol)?
Common Side Effects
- Breast pain or discomfort (up to 18%)
- Vaginal bleeding (up to 14%)
- Belly pain (up to 7%)
Other Side Effects
- Headache
- Migraines
- Vaginal yeast infection
- Nausea
- Diarrhea
- Swelling in your lower legs or hands
- Cervical polyps
- Changes in mood
Serious Side Effects
- Heart attack: chest pain, belly discomfort, sweating, nausea, dizziness
- Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Liver or gallbladder problems: yellowing of the skin or the whites of the eyes, tiredness, pain in the right upper stomach, dark urine
- Unusual vaginal bleeding, vaginal discharge, or pelvic pain
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine 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:
More common
Breast pain
full or bloated feeling
heavy non-menstrual vaginal bleeding
pressure in the stomach
surgery
swelling of the abdominal or stomach area
Less common
Bloating or swelling of the face, arms, hands, legs, or feet
change in vaginal discharge
increased clear or white vaginal discharge
pain or feeling of pressure in the pelvis
rapid weight gain
tingling of the hands or feet
unusual weight gain or loss
vaginal bleeding
Incidence not known
Abdominal or stomach pain
blurred vision
change in vision
chest pain or discomfort
clear or bloody discharge from nipple
confusion
coughing up blood
difficulty with speaking
dimpling of the breast skin
dizziness or lightheadedness
double vision
fainting
fast heartbeat
headache
headache, severe and throbbing
inability to move the arms, legs, or facial muscles
inability to speak
incoherent speech
increased urination
inverted nipple
loss of appetite
lump in the breast or under the arm
metallic taste
muscle weakness
numbness or weakness in your arm or leg, or on one side of your body
pain or discomfort in the arms, jaw, back, or neck
pain or redness in your lower leg (calf)
persistent crusting or scaling of the nipple
poor insight and judgment
problems with memory, vision, speech, or walking
redness or swelling of the breast
seeing double
shortness of breath
slow speech
sore on the skin of the breast that does not heal
sudden or severe headache
sudden shortness of breath or troubled breathing
sweating
thirst
trouble recognizing objects
trouble thinking and planning
trouble walking
unusual tiredness or weakness
Some side effects 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
Accidental injury
back pain
body aches or pain
chills
difficulty breathing
ear congestion
fever, sneezing, or sore throat
general feeling of discomfort or illness
joint pain
loss of voice
muscle aches and pains
pain in the arms or legs
pain or tenderness around the eyes and cheekbones
shivering
stuffy or runny nose
sweating
tightness of the chest or wheezing
trouble sleeping
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Angeliq (drospirenone / estradiol)
Pros
Taken by mouth
Taken once daily
Might work well for people who didn’t see benefits with topical medications for vaginal symptoms caused by menopause
Cons
Only available as a brand-name medication
Raises the risk of estrogen-dependent cancers (e.g., breast or ovarian cancer)
Not safe for use in liver or kidney problems
Pharmacist tips for Angeliq (drospirenone / estradiol)
You might have light vaginal bleeding or spotting while taking Angeliq (drospirenone / estradiol), especially if you missed a dose or more of this medication. Let your healthcare team know if you notice any vaginal bleeding. Sometimes it can also be a warning sign for more serious medical problems.
Angeliq (drospirenone / estradiol) can raise your blood pressure, so make sure you check your blood pressure while you're taking this medication.
Angeliq (drospirenone / estradiol) can cause changes in electrolytes (e.g., potassium, sodium, and calcium), which can worsen certain medical conditions. Your healthcare team might ask you to get bloodwork done before starting or during treatment to make sure this medication is safe for you. Let your healthcare team know if you feel weak, muscle tingling, nausea, constipation, or belly pain while taking Angeliq (drospirenone / estradiol).
Let your healthcare team know if you're scheduled to have surgery while taking Angeliq (drospirenone / estradiol). Because taking this medication can raise your risk of blood clots after surgery, your healthcare team will likely ask you to stop taking Angeliq (drospirenone / estradiol) at least a month before your surgery.
Get immediate medical attention if you notice symptoms of a blood clot, including trouble catching your breath, leg pain that won't go away, or sudden and severe headache. Though rare, taking Angeliq (drospirenone / estradiol) can raise the risk for blood clots.
Call 911 if you experience sudden swelling around the face, lips, or throat that makes it hard for you to breathe. Though rare, Angeliq (drospirenone / estradiol) can trigger a reaction called angioedema, especially in people who've had similar reactions in the past.
Frequently asked questions about Angeliq (drospirenone / estradiol)
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What are the risks and warnings for Angeliq (drospirenone / estradiol)?
Angeliq (drospirenone / estradiol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of blood clot
Risk factors: Females at or over 50 years old | High blood pressure | People identified as obese | High cholesterol | Diabetes | History of smoking cigarettes | Recent surgery or bedrest
Angeliq (drospirenone / estradiol) can raise the risk of serious blood clots because it contains estradiol (an estrogen). More estrogen can lead to more blood proteins that stimulate clot formation. These blood clots can be life-threatening and can happen anywhere in your body. Get medical attention right away if you have any signs or symptoms of a blood clot:
Brain (e.g., stroke): weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion
Eyes (e.g., retinal thrombosis): trouble seeing, bulging eye, double vision
Heart (e.g., heart attack): chest pain, sweating, nausea, or dizziness
Lungs (e.g., pulmonary embolism or PE): trouble breathing, chest pain, or cough
Legs (e.g., deep vein thrombosis or DVT): cramps, swelling, pain, or muscle tightness
Your risk of getting a blood clot is higher if you're older, smoke cigarettes, or have certain medical conditions. Your risk is also higher if you're on bedrest after surgery. Typically your gynecologist will temporarily stop Angeliq (drospirenone / estradiol) for 4-6 weeks before surgery, then restart it 2 weeks after. If you recently delivered a baby, you shouldn't start this medication until 4 weeks after delivery and if you're not breastfeeding. Talk with your gynecologist if you have any questions regarding your risk of blood clots.
Breast cancer
Risk factors: Personal or family history of breast cancer | Using hormonal therapy for a long period of time
Estrogen/progestin combination HRTs, like Angeliq (drospirenone / estradiol), can raise your risk of breast cancer. This risk might be higher compared to estrogen-only therapy. Don't use Angeliq (drospirenone / estradiol) if you currently have or have had breast cancer in the past. You're also at greater risk if you've used Angeliq (drospirenone / estradiol) or similar medications for a long period of time. To lower your risk of breast cancer, your HCP will prescribe the lowest dose of estrogen for the shortest period of time possible. It's important that you regularly check your breasts for any changes and get breast scans (mammograms) done. Let your healthcare professional know if you notice any unusual changes in breast shape, size, or color.
Uterine or endometrial cancer
Risk factors: Estrogen therapy without additional progestin | People with a healthy uterus | Using estrogen therapy for more than 1 year | High estrogen dose
Angeliq (drospirenone / estradiol) contains estradiol, which works like estrogen in your uterus. It can change the lining of your uterus, called the endometrium. Uncontrolled growth of the uterus lining can cause uterine or endometrial cancer in people with a healthy uterus. This risk is especially high in people taking estrogen therapy without a progestin to balance out estrogen's effect on the growth of the uterine lining. You can still have the risk of uterine cancer several years after stopping your hormonal therapy.
People using Angeliq (drospirenone / estradiol) might have a lower risk of uncontrolled endometrial growth compared to those taking estrogen-only therapy, since Angeliq (drospirenone / estradiol) contains a progestin. Regardless of the hormonal therapy you're taking, it's important to be aware of the warning signs of uterine (endometrial) cancer, including vaginal bleeding that doesn't go away or keeps coming back. Let your HCP know if you notice any unusual vaginal bleeding. If you're worried about getting uterine cancer, talk to your HCP.
Risk of dementia
Risk factor: Females 65 years of age and older
People taking estrogen/progestin combinations or estrogen-only therapy might be at greater risk for dementia. Your risk is higher if you start hormonal therapy after age 65. Estrogen/progestin combination and estrogen-only therapies shouldn't be used to prevent dementia. Early symptoms of dementia include new forgetfulness, confusion, getting lost, and wandering out into the neighborhood. If the risk of dementia worries you, talk to your HCP.
High blood potassium levels
Risk factors: Kidney problems | Liver problems | Addison's disease | Taking other medications that raise potassium levels
Angeliq (drospirenone / estradiol) can raise your blood potassium levels, which can be serious. Your risk is higher if you've kidney problems, liver problems, or Addison's disease. Your risk is also higher if you are taking other medications that can raise your potassium levels. Your healthcare team will check your potassium levels regularly while you're taking this medication. If your potassium level is too high, then they might lower your dose of Angeliq (drospirenone / estradiol) or ask you to stop taking it all together. Let your healthcare team know if you feel symptoms of high potassium, such as heart palpitations, muscle weakness, and nausea.
Liver or gallbladder problems
Risk factors: History of liver disease or jaundice
Estrogen therapy can raise the risk of gallbladder disease. Let your HCP know if you've had jaundice (yellowing of your skin or eyes, or dark urine) in the past. If your jaundice comes back while using Angeliq (drospirenone / estradiol), stop the medication and talk to your HCP. These can be signs of liver damage or gallbladder disease.
Changes in calcium levels in the blood
Risk factors: Breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Estrogen therapy can change the calcium levels in your blood. Females with breast cancer that has spread to the bones are at higher risk of extremely high calcium levels. Symptoms of high calcium levels include feeling tired and having muscle weakness, nausea, vomiting, or constipation.
On the other hand, females with low parathyroid hormone levels from the parathyroid gland are at higher risk of low calcium levels during estrogen therapy. Symptoms of low calcium levels include muscle spasms or twitching and numbness and tingling in your fingers, toes, or around your mouth.
Let your HCP know if you notice any of these symptoms. You might need regular blood tests done so that your HCP can check your calcium levels while you're taking Angeliq (drospirenone / estradiol).
Vision problems
Although very rare, some people taking estrogens have had vision problems due to clot formation in the eyes. If you have sudden partial or complete vision loss, bulging eyes, double vision, or migraines, stop Angeliq (drospirenone / estradiol) and tell your HCP.
High triglyceride (fat) levels
Risk factors: History of high triglyceride levels in the blood
Estrogen therapy might raise the triglyceride (fat) levels in your blood. Too much triglyceride in your blood can lead to problems in your pancreas, including swelling (pancreatitis). You might need to get blood tests done regularly while taking Angeliq (drospirenone / estradiol) so your HCP can make sure your pancreas is healthy. If you experience signs of pancreatitis, like stomach pain that spreads to your back, stomach tenderness, fever, nausea, or vomiting, let your HCP know right away.
Buildup of fluids in your body (fluid retention)
Risk factors: Certain heart conditions | Kidney damage
Estrogen/progestin combination therapies can cause excess fluids to build up inside your body. Signs of fluid retention include swelling of your hands and ankles. You're at higher risk of fluid retention if you have certain heart conditions, like heart failure, or kidney damage. If you have these conditions, let your HCP know if you notice any signs of worsening fluid retention while using Angeliq (drospirenone / estradiol).
Worsening of other medical conditions
Taking estrogen-containing medications can worsen certain medical conditions. These include high blood pressure, hereditary angioedema, asthma, diabetes, migraine, and seizures. Before you start Angeliq (drospirenone / estradiol) let your healthcare team know about your past medical history so they can talk with you about the risks and benefits of taking this medication.
Interaction with other medications
Some medications can interfere with how your body gets rid of Angeliq (drospirenone / estradiol). This can affect the amount of Angeliq (drospirenone / estradiol) in your body, how well it works, and the risk of side effects.
Taking medications like ketoconazole or diltiazem (Cardizem) can raise the amount of Angeliq (drospirenone / estradiol) in your body, which might raise the risk of side effects.
Taking medications like carbamazepine (Tegretol) or rifampin (Rifadin) can lower the amount of Angeliq (drospirenone / estradiol) in your body. This can cause your birth control to not work as well. Your healthcare team might recommend that you use a condom when you take certain medications together with Angeliq (drospirenone / estradiol).
If you take Angeliq (drospirenone / estradiol) and a medication to replace your thyroid hormone, such as levothyroxine (Synthroid), you might need to take a higher dose of your thyroid medication since Angeliq (drospirenone / estradiol) can cause it to not work as well.
Let your healthcare team know what other medications you’re taking before and while taking Angeliq (drospirenone / estradiol).
Angeliq (drospirenone / estradiol) dosage forms
Typical dosing for Angeliq (drospirenone / estradiol)
Angeliq tablets come in two different strengths:
0.25 mg of drospirenone and 0.5 mg of estradiol (VSM symptoms only)
0.5 mg of drospirenone and 1 mg of estradiol (VSM and vaginal symptoms)
Your healthcare team will recommend a dose based on your condition.
Adults: The typical dose is 1 tablet by mouth once daily.
Interactions between Angeliq (drospirenone / estradiol) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Boceprevir
- Tranexamic Acid
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Amifampridine
- Amoxicillin
- Ampicillin
- Amprenavir
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Bosentan
- Brigatinib
- Bupropion
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Conivaptan
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Netupitant
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pitolisant
- Pixantrone
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Ulipristal
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amitriptyline
- Atazanavir
- Clomipramine
- Diazepam
- Doxepin
- Ginseng
- Imipramine
- Lamotrigine
- Levothyroxine
- Licorice
- Lorazepam
- Prednisolone
- Selegiline
- Tacrine
- Temazepam
- Tipranavir
- Triazolam
- Troleandomycin
- Voriconazole
- Warfarin
How much does Angeliq (drospirenone / estradiol) cost?
Angeliq (drospirenone / estradiol) contraindications
Abnormal vaginal bleeding that your gynecologist doesn’t know about or you haven’t gone to them about
Currently have or have had breast cancer
Estrogen-dependent cancers (e.g., endometrial cancer, ovarian cancer)
High risk for developing a blood clot
History of blood clots, stroke, or heart attack
Have a bleeding disorder
Kidney problems
Liver problems
Currently have Addison's disease or a disease of your adrenal glands
Have had your uterus (womb) removed
What are alternatives to Angeliq (drospirenone / estradiol)?
In females who have a healthy uterus:
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy, like vaginal dryness and irritation
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness and burning caused by menopause
Prevention of postmenopausal osteoporosis (not a first-choice)
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe vaginal symptoms due to menopause, like vaginal dryness and irritation
Prevention of bone loss (osteoporosis) after menopause
Angeliq (drospirenone / estradiol) images
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.
Bayer HealthCare Pharmaceuticals Inc. (2023). Angeliq- drospirenone and estradiol tablet, film coated [package insert]. DailyMed.
Camber Pharmaceuticals, Inc. (2023). Drospirenone and ethinyl estradiol kit [package insert]. DailyMed.
Consumer MedSafety.org. (2014). Angeliq – it’s not a birth control pill.
MedlinePlus. (2016). Gallbladder diseases.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Adrenal insufficiency & Addison’s disease.
Rehak, M., et al. (2010). Retinal vein thrombosis: Pathogenesis and management. Journal of Thrombosis and Haemostasis.
Rosendaal, F. R., et al. (2002). Female hormones and thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology.
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