Climara Pro
Climara Pro is a patch that's applied to the skin once a week. It's approved to prevent osteoporosis in people who've gone through menopause. This medication can also treat symptoms like hot flashes and night sweats from menopause. The patch is a hormone replacement therapy; it contains the hormones estradiol and levonorgestrel. Side effects include irregular vaginal bleeding or spotting, breast pain, and skin irritation where the patch is applied.
What is Climara Pro (estradiol / levonorgestrel)?
What is Climara Pro (estradiol / levonorgestrel) used for?
Treatment of moderate-to-severe symptoms of menopause (e.g., hot flashes, night sweats) for people with a healthy uterus
Prevention of osteoporosis for people who've gone through menopause with a healthy uterus
How Climara Pro (estradiol / levonorgestrel) works
Climara Pro (estradiol / levonorgestrel) is a combination of two medications that act as hormones important to your reproductive health. They balance the hormonal changes that your body goes through during and after menopause.
Estradiol is an estrogen replacement. It provides your body with a form of estrogen. This relieves symptoms of menopause that are caused by having low estrogen, such as hot flashes and night sweats. In addition, estrogen and estradiol help prevent bone loss and make bones stronger.
Levonorgestrel is a progestin. It acts like progesterone. It helps balance the effect of estrogen on the growth of your uterine lining.
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What are the side effects of Climara Pro (estradiol / levonorgestrel)?
Common Side Effects
- Application site reaction (e.g., skin irritation; 41%)
- Vaginal bleeding or spotting (37%)
- Breast pain (19%)
- Upper respiratory infection (13%)
- Depression (6%)
- Back pain (6%)
- General pain (5%)
- Headache (5%)
- Flu-like symptoms (5%)
Other Side Effects
- Stomach pain
- Gas
- Joint pain
- Swelling
- Weight gain
- High blood pressure
- Bronchitis
- Sinus infection
- Other infection
- Urinary tract infection (UTI)
- Vaginal inflammation, discharge, itching, or pain
- Rash
Serious Side Effects
- Blood clot: trouble breathing, leg pain or swelling, skin that's warm to the touch
- Heart attack: chest pain, arm pain, shortness of breath, cold sweat, lightheadedness
- Stroke: sudden weakness on one side of your body, drooping face, changes in your speech or vision, confusion, headache
- Vaginal bleeding
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Vaginal bleeding after menopause, pelvic pain
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Climara Pro (estradiol / levonorgestrel)
Pros
Comes as a patch, so it might be a good option for people who have trouble swallowing pills
Applied once every week
Might have fewer side effects than estrogen pills
Cons
Can fall off if it gets too wet
No lower-cost generic available; brand name only
Not a first-choice option for preventing osteoporosis for people who've gone through menopause
Pharmacist tips for Climara Pro (estradiol / levonorgestrel)
Speak with your primary care provider about when you should apply your first Climara Pro (estradiol / levonorgestrel) patch. It'll depend on whether you're currently taking continuous estrogen-only therapy or continuous estrogen-progestin combination therapy or not.
Apply the Climara Pro (estradiol / levonorgestrel) patch once a week, on the same day of each week. Set a reminder on your calendar to help you remember when to change your patch each week.
Replace your Climara Pro (estradiol / levonorgestrel) patch every time. Remove the worn patch before you apply a new one on each week. Don't apply more than one patch onto the skin at any time; this helps lower your risk for side effects.
Your skin might get irritated where you applied Climara Pro (estradiol / levonorgestrel). Other common side effects of the medication include irregular vaginal bleeding or spotting and breast pain and tenderness. Let your care team know if these side effects become too bothersome.
It's fine to get Climara Pro (estradiol / levonorgestrel) wet, such as while using a sauna, bathing, showering, or swimming. Keep in mind that the patch might fall off if it gets too wet. Check whether the patch is still sticking well to your skin or whether it's fallen off after you get it wet.
Apply the patch onto the skin right after you open the pouch and after you remove the clear plastic film that's attached to the clear thicker plastic backing. Avoid touching the sticky side of the patch with your fingers to prevent accidental exposure to active hormones.
Place the sticky side of the patch onto clean, dry, hairless skin on your lower stomach or upper area of your buttock. Press the patch against your skin with your fingers for at least 10 seconds. Smooth down the edges of the patch.
Place a new patch onto a different area of skin each time to avoid skin irritation. Don't apply the patch to any injured, burned, scarred, or tattooed skin. Avoid areas of hairy skin since peeling the patch off might be painful.
Avoid applying the patch to areas near your waistline since your clothes or belt can cause the patch to fall off if they rub against each other.
Don't apply the patch onto your breasts. The hormones in the patch can get absorbed into your breasts and raise your risk for side effects.
How to remove and throw away Climara Pro (estradiol / levonorgestrel):
Carefully and slowly peel the patch off your skin. Fold the sticky sides of the patch together. This helps prevent accidentally exposing others to the active hormones that are still on the used patch. Place the folded patch in a strong child-proof container, and throw it away in the trash. Don't flush the used patch down the toilet.
Frequently asked questions about Climara Pro (estradiol / levonorgestrel)
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What are the risks and warnings for Climara Pro (estradiol / levonorgestrel)?
Climara Pro (estradiol / levonorgestrel) 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.
Blood clots and related complications (e.g., heart attacks, strokes)
Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes (high blood sugar) | High cholesterol | Tobacco use | People who are considered obese | Systemic lupus erythematosus (SLE)
There's a small risk that estrogen-progestin combination therapy, like Climara Pro (estradiol / levonorgestrel), and estrogen-only therapy can raise your risk for blood clots. These clots can block blood from reaching other parts of your body, such as your legs, lungs, heart, or brain. Some clots can lead to dangerous complications, like heart attack or stroke.
Before you start taking Climara Pro (estradiol / levonorgestrel), make sure to discuss with your primary care provider about whether the medication is safe for you. This is because there are many factors that raise your risk for blood clots. Let your primary care provider know at least 4 to 6 weeks before any planned surgeries or periods of time when you won't be moving much. They'll tell you when you should stop before and restart Climara Pro (estradiol / levonorgestrel) after this planned event to lower your blood clot risk. Don't take this medication to prevent heart disease.
Take off the Climara Pro (estradiol / levonorgestrel) patch and get emergency medical help right away if you have any of the following symptoms of a blood clot, heart attack, or stroke.
Clot in the leg (deep vein thrombosis, DVT): swelling, tenderness, or pain in the leg
Clot in the lung (pulmonary embolism, PE): shortness of breath
Heart attack: chest pain, arm pain, shortness of breath, a cold sweat, lightheadedness
Stroke: sudden weakness on one side of your body, drooping face, trouble breathing, bad headaches, changes in your speech or vision.
Breast cancer
Risk factors: Personal or family history of breast cancer | Have taken hormonal replacement therapy in the past | Taking hormonal replacement therapy for a long period of time
Studies show that estrogen-progestin combination therapy like Climara Pro (estradiol / levonorgestrel) can raise your risk for invasive breast cancer. The risk with estrogen-progestin combination therapy might be higher than that with estrogen-only therapy. You're also at greater risk if you've taken hormonal replacement therapy for a long period of time. Don't take Climara Pro (estradiol / levonorgestrel) if you currently have or have had breast cancer in the past.
To lower your risk for breast cancer, your primary care provider will prescribe Climara Pro (estradiol / levonorgestrel) for the shortest period of time possible. It's important that you regularly perform a self-exam to check for any abnormal changes to your breasts and to get scheduled breast scans (mammograms) done. Let your primary care provider 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 | Taking estrogen therapy for more than 1 year | High estrogen dose
Climara Pro contains estradiol, which works like estrogen in your uterus. Estrogens can thicken and 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.
People who take Climara Pro (estradiol / levonorgestrel) might not have as high of a risk for endometrial cancer as people who take estrogen therapy without a progestin. Progestins help balance out estrogen's effect on the growth of the uterine lining. And Climara Pro has a progestin in it called levonorgestrel.
To be safe, it's important to be aware of the warning signs of endometrial cancer, including vaginal bleeding that doesn't go away or keeps coming back. Let your care team know if you notice any unusual vaginal bleeding that doesn't go away. Speak with your primary care provider if you're concerned about the risk for endometrial cancer.
Ovarian cancer
Studies show that estrogen-progestin combination therapy, like Climara Pro (estradiol / levonorgestrel), and estrogen-only therapy can potentially raise the risk for ovarian cancer in people who've gone through menopause. Talk with your primary care provider if you notice any pelvic pain, bloating, or trouble eating. These can be signs of ovarian cancer.
Risk for dementia
Risk factors: Age 65 years or older
Studies suggest that people who've gone through menopause and are taking estrogen-progestin combinations or estrogen-only therapy might be at greater risk for dementia. This risk appears higher if you start hormonal replacement therapy like Climara Pro (estradiol / levonorgestrel) after age 65. Be aware of the early signs of dementia, such as memory loss, confusion about time, getting lost, and misplacing things often. Speak with your primary care provider if the risk of dementia worries you. Don't take Climara Pro (estradiol / levonorgestrel) to prevent dementia.
Gallbladder problems and jaundice
Risk factors: History of liver problems or jaundice
Estrogen therapy such as Climara Pro (estradiol / levonorgestrel) can raise the risk of gallbladder problems in people who've gone through menopause. Let your primary care provider know if you've had jaundice, or yellowing of your skin or eyes, that's related to previous estrogen therapy or pregnancy. It's possible for your jaundice to come back while you're taking Climara Pro (estradiol / levonorgestrel). Talk to your primary care provider if you have jaundice while you're taking this medication because it can be a sign of gallbladder disease. You might have to stop taking the medication.
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. People with breast cancer or other cancer that's spread to the bones who take estrogens are at higher risk of having extremely high calcium levels. On the other hand, people with low parathyroid hormone levels from the parathyroid gland who take estrogens are at risk of having low calcium levels during estrogen therapy.
Tell your care team if you notice any symptoms of abnormal calcium levels. These can include tiredness, weakness, low appetite, constipation, muscle spasms, and a numbness or tingling sensation. Your primary care provider might check your calcium levels.
Changes in vision
Although very rare, some people who took estrogens reported having changes in their vision due to a clot that formed in the eyes. Stop taking Climara Pro (estradiol / levonorgestrel) and let your primary care provider know if you have sudden partial or complete vision loss, bulging eyes, double vision, or migraines.
High triglyceride (fat) levels
Risk factors: History of high triglyceride levels in the blood
Estrogen therapy might make the triglyceride (fat) levels in your blood go up. Too much triglyceride in your blood can lead to problems with your pancreas, including swelling or pancreatitis. The risk for these pancreas problems might be higher for people who already have high triglyceride levels. Call your primary care provider right away if you notice symptoms of pancreatitis, like stomach pain that spreads to your back, stomach tenderness, fever, nausea, or vomiting.
Low thyroid hormone levels in people who take thyroid hormone replacement therapy
Risk factors: Low thyroid hormone levels (hypothyroidism)
Estrogens can cause changes in the thyroid hormone levels in your body. Normally, your body can adjust to these changes accordingly. But it might be harder to do if you have low thyroid hormone levels (hypothyroidism). To help your body adjust to changes to thyroid hormone levels while you're taking Climara Pro (estradiol / levonorgestrel), you might need to take a higher dose of your thyroid hormone replacement medication for your thyroid condition. Continue to get blood tests done as instructed by your primary care provider to check your thyroid hormone levels.
Buildup of fluids in your body (fluid retention)
Risk factors: Heart failure | Kidney problems
It's possible for estrogen-progestin combination therapies like Climara Pro (estradiol / levonorgestrel) to cause your body to hold onto extra fluid. Signs of fluid retention include swelling of your hands, feet, or ankles.
Let your primary care provider know if you have heart failure or kidney problems. You're at higher risk for fluid retention, which can worsen your medical condition. Contact your primary care provider if you notice swelling and signs of worsening of your heart or kidney problem while you're taking this medication.
Climara Pro (estradiol / levonorgestrel) dosage forms
Typical dosing for Climara Pro (estradiol / levonorgestrel)
Apply 1 patch to your lower stomach or upper buttock once a week on the same day of the week. Remove the worn patch before you place a new one on each week.
Each patch gives you 0.045 mg of estradiol and 0.015 mg of levonorgestrel a day.
How much does Climara Pro (estradiol / levonorgestrel) cost?
Climara Pro (estradiol / levonorgestrel) contraindications
Abnormal vaginal bleeding that hasn't been examined by a healthcare professional
Currently have or have had breast cancer
Estrogen-dependent cancer or tumor
Currently have or have had a blood clot (DVT or PE)
Currently have or have had a heart attack or stroke
Liver problem
Blood-clotting conditions
What are alternatives to Climara Pro (estradiol / levonorgestrel)?
Treatment of moderate-to-severe symptoms of menopause (e.g., hot flashes, night sweats) for people with a healthy uterus
Prevention of osteoporosis for people who've gone through menopause with a healthy uterus
Moderate-to-severe symptoms of menopause, like hot flashes, night sweats, vaginal dryness, and vaginal irritation
Low estrogen levels caused by certain health conditions (e.g., ovaries aren't working as they should)
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness and irritation caused by menopause
Low estrogen levels due to certain conditions
Prevention of osteoporosis after menopause
What is the latest news about Climara Pro (estradiol / levonorgestrel)?
Climara Pro (estradiol / levonorgestrel) images
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2024). Endometrial hyperplasia.
American College of Obstetricians and Gynecologists’ Committee on Clinical Consensus–Gynecology. (2012). Compounded bioidentical menopausal hormone therapy. The American College of Obstetricians and Gynecologists.
Bayer HealthCare Pharmaceuticals Inc. (2023). Climara Pro- estradiol and levonorgestrel patch [package insert]. DailyMed.
Camacho, P. M., et al. (2020). American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocrine Practice.
Endocrine Society. (2022). Hypoparathyroidism.
Kim, J. J., et al. (2010). Role of progesterone in endometrial cancer. Seminars in Reproductive Medicine.
Lewis, J. L., III. (2023). Hypocalcemia (low level of calcium in the blood). Merck Manual Consumer Version.
National Institute on Aging. (2021). What is menopause?
Pattimakiel, L., et al. (2011). Bioidentical hormone therapy: Clarifying the misconceptions. Cleveland Clinic Journal of Medicine.
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