6 Evamist Side Effects You Should Know About

Evamist (estradiol spray) is a topical form of menopausal hormone therapy (MHT; also referred to as hormone replacement therapy). It helps reduce vasomotor menopause symptoms, such as hot flashes and night sweats.

There’s been a lot of recent conversation around the safety of hormone therapy for menopause. So side effects are often top of mind when considering or starting Evamist treatment. Here, we’ll review what you should know about Evamist side effects and how to manage them.

Evamist side effects at a glance

Below is a list of common and rare but serious Evamist side effects. Keep in mind that this isn’t a complete list. Talk to your healthcare team about any side effects that occur during treatment, even if they aren’t listed here.

Common Evamist side effects include:

• Headache

• Breast tenderness

• Nipple pain

• Nausea

• Fluid retention

• Back pain

• Common cold symptoms

Rare but serious Evamist side effects include:

• Increased risk of uterine and breast cancer

• Increased risk of gallbladder problems

• Vision problems

• Increased risk of blood clots, heart attacks, and strokes

• Increased risk of dementia

The increased risk of dementia and heart-related issues is more likely if you start treatment with Evamist after age 60 or more than 10 years after the onset of menopause.

Let’s take a closer look at five Evamist side effects and what to do if they occur.

Good to know: Evamist contains alcohol, so it is flammable in the container and after you first apply it. Keep your Evamist bottle away from high-heat areas, and avoid going near open flames or high heat after you apply it until it dries.

1. Headache

Headache is a common Evamist side effect. But menopause can also cause headaches. So it’s possible that this side effect may improve on its own as Evamist starts to balance your hormone levels.

In the meantime, you can typically manage headaches on your own. Staying hydrated and exercising regularly can help prevent headaches from occurring. A cold compress or warm bath can help ease headache pain. An over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol), can also help.

Let your prescriber know if headaches are severe or persistent while using Evamist. But if you experience sudden, intense pain along with weakness on one side of your body or facial drooping, seek emergency care. These could be signs of a stroke.

2. Breast and nipple tenderness

Tender, sore breasts and nipples are another common Evamist side effect. This may improve as your body adjusts to the change in your estrogen levels.

To help reduce breast pain, try:

• Wearing a supportive sports bra

• Applying a warm or cool compress

• Taking an OTC pain reliever

It isn’t common, but Evamist can increase the risk of developing breast cancer in some people. So if you notice changes in your breast or nipple size, shape, or appearance, tell your prescriber right away. These can be signs of breast cancer or other more serious problems.

3. Nausea

Evamist can cause nausea in some people. But this was reported more often in people using the placebo (spray with no medication in it) in clinical studies than in people using Evamist.

Nausea seems more common with higher Evamist dosages (2 to 3 sprays per day). So if it doesn’t improve on its own, ask your prescriber about lowering your dose. You can also try eating smaller, more frequent meals and avoiding fried or spicy foods.

4. Fluid retention

You may feel bloated or notice swelling in your legs and ankles while using Evamist. This is because estradiol (the active ingredient in Evamist) can cause fluid retention. It’s more common with birth control pills, since they typically contain a more potent form of estradiol than menopause replacement therapies. But it’s still possible to experience fluid retention with Evamist.

You can often manage fluid retention on your own by:

• Elevating your legs

• Massaging the swollen area

• Reducing salt in your diet

• Exercising regularly

But if fluid retention is severe or is interfering with your life, talk to your prescriber for guidance.

Good to know: If you develop swelling in just one leg along with pain or redness, it’s best to seek emergency care. This can be a sign of a blood clot. Blood clots from Evamist aren’t common, but the medication could raise your risk (more on this later).

5. Increased risk of uterine and breast cancer

Estradiol can thicken the endometrium (uterine lining) when used on its own. This can lead to uterine cancer. Progesterone can help prevent this side effect. So if you have an intact uterus, it’s recommended to combine Evamist with a progesterone medication to reduce this risk.

The combination of Evamist and progesterone can raise the risk of breast cancer. The higher your dosage, the greater your risk. Using these medications long term and the age when you start them also seem to contribute to your breast cancer risk.

Evamist is still considered a safe option for most people. But it’s best to discuss its risks and benefits with your prescriber, especially if you have a family history of uterine or breast cancer.

6. Increased risk of heart-related issues

Evamist and other forms of MHT can increase your risk of blood clots, heart attack, and stroke. But this risk is much lower if you are age 60 or younger and start treatment less than 10 years after menopause symptoms start. The risk is also lower with topical forms of estradiol, such as Evamist.

Using the lowest effective dose of Evamist for the shortest time needed can help keep the risk of heart-related side effects low. Still, it’s best to seek emergency care if you develop:

• Symptoms of a blood clot, such as pain and swelling in one leg or sudden trouble breathing

• Symptoms of a stroke, such as trouble speaking or numbness on one side of the body

• Symptoms of a heart attack, such as chest pain, fatigue, and severe heartburn

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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