6 Evamist Side Effects You Should Know About
Evamist can treat menopause symptoms. Read on to learn about the side effects of Evamist, including common and long-term side effects, and how to manage them.
Evamist
Used for Menopause
Used for Menopause
Evamist (estradiol) is a topical hormone spray that helps relieve the hot flashes and night sweats caused by menopause. It's a hormone replacement therapy (HRT) that's sprayed onto the skin of your inner forearm once a day. The typical dose ranges from 1 to 3 sprays daily, depending on your symptoms. Some potential side effects of this medication include headache, tender breasts, and back pain.
What is Evamist (estradiol)?
What is Evamist (estradiol) used for?
- Moderate-to-severe vasomotor symptoms of menopause, like hot flashes and night sweats
How Evamist (estradiol) works
Evamist (estradiol) is a hormone replacement therapy (HRT). It replaces estrogen hormones that your body loses during menopause. Replacing estrogen helps relieve symptoms of menopause, such as hot flashes and night sweats.
Drug facts
| Common Brands | Evamist |
|---|---|
| Drug Class | Estrogen replacement |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Evamist (estradiol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (up to 12%)
- Breast tenderness (up to 7%)
- Nipple pain (up to 7%)
- Cold-like symptoms (up to 5%)
- Back pain (up to 5%)
- Joint pain (up to 4%)
Less Common Side Effects
- Nausea
- Dizziness
- Stomach pain
- Dry mouth
- Trouble sleeping (insomnia)
- Mood changes
Evamist (estradiol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking, difficulty walking, numbness on one side of your body or face, shortness of breath, sudden, severe headaches
- 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
More on Evamist (estradiol) side effects
The following Evamist (estradiol) 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:
Incidence not known
Abdominal or stomach cramps or pain
acid or sour stomach
backache
belching
blistering, peeling, or loosening of the skin
blurred vision
breast tenderness, enlargement, pain, or discharge
change in vaginal discharge
changes in skin color
changes in vision
chest pain or discomfort
chills
clay-colored stools
clear or bloody discharge from the nipple
confusion
convulsions
darkening of the urine
difficulty with breathing
difficulty with swallowing
dimpling of the breast skin
dizziness or lightheadedness
double vision
fainting
fast heartbeat
fluid-filled skin blisters
full or bloated feeling or pressure in the stomach
headache
headache, severe and throbbing
indigestion
inverted nipple
irregular heartbeat
itching of the vagina or genital area
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
loss of appetite
loss of bladder control
lump in the breast or under the arm
migraine headache
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
muscle spasm or jerking of all extremities
noisy breathing
numbness and tingling around the mouth, fingertips, or feet
pain during sexual intercourse
pain in the ankles or knees
pain or discomfort in the arms, jaw, back, or neck
pain or feeling of pressure in the pelvis
pain, redness, or swelling in the arm, foot, or leg
painful, red lumps under the skin, mostly on the legs
pains in the stomach, side, or abdomen, possibly radiating to the back
persistent crusting or scaling of the nipple
poor insight and judgment
problems with memory or speech
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red, irritated eyes
redness or swelling of the breast
sensitivity to the sun
skin thinness
sore on the skin of the breast that does not heal
sores, ulcers, or white spots in the mouth or on the lips
stomach discomfort, upset, or pain
sudden loss of consciousness
sudden shortness of breath or troubled breathing
sweating
swelling
swelling of the abdominal or stomach area
thick, white vaginal discharge with no odor or with a mild odor
tightness in the chest
trouble recognizing objects
trouble thinking and planning
trouble walking
unexpected or excess milk flow from the breasts
unpleasant breath odor
unusual tiredness or weakness
unusually heavy or unexpected menstrual bleeding
vaginal bleeding or spotting
vomiting
vomiting of blood
yellow eyes or skin
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:
Incidence not known
Decreased interest in sexual intercourse
hives or welts
inability to have or keep an erection
increased hair growth, especially on the face
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
irritability
leg cramps
loss in sexual ability, desire, drive, or performance
loss of scalp hair
mental depression
mood disturbances
patchy brown or dark brown discoloration of the skin
redness of the skin
twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
weight changes
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.
Get your GoodRx coupon
$178.76
Manufacturer exclusive discount
$75.00
Pros and cons of Evamist (estradiol)
Pros
- Dries within 2 minutes, doesn't need to be rubbed in
- Possible option if you can't swallow pills
- Only needs to be applied once a day
Cons
- Raises your risk of certain cancers, blood clots, and strokes
- Need to use with progestin to lower your risk of uterine cancer (in females who have uterus)
- Must cover with clothing to prevent exposure to others
Pharmacist tips for Evamist (estradiol)
- If you're using a bottle of Evamist (estradiol) for the first time, you'll need to prime it by holding the bottle upright and spraying 3 sprays with the cover on. After this, you don't need to prime the medication again.
- When you're ready to spray Evamist (estradiol), hold the container upright and lay the cone flat against the skin on the inside of your forearm only. If you need to use more than 1 spray, place each spray on a different area on your forearm. Don't spray Evamist (estradiol) on any areas where the skin is broken (e.g., cuts, scrapes, wounds).
- Don't rub Evamist (estradiol) in after spraying. Let the spray dry for about 2 minutes before dressing, and don't get the application area wet for at least 1 hour.
- It's possible for some of the Evamist (estradiol) to rub off on other people or pets after you've applied your dose, even if your skin feels dry. If you know you're likely to come into contact with children or animals, it would be best to cover the area where you applied the medication to prevent this from happening.
- Evamist (estradiol) is flammable, so avoid open flames and smoking while applying it. Once the medication has dried, this is no longer a concern.
- It's best to put on sunscreen at least 1 hour before applying Evamist (estradiol). Applying sunscreen after you've sprayed the medication can cause your skin to absorb less estradiol.
- Let your prescriber know if you experience vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting Evamist (estradiol). These are not typical side effects and could be a sign of more serious problems.
Risks and warnings for Evamist (estradiol)
Evamist (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.
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
Vaginal bleeding after menopause can be a warning sign of uterine or endometrial cancer (cancer of the lining of the uterus), so let your prescriber know if you notice any unusual bleeding. Using estrogen replacement medications like Evamist (estradiol) for more than a year can raise your risk of this. If you have a healthy uterus, your healthcare team will lower your risk of cancer by also prescribing a progestin to balance out estrogen's effect on the growth of the uterine lining.
Breast cancer
- Risk factors: Personal or family history of breast cancer | Using estrogen and progestin together for more than one year
There's a higher risk of developing breast cancer when taking estrogen medications, such as Evamist (estradiol). To lower your risk of breast cancer, your prescriber 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.
Blood clots, heart attacks, and strokes
- Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking | Larger body size | Systemic lupus erythematosus (SLE)
Evamist (estradiol) can raise your risk of blood clots, which can be very dangerous and lead to a heart attack, stroke, or pulmonary embolism (life-threatening blood clot in the lungs). Your risk for blood clots is higher if you smoke or have had blood clots in the past. Be sure to discuss all your past and present medical conditions with your prescriber before starting Evamist (estradiol). Call 911 or seek immediate medical attention if you have pain in your legs or arms, chest pain, sudden severe headaches, trouble breathing, or sudden changes in your speech or vision.
Risk of dementia
- Risk factors: 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 prescriber.
Risk of harm in children (accidental contact with medication)
- Risk factors: Children who haven't entered puberty
Evamist (estradiol) can rub off your skin and transfer onto other people, even once the medication has dried after applying it. When the medication rubs off onto children, it can cause early signs of puberty, including breast development in both girls and boys. This usually goes away once the child is no longer exposed to the medication. Keep Evamist (estradiol) out of the reach of children, and don't let anyone touch the area where you sprayed your dose(s). If you know children have been exposed to Evamist (estradiol), wash their skin with soap and warm water right away. If you have frequent physical contact with young children, you might want to discuss alternatives with your prescriber.
Gallbladder problems
Evamist (estradiol) can cause you to have problems with your gallbladder. Some people have even needed to have their gallbladder removed after starting this medication. If you experience stomach pain, nausea or vomiting that doesn't go away, fever, or a yellowing of the skin and eyes (jaundice), speak with your prescriber or get medical help right away.
Higher risk of side effects
- Risk factors: History of or current liver problems
Evamist (estradiol) is broken down by the liver, so if it's not working properly, you might experience more side effects from this medication. Because of this, if you have or have had any problems with your liver, including liver problems during a past pregnancy, you shouldn't use Evamist (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 Evamist (estradiol) and tell your care team.
High triglycerides
- Risk factors: High levels of triglycerides
Estrogens can raise the amount of your body's blood fats (triglycerides), which can cause heart problems or inflammation of the pancreas. Your prescriber might order regular blood tests to watch for this while you're using Evamist (estradiol). If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or get medical care right away.
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 care team know if you notice any of these symptoms. You might need regular blood tests done so that your prescriber can check your calcium levels while you're taking Evamist (estradiol).
Low thyroid hormone levels (hypothyroidism)
- Risk factors: Low thyroid hormone levels
Evamist (estradiol) can affect thyroid hormone levels in your blood. If you take medications for low thyroid hormone levels, you might require higher doses of thyroid replacement therapy. Your prescriber might have you perform regular blood tests to check your thyroid hormone levels.
Swelling from fluids
- Risk factors: History of heart or kidney problems
Evamist (estradiol) might cause some fluid retention, or edema. This could worsen symptoms of certain conditions, like heart conditions (e.g., congestive heart failure) or kidney problems. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your prescriber know.
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 Evamist (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.
More on Evamist (estradiol) warnings
Evamist (estradiol) dosage
The average cost for 1 bottle of 8.1ml of 1.53mg/spray of Evamist (estradiol) is $75.00 with a free GoodRx coupon. This is 58.04% off the average retail price of $178.76. 
Bottle of spray
Bottle of spray| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 8.1ml of 1.53mg/spray | 1 bottle | $75.00 | $75.00 |
Typical dosage for Evamist (estradiol)
Each spray of Evamist contains 1.53 mg of estradiol.
The typical starting dose is 1 spray to the inner portion of your forearm by the elbow once a day in the morning. Your prescriber might raise your dose to 2 or 3 sprays depending on your response.
If you're applying more than 1 spray, try your best to place the doses next to each other on your skin without overlapping them.
More on Evamist (estradiol) dosage
Interactions between Evamist (estradiol) and other drugs
Evamist (estradiol) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Evamist (estradiol). Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
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.
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
- 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.
- Atazanavir
- Diazepam
- Ginseng
- Lamotrigine
- Levothyroxine
- Licorice
- Lorazepam
- Prednisolone
- Selegiline
- Tacrine
- Temazepam
- Tipranavir
- Triazolam
- Troleandomycin
- Voriconazole
- Warfarin
How much does Evamist (estradiol) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Evamist (brand)
$75.00
Evamist (estradiol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Evamist (estradiol) will not be safe for you to take.
- 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)
- Current or past blood clots, stroke, or heart attack
- Bleeding disorder
- Liver problems
What are alternatives to Evamist (estradiol)?
There are a number of medications that your doctor can prescribe in place of Evamist (estradiol). Compare a few possible alternatives below.
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Evamist (estradiol) images
