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Estradiol patch side effects and how to avoid them

Estradiol patch side effects are typically temporary if they occur at all
Sarah Bradley writer headshot
By | Jan. 6, 2026 Medically reviewed by Jessica Swirble, Pharm.D.
Two medication patches: Estradiol patch side effects and how to avoid them

Key takeaways

  • Estradiol patches like Menostar and Vivelle-Dot are used to treat symptoms of menopause, like hot flashes and vaginal changes. The hormone is absorbed through the skin and enters the bloodstream directly.

  • Common side effects of the patch include headaches, breast tenderness, upper respiratory infection, and upset stomach. Many of these symptoms go away after your body adjusts to the medication.

  • Although the estradiol patch is considered safer than some other types of estrogen therapies, it may still increase your risk for heart disease, stroke, blood clots, and certain types of cancers, especially if you have a history of these conditions.

In this article:

An estradiol patch is a type of hormone replacement therapy (HRT) used to treat symptoms of menopause, like hot flashes and vaginal dryness or itching. The patch releases a continuous dose of estrogen that is absorbed transdermally, or through the skin. There are many forms of estradiol, including tablets, gels, sprays, and vaginal rings. This article focuses specifically on the transdermal patch and its possible side effects. 

What is an estradiol patch?

An estradiol patch increases the amount of estradiol in the body. Estradiol is the most potent of the four types of estrogen and helps protect against bone loss and heart disease. Having low levels of estrogen is common during and after menopause. However, some women have low estrogen levels because of certain health conditions, cancer treatments, or reproductive surgeries like the removal of the ovaries.

To treat low estrogen levels, your healthcare provider may recommend an estradiol patch: a small, thin adhesive patch applied directly to the skin and left on for a prescribed amount of time before being removed or replaced. The estradiol is continually absorbed from the patch through your skin and then released into your bloodstream, where it circulates throughout your whole body.

Even though transdermal estradiol affects your whole body, it’s generally considered safer than oral estradiol. That’s because oral estradiol is processed through your liver, which increases your risk of blood clots, while transdermal estradiol skips the liver and goes straight to your bloodstream. Transdermal estradiol is also administered at consistently lower levels and increases your estrogen on a slower, steadier basis than the pill does, mimicking the way your body naturally releases hormones.

There are many common brand names of estradiol patches, including:

Common side effects of the estradiol patch

Although it works well to treat menopause symptoms, the patch can cause side effects.

Based on clinical trials, the most common side effects of the estradiol patch are headache, breast pain, and upper respiratory tract infection. Many women using the patch also experience gastrointestinal upset, including nausea, vomiting, and abdominal pain.

Other side effects of the patch include:

  • Irritation at the application site
  • Back pain
  • Swelling
  • Joint pain
  • Irregular menstrual bleeding or spotting
  • Depression

Estradiol patch weight gain

Weight changes, including both weight loss and weight gain, are listed as a possible side effect of the estradiol patch. However, it’s not as common as other estradiol side effects. 

Some studies suggest weight gain is actually less common than weight loss. Having the right estradiol levels may prevent overeating, and an HRT method like the estradiol patch can help some menopausal women better manage their weight.

Serious side effects of the estradiol patch

Though rare, some people may experience serious side effects while using the estradiol patch. This includes the possibility of having a heart attack, stroke, or blood clot, or potentially serious problems with your liver or gallbladder.

Get immediate medical care for any of the following symptoms, some of which could indicate a heart attack or blood clot:

  • Itching, hives, or swelling of the mouth, face, or extremities
  • Hoarseness or difficulty breathing or swallowing
  • Yellow skin or eyes (jaundice) 
  • Fever
  • Loss of appetite
  • Pressure or pain in your chest
  • Pain in your arm, neck, jaw, or back
  • Nausea
  • Pain, swelling, or warmth in the arm or leg
  • Increased heart rate
  • Sweating
  • Vision problems
  • Sudden weakness or fatigue

How soon do estradiol patch side effects start?

According to Janet Choi, MD, OB-GYN, reproductive endocrinology and infertility specialist, and chief medical officer of Progyny, estradiol patch side effects typically start within the first few days to weeks of starting treatment. There’s one exception: redness and itching at the patch site, which Dr. Choi notes can occur right away or not for several months.

Although most side effects appear quickly, remember that how you respond to estradiol may be different.

“The timing varies among individuals, with some women noticing effects almost immediately and others not experiencing side effects until they’ve been using the patch for a week or two,” Dr. Choi says. She says some women don’t have any side effects at all.  

How long do estradiol patch side effects last?

Many of the more common side effects of the estradiol patch are temporary. According to Dr. Choi, initial symptoms like vaginal spotting, breast tenderness, mild headaches, nausea, and bloating usually go away within the first two to three months as your body adapts to the steady increase in estradiol. If they don’t, Dr. Choi recommends reaching out to your healthcare provider. They may want to adjust your dose or change your medication to reduce your side effects.

What are the long-term side effects of the estradiol patch?

Women who use the estradiol patch long-term are at a higher risk for several serious health conditions. Here’s what to know:

  • Some studies show long-term use of estradiol may increase your risk of heart attack, stroke, and blood clots. This risk is higher if you have a history of any of these conditions.
  • Some research suggests that women who take estradiol, especially over the age of 65, may have a higher risk of developing dementia or other cognitive problems. However, results differ between studies, and some research suggests that HRT earlier in life may actually have protective effects on brain aging. 
  • Taking estradiol long-term has been associated with a higher risk of breast and endometrial cancers, though some warnings about this risk are changing. (See “Safety measures while using the estradiol patch” for more.) We now know that estradiol doesn’t increase the risk of endometrial cancer when combined with progestin; the risk is related to estrogen-only forms of HRT. 

Estradiol patch interactions

If you are using the estradiol patch, there are a few drug interactions to be aware of. According to Katie Rowan, MD, internal medicine provider and Menopause Society Certified Practitioner, this includes:

  • Certain seizure medications: Drugs like carbamazepine, phenobarbital, or phenytoin can lower estradiol levels, making the patch less effective.
  • Antifungal medications: Drugs like ketoconazole and itraconazole can raise estradiol levels in the body, potentially increasing side effects.
  • Macrolide antibiotics: These antibiotics, which include erythromycin and azithromycin, can change your gut bacteria and potentially increase your estradiol levels. 
  • Immunosuppressants: Estradiol can affect how anti-rejection medications used after an organ transplant, such as cyclosporine, are metabolized.
  • Thyroid drugs: Estradiol may also affect how some thyroid medications are metabolized, including levothyroxine. People taking levothyroxine may need to have their thyroid levels checked after starting estradiol and then again once they’ve reached a stable dose.
  • Alcoholic drinks: Alcohol can temporarily raise estradiol levels, potentially increasing symptoms like breast tenderness, nausea, or mood swings, and estrogen may make alcohol’s effects feel stronger. 

Safety measures while using the estradiol patch

In general, the estradiol patch is recommended for use in women over the age of 45 because menopause symptoms typically begin sometime between the ages of 45 and 55. Some younger women may need to take estradiol if they enter menopause early or have other health conditions. However, estradiol is not recommended for pregnant women and can interfere with milk production in breastfeeding women.

Although anyone using the estradiol patch could develop short- or long-term side effects, some people are more at risk. This includes women with:

  • Undiagnosed, unexplained vaginal bleeding
  • Breast cancer or a history of breast cancer
  • Endometrial cancer or a history of endometrial cancer
  • A history of blood clots or stroke
  • A known allergy to drugs containing estradiol 
  • Liver disease
  • A clotting disorder

In 2003, the Food and Drug Administration (FDA) issued a black box warning to all products containing estradiol in response to study findings from the Women’s Health Initiative (WHI). However, in November of 2025, the FDA announced it was removing all warnings related to the increased risk of heart disease, breast cancer, and probable dementia from estradiol drug packaging. 

New information suggests these risks don’t apply to all women, and the black box warnings often cause providers and patients to avoid using estradiol when it would actually be beneficial. Warnings about the increased risk of endometrial cancer when using estrogen-only products will still be included.

How to avoid estradiol patch side effects

The estradiol patch is fairly user-friendly compared to many other forms of estradiol: You apply it to your skin and leave it in place for several days, then remove it (and replace it with a new patch, if needed). You don’t need to worry about remembering to keep your dosing consistent or taking it with or without food. 

One of the most common side effects of the patch, skin irritation, is also one of the easiest to avoid. You can place an estradiol patch in several places below your waistline, like your lower abdomen, hips, or upper buttocks, so Dr. Rowan recommends changing up your application site each time you put on a new patch to avoid irritating the same area of skin.  

How long can you use estradiol patches?

You might have heard that you should use the lowest dose of estrogen for the shortest amount of time possible, but that doesn’t apply to the estradiol patch.

“[That mantra] came out of studies that were halted early due to the perceived increased risk of breast cancer … and an increased risk of heart disease and blood clots,” Dr. Rowan says. “These studies were done using oral synthetic estrogens, which are much different than the estrogen patch, and we now know that estrogen alone does not increase the risk of breast cancer. And when used in topical forms such as the patch, it does not increase the risk of blood clots.”

Topical systemic estrogen, like the patch, also carries a low risk of increasing heart disease and stroke, per Dr. Rowan. The new information we have shows there’s no clear limit for how long you can use the estradiol patch. Your healthcare provider can help you choose what’s right for you, as long as you’re not experiencing any notable changes to your health. 

How to treat side effects of the estradiol patch

As we noted, many side effects of the estradiol patch are temporary and will go away on their own as your body adjusts to the medication. In the meantime:

  • Apply your patch to a new site every time you change it to avoid irritation; use topical antihistamines or hydrocortisone on previous sites to relieve any itching and redness.
  • Talk to your healthcare provider if you’re having moderate or persistent signs of high estrogen, like breast tenderness, headaches, mood changes, nausea, bloating, and swelling. Per Dr. Rowan, these symptoms could mean your dose is too high, and your provider may want to lower it. 
  • Consider taking over-the-counter pain relievers like Tylenol or Motrin to relieve mild symptoms like headaches or breast tenderness.
  • Upset stomach and acid reflux are common symptoms of treatment with HRT. Consider taking over-the-counter acid reducers like Pepcid or Pepto Bismol to relieve symptoms of GERD, like nausea, acid reflux, or bloating.
  • Prepare for light bleeding or spotting, which can occur during the first several months after starting the patch or increasing your dose, as advised by Dr. Rowan. Always let your healthcare provider know about irregular bleeding so they can determine what’s normal for you and assess whether you need to add more progesterone to your dose.

Most estradiol patch side effects aren’t an emergency, but if you have any signs of allergic reaction, heart attack, stroke, or blood clot, you should get immediate medical attention.  

Bottom line: Is the estradiol patch safe?

For many menopausal and postmenopausal women, the estradiol patch is a relatively safe way to increase their estrogen levels and treat symptoms like hot flashes and vaginal dryness, itching, and burning. While taking oral estradiol increases your risk for heart disease, stroke, and blood clots, the patch is often considered a safer option than oral estradiol because it delivers a lower, steadier dose of hormone. 

However, the estradiol patch isn’t right for all women, and it’s not without risks. Taking estradiol alone, without progestin, increases your risk for endometrial cancer. Taking estradiol with progestin may slightly increase your risk for breast cancer if you’re 50 years or older. If you have a history of hormone-related cancers, it may not be safe for you to use the estradiol patch. Always share your full medical history with your healthcare provider so they can help you determine what treatments are right for you.

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