Combined HRT patch (oestrogen + progestogen) Pregnancy: §4.6: not indicated during pregnancy. If pregnancy occurs during treatment, withdraw immediately. Data on a large number of exposed pregnancies indicate no adverse effects of levonorgestrel on the foetus, and most epidemiological studies relevant to inadvertent foetal exposure to combinations of oestrogens and progestagens indicate no teratogenic or foetotoxic effect. Not indicated during lactation.

Estradiol with levonorgestrel

Brand names: FemSeven Conti, FemSeven Sequi

A combined hormone replacement therapy of estradiol with the progestogen levonorgestrel, used to treat menopausal symptoms in women with a uterus, often as a continuous combined preparation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One transdermal patch (50 micrograms/7 micrograms per 24 hours) applied once a week — each patch is replaced every 7 days

Route: Transdermal

Frequency: Once weekly, continuously — as one patch is removed the next is applied immediately, with no treatment-off phase

SOURCE PRODUCT: FemSeven Conti 50 micrograms/7 micrograms/24 hours transdermal patch — a continuous combined HRT. For initiation and continuation of treatment of postmenopausal symptoms the lowest effective dose for the shortest duration should be used. STARTING: in women with amenorrhoea not taking HRT, or women transferring from another continuous combined HRT product, treatment may be started on any convenient day; in women transferring from sequential HRT regimens, treatment should start right after their withdrawal bleeding has ended. Forgetting to change a patch on schedule may increase the likelihood of break-through bleeding or spotting. APPLICATION: apply to clean, dry, healthy skin that is neither irritated nor grazed and free of any cream, lotion or oily product; use an area without major skin folds (buttocks or hips) not subject to chafing by clothing — avoid the waist and tight clothing; MUST NOT be applied on or near the breasts; avoid applying to the same site twice running, allowing at least one week between applications to the same site. Press the patch firmly with the palm for at least 30 seconds, concentrating on the edges. Showering or bathing is possible without removing the patch. Once applied, cover the patch with clothing to avoid direct sunlight. If the patch becomes detached before the seventh day (vigorous physical activity, excessive sweating, abnormal chafing of clothing), apply a new patch and continue changing the patch on the original scheduled day. Remove the patch slowly to avoid skin irritation; after use fold it in two with the adhesive surface inside and dispose of it with normal household solid waste.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known, past or suspected breast cancer
Known or suspected oestrogen-dependent malignant tumours (e.g. endometrial cancer)
Undiagnosed genital bleeding
Untreated endometrial hyperplasia
Previous idiopathic or current venous thromboembolism (deep venous thrombosis, pulmonary embolism)
Known thrombophilic disorders (e.g. protein C, protein S or antithrombin deficiency)
Active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction)
Acute liver disease, or a history of liver disease as long as liver function tests have failed to return to normal
Known hypersensitivity to the active substances or to any excipient
Porphyria

Side effects

Application site reactions (>10% in clinical trials) — mostly mild skin reactions that usually disappear 2–3 days after patch removal
Breast tenderness / mastodynia (>10%, usually mild or moderate and tending to decrease with treatment time) and bleeding or spotting
Headache (common); dizziness and migraine (uncommon)
Fluid retention / oedema, weight increase or loss, fatigue, leg cramps (common)
Dyspepsia (common); bloating, abdominal cramps, nausea (uncommon); cholelithiasis and cholestatic jaundice (rare)
Hypertension, depression, endometrial hyperplasia, benign breast tissue changes and increase in size of uterine fibroids (uncommon). Up to a 2-fold increased risk of breast cancer diagnosis with combined oestrogen-progestagen therapy for more than 5 years

Clinical monograph

How it works

Estradiol relieves oestrogen-deficiency symptoms while levonorgestrel opposes endometrial proliferation, allowing a bleed-free regimen in suitably postmenopausal women.

Prescribing in practice

Levonorgestrel is present to protect the endometrium against unopposed oestrogen, so it is essential for women who retain a uterus and the product should not be substituted with oestrogen alone.
Continuous combined regimens suit women who are clearly postmenopausal; breakthrough bleeding in the early months is common but persistent bleeding needs investigation.
Weigh thrombotic, stroke and breast cancer risk and avoid in active thromboembolic disease or oestrogen-dependent malignancy.

Monitoring

Monitor symptom response, blood pressure and bleeding pattern, and investigate bleeding that persists or starts after an initial settled phase.

Counselling the patient

Some irregular bleeding or spotting is common in the first few months but report bleeding that persists or recurs.
Seek urgent advice for breast changes or symptoms of a clot.
Attend routine breast and cervical screening.

Evidence & guidelines

NICE menopause guidance underpins the use of combined continuous oestrogen-progestogen hormone replacement therapy in postmenopausal women.

Reference: NICE NG23; British Menopause Society; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

FAST Exam Protocol — Focused Assessment with Sonography in Trauma · Trauma

Pathways