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Progynova

Generic name: Estradiol aka Estradiol Valerate

What Progynova-Estradiol Valerate is used for
Relief of symptoms occuring after menopause During the menopause, the amount of the oestrogen produced by a woman s body drops. This can cause symptoms such as hot face, neck and chest ( hot flushes ). Progynova alleviates these symptoms after menopause. You will only be prescribed Progynova if your symptoms seriously hinder your daily life.

go for regular breast screening and cervical smear regularly check your breasts for any changes such as
tests, as recommended by your doctor. dimpling of the skin, changes in the nipple, or any lumps you can see or feel.

Be sure to:

R If you have any reason to believe that you either are,

Progynova- Estradiol Valerate 2 mg and Progynova 1mg
Estradiol valerate Read all of this leaflet carefully before you start taking this medicine. R Keep this lea et. You may need to read it again. R If you have any further questions, ask your doctor or pharmacist. R This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. R If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. In this leaflet 1. WHAT PROGYNOVA IS AND WHAT IT IS USED FOR 2. BEFORE YOU TAKE PROGYNOVA Medical history and regular check-ups Do not take Progynova When you need to take special care with Progynova HRT and cancer Effects of HRT on heart or circulation Blood clots in a vein (thrombosis) Heart disease (heart attack) Stroke Other conditions Using other medicines Laboratory tests Pregnancy and breast-feeding Driving or using machines Important information about some of the ingredients of Progynova 3. HOW TO TAKE PROGYNOVA About the pack When to start If you take more Progynova than you should If you forget to take Progynova If you stop taking Progynova If you need to have surgery 4. POSSIBLE SIDE FFECTS 5. HOW TO STORE PROGYNOVA 6. FURTHER INFORMATION

or may be, pregnant, or if you are producing milk (lactating) and breast-feeding. (See also the Pregnancy and breast-feeding section of this leaflet) If any of the above conditions appear for the rst time while taking Progynova, stop taking it at once and consult your doctor immediately.

Stop taking Progynova- Estradiol Valerate and see a doctor immediately
If you notice any of the following when taking HRT: R any of the conditions mentioned in the DO NOT take Progynova section R yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease R a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness). R migraine-like headaches which happen for the first time. R if you become pregnant R if you notice signs of a blood clot, such as: R painful swelling and redness of the legs R sudden chest pain R difficulty in breathing for more information, see Blood clots in a vein (thrombosis) Note: Progynova is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice.

If you ve had your womb removed because of endometriosis, any endometrium left in your body may be at risk. So your doctor may prescribe HRT that includes a progestogen as well as an oestrogen. Compare In women who still have a womb and who are not taking HRT, on average, 5 in 1000 will be diagnosed with endometrial cancer between the ages of 50 and 65. For women, aged 50 to 65, who still have a womb and who take oestrogen-only HRT, between 10 and 60 women in 1000 will be diagnosed with endometrial cancer (i.e. between 5 and 55 extra cases), depending on the dose and how long it is taken.

Regularly check your breasts. See your doctor if you notice any changes in your breast such as: R dimpling of the skin R changes in the nipple R any lumps you can see or feel

Do not take Progynova- Estradiol Valerate:
If any of the following applies to you. If you are not sure about any of the points below, talk to your doctor before taking Progynova, Do not take Progynova R If you have or have ever had breast cancer, or if you are suspected of having it R If you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium) or if you are suspected of having it R If you have any unexplained vaginal bleeding R If you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated R If you have or have ever had a blood clot in a vein (thrombosis) such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism) R If you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency) R If you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina R If you have or have ever had a liver disease, and your liver function tests have not returned to normal R If you have a rare blood problem called porphyria which is passed down in families (inherited) R If you are allergic (hypersensitive) to estradiol valerate or to any of the other ingredients in Progynova (listed in section 6 Further information ) R If you have been told to avoid lactose, that you have a rare hereditary condition called Lapp lactase deficiency or glucose-galactose malabsorption

Ovarian cancer
Ovarian cancer (cancer of the ovaries) is rare. It can be difficult to diagnose because there are often no obvious signs of the disease. A slightly increased risk of ovarian cancer has been reported in women taking HRT for at least 5 to 10 years. Women aged 50 to 69 who are not taking HRT, on average about 2 women in 1000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be between 2 and 3 cases per 1000 users (i.e. up to 1 extra case).

Prevention of osteoporosis
After the menopause some women may develop fragile bones (osteoporosis). You should discuss all available options with your doctor. If you are at an increased risk of fractures due to osteoporosis and other medicines are not suitable for you, you can use Progynova to prevent osteoporosis after menopause.

When you need to take special care with Progynova Estradiol Valerate

Tell you doctor if you have ever had any of the following problems, before you start the treatment, as these may return or become worse during treatment with Progynova. If so, you should see your doctor more often for check-ups: R fibroids inside your womb R growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia) R increased risk of developing blood clots (see Blood clots in a vein (thrombosis ) R increased risk of getting an oestrogen-sensitive cancer (such as mother, sister or grandmother who has had breast cancer) R high blood pressure R a liver disorder, such as a benign liver tumour R diabetes R gallstones R migraine or severe headaches R a disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE) R epilepsy R asthma R a disease affecting the eardrum and hearing (otosclerosis) R a very high level of fat in your blood (triglycerides) R fluid retention due to cardiac or kidney problems

Breast cancer
Evidence suggests that taking combined oestrogenprogestogen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you take HRT. The additional risk becomes clear within a few years. However, it returns to normal within a few years (at most 5) after stopping treatment. For women who have had their womb removed and who are using oestrogen-only HRT for 5 years, little or no increase in breast cancer risk is shown. Your risk of breast cancer is also higher: R if you have a close relative (mother, sister or grandmother) who has had breast cancer R if you are seriously overweight Compare Women aged 50 to 79 who are not taking HRT, on average, 9 to 14 in 1000 will be diagnosed with breast cancer over a 5-year period. For women aged 50 to 79 who are taking oestrogen-progestogen HRT over 5 years, there will be 13 to 20 cases in 1000 users (i.e. an extra 4 to 6 cases).

2. BEFORE YOU TAKE PROGYNOVA- Estradiol Valerate
Medical history and regular check-ups
The use of HRT carries risks which need to be considered when deciding whether to start taking it, or whether to carry on taking it. The experience in treating women with a premature menopause (due to ovarian failure or surgery) is limited. If you have a premature menopause the risks of using HRT may be different. Please talk to your doctor. Before you start (or restart) HRT, your doctor will ask about your own and your family s medical history. Your doctor may decide to perform a physical examination. This may include an examination of your breasts and/or an internal examination, if necessary. Once you have started on Progynova, you should see your doctor for regular check-ups (at least once a year). At these check-ups, discuss with your doctor the benefits and risks of continuing to take Progynova.

Effects of HRT on heart or circulation
Blood clots in a vein (thrombosis) The risk of blood clots in the veins (also called deep vein thrombosis, or DVT) is about 1.3 to 3 times higher in HRT users than non-users, especially during the first year of taking it. Blood clots can be serious, and if one travels to the lungs, it can cause chest pain, breathlessness, fainting or even death. This condition is called pulmonary embolism, or PE. DVT and PE are examples of a condition called venous thromboembolism, or VTE. You are more likely to get a blood clot in your veins as you get older and if any of the following applies to you. Inform your doctor if any if these situations apply to you: R you are unable to walk for a long time because of major surgery, injury or illness (see also sections 3, If you need to have surgery ) R you are seriously overweight (BMI >30 kg/m2)

1. WHAT PROGYNOVA- Estradiol Valerate IS AND WHAT IT IS USED FOR
What Progynova- Estradiol Valerate is
Progynova is a Hormone Replacement Therapy (HRT). It contains the female hormone, oestrogen. Your ovaries gradually make less of this hormone as you get older and will no longer produce it after you have been through the menopause. Progynova can be used in peri- and postmenopausal women.

HRT and cancer
Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer) Taking oestrogen-only HRT will increase the risk of excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the womb lining (endometrial cancer). Taking a progestogen in addition to the oestrogen for at least 12 days of each 28 day cycle protects you from this extra risk. If you still have your womb, your doctor will prescribe a progestogen separately. If you have had your womb removed (a hysterectomy), discuss with your doctor whether you can safely take this product without a progestogen.

R you have any blood clotting problem that needs long-

term treatment with a medicine used to prevent blood clots R any of your close relatives has ever a had blood clot in the leg, lung or any other organ R you have had one or more miscarriages R you have systemic lupus erythematosus (SLE) R you have cancer For signs of a blood clot, see Stop taking Progynova and see a doctor immediately . Compare Looking at women in their 50s who are not taking HRT, on average, over a 5-year period, 4 to 7 in 1000 would be expected to get a blood clot in a vein. For women in their 50s who are taking oestrogenprogestogen HRT, for over 5 years, there will be 9 12 cases in 1000 (i.e. an extra 5 cases). For women in their 50s who have had their womb removed and have been taking oestrogen-only HRT for over 5 years, there will be 5 to 8 cases in 1000 users (i.e. 1 extra case) Heart disease (heart attack) There is no evidence that HRT will prevent a heart attack. HRT is not recommended for women who have heart disease, or have had heart disease recently. If you have ever had heart disease, talk to your doctor to see if you should be taking HRT. Women over the age of 60 years who use oestrogenprogestogen HRT are slightly more likely to develop heart disease than those not taking any HRT. For women who have had their womb removed and are taking oestrogen-only therapy there is no increased risk of developing a heart disease. If you get: R a pain in your chest that spreads to your arm or neck See a doctor as soon as possible and do not take any more HRT until your doctor says you can. This pain could be a sign of heart disease.

Stroke The risk of getting a stroke is about 1.5 times higher in HRT users than in non users. The number of extra cases of stroke due to HRT use will increase with age. Other things that can increase the risk of stroke include: R high blood pressure R smoking R drinking too much alcohol R an irregular heartbeat If you are worried about any of these things, or if you have had a stroke in the past, talk to your doctor to see if you should take HRT. Compare Looking at women in their 50s who are not taking HRT, on average, 8 in 1000 would be expected to have a stroke over a 5-year period. For women in their 50s who are taking HRT, there will be 11 cases in 1000 users, over 5 years (i.e. an extra 3 cases). Other conditions R HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. R If you have heart or kidney problems, your doctor should examine you carefully as oestrogens may cause fluid retention resulting in swelling. R If you have pre-existing elevated triglycerides (a type of blood fat) your doctor should monitor you closely during oestrogen replacement therapy or HRT. Rare cases of large increases of plasma triglycerides (hypertriglyceridemia) leading to inflammation of the pancreas (pancreatitis) have been reported with oestrogen replacement therapy. R If you have a tendency to develop blotchy brown patches (chloasma) on the face you should avoid exposure to the sun or ultraviolet light whilst using Progynova.

R Your doctor will monitor you carefully if you have

terminal kidney insufficiency as the blood levels of the active substances in Progynova will probably increase

3. HOW TO TAKE PROGYNOVA- Estradiol Valerate
Progynova is not for use in adolescents or children. Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough.

Using other medicines
Some medicines may interfere with the effect of Progynova. This might lead to irregular bleeding. This applies to the following medicines. R medicines for epilepsy (such as phenobarbital, phenytoin, carbamazepine) R medicines for tuberculosis (such as rifampicin, rifabutin) R medicines for HIV infection (such as nevirapine, efavirenz, ritonavir and nelfinavir) R herbal remedies containing St. John s wort (Hypericum perforatum) Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines including medicines obtained without a prescription, herbal medicines or other natural products.

If this is your first HRT treatment and you are still having regular periods: start your Progynova tablets on the first day of bleeding If this is your first HRT treatment and your periods have become very infrequent or have stopped completely: you can start your Progynova tablets at any time if you are sure you are not pregnant.

4. POSSIBLE SIDE EFFECTS
Like all medicines, Progynova can cause side effects, although not everybody gets them. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. The following diseases are reported more often in women using HRT compared to women not using HRT: Serious side effects R breast cancer R abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer) R ovarian cancer R blood clots in the veins of the legs or lungs (venous thromboembolism) R heart disease R stroke R probable memory loss if HRT is started over the age of 65 For more information about these side effects see Section 2. Other side effects that have been linked to the use of Progynova and other oral hormone replacement therapies: R During the first few months of treatment you may experience some vaginal bleeding at unexpected times (breakthrough bleeding and spotting). These symptoms normally lessen with continued treatment. If they don t, contact your doctor (see section 2 HRT and cancer/ Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer) for more information) R breast pain, tenderness or enlargement, breast discharge R painful periods, changes in vaginal secretions, premenstrual symptoms, increased size of fibroids in the womb, thrush, changes to the neck of the womb R indigestion, a feeling of being bloated, passing wind, feeling or being sick, abdominal pain, gall bladder disease

R skin rashes or discolouration, itching, eczema, acne,

If you take more Progynova- Estradiol Valerate than you should
If you have taken too many Progynova tablets by mistake, you may feel sick, vomit or have some menstruation-like bleeding. No specific treatment is necessary but you should consult your doctor or pharmacist if you are worried.

If you forget to take Progynova- Estradiol Valerate
If you forget to take a tablet at your usual time and you are less than 12 hours late, take it as soon as possible. Take the next tablet at the usual time. If you are more than 12 hours late, leave the forgotten tablet in the pack. Continue to take the rest of the tablets at the usual time every day. You may experience breakthrough bleeding.

Laboratory tests
If you need a blood test, tell your doctor or the laboratory staff that you are taking Progynova, because this medicine can affect the results of some tests.

unusual hair loss or hair growth, increased skin pigment especially on the face (chloasma see section 2 other conditions for more information), some rare skin problems R headache, migraine, dizziness, anxiety or depressive symptoms, fatigue R fast or irregular heartbeat (palpitations), high blood pressure, inflammation of veins usually in the legs R fluid retention leading to swelling of parts of the body R changes in body weight and sex drive, increased appetite R muscle cramps, leg pains R nose bleeds, visual disturbances (such as blurred vision), discomfort with contact lenses, allergic-type reactions, a worsening of glucose tolerance, bladder inflammation, rare disorders (porphyria, chorea) The following side effects have been reported with other HRTs: R various skin disorders: R painful reddish skin nodules (erythema nodosum) R rash with target-shaped reddening or sores (erythema multiforme)

6. FURTHER INFORMATION
What Progynova- Estradiol Valerate contains
The active substance is estradiol valerate. The other ingredients are lactose monohydrate, maize starch, povidone 25,000, talc, magnesium stearate (E572), sucrose, povidone 700,000, macrogol 6000, Calcium carbonate (E170), titanium dioxide (E171), glycol 85% [E422], montan glycol wax, carmine [E132], purified water.

What Progynova- Estradiol Valerate looks like and contents of the pack
Progynova 2 mg tablets are pale blue sugar-coated tablets. They are supplied in a blister pack (memo strip) containing 28 tablets with the days of the week printed on the blister. Boxes containing three blister packs are available. Marketing Authorisation Holder Bayer PLC Bayer House Strawberry Hill Newbury Berkshire RG14 1JA. Manufacturer Progynova 2 mg is made by: Bayer Pharma AG, Berlin, Germany or Delpharm Lille SAS, Lys Lez Lannoy, France. Date of the last revision of this leaflet September 2012

Pregnancy and breast-feeding
Progynova is for use in post-menopausal women only. Do not take if you are pregnant or breast-feeding. If you become pregnant, stop taking Progynova immediately and contact your doctor.

If you stop taking Progynova- Estradiol Valerate
You may begin to feel the usual symptoms of menopause again, which may include hot flushes, trouble sleeping, nervousness, dizziness or vaginal dryness. Consult your doctor or pharmacist if you want to stop taking Progynova tablets.

5. HOW TO STORE PROGYNOVA- Estradiol Valerate
Keep out of the reach and sight of children. Do not use Progynova after the expiry date which is printed on the label after EXP . The expiry date refers to the last day of the month stated. Do not dispose of medicines down the drain or in the household rubbish. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Driving or using machines
There is nothing to suggest that the use of Progynova affects driving or use of machines.

If you need to have surgery
If you are going to have surgery, tell the surgeon that you are taking Progynova. You may need to stop taking Progynova about 4 to 6 weeks before the operation to reduce the risk of a blood clot (see section 2, Blood clots in a vein (thrombosis) ). Ask your doctor when you can start taking Progynova again.

When to start
If you have been taking other HRT preparations: carry on until you have finished your current pack and have taken all the tablets for that month. Take your first Progynova tablet the next day. Do not leave a break between your old tablets and the Progynova tablets.

Important information about some of the ingredients of Progynova

Progynova- Estradiol Valerate contains lactose (a type of sugar). If you have an intolerance to some sugars, check with your doctor before taking Progynova.
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