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PACKAGE LEAFLET: INFORMATION FOR THE USER

Femoston® conti 0.5 mg /2.5 mg, film-coated tablets

Active substances: estradiol/dydrogesterone

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

-    Keep this leaflet. You may need to read it again.

-    If you have any further questions, ask your doctor or pharmacist.

-    This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

-    If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

The full name of your medicine is Femoston-conti

0. 5.mg/2.5 mg. In this leaflet the shorter name Femoston-conti is used.

What is in this leaflet:

1.    What Femoston-conti is and what it is used for

2.    What you need to know before you take Femoston-conti

3.    How to take Femoston-conti

4.    Possible side effects

5.    How to store Femoston-conti

6.    Contents of the pack and other information

1. What FEMOSTON-CONTI is and what it is used for

Femoston-conti is a Hormone Replacement Therapy (HRT). It contains two types of female hormones, an oestrogen called estradiol and a progestogen called dydrogesterone. Femoston-conti is used in postmenopausal women with at least 12 months since their last natural period.

Femoston-conti is used for

Relief of symptoms occurring 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”). Femoston-conti alleviates these symptoms after menopause. You will only be prescribed Femoston-conti if your symptoms seriously hinder your daily life.

2. What you need to know before you take FEMOSTON-CONTI

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 Femoston-conti 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 with Femoston-conti.

Go for regular breast screening, as recommended by your doctor.

DO NOT take Femoston-conti 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 Femoston-conti.

DO NOT take Femoston-conti

-    if you have or have ever had breast cancer, or if you are suspected of having it

-    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

-    if you have any unexplained vaginal bleeding

-    if you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated

-    if you have or have ever had a blood clot in a vein (thrombosis) such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism)

-    if you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)

-    if you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina

-    if you have or have ever had a liver disease and your liver function tests have not returned to normal

-    if you have a rare blood problem called “porphyria” which is passed down in families (inherited)

-    if you are allergic (hypersensitive) to estradiol, dydrogesterone or any of the other ingredients of this medicine (listed in section 6)

If any of the above conditions appear for the first time

while taking Femoston-conti, stop taking it at once

and consult your doctor immediately.

Warnings and precautions

Talk to your doctor or pharmacist before taking Femoston-conti, if you have ever had any of the following problems, as these may return or become worse during treatment with Femoston-conti. If so, you should see your doctor more often for check-ups:

-    fibroids inside your womb

-    growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)

-    a tumour of the brain that may be affected by the levels of progestogens (meningioma)

-    increased risk of developing blood clots (see “Blood clots in a vein (thrombosis)”)

-    increased risk of getting an oestrogen-sensitive cancer (such as having a mother, sister or grandmother who has had breast cancer)

-    high blood pressure

-    a liver disorder such as a benign liver tumour

-    diabetes

-    gallstones

-    migraine or severe headaches

-    a disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE)

-    epilepsy

-    asthma

-    a disease affecting the eardrum and hearing (otosclerosis)

-    a very high level of fat in your blood (triglycerides)

-    fluid retention due to cardiac or kidney problems

Stop taking Femoston-conti and see a doctor immediately

If you notice any of the following when taking HRT:

-    any of the conditions mentioned in the ‘Do NOT take Femoston-conti’ section

-    yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease

-    a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness).

-    migraine-like headaches which happen for the first time

-    if you become pregnant

-    if you notice signs of a blood clot, such as:

painful swelling and redness of the legs sudden chest pain difficulty in breathing

For more information, see ‘Blood clots in a vein (thrombosis)’

Note: Femoston-conti 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.

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).

The progestogen in Femoston-conti protects you from this extra risk.

Irregular bleeding

You may have irregular bleeding or drops of blood (spotting) during the first 3-6 months of taking Femoston-conti. However, if the irregular bleeding:

•    carries on for more than the first 6 months

•    starts after you have been taking Femoston-conti for more than 6 months

•    carries on after you have stopped taking Femoston-conti

see your doctor as soon as possible.

Breast cancer

Evidence suggests that taking combined oestrogen-progestogen 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.

Compare

Women aged 50 to 79 who are not taking HRT, on average, 9 to 17 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 23 cases in 1000 users (i.e. an extra 4 to 6 cases).

Regularly check your breasts. See your doctor if you notice any changes such as:

•    dimpling of the skin

•    changes in the nipple

•    any lumps you can see or feel

Additionally, you are advised to join mammography screening programs when offered to you. For mammogram screening, it is important that you inform the nurse/healthcare professional who is actually taking the x-ray that you use HRT, as this medication may increase the density of your breasts which may affect the outcome of the mammogram. Where the density is increased, mammography may not detect all lumps.

Ovarian cancer

Ovarian cancer is much rarer than breast cancer. The use of oestrogen-only or combined oestrogen-progestogen HRT has been associated with a slightly increased risk of ovarian cancer. The risk of ovarian cancer varies with age. For example in women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be about 3 cases per 2000 users (i.e. about 1 extra case).

Effects of HRT on heart and circulation

Blood clots in a vein (thrombosis)

The risk of blood clots in the veins is about 1.3 to 3- times higher in HRT users than in 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.

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 of these situations applies to you:

•    you are unable to walk for a long time because of major surgery, injury or illness (see also section 3, If you need to have surgery)

•    you are seriously overweight (BMI >30 kg/m²)

•    you have any blood clotting problem that needs long-term treatment with a medicine used to prevent blood clots

•    if any of your close relatives has ever had a blood clot in the leg, lung or another organ

•    you have systemic lupus erythematosus (SLE)

•    you have cancer

For signs of a blood clot, see “Stop taking Femoston-conti 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 have been taking oestrogen-progestogen HRT for over 5 years, there will be 9 to 12 cases in 1000 users (i.e. an extra 5 cases).

Heart disease (heart attack)

There is no evidence that HRT will prevent a heart attack. Women over the age of 60 years who use oestrogen-progestogen HRT are slightly more likely to develop heart disease than those not taking any HRT.

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 use of HRT will increase with age.

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

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.

Tell your doctor if you have or have had any of the following medical conditions since he will have to monitor you more closely:

>    heart disease

>    kidney impairment

>    higher than normal levels of certain blood fats (hypertriglyceridemia)

Children

Femoston-conti is not intended for use in children.

Other medicines and Femoston-conti

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Some medicines may interfere with the effect of Femoston-conti. This might lead to irregular bleeding. This applies to the following medicines:

- medicines for epilepsy (such as phenobarbital, carbamazepine, phenytoin)

- medicines for tuberculosis (such as rifampicin, rifabutin)

-    medicines for HIV infection [AIDS] (such as nevirapine, efavirenz, ritonavir, nelfinavir)

-    herbal remedies containing St John’s Wort (Hypericum perforatum)

Laboratory tests

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

Femoston-conti with food and drink

Femoston-conti can be taken with or without food.

Pregnancy and breast-feeding

Femoston-conti is for use in postmenopausal women only. If you become pregnant

> stop taking Femoston-conti and contact your doctor.

Femoston-conti is not indicated for use during breastfeeding.

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Driving and using machines

The effect of Femoston-conti on driving or using machinery has not been studied. An effect is unlikely.

Femoston-conti tablets contain lactose.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3.    How to take FEMOSTON-CONTI

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

When to start taking Femoston-conti

Do not start taking Femoston-conti until at least 12 months after your last natural period.

You can start taking Femoston-conti on any convenient day if:

•    You are currently not taking any HRT product.

•    You are switching from a ‘continuous combined’ HRT product. This is when you take a tablet or use a patch every day that contains both, an oestrogen and a progestogen.

You start taking Femoston-conti the day after you finish the 28 day cycle if:

•    You are switching from a ‘cyclic’ or ‘sequential’ HRT product. This is when you take a tablet or use a patch that contains oestrogen for the first part of your cycle. Afterwards you take a tablet or use a patch containing both, an oestrogen and a progestogen for up to 14 days.

Taking this medicine

•    Swallow the tablet with water.

•    You can take your tablet with or without food

•    Try to take your tablet at the same time each day. This will make sure that there is a constant amount of the product in your body. This will also help you remember to take your tablets.

•    Take one tablet every day, without a break between packs. The blisters are marked with the days of the week. This makes it easier for you to remember when to take your tablets.

How much to take

•    Your doctor will aim to prescribe the lowest dose to treat your symptoms for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough.

•    Take one yellow-coloured tablet every day for a 28 day cycle.

If you need to have surgery

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

If you take more Femoston-conti than you should

If you (or someone else) take too many Femoston-conti tablets, you are unlikely to come to any harm. You may feel sick (nauseous), or be sick (vomit), may have tender or painful breasts, dizziness, abdominal pain, drowsiness/ tiredness, or withdrawal bleeding. No treatment is necessary. But if you are worried, contact your doctor for advice.

If you forget to take Femoston-conti

Take the missed tablet as soon as you remember. If it is more than 12 hours after you should have taken the tablet, take the next dose at the regular time. Do not take the forgotten tablet. Do not take a double dose. Bleeding or spotting may occur if you miss a dose.

If you stop taking Femoston-conti

Do not stop taking Femoston-conti without first talking to your doctor.

> If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4.    Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

The following diseases are reported more often in women using HRT compared to women not using HRT:

•    breast cancer

•    abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)

•    ovarian cancer

•    blood clots in the veins of the legs or lungs (venous thromboembolism)

•    heart disease

•    stroke

•    probable memory loss if HRT is started over the age of 65

For more information about these side effects, see Section 2.

The following side effects may happen with this medicine:

Very common (may affect more than 1 in 10 patients):

-    headache

-    abdominal pain

-    back pain

-    tender or painful breasts

Common (may affect up to 1 in 10 patients):

-    vaginal thrush (a vaginal infection due to a fungus called Candida albicans)

-    feeling depressed, nervousness

-    migraine. If you have a migraine-like headache for the first time, stop taking Femoston-conti and see a doctor immediately

-    dizziness

-    feeling sick (nausea), vomiting, bloating (swelling of the abdomen), including wind (flatulence)

-    allergic skin reactions (such as rash, severe itching (pruritus) or hives (urticaria))

-    menstrual disorder such as irregular bleeds, spotting, painful periods (dysmenorrhoea), heavier or less bleeding

-    pelvic pain

-    vaginal discharge

-    feeling weak, tired or unwell

-    swelling of your ankles, feet or fingers (peripheral oedema)

-    weight increase

Uncommon (may affect up to 1 in 100 patients):

-    cystitis-like symptoms

-    growths in the womb (fibroids) get bigger

-    hypersensitivity reactions such as dyspnoea (allergic asthma)

-    change in sex drive

-    blood clots in the legs or lungs (venous thromboembolism or pulmonary embolism)

-    high blood pressure (hypertension)

-    problems with your circulation (peripheral vascular disease)

-    enlarged and tortuous (varicose) vein

-    indigestion

-    liver disorders, sometimes with yellowing of the skin (jaundice), feeling weak (asthenia) or generally feeling unwell (malaise), and abdominal pain. If you notice yellowing of the skin or the whites of your eyes, stop taking Femoston-conti and see a doctor immediately.

-    gallbladder disease

-    swelling of your breasts

-    pre-menstrual syndrome (PMS)

-    weight decrease

Rare (may affect up to 1 in 1,000 patients):

(*Side effects from the market not observed in clinical trials have been attributed to the frequency “rare”.)

-    illness resulting from the destruction of red blood cells (haemolytic anaemia)*

-    meningioma (a brain tumor)*

-    change in the surface of the eye (steepening of corneal curvature)*, not being able to wear your contact lenses (contact lense intolerance)*

-    heart attack (myocardial infarction)

-    stroke*

-    swelling of the skin around the face and throat. This may cause difficulty in breathing (angioedema)

-    purplish patches or spots on the skin (vascular purpura)

-    painful reddish skin nodules (erythema nodosum)*, discoloration of the skin especially of the face or neck known as “pregnancy patches” (chloasma or melasma)*

-    leg cramps*

The following side effects have been reported with other HRTs:

-    benign or malignant tumours which may be affected by the levels of oestrogens, such as cancer of the womb lining, ovarian cancer (see section 2 for more information)

-    increased size of tumours that may be affected by the levels of progestogens (such as meningioma)

-    a disease where the immune system abnormally attacks many organs of the body (systemic lupus erythematosus)

-    probable dementia

-    worsening of fits (epilepsy)

-    muscle twitches you cannot control (chorea)

-    blood clots in the arteries (arterial thromboembolism)

-    inflammation of the pancreas (pancreatitis) in women with pre-existing high levels of certain blood fats (hypertriglyceridemia)

-    rash with target-shaped reddening or sores (erythema multiforme)

-    urinary incontinence

-    painful/lumpy breasts (fibrocystic breast disease)

-    erosion of the neck of the womb (uterine cervical erosion)

-    worsening of a rare blood pigment disorder (porphyria)

-    high levels of certain blood fats (hypertriglyceridemia)

-    increased total thyroid hormones

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:

www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5.    How to store FEMOSTON-CONTI

Keep this medicine out of the sight and reach of children.

This medicine does not require any special storage conditions.

Do not use this medicine after the expiry date, which is stated on the blister and the carton. The expiry date refers to the last day of that month.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6.    Contents of the pack and other information What Femoston-conti contains

•    The active substances are estradiol as estradiol hemihydrate and dydrogesterone.

•    Each tablet contains 0.5 mg estradiol and 2.5 mg dydrogesterone.

•    The other ingredients in the tablet core are lactose monohydrate, hypromellose, maize starch, colloidal anhydrous silica and magnesium stearate.

•    The other ingredients in the coating are:

•    Titanium Dioxide (E171), Iron oxide yellow (E172),

Polyvinyl alcohol, Macrogol 3350, Talc.

What Femoston-conti looks like and contents of the pack

•    This medicinal product is a film-coated tablet. The tablet is round, biconvex and marked 379 on one side. Each blister strip contains 28 tablets.

•    The tablets are yellow coloured.

•    The tablets are packed in PVC film with a covering aluminium foil.

•    The blister packs contain 28, 84 or 280 (10 x 28) film-coated tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Mylan Products Ltd.

20 Station Close, Potters Bar,

Herts, EN6 1TL, UK

Manufacturer

Abbott Biologicals B.V.

Veerweg 12 8121 AA Olst The Netherlands

This medicinal product is authorised in the Member States of the EEA under the following names:

HMylan

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