CombiPatch
CombiPatch is a transdermal patch changed twice weekly delivering both estradiol and a progestin through the skin, for postmenopausal women with a uterus.
How it works
CombiPatch is a combination transdermal patch that delivers estradiol and norethindrone acetate simultaneously, eliminating the need for separate estrogen and progestogen prescriptions. Both hormones bypass liver first-pass metabolism via the transdermal route. This is clinically relevant for women who prefer transdermal estradiol (for its more favorable thromboembolism risk profile compared to oral) but also want progestogen included in the same dosing system. The patch is changed twice weekly on a consistent two-days-per-week schedule.
The norethindrone acetate component is a synthetic progestin with some androgenic activity. Unlike bioidentical progesterone, it does not produce the GABA-A neurosteroid sleep benefit. Some people experience mood changes, acne, or bloating that are attributable to the progestin component. Skin reactions at the patch application site are the most common local side effect, managed by site rotation.
How to track CombiPatch
- Hot flash frequency and severity — the primary estradiol response indicator.
- Breakthrough bleeding or spotting — log with dates and description; this is the most diagnostically important data on any combined hormonal regimen.
- Skin reactions at the patch application site — redness, itching, or adhesion problems, logged with site location.
- Mood changes that may be attributable to the norethindrone component — particularly if clustered around changes in the patch schedule.
- Androgenic side effects of norethindrone: acne, oily skin, or hair changes.
- Use a consistent twice-weekly change schedule (e.g., Monday/Thursday) and log each change day — missed or late changes can cause symptom fluctuations from both hormones.
- Rotate application sites across at least three to four areas (lower abdomen, buttocks, lower back) and log site with each change to minimize cumulative skin irritation.
- Track all bleeding and spotting with dates and description — breakthrough bleeding is the most clinically important monitoring variable on any combined estrogen-progestogen patch.
- Log mood changes with timestamps and patch change timing — if mood effects cluster around the end of a cycle before change day, that is a meaningful pattern.
- Track androgenic side effects (acne, oily skin) separately from other side effects — they have a distinct mechanism related to the norethindrone component.
Questions to ask your physician
- My hot flash frequency before starting was [X] per day. At [N] weeks on CombiPatch, my current average is [Y]. Is that response consistent with the expected estradiol effect?
- I've been logging breakthrough bleeding on [dates and description] — what does that pattern suggest about my regimen?
- My mood tracking shows [pattern] — particularly changes that seem to correlate with my patch change schedule. Is that consistent with the norethindrone component?
- I've been logging skin irritation at [sites] — here is the pattern. Is that level of irritation typical for combination patches, or should we consider a different regimen?