• breast or ovarian cancer
• abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)
• blood clots in the veins of the legs or lungs (venous thromboembolism)
• heart disease
• stroke
• vaginal bleeding at unexpected times (breakthrough bleeding and spotting)
• breast pain, tenderness or enlargement, breast discharge painful periods, changes in vaginal secretions, pre-menstrual symptoms, increased size of fibroids in the womb, thrush, changes to the neck of the womb
• indigestion, a feeling of being bloated, passing wind, feeling or being sick, abdominal pain, gall bladder disease
• skin rashes or discolouration, itching, eczema, acne, unusual hair loss or hair growth, increased skin pigment especially on the face some rare skin problems
• headache, migraine, dizziness, anxiety or depressive symptoms, fatigue
• fast or irregular heartbeat (palpitations), high blood pressure, inflammation of veins usually in the legs
• fluid retention leading to swelling of parts of the body
• changes in body weight and sex drive, increased appetite
• muscle cramps, leg pains
• nose bleeds, visual disturbances, discomfort with contact lenses, allergic-type reactions, a worsening of glucose tolerance, bladder inflammation, rare disorders (porphyria, chorea)

HRT and cancer

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

Irregular bleeding

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

• carries on for more than the first 6 months
• starts after you have been using this medicine for more than 6 months
• carries on after you have stopped using this medicine

Breast cancer

• HRT increases the risk of breast cancer
• 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
• Regularly check your breasts. See your doctor if you notice any changes such as: dimpling of the skin, hanges in the nipple,lumps you can see or feel
• you are advised to take mammography screening test as this medication may increase the density of your breasts where the density of the breast is increased, mammography may not detect all lumps

Ovarian cancer

The use of oestrogen-only or combined oestrogen-progestogen HRT has been associated with a slightly increased risk of ovarian cancer