Short answer: Both are skin patches with estradiol plus a progestin, for women with a uterus.12 CombiPatch (with norethindrone acetate) is changed twice a week on the lower abdomen. Climara Pro (with levonorgestrel) is changed once a week on the lower abdomen or upper buttock. Each label compared its patch with an estradiol-only patch, not with the other. Both carry a boxed warning.
| CombiPatch | Climara Pro | |
|---|---|---|
| What is in it | Estradiol 0.05 mg plus norethindrone acetate 0.14 or 0.25 mg per day1 | Estradiol 0.045 mg plus levonorgestrel 0.015 mg per day2 |
| How often | New patch every 3 to 4 days (twice weekly)1 | Once weekly2 |
| Where | Lower abdomen1 | Lower abdomen or upper buttock2 |
| Approved for | Hot flashes and vaginal atrophy from menopause; low estrogen from hypogonadism, castration or ovarian failure1 | Hot flashes from menopause; preventing postmenopausal osteoporosis2 |
| Regimens | Continuous combined, or sequential with an estradiol-only patch for days 1 to 141 | Continuous, one patch a week2 |
| Endometrial hyperplasia, 1 year | 1 of 123 (<1%) and 1 of 98 (1%) vs 39 of 103 (38%) on Vivelle 0.05 mg1 | 0 of 102 (0%) vs 19 of 110 (17.3%) on an estradiol-only patch2 |
| Breast pain, 1-year study | 34% and 48% vs 40% on Vivelle1 | 18.9% vs 9.8% on estradiol alone2 |
| Storage | In the refrigerator, 36°F to 46°F, in the sealed pouch1 | 68°F to 77°F in its pouch2 |
| Missed patch | Apply a new patch as soon as possible1 | Apply a new patch as soon as possible2 |
| Boxed warning | WARNING: CARDIOVASCULAR DISORDERS, BREAST CANCER, ENDOMETRIAL CANCER, AND PROBABLE DEMENTIA1 | WARNING: CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, BREAST CANCER, and ENDOMETRIAL CANCER2 |
The CombiPatch label reports two 1-year studies of 955 women with a uterus against an estradiol-only patch it names as Vivelle 0.05 mg. On the continuous combined regimen, endometrial hyperplasia was found in 1 of 123 women on 0.05/0.14 mg and 1 of 98 on 0.05/0.25 mg, vs 39 of 103 (38%) on Vivelle.1
The Climara Pro label reports a 1-year study against "a continuous estradiol-only transdermal system" at 0.045 mg a day, with no brand named. Hyperplasia was 0 of 102 on Climara Pro vs 19 of 110 (17.3%) on estradiol alone.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
CombiPatch is changed twice a week, kept in the refrigerator before use, and can be used in a sequential regimen with an estradiol-only patch for the first 14 days of each 28-day cycle. Climara Pro is changed once a week and kept at room temperature. Application site reactions were 20% and 23% on CombiPatch (17% on Vivelle) and 40.6% on Climara Pro (33.8% on estradiol alone).12
Which, if either, fits is for your prescriber. More detail: CombiPatch side effects, Climara Pro side effects, the CombiPatch and Climara Pro dosing schedules and Prempro vs Activella: how do the two combined HRT tablets differ?.