HealthRX.com · Printable medication review sheet
Estradiol with NMN or NR: hot flush, bleeding and label-check record
Record which estradiol you use and which NAD+ product you added, tick any product the estrogen label says can change estrogen levels, and keep a weekly note of hot flushes and bleeding to take to your prescriber. The warning signs are the ones the Climara patient information lists.
Your estradiol
Product and routepatch, tablet, gel, spray or vaginal
Strength and schedule as prescribedfor a patch, the change day
Progestogen also prescribed?name, or none
Prescriber and date of last review
The NAD+ product you added
Product name, NMN or NR
Amount per serving and servings per day
Start date
Tick anything you also take that the label says can change estrogen levels
These are the label's CYP3A4 examples. NMN and NR are not on the list.
- St. John's wort
- Phenobarbital
- Carbamazepine
- Rifampin
- Erythromycin or clarithromycin
- Ketoconazole or itraconazole
- Ritonavir
- Grapefruit juice
What the estrogen label says
- CYP3A4 inducers such as St. John's wort may lower estrogen levels, possibly reducing the effect or changing the bleeding pattern.[1]
- CYP3A4 inhibitors such as grapefruit juice may raise estrogen levels and cause side effects.[1]
- Talk with your healthcare provider regularly, every 3 to 6 months, about your dose and whether you still need treatment.[1]
Weekly symptom note
Start a week or two before the NAD+ product if you can, so you have a baseline to compare.
| Week starting | Hot flushes this week (count) | Night sweats | Vaginal bleeding or spotting | Missed or loose patch, or missed tablet | NMN or NR taken every day? |
|---|---|---|---|---|---|
Call your healthcare provider right away if you notice
- New breast lumps.[1]
- Unusual vaginal bleeding.[1]
- Changes in vision or speech, or sudden new severe headaches.[1]
- Severe pains in your chest or legs, with or without shortness of breath, weakness and fatigue.[1]
Sources for the facts on this sheet
- Bayer HealthCare Pharmaceuticals Inc., via DailyMed. Climara (estradiol transdermal system): prescribing information and patient information. Effective 2026-03-26. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e9702c4-f2d7-4ea8-b6e8-7dca31671864
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.