Evorel Sequi Patches

Evorel Sequi HRT Patches

Uses for Evorel Sequi Patches

Evorel Sequi is a type of HRT (hormone replacement therapy) used to treat symptoms of the menopause in women who still have a womb.

This treatment is used for:

• Relief of symptoms of menopause like hot flushes, night sweats, mood changes, vaginal dryness, and uncomfortable intercourse
• Prevention of osteoporosis (fragile bones) in women after menopause who are at increased risk of fractures, when other treatments have been tried first and haven’t worked

Evorel Sequi is only prescribed if your symptoms seriously affect your daily life and require HRT treatment.

How do Evorel Sequi patches work?

Evorel Sequi is a continuous sequential combined hormone replacement therapy, which means it uses two types of patches, one after the other, throughout a four-week cycle.

Each pack contains eight patches:

• Four Evorel 50 patches (weeks 1 and 2) containing only estradiol
• Four Evorel Conti patches (weeks 3 and 4) containing estradiol and norethisterone

During menopause, your ovaries produce less of the hormone oestrogen. This drop in hormone levels causes the uncomfortable symptoms many women experience.

Evorel Sequi works by replacing the oestrogen your body no longer produces. The estradiol in the patches is a form of oestrogen that’s absorbed through your skin into your bloodstream, helping relieve menopausal symptoms.

However, taking oestrogen on its own can cause the lining of your womb to build up and thicken over time. This is why a progestogen hormone (norethisterone) is added during weeks 3 and 4 of each cycle using combined patches. The progestogen helps shed the lining of your womb, which usually results in a withdrawal bleed similar to a period. This bleed typically starts during week 4 of your treatment cycle.

Who can use Evorel Sequi patches?

Evorel Sequi is suitable for women who still have a womb and are experiencing menopause symptoms. It’s designed for women who have reached menopause or are going through the menopause (perimenopausal).

However, Evorel Sequi is not suitable for everyone. You should not use Evorel Sequi if you:

• Have or have ever had breast cancer, or if you’re suspected of having it
• Have cancer that’s sensitive to oestrogens, such as cancer of the womb lining, or if you’re suspected of having it
• Have any unexplained vaginal bleeding
• Have a thickening of the womb lining (endometrial hyperplasia) that’s not being treated
• Have ever had a blood clot in a vein, such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• Have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• Have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke, or angina
• Have or have ever had liver disease and your liver function tests have not returned to normal
• Have a rare blood problem called porphyria which is passed down in families
• Are allergic to estradiol, norethisterone, or any other ingredients in the patches

You should speak to your doctor before using Evorel Sequi if you have ever had:

• Fibroids inside your womb
• Growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
• Increased risk of developing blood clots
• Increased risk of getting an oestrogen-sensitive cancer (such as having a mother, sister, or grandmother who has had breast cancer)
• A liver disorder, such as a benign liver tumour
• High blood pressure
• Diabetes
• A disease of the immune system that affects many organs of the body (systemic lupus erythematosus)
• Gallstones
• Epilepsy
• Migraine or severe headaches
• Asthma
• A disease affecting the eardrum and hearing (otosclerosis)
• Very high levels of fat in your blood (triglycerides)
• Fluid retention due to heart or kidney problems

If any of these conditions apply to you, talk to your doctor before starting Evorel Sequi. Your doctor will assess whether Evorel Sequi is safe for you based on your medical history and any risk factors you may have.

How to Use Evorel Sequi Patches

Evorel Sequi patches need to be changed twice a week, on the same two days each week. Each pack contains eight patches that you’ll use over a four-week cycle.

During weeks 1 and 2, use the four Evorel 50 patches (marked CE50) one at a time. These contain estradiol only. During weeks 3 and 4, use the four Evorel Conti patches (marked CEN1) one at a time. These contain both estradiol and norethisterone. Start a new pack as soon as you finish one without leaving a gap.

Change your patch on the same two days every week. For example, if you apply your first patch on a Monday, change it on Thursday, and then apply it again on the following Monday. This means one patch will be on for three days and the next for four days.

Where to Apply the Patch

Stick the patch onto a hairless area of skin below the waist, such as your thigh or bottom:

• Don’t apply on or near your breasts
• Don’t put it on irritated skin, cuts, or spots
• Don’t use cream, moisturiser, or talc before applying
• Don’t apply the patch on the same area of skin twice in a row
• Don’t wear a patch under tight clothing or elasticated waistbands

How to Apply the Patch

1. Tear open the protective pouch and remove the patch
2. Bend and peel off half the backing without touching the sticky side
3. Apply the open half to your skin
4. Remove the remaining backing and press down the rest of the patch
5. Press firmly with the palm of your hand for at least 10 seconds

To remove a patch, peel it smoothly away from the skin, fold it in half with the sticky side together, and dispose of it safely out of reach of children and pets. Don’t flush patches down the toilet.

Evorel Sequi Side Effects

Like all medicines, Evorel Sequi can cause side effects, although not everyone experiences them. Most side effects are mild and often settle down as your body adjusts to the treatment.

Very Common Side Effects

These may affect more than 1 in 10 people:

• Irritated, itchy, red skin and rash where the patch is applied

Common Side Effects

These may affect up to 1 in 10 people:

• Feeling depressed or nervous
• Being unable to sleep
• Headache
• Itchy skin or red rash
• Feeling sick (nausea), stomach pain, wind, or other stomach upsets
• Diarrhoea
• Pain including back pain, muscle pain, or joint pain
• Breast pain
• Feeling generally unwell
• Weight gain
• Heavy vaginal bleeding or painful periods
• Water retention or build-up of fluid under the skin (oedema)

Uncommon Side Effects

These may affect up to 1 in 100 people:

• Concentration problems
• More or less interest in sex than usual
• A fungal infection like thrush
• Feeling tired
• Being aware of your heartbeat (palpitations)
• Numb or tingling hands or feet
• Feeling dizzy
• Breast lumps (non-cancerous)
• Fuller breasts
• Allergic reaction
• Irregular vaginal bleeding
• Thickening of the lining of the womb

Serious Side Effects

Stop taking Evorel Sequi and seek immediate medical help if you experience:

• Signs of a blood clot – such as sudden chest pain, difficulty breathing, severe leg pain or swelling, or sudden weakness or numbness
• Severe abdominal pain
• Severe headaches or migraines that are worse than usual
• Changes in your vision, speech, or coordination
• Yellowing of your skin or eyes (jaundice)
• Severe allergic reactions – such as swelling of the face, lips, or tongue, or difficulty breathing
• Sudden swelling of the face or throat which may cause difficulty swallowing or breathing, rapid swelling of the hands and feet, and stomach cramps

For a complete list of side effects, please read the patient information leaflet.

If you experience any side effects, whether listed here or not, speak to your doctor or pharmacist. You can also report side effects through the Yellow Card Scheme, which helps improve the safety of medicines for everyone.

Evorel Sequi Patches Ingredients

Evorel 50 patches (weeks 1 and 2)

Active ingredient: Estradiol hemihydrate 3.2mg (delivers 50 micrograms of estradiol per day)

Evorel Conti patches (weeks 3 and 4)

Active ingredients: Estradiol hemihydrate 3.2mg (delivers 50 micrograms of estradiol per day) and Norethisterone acetate 11.2mg (delivers 170 micrograms of norethisterone acetate per day)

Inactive ingredients: Duro-Tak 387-2287 (adhesive), guar gum, and Hostaphan MN19 (backing film).

Warnings & Precautions

• Keep Evorel Sequi out of sight and reach of children.
• Store at room temperature (do not store above 25°C).
• Do not use Evorel Sequi after the expiry date shown on the packaging.
• Do not use a patch if the protective pouch is already open.
• Combined HRT increases your risk of blood clots, particularly in the first year of use or when restarting after a break. Stop using the patches and see a doctor immediately if you notice signs of a blood clot (painful swelling in your legs, sudden chest pain, or difficulty breathing).
• If you need to have surgery, tell your doctor that you’re taking Evorel Sequi. You may need to stop taking it about 4 to 6 weeks before the operation to reduce the risk of a blood clot.
• Smoking increases your risk of serious cardiovascular side effects when taking HRT, especially if you’re over 35.
• Evorel patches don’t protect against sexually transmitted infections (STIs). Use condoms for protection against STIs.
• Evorel Sequi is not a contraceptive. If it’s less than 12 months since your last menstrual period or you’re under 50 years old, you may still need to use additional contraception to prevent pregnancy.
• Go for regular breast screening and cervical smear tests as recommended by your doctor. Regularly check your breasts for any changes such as dimpling of the skin, changes in the nipple, or any lumps you can see or feel.
• If you have unexpected bleeding or spotting that carries on for more than the first 6 months, starts after 6 months of treatment, or continues after you’ve stopped taking Evorel Sequi, see your doctor as soon as possible.