Evorel Sequi

What is Evorel Sequi?

Evorel Sequi is a form of hormone replacement therapy, prescribed to women undergoing menopause. It acts as a supplement of the declining levels of oestrogen and progesterone in the body and thus helps relieve the symptoms of menopause. 

Evorel Sequi should not be used as a contraceptive method, and other contraceptive methods should still be used if you are under 50 or have had a period in the last 12 months. 

How does Evorel Sequi work?

Evorel Sequi belongs to a group of medications called hormone replacement therapy (HRT). It is used to combat the symptoms of menopause, which occur when the woman’s ovaries start producing less oestrogen. This results in irregular periods, hot flashes, sweating and mood swings. 

Evorel Sequi contains two hormones: oestrogen (estradiol) and progesterone (norethisterone). These are both naturally occurring hormones in the female body. Evorel sequi helps by replenishing the falling levels of oestrogen in the body, helping reduce the symptoms of menopause. 

It is only prescribed to women who still have a womb and suitable for women who have already undergone menopause or who are around the age of reaching menopause.

The declining level of oestrogen also results in osteoporosis, a fragile bone condition. Evorel Sequi can be prescribed to treat this problem; however, only when other medications have been trailed and failed.

Active ingredients

The active substances in Evorel Sequi are estradiol hemihydrate and norethisterone acetate. Each Evorel 50 patch contains 3.2 mg of estradiol hemihydrate and delivers 50 micrograms of estradiol a day. 

Inactive ingredients

The other ingredients are Duro-Tak 387-2287 (this makes the patches sticky), guar gum and Hostaphan MN19 (backing film). 

How to use Evorel Sequi

Evorel Sequi is known as ‘continuous sequential’ HRT as it involves taking two hormones one after another. In the first two weeks, estradiol is used by itself. In the following two weeks, estradiol is used in conjunction with norethisterone. Evorel sequi comes in the form of patches and is used to replace the declining levels of oestrogen in the body. However, progesterone needs to be added, as using oestrogen alone regularly causes the overgrowth of the lining of the womb. Progesterone helps shed the lining of the uterus,  which can result in ‘withdrawal bleed.’ 

Using the patches

The patches need to be changed twice a week and must be used in the right order.

Weeks 1 and 2 

Use the four Evorel 50 patches one at a time. 

Weeks 3 and 4 

Use the four Evorel Conti patches one at a time. After removing the  Evorel 50 patch, replace it with the first Evorel Conti patch. Start a new pack of Evorel Sequi as soon as you finish one. Do not leave a break between packs. 

Evorel Sequi side effects

All medications come with side effects; however, not everyone gets them. 

Very common side effects: (more than 1 in 10 women)

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

Common side effects: (affects less than 1 in 10 people)

• Feeling depressed or nervous  
• Inappropriate signs of emotion 
• Being unable to sleep  
• Headache  
• Itchy skin or red rash  
• Nausea
• Having an upset stomach
• Diarrhoea  
• Pain including pain in the back, muscles, joints  
• Breast pain  
• Feeling generally unwell  
• Weight gain  
• Heavy vaginal bleeding, painful periods  
• Water retention or build-up of fluid under the skin (oedema)

Very Uncommon (affects less than 1 in 100 people):

• Concentration problems  
• Feeling dizzy  
• More or less interest in sex than usual  
• Allergic reaction  
• Thrush (fungal infection)
• Tiredness
• Experiencing palpitations
• Numb or tingling hands or feet, less skin sensitivity  
• Breast lumps (non-cancerous)  
• Fuller breasts  
• Irregular vaginal bleeding  
• Thickening of the lining of the womb

Frequency not known side effects:

• Mood swings  
• Bloated feeling  
• Gallstones  
• Swelling of the hands and feet (peripheral oedema) 
• Puffy skin where the patch is applied

HRT also slightly increases your risk of developing the following serious conditions:

• Breast cancer  
• Abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)  
• Ovarian cancer  
• blood clots in the veins of the legs or lungs (venous thromboembolism)  
• Heart disease  
• Stroke  
• Memory loss if HRT is started over the age of 65 

Contraindications

Evorel sequi should not be used if:

• You are allergic to anything in the patches 
• You have (or have ever had) or think you may have breast cancer  
• You have (or are suspected of having) or ever had a cancer that is made worse by oestrogens (such as endometrial cancer)  
• You have a thickening of the lining of the womb which has not been treated (endometrial hyperplasia)  
• You unexplainable vaginal bleeding
• You have ever had blood clots in a vein (thrombosis) i.e. deep vein thrombosis, or a blood clot that has travelled to your lung (pulmonary embolism)  
• You have problems with your blood which increases the likelihood of developing a blood clot (thrombosis) (such as protein C, protein S or antithrombin deficiency)  
• You have ever had blocked arteries (arterial thromboembolic disease) that gave you angina or a heart attack or a stroke  
• You have (or have ever had) liver disease and your liver function tests have not returned to normal  
• You have “porphyria.”

If you ever have/had any of these conditions, do not use the medication. If you are unsure if this applies to you, speak to your doctor before starting. 

Does Evorel Sequi cause weight gain?

Weight gain is listed as a more common side effect caused by Evorel Sequi. However, there has been limited clinical evidence to confirm this as an HRT side rather than a natural part of ageing. As we get older, our metabolism slows and menopause can also cause weight gain. The diminishing levels of oestrogen can cause weight gain, as oestrogen is linked to an increased metabolic rate. The changes in hormones are also thought to cause an increased appetite, lower metabolic rate and weight gain. Current research shows that HRT, such as Evorel Sequi, can help slow menopausal weight gain, but does not stop it entirely. If you are worried about weight gain, speak to your doctor to find a better alternative. 

How do I use Evorel Sequi patches?

The patches should be applied to clean, dry, unbroken and non-irritated skin. This area should be skin below the waist, preferably on the buttock or hip. Each fresh patch should be applied to a slightly different area of the body to prevent skin irritation. Leave a week in between applying patches to the same area of the body. Do not use powder, creams, lotions, or other oily products before the patch application as it will stop the patch from sticking. You should NOT apply patches near the breast or under the waistband, and they should not be exposed to the sunlight. If the patch falls off before it is due for a change, apply a new patch. If you forget to change your patch on the day indicated, change it as soon as you remember and carry on as usual.