Evorel Sequi

What is Evorel Sequi?

Evorel Sequi is a transdermal patch form of hormone replacement therapy, prescribed to women going through menopause. It acts as a supplement for the declining level of oestrogen 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 a woman’s ovaries start producing less oestrogen. This may result in irregular periods, hot flashes, sweating and mood swings. 

Evorel Sequi contains two hormones: an oestrogen (estradiol) and a progestogen (norethisterone). These are synthetic versions of the naturally occurring hormones in the female body. 

The estradiol works to relieve troublesome symptoms of menopause, and the norethisterone stops the oestrogen from causing a thickening in the lining of the womb. Oestrogen given alone to a woman with a uterus will result in proliferation (thickening) of the womb lining and can result in endometrial hyperplasia or even endometrial cancer. 

Evorel Sequi contains two different hormone formulations that are taken at different times during a 28-day period, which allow for a regular and predictable menstrual bleed. It is therefore suitable for women who are still having periods. 

Evorel Sequi can also be prescribed to menopausal and post-menopausal women for the purposes of preventing osteoporosis, if first-line treatments are unsuitable.

Active ingredients

The active substances in Evorel Sequi are estradiol hemihydrate and norethisterone acetate. 

Each Evorel 50 patch contains 3.2mg of estradiol hemihydrate and delivers 50mcg of estradiol a day. 

Each Evorel Conti patch contains 3.2mg of estradiol hemihydrate and delivers 50mcg of estradiol a day. It also contains 11.2mg of norethisterone acetate and delivers 170mcg of norethisterone a day. 

Inactive ingredients

The other ingredients are acrylate-vinylacetate copolymer (Duro-Tak 387-2287), polyethylene terephthalate foil (Hostaphan MN19) and guar gum.

How to use Evorel Sequi?

Evorel Sequi is known as “continuous sequential” or “continuous cyclical” HRT as it involves taking two different combinations of hormones one after another. In the first two weeks, Evorel 50 patches are used, which contain estradiol by itself. In the following two weeks, Evorel Conti patches are used which contain estradiol in conjunction with norethisterone. 

A new patch is applied to the skin twice per week, according to the pack instructions. If you’re already using a form of HRT, it’s best to complete that pack before starting Evorel Sequi. If you’re just starting HRT, it’s recommended to start Evorel Sequi within 5 days of the start of a regular menstrual period. If you have an irregular cycle, you can start Evorel Sequi at any time.

Using the patches

The patches come in a pack, which corresponds to a 28-day cycle. They 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, replacing every 3–4 days.
Weeks 3 and 4: use the four Evorel Conti patches one at a time, replacing every 3–4 days. 

Start a new pack of Evorel Sequi as soon as you finish one. Do not leave a break between packs. 

Each patch should be applied to clean, hairless skin, below the waist, and can remain in place during showering or bathing. Most people place patches on the thighs or buttocks. Avoid areas of friction such as belt-lines as this can cause your patch to fall off.

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
• Breast tenderness

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

• Feeling depressed
• Emotional lability
• Feeling nervous 
• Being unable to sleep  
• Headache or migraine
• Hypertension (increased blood pressure)
• Itchy skin or red rash  
• Nausea
• Having an upset stomach or diarrhoea  
• Indigestion
• Increased flatulence
• Abdominal pain
• Pain including pain in the back, muscles, joints  
• Weight gain  
• Heavy vaginal bleeding, painful periods  
• Water retention or build-up of fluid under the skin (oedema)

Uncommon (affects less than 1 in 100 people):

• Concentration problems  
• Feeling dizzy  
• More or less interest in sex than usual  
• Allergic reaction or hypersensitivity
• Thrush (fungal infection)
• Tiredness
• Experiencing palpitations
• Numb or tingling hands or feet 
• Breast lumps (non-cancerous)  
• Fuller breasts  
• Irregular vaginal bleeding  
• Thickening of the lining of the womb
• Breast conditions such as fibroadenoma and cancer
• Palpitations
• Vertigo
• Varicose veins
• Skin discolouration

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
• Endometrial cancer
• Stroke
• Epilepsy
• Deep vein thrombosis
• Pulmonary embolism

If you experience side effects, speak to your doctor to see if there is a more suitable HRT option.

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 (over the age of 60)
• 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 
• Have (or have ever had) or think you may have breast cancer  
• Have (or are suspected of having) or ever had a cancer that is made worse by oestrogens (such as endometrial cancer)  
• Have a thickening of the lining of the womb which has not been treated (endometrial hyperplasia)  
• Have unexplained vaginal bleeding
• May be pregnant
• Are breastfeeding
• 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)  
• Have problems with your blood which increases the likelihood of developing a blood clot (thrombosis) (such as protein C, protein S or antithrombin deficiency)  
• Have ever had blocked arteries (arterial thromboembolic disease) that gave you angina or a heart attack or a stroke  
• Have (or have ever had) liver disease and your liver function tests have not returned to normal  
• 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 common side effect of Evorel Sequi, occurring in between 1 in 100 and 1 in 10 women. 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 itself 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, may actually help slow menopausal weight gain, but does not stop it entirely. If you are worried about weight gain, speak to your doctor.

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.