Evorel

What is Evorel?

Evorel is a form of hormone replacement therapy (HRT) used to relieve the symptoms of menopause in women. During menopause, the level of oestrogen produced by the ovaries declines, leading to symptoms such as hot flushes and night sweats, mood swings, irregular periods and vaginal dryness. Evorel may also be used for the temporary prevention of osteoporosis (weakening of the bones) in postmenopausal women, where other medications are unsuitable. Evorel comes in a patch, which releases a steady amount of estradiol each day. Evorel contains a bioidentical form of HRT, meaning the molecular makeup of the synthetic hormone is identical to that of the hormone produced naturally in women.

How does Evorel work?

Evorel contains the active ingredient estradiol, a synthetic form of the female hormone oestrogen. This treatment comes in the form of transdermal patches which, when applied to the skin, allow estradiol to be absorbed directly into the bloodstream. This supplements the natural level of oestrogen produced by the body, relieving symptoms caused by menopause and, in some cases, preventing the onset of osteoporosis.

Active ingredients

The active ingredient of Evorel is estradiol.

Evorel patches come in four strengths: 25mcg per day, 50mcg per day, 75mcg per day and 100mcg per day.

Inactive ingredients

The inactive ingredients in Evorel are Duro-Tak 387-2287, guar gum and Hostaphan MN19.

How to use Evorel?

Evorel should always be used as instructed by a doctor. If you are already using a different form of HRT, finish the current treatment cycle before starting Evorel. If you still have regular bleeds, start Evorel within 5 days of the start of your bleed. Your patch needs to be changed twice a week to provide a steady flow of oestrogen (for example, on a Monday and a Thursday) without leaving a break between patches.

Apply the patch according to packet instructions. Do not apply the patch if the protective pouch is not properly sealed. If a patch falls off, apply a new one immediately but keep to your normal schedule when it comes to applying the next patch. If you forget to change your patch, change it as soon as you remember. You may experience some spotting or light bleeding during this time.

Evorel dosage

Evorel can be prescribed at 4 different doses: 

• Evorel 25, which contains a total of 1.6mg estradiol, with 25mcg released each day
• Evorel 50, which contains a total of 3.2mg estradiol, with 50mcg released each day 
• Evorel 75, which contains a total of 4.8mg estradiol, with 75mcg released each day
• Evorel 100, which contains a total of 6.4mg estradiol, with 100mcg released each day. 

A doctor will usually prescribe the lowest dose possible for the treatment of your symptoms. For prevention of osteoporosis, Evorel 50, 75, or 100 will be prescribed if other treatments have previously failed.

Can Evorel patches be cut in half?

Evorel patches should NOT be cut in half. This damages the mechanism used to deliver the hormones to your system, meaning you will not receive the correct daily dose.

Where should I put Evorel patches?

Evorel patches should be applied to a hairless area of the skin below the waist, usually the thigh or buttocks. Do not apply the patch on or near the breasts, on damaged or irritated skin, under elasticated areas, or on the same area of skin twice in a row. Do not use moisturiser or talc before applying the patch, as this may affect its ability to stick.

Evorel side effects

As is the case with all medications, Evorel can cause side effects in some people. If you notice andy of the following, remove the patch and seek medical attention immediately:

• Allergic reaction, characterised by sudden swelling of the face or throat and difficulty breathing or swallowing
• Thrombosis (blood clots), heart attack or stroke
• Migraine-type headaches
• An increase in blood pressure
• Breast or ovarian cancer, endometrial cancer or hyperplasia
• Long, heavy or irregular vaginal bleeding
• Convulsions or fits

Common side effects, affecting around 1 in 10 people, include:

• Irritation, itchy skin or rash where the patch is applied.
• Redness or puffiness where the patch is applied.
• Breast pain.
• Rash or feeling itchy.
• Feeling depressed.
• Headache.
• Nausea or stomach pain.
• Diarrhoea.
• Pain in the muscles or joints.
• Weight gain.

Uncommon side effects, which affect less than 1 in 100 people, include:

• Vaginal thrush.
• Wind.
• Palpitations.
• Fuller breasts.
• Painful periods.
• Swelling of the hands and feet.
• Water retention or build-up of fluid under the skin.
• Muscle pain.
• Hypersensitivity.

Rare side effects only appear in less than 1 in 1,000 people and include:

• Bloated feeling.
• Gallstones.

Contraindications

You should NOT use Evorel if you:

• Are allergic to any of the ingredients in this medication
• Have, have ever had, or think you might have breast cancer
• Have, have ever had, or are suspected of having a type of cancer that is sensitive to oestrogen
• Have a thickening of the lining of the womb that is not being treated
• Have unexplained vaginal bleeding
• Have ever had a thrombosis (blood clot in a vein) or a pulmonary embolism (blood clot in the lung)
• Have problems with your blood which increase the likelihood of developing thrombosis
• Have or have ever had a liver disease and still have abnormal liver function tests
• Have ever had arterial thromboembolic disease (blocked arteries) e.g. angina, heart attack or stroke.
• Have porphyria.

Before taking Evorel, tell your doctor if you have ever had any of the following:

• Fibroids inside the womb, endometriosis or endometrial hyperplasia
• Increased risk of blood clots
• A family history of oestrogen-sensitive cancers e.g. breast or ovarian cancer
• Hypertension (high blood pressure)
• Diabetes
• Gallstones
• Migraines or severe headaches
• Systemic lupus erythematosus (SLE)
• Epilepsy
• Asthma
• Otosclerosis (a condition of the bones inside the ear)
• Liver, heart or kidney problems
• High level of fat (triglycerides) in the blood
• Any breast problems
• History of sudden swelling of the face, throat, hands or feet, and stomach cramps.

You will need to make sure that you go for regular medical checkups, breast screening and cervical smear tests while using Evorel.

Drug interactions

Tell your doctor if you are taking any other medications before starting Evorel, including those bought over the counter without a prescription. In particular, tell your doctor if you are taking any of the following:

• Epilepsy medication, such as phenobarbital, phenytoin, lamotrigine or carbamazepine
• Medicines for infections, such as rifampicin, nevirapine, efavirenz, ritonavir or nelfinavir
• Bosentan
• St John’s wort

How to cope with Evorel side effects?

Like all medications, Evorel can have side effects. Where these side effects are mild, it is up to you to decide whether the benefits of Evorel or other types of HRT outweigh the disadvantages. In some cases, the side effects of HRT are easier to put up with than the symptoms of menopause. It is a good idea to wait for around 3 months to let your body adjust to the treatment – side effects are more common when you begin hormonal therapies and often go away over time. 

If you experience headaches, simple painkillers such as paracetamol may help. If you experience irritation at the site of the patch, be sure to avoid that area until this has resolved. If you feel nauseous, try to eat smaller meals and keep well hydrated. 

You can always speak to your doctor about troublesome side effects and the options available to you. If you wish to stop treatment, or switch to a different kind of HRT, consult your doctor first.

Evorel vs. Evorel Sequi vs. Evorel Conti

Evorel comes in three different forms: Evorel, Evorel Conti and Evorel Sequi.

Evorel contains estradiol (oestrogen) only and is therefore only prescribed for women who have had a hysterectomy or who have a Mirena coil fitted. 

Evorel Sequi is a sequential combined form of HRT that contains estradiol (an oestrogen) and norethisterone (a progestogen). It is used in women who have not had a hysterectomy and the norethisterone counters the thickening effect of estradiol on the womb lining, reducing the risk of developing endometrial cancer. Each pack contains eight patches, four containing estradiol only and four containing estradiol and norethisterone. At the end of a pack, the woman will have a bleed as she switches back to the estradiol-only patches.

Evorel Conti is a continuous combined form of HRT that contains estradiol (an oestrogen) and norethisterone (a progestogen). Evorel Conti is continuous, meaning each patch contains both hormones and that most women will not experience a monthly bleed. It is suitable for use in women who have not had a hysterectomy and who no longer menstruate. 

None of the above treatments act as contraceptives. If you are under the age of 50, or if it is less than 12 months since your last period, you may still need to use additional contraception to avoid pregnancy. Speak to your doctor for advice.
 

Alternatives to HRT

HRT is considered to be the most effective treatment for the symptoms of menopause and is available online via Dr Felix. Some women may choose to try herbal supplements as an alternative, though the effectiveness of these treatments is unknown. It is important to seek the advice of a doctor or pharmacist about the effects of different herbal supplements before trying them.

Lifestyle changes to improve menopause symptoms

There are some lifestyle changes you can make to help manage the symptoms of menopause and increase the effectiveness of HRT. Increasing your intake of vitamin D can help keep your bones strong and healthy while exercising regularly will improve your heart and bone health and help relieve stress. Cut down on caffeine, alcohol and spicy foods, and quit smoking to help reduce the impact of hot flushes and night sweats. For those suffering from vaginal dryness, moisturisers and lubricants can be bought over the counter.

Are Evorel patches safe?

Evorel patches are safe for use in most menopausal and postmenopausal women who have had a hysterectomy or have endometrial protection in the form of a Mirena intrauterine system (coil). While the type of HRT you choose is dependent on personal preference, patches do have some benefits over oral types of HRT. As they are applied to the skin, they result in fewer side effects than oral HRTs such as indigestion and migraines. Patches also have fewer interactions with other medications than oral HRT tablets and are less likely to interfere with your sex drive. Patches also do not harbour the same risk of blood clots as oral therapy.

Will I need to take Evorel for the rest of my life?

Most medical professionals recommend that HRT should be prescribed at the lowest dose and for the shortest time needed. This is because the risks and potential side effects of HRT increase with time and age. When to come off HRT is a personal decision and your doctor will be able to advise you on your options. Never come off of Evorel or any other form of HRT without first consulting a doctor. HRT is not usually recommended for women over the age of 65.