Evorel

What is Evorel?

Evorel is a form of hormone replacement therapy (HRT) used for relieving 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 vagina dryness. Evorel can also be used for the temporary prevention of osteoporosis (weakening of the bones) in postmenopausal women, but is only recommended for this purpose if other medications have previously failed.

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.

Inactive ingredients

The inactive ingredients of 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 (1.6mg estradiol), Evorel 50 (3.2mg estradiol), Evorel 75 (4.8mg estradiol) and Evorel 100 (6.4mg estradiol). A doctor will always prescribe the lowest dose possible for treatment of your symptoms. For prevention of osteoporosis, Evorel 50, 75 or 100 will be prescribed only 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 of talc before applying the patch, as this may affects 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.
• You have, have ever had, or think you might have breast cancer.
• You have, have ever had, or are suspected of having a cancer that is sensitive to oestrogen.
• You have a thickening of the lining of the womb that is not being treated.
• You have unexplained vaginal bleeding.
• You have ever had a thrombosis (blood clots in a vein ) or a pulmonary embolism (blood clot in the lung).
• You have problems with your blood which increase the likelihood of developing thrombosis.
• You have or have ever had a liver disease.
• You have ever had arterial thromboembolic disease (blocked arteries) that lead to angina, heart attack or a stroke.
• You have porphyria.

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

• Fibroids inside the womb, endometriosis or endometrial hyperplasia
• Increased risk of blood clots
• A family history of oestrogen-sensitive cancers
• Hypertension (high blood pressure)
• Diabetes
• Gallstones
• Migraines or severe headaches
• Systemic Lupus Erythematosus (SLE)
• Epilepsy
• Asthma
• Otosclerosis
• 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.
• Chloasma (brown patches on your face or body).

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 or carbamazepine
• Medicines for infections, such as rifampicin, nevirapine, efavirenz, ritonavir or nelfinavir
• Bosentan
• St John’s Wort
• Lamotrigine for epilepsy

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. 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 an intrauterine system (IUS), or mirena coil fitted. It is also a bioidentical form of HRT, meaning the molecular makeup of the synthetic hormone is identical to that of the hormone produced naturally in women.

Evorel Sequi contains estradiol (oestrogen) and norethisterone (progestogen) and is only used in women who have not had a hysterectomy. 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 also contains estradiol (oestrogen) and norethisterone (progestogen). This is a continuous form of HRT, 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. The norethisterone in Evorel Sequi and Evorel Conti is not bioidentical.

None of the above treatments act as contraceptives. If you are under the age of 50, or if it 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 the be the most effective treatment for the symptoms of menopause, and is available with a prescription through the NHS and online at 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 general exercise 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 with vaginal dryness, moisturisers and lubricants can be bought in any chemist with the help of a pharmacist.

Are Evorel patches safe?

Evorel patches are safe for use in most postmenopausal women who have had a hysterectomy. 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 are a non-invasive treatment which are a good option if you suffer from side effects from oral HRTs such as indigestion and migraines. Patches also have less interactions with other medications than oral HRT tablets, and are less likely to interfere with your sex drive.

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 dependent on the patient 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.

Sources

• Patient information leaflet > Evorel
• Patient information leaflet > Evorel Sequi
• Patient information leaflet > Evorel Conti
• NHS > HRT
• WebMD > Quitting HRT