Evorel Patches

Evorel is a hormone Replacement Therapy (HRT) for oestrogen deficiency symptoms in peri- and post-menopausal women. Evorel comes as a transdermal patch and is available in four sizes corresponding to the four different concentrations: Evorel contains 1.6 mg estradiol corresponding to a release rate of 25 micrograms of estradiol in 24 hours. Evorel 50 contains 3.2 mg estradiol corresponding to a release rate of 50 micrograms of estradiol in 24 hours.Evorel contains 4.8 mg estradiol corresponding to a release rate of 75 micrograms of estradiol in 24 hours. Evorel contains 6.4 mg estradiol corresponding to a release rate of 100 micrograms of estradiol in 24 hours. Evorel Patches are beneficial for patients without a womb/uterus (following hysterectomy) who have had no bleed for at least 12m.

Evorel is used for relief of symptoms occurring after menopause. During the menopause, the amount of oestrogen produced by a woman’s body drops. This can cause symptoms such as hot face, neck and chest (“hot flushes”). Evorel alleviates these symptoms after menopause.

Please Note: Evorel is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Do not use a hormonal contraceptive while using HRT.

Evorel is an oestrogen-only HRT patch applied to the skin twice weekly.For initiation and continuation of treatment of menopausal symptoms, the lowest effective dose for the shortest duration should be used.

For women with an intact uterus progestogen should normally be added to Evorel for the prevention of adverse endometrial effects, eg hyperplasia and cancer. The regimen may be either cyclic or continuous sequential. Only progestogens approved for addition to oestrogen treatment may be prescribed (eg oral norethisterone, 1mg/day or medroxyprogesterone acetate, 2.5mg/day) and should be added for at least 12-14 days every month/28 day cycle.

Unless there is a previous diagnosis of endometriosis, it is not recommended to add a progestogen in hysterectomised women.

Treatment of oestrogen deficiency symptoms: Therapy should be started with one Evorel 50 patch (delivering 50 micrograms of estradiol/24 hours) and the dose adjusted after the first month if necessary depending on efficacy and signs of over-oestrogenisation (eg breast tenderness). For maintenance therapy the lowest effective dose should be used; a maximum dose of 100 micrograms of estradiol/24 hours should not be exceeded.

Evorel should be applied to the skin as soon as it is removed from the wrapper. Recommended application sites are on clean, dry, healthy, intact skin and each application should be made to a slightly different area of skin on the trunk below waistline. Evorel should not be applied on or near the breasts.

Evorel should remain in place during bathing and showering. Should it fall off during bathing or showering the patient should wait until cutaneous vasodilation ceases before applying a replacement patch to avoid potential excessive absorption. Should a patch fall off at other times it should be replaced immediately. Patients can be advised to use baby oil to help remove any gum/glue which may remain on their skin after patch removal.

Missed dose

If the patient forgets to change their patch, they should change it as soon as possible and apply the next one at the normal time. However, if it is almost time for the next patch, the patient should skip the missed one and go back to their regular schedule. Only one patch should be applied at a time. There is an increased likelihood of break-through bleeding and spotting when a patch is not replaced at the normal time.

Like all medicines, Premarin can cause side effects, although not everybody gets them. The following side effects are reported more often in women using HRT compared to women not using HRT:

Take off the patch and tell your doctor straight away if you notice or suspect any of the following. You may need urgent medical treatment.

• Sudden swelling of the face or throat which may cause difficulty in swallowing or breathing. This may be a sign of an allergic reaction. This only happens in a small number of people
• Blood clots (thrombosis), a heart attack or stroke
• Yellowing of the skin or whites of the eyes (jaundice), or other liver problems
• Migraine-type headaches for the first time or more frequent (affects less than 1 in 10 people)
• An increase in blood pressure
• Breast or ovarian cancer, endometrial cancer or hyperplasia (long, heavy or irregular vaginal bleeding)
• Convulsions or fits (frequency not known)

Tell your doctor if you notice any of the following side effects while using Evorel:

Very common (affects more than 1 in 10 people)

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

Common (affects less than 1 in 10 people)

• Red, puffy skin where the patch is applied
• Breast pain
• Rash or feeling itchy
• Feeling dizzy
• Feeling depressed
• Headache
• Feeling sick or having stomach pains
• Diarrhoea
• Pain, including pain in joints
• Break through bleeding, spotting or periods
• Weight gain

The list above isn’t exhaustive. If you experience serious side effects or side effects lasting longer than 3 months then you should consult your doctor immediately.

Make sure you read the patient information leaflet for a full list of side effects, cautions and contraindications. You should only take HRT once you have understood all the warnings and precautions as HRT may increase your chances of getting certain cancers or cardiovascular disease. If you are concerned discuss this with your doctor or The Family Chemist clinician.

Do not use Evorel if:

• You are allergic to anything in the patches (listed in section7)
• 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
• You have vaginal bleeding you cannot explain
• You have ever had blood clots in a 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 (or have ever had) a liver disease and your liver functiontests have not returned to normal
• You have ever had blocked arteries (arterial thrombo-embolic disease) that gave you angina or a heart attack or resulted in astroke
• You have a blood problem called ‘porphyria’

Do not use this medicine if any of the above applies to you. If you are not sure,talk to your doctor or pharmacist before using Evorel.

Stop using Evorel at once if any of the above appears for the first time and talk to your doctor immediately.

Medical chek-ups

Before taking HRT, your doctor should ask about you and your family’s medical history. Your doctor may decide to examine your breasts or your tummy, and may do an internal examination. They will only do this if it is necessary for you, or if you have any special concerns. Once you have started on HRT, see your doctor for regular check-ups (at least once a year). At these check-ups, your doctor may discuss the benefits and risks of continuing to take HRT.

Make sure that you:

• Go for regular breast screening and cervical smeartests
• 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
• Tell your doctor if you have ever had any of the following. You may need
• these checks more often.
• A problem caused by growth of the womb lining
• Inside the womb (fibroids)
• Outside the womb (endometriosis)
• Thickening of the lining of the womb (endometrial hyperplasia)
• Increased risk of blood clots
• A family history of increased risk of cancers related to oestrogens
• High blood pressure (hypertension). Your doctor may tell you to stop using Evorel if your blood pressure goes up
• Diabetes
• Gallstones
• Migraine or severe headaches
• Systemic Lupus Erythematosus (SLE). This is an allergic condition thatcauses joint pain, skin rashes and fever
• Epilepsy
• Asthma
• A disease affecting the eardrum (otosclerosis)
• Liver, heart or kidney problems
• High levels of fat (triglycerides) in your blood, as you may have a higher risk of pancreatitis (inflammation of the pancreas, which causes severe pain in the abdomen and back)
• Any breast problems
• History of sudden swelling of the face or throat, which may cause difficulty in swallowing or breathing, rapid swelling of the hands and feet and, stomach cramps

You may still be able to use Evorel, but you should discuss this with your doctor first. Also tell your doctor if these illnesses return or get worse while you are using Evorel. If you have had a premature menopause the risk of using HRT may be different.

Other conditions

• If you have brown patches on your face or body (chloasma) or have a history of them, you may need to keep out of the sun or away from sunbeds (these patches may not completely disappear again)

• https://www.medicines.org.uk/emc/files/pil.10931.pdf
• https://www.womens-health-concern.org/
• https://patient.info/medicine/oestrogen-and-progestogen-for-hrt
• https://www.nhs.uk/conditions/menopause/
• https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/