Evorel Sequi

EVOREL SEQUI is composed of EVOREL 50 and EVOREL CONTI. Both EVOREL 50 and EVOREL CONTI are a Transdermal Delivery System (TDS), or transdermal patch. Evorel Conti contains 3.2 mg of estradiol corresponding to a nominal release of 50 micrograms of estradiol per 24 hours and 11.2 mg of norethisterone acetate corresponding to a nominal release of 170 micrograms of norethisterone acetate per 24 hours.). They are both female hormones. Evorel 50 contains 3.2mg of estradiol hemihydrate. The pack contains 4 Evorel 50 and 4 Evorel Conti.

Evorel Sequi comes in a ‘memory pack’. This can be used to help you remember when to change your patches. Each pack contains eight or twenty-four patches. The hormones are spread evenly in each patch. They pass slowly into your body through the skin. Evorel Sequi is used For the symptoms of the menopause. It is only used in women who still have a womb. It is suitable for women who have had the menopause (postmenopausal) or who are around the time of the menopause (perimenopausal).

Evorel Sequi is known as ‘continuous sequential’ HRT. This is because two hormones are used one after another. Evorel 50 is used by itself for two weeks, then Evorel Conti are used together for the next two weeks. Evorel Sequi patches replace the oestrogen that is normally released by the ovaries. However, taking an oestrogen hormone regularly may cause the lining of your womb to build up and get thicker. This means it is necessary to add a progestogen hormone to the oestrogen. This helps shed the lining of the womb and stop any problems happening. Evorel Conti patches used during weeks 3 and 4 contain this progestogen. The shedding of the lining of the womb will probably give a ‘withdrawal bleed’. This will be like having a period each month. The withdrawal bleed will start during week 4, before you finish an Evorel Sequi pack.

Please Note: Evorel Sequi 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.

The patches need to be changed twice a week. You must use the patches 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. As soon as you remove your fourth 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.

You must change the patches twice a week to give your body a steady supply of hormones. There is enough hormone in each patch to last for several days. Change your patch on the same two days every week. This will mean that one patch is on for three days and the next patch for four days. For example, if you apply your first patch on a Monday, change it on Thursday and again on the following Monday. You can work out your two days from the following table, starting from the first day of use.

Stick the patch onto a hairless area of skin below the waist. Most women prefer to wear the patch on the thigh or bottom.

• Do not apply on or near the breasts
• Do not put it on top of cuts, spots or anywhere the skin is irritated
• Do not use cream, moisturiser or talc before applying the patch
• Do not apply the patch on the same area of skin twice in a row
• It can be worn under loose areas of clothing
• Do not wear a patch under elasticated areas or a tight waistband
• Apply the patch to clean, dry, cool skin as soon as you open the protective pouch

Do not use a patch if its protective pouch is already open.

Step 1: Open and Peel

Using the notches as a guide, tear along two edges of the pouch. Remove the patch. With the protective backing facing you, bend and peel off half the backing. Don’t touch the sticky side – it may not stick properly if you do.

Step 2: Apply and Press

Apply the open half of the patch to your skin. Remove the remaining backing and press down the rest of the patch. Press the patch with the palm of your hand to make sure it is firmly stuck. Removing a patch. Peel an edge of the patch smoothly away from the skin. Fold the patch in half, so that the sticky side sticks to itself. Put it in with the household rubbish, safely out of the reach of children and pets. Do not flush used patches down the toilet. When you remove the patch some glue may remain on your skin. It will disappear with time, or you can use baby oil to remove it.

If a patch falls off apply a new patch but keep to your original ‘patch change’ days. If you have just had a bath or a shower, wait until your skin cools before applying the new patch.

Change it as soon as you remember and then keep to your original ‘patch change’ days. You may get some bleeding and spotting like a period during this time.

You can have a bath or shower as normal. Do not scrub too hard as this can loosen the edges of the patch. You can go swimming. The patch will not be affected. You can exercise and play sports. However, do not wear the patch under tight clothing or waist bands. You can sunbathe. However, keep the patch covered, out of direct sunlight.

Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects have been associated with Evorel Sequi:

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, rapid swelling of the hands and feet and stomach cramps
• Blood clots (thrombosis), or stroke (frequency not known)
• 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 (affects less than 1 in 10 people)
• Breast or ovarian cancer, endometrial cancer or hyperplasia (long, heavy or irregular vaginal bleeding).
• Widespread rash with peeling skin and blistering in the mouth, eyes and genitals (Stevens-Johnson syndrome)
• Convulsions or fits (frequency not known)

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

Very common (affects more than 1 in 10 people)

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

Common (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
• Feeling sick (nausea), or having stomach pain wind or other stomach upsets
• 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)

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 Sequi 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 was made worse by oestrogens (such as endometrial cancer)
• You have a thickening of the lining of the womb (endometrial hyperplasia) which has not been treated
• You have vaginal bleeding you cannot explain
• You have ever had blood clots in a vein (thrombosis), such as in the legs (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 (or have ever had) a liver disease and your liver function tests have not returned to normal
• You have ever had blocked arteries (arterial thrombo-embolic disease) that gave you angina or a heart attack resulted in a stroke
• 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 Sequi. Stop using Evorel Sequi at once if any of the above appears for the first time and talk to your doctor immediately.

Medical check-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 smear tests
• 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 (see ‘Blood clots’ in section 3 below)
• A family history of increased risk of cancers related to oestrogens such as having a mother, sister or grandmother who has had breast cancer
• High blood pressure (hypertension). Your doctor may tell you to stop using Evorel Conti if your blood pressure goes up
• Diabetes
• Gallstones
• Migraine or severe headaches
• Systemic lupus erythematosus (SLE). This is an allergic condition that
• causes joint pain, skin rashes and fever
• Epilepsy
• Asthma
• A disease affecting the eardrum and hearing(otosclerosis)
• A liver disorder, such as a benign liver tumour
• Fluid retention due to 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
• Thyroid 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 Sequi, 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 Sequi.

Stop using Evorel Sequi and see a doctor immediately If you notice any of the following when using Evorel Sequi:

• any of the conditions mentioned in the ‘DO NOT use Evorel Sequi section
• yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease
• a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness)
• migraine-like headaches which happen for the first time
• if you become pregnant
• if you notice signs of a blood clot, such as:
  • painful swelling and redness of the legs
  • sudden chest pain
  • difficulty in breathing

• https://www.medicines.org.uk/emc/files/pil.10930.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/