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Evorel Sequi

Evorel Sequi is a hormone replacement therapy (HRT) that comes as a transdermal patch. It contains two different female hormones, oestrogen in the form of estradiol and progesterone in the form of norethisterone. Estradiol is used by itself for the first two weeks of your menstrual cycle, then estradiol and norethisterone are used together for the last two weeks. The reason both hormones are present is to prevent excessive thickening of the lining of the womb.

The menopause is a time that is full of ups and downs for women, as the ovaries stop producing eggs, causing fluctuations in the levels of the hormone oestrogen in the body which can lead to a whole host of side effects. Sometimes periods will be normal, other times they will be lighter or heavier.

Around 70% of women are affected by menopausal changes, although lifestyle and other medication may influence the symptoms they experience. Women can often benefit from lifestyle changes such as exercising more, losing weight, stopping smoking and reducing alcohol intake, and this alone will be enough for some women to control the symptoms. For other women, the symptoms are severe and even with lifestyle changes, they still need extra help to live life to the full.

Many women first experience symptoms of menopause when they are still having their periods, since the change can take several years to occur and happens in stages. Hot flushes usually come in the early stages of menopause and affect 60%- 85% of menopausal women. The severity of these can vary drastically. At their worst, they can cause a lot of distress, disturb sleep and interfere with work., On average, the hot flushes last for two years but can continue for more than 15. A hot flush usually lasts three-to-five minutes at a time and often there is a daily pattern. Taking a cold shower, wearing layers so you have something to remove, ensuring you wear cool cotton clothing and avoiding spicy foods, caffeine and alcohol can all help to minimise the disturbance you experience with hot flushes.

Hot flushes can also go hand in hand with night sweats, palpitations, insomnia, joint aches and headaches, which can all occur early in the menopause, with changes in mood being another early symptom. You may experience difficulty coping, become forgetful or excessively anxious, or simply feel that life is getting on top of you. If you are feeling low, find someone to talk to and do not hesitate to seek medical assistance.

Your sex life may also suffer if you experience vaginal dryness due to the low levels of oestrogen in your body, or simply lower libido. You may find that if you get help in the form of HRT for your other symptoms, your libido will improve along with your mood. You can also get treatments specifically to help with vaginal dryness.

Later in the menopause cycle, you may experience urine infections or leaks, or the need to urinate frequently and an increased likelihood of vaginal dryness. These symptoms are often under-reported as many women are embarrassed to discuss such issues, but real help is available for those who do. Other later symptoms include skin itching or a crawling sensation and thinning hair. All in all, your body has a lot to go through, so there is no shame in seeking medical help if, after making lifestyle changes, you are still unable to lead a full, active life. Symptoms of menopause can last for many years, so there is no sense to suffer in silence.

One of the many treatment options available to help with menopausal symptoms is Evorel Sequi, an HRT that comes as a transdermal patch. The following paragraphs will explain how it works.

What is Evorel Sequi?

Evorel Sequi is a hormone replacement therapy (HRT) that comes as a transdermal patch. It contains two different female hormones, oestrogen in the form of estradiol and progesterone in the form of norethisterone. Estradiol is used by itself for the first two weeks of your menstrual cycle, then estradiol and norethisterone are used together for the last two weeks. The reason both hormones are present is to prevent excessive thickening of the lining of the womb.

When is Evorel Sequi used?

Evorel Sequi patches are used to treat menopausal symptoms. They can be used both during and after the menopause (as symptoms can continue for some time after menopause has finished). It can only be used by women who still have their womb. In certain cases, Evorel Sequi can also be used to prevent osteoporosis, but it should not be the first line of treatment.

How do you use Evorel Sequi?

Evorel Sequi patches come in what is known as a ’memory pack’, to help you remember when to use / remove the patches. Each pack contains four Evorel patches and four Evorel Conti patches. Always use Evorel Sequi as directed by your doctor. They will aim to give you the lowest dose of HRT for the shortest possible time to alleviate your symptoms.

You only ever need to wear one Evorel Sequi patch at a time. Apply the patch below the waist (usually on the thigh or bottom). Do not use on irritated or broken skin or near the breast. Avoid putting any creams or products on the skin before trying to apply the patch, and do not wear it in the same place twice in a row. Apply the Evorel Sequi patch to clean, dry, cool skin.

To apply the Evorel Sequi patch, tear along the two edges of the pouch using the notches as a guide. Peel off half of the backing, and do not touch the sticky side. Apply the open half of the patch to your skin and press firmly. Remove the remaining backing and press again to make sure the patch is firmly in place.

To remove the Evorel Sequi patch, peel smoothly away from the skin starting at one edge. Fold the patch in half, sticking the sticky side together, and place it in your household rubbish. Keep it away from children and pets.

What dosages are there?

Each Evorel 50 patch delivers 50 mg of estradiol per day. Each Evorel Conti patch delivers 50 mg of estradiol and 170 mg of norethisterone per day. Use the Evorel Sequi patches one at a time and change them twice a week. The memory pack will help you keep track of this:

  • weeks 1 and 2, you use the Evorel 50 patches;
  • weeks 3 and 4, you use the Evorel Conti patches.

When do you start using Evorel Sequi?

If you are still having periods, start your first Evorel Sequi patch within five days of bleeding. If you are already on a different HRT, start your first Evorel Sequi patch at the end of a treatment cycle or within one week of stopping. Otherwise, you can put on your first patch straight away.

What are the side effects of Evorel Sequi?

As with all medicines, Evorel Sequi patches come with some side effects, although not everyone will get them. The following diseases are reported more often in women using HRT compared to women who do not:

  • Ovarian cancer;
  • Breast cancer;
  • Heart disease;
  • Stroke;
  • Abnormal growth or cancer of the lining of the womb;
  • Blood clots in the leg veins or lungs;
  • Probable memory loss if HRT is started over the age of 65.

Be aware of the following when using Evorel Sequi patches as they may be signs of a serious problem:

  • Migraine for the first time;
  • Blood clots or stroke;
  • Yellowing skin or white of the eyes (jaundice);
  • Sudden swelling of the face or throat, difficulty breathing;
  • An increase in blood pressure;
  • Convulsions or fits;
  • Breast cancer or ovarian cancer.

If any of these occur take off the patch straight away and seek urgent medical assistance.

Very common side effects, affecting more than 1 in 10 people:

  • Irritated, itchy red skin where the patch has been applied.

Common side effects, affecting fewer than 1 in 10 people:

  • Unsteady emotions;
  • Insomnia;
  • Feeling depressed or nervous;
  • Headache;
  • Feeling sick;
  • Upset stomach;
  • Diarrhoea;
  • Breast pain;
  • Weight gain;
  • Heavy vaginal bleeding;
  • Water retention.

Uncommon side effects, affecting fewer than 1 in 100 people:

  • Dizziness;
  • Allergic reaction;
  • Numb or tingly hands or feet;
  • Irregular bleeding;
  • Thickening of the lining of the womb;
  • Thrush;
  • Changes in libido;
  • Feeling tired;
  • Concentration problems.

Uncommon sides effects, affecting fewer than 1 in 100 people:

  • Varicose veins;
  • Skin discolouration;
  • Vomiting;
  • Dizziness;
  • Abnormal liver function tests.

In rare cases, you may experience the following, which affect fewer than 1 in 1,000 people:

  • Muscle weakness;
  • Benign growth in the uterus;
  • Cysts close to the fallopian tube;
  • Cervical polyps;
  • Gallstones.

When should you not use Evorel Sequi? You should not use Evorel Sequi if you:

  • Have or have ever had breast cancer;
  • Are allergic to anything in the patches;
  • Have thickening of the lining of the womb;
  • Have or have ever had cancer that is made worse with oestrogens;
  • Have unexplained vaginal bleeding;
  • Have an increased risk of blood clots;
  • Have ever had a blood clot in a vein or lung;
  • Have or have ever had a liver disease and your liver function tests have not returned to normal;
  • Have ever had blocked arteries;
  • Have a blood problem called porphyria.

If any of these appear for the first time while using Evorel Sequi, seek immediate medical assistance. You may also need to take special care with Evorel Sequi if you have any of the following:

  • A family history of breast cancer or ovarian cancer;
  • High blood pressure;
  • Diabetes;
  • Gallstones;
  • Previous problems caused by the growth of the lining of the womb (fibroids, endometriosis);
  • Previous unexplained vaginal bleeding;
  • Epilepsy;
  • Asthma;
  • Migraines;
  • Breast problems;
  • Thyroid problems;
  • Otosclerosis;
  • A history of sudden swelling in the face or throat;
  • High levels of fat in your blood.

If any of these apply to you, you can still take Evorel Sequi patches but will need to have more frequent check-ups so that you can be closely monitored by your doctor.

Does Evorel Sequi interact with other medications?

You should always talk to your doctor about any other medication you are taking, including complementary medicines as these may interfere with Evorel Sequi or vice versa. It is particularly important you let your doctor know if you are taking any of the following:

  • Medicine for hepatitis C;
  • St John’s Wort;
  • Medication for epilepsy;
  • Certain medicines for tuberculosis;
  • Medicine for HIV infection;
  • Bosentan for high blood pressure.

Where can you buy Evorel Sequi?

You can buy Evorel Sequi patches from any pharmacy, wherever it is convenient for you. You can go to your local chemist or supermarket, or order online.

Can I get Evorel Sequi without a prescription?

You cannot buy Evorel Sequi without a prescription, as you will need to talk to a doctor so that they can assess if the medicine is suitable for you and weigh up any risks involved with your medical history.

References:

Jannsen-Cilag Ltd Evorel Sequi Patient Leaflet (June 2016) Retrieved from https://www.medicines.org.uk/emc/product/10930

MenopauseMatters.co.uk Menopause symptoms (March 2019) Retrieved from https://www.menopausematters.co.uk/symptoms.php

NHS UK Menopause Treatment (August 2018) Retrieved from https://www.nhs.uk/conditions/menopause/treatment/

Patient Leaflet(s)
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