Evorel Sequi patches are a type of HRT used to treat menopause symptoms. It is known as a sequential or cyclical hormone replacement therapy because it contains 2 types of patch that you switch between. Each box of Evorel Sequi holds:

• 4 Evorel 50 patches containing estradiol (oestrogen) only
• 4 Evorel Conti patches containing a combination of estradiol and a man-made version of progesterone (norethisterone)

The patches are applied to the skin twice a week to deliver a controlled amount of hormones into the bloodstream to provide effective relief from menopause symptoms. Evorel Sequi is supplied in a ‘memory pack’ to help you keep track of your treatment and remind you when you need to change your patch.

“Evorel Sequi patches are not suitable for people who have had their womb removed because they contain both oestrogen and progesterone hormones. If you’ve had a hysterectomy, you should use oestrogen-only HRT treatments. Your doctor will advise you on the most suitable HRT for you.” Dr Brenda Ikeji, Medical Editor.

Evorel Sequi patches work by replacing the hormones that are low as you approach menopause. During menopause, the body produces less oestrogen, a female sex hormone that is vital for regulating the menstrual cycle. Oestrogen is usually released by the ovaries, but as it declines, it causes many of the uncomfortable symptoms associated with the menopause. So, Evorel Sequi restores your oestrogen levels to relieve menopause symptoms by delivering oestrogen in a controlled and continuous way.

However, if you still have your womb intact, taking a regular oestrogen hormone can cause the lining of the womb to build up. So, the addition of Evorel Conti patches during weeks 3 and 4 of your treatment helps shed the womb lining and reduces the risk of adverse effects, meaning most women experience a ‘withdrawal bleed’, like a period, each month.

How long does Evorel Sequi take to work?

Evorel Sequi works quickly to relieve the symptoms of the menopause but it can take a few weeks to notice a significant improvement. In some people, it can take up to 3 months for HRT to fully improve your symptoms.

How long Evorel Sequi takes to work can vary from person to person. If you are concerned that your treatment isn’t working or may not be right for you, speak to your doctor for advice.

How effective are Evorel Sequi patches?

Some research shows that relief from menopause symptoms was achieved in the first few weeks of Evorel Sequi treatment.

Further studies have shown that the average number of hot flushes is reduced during treatment with a low dose estradiol and norethisterone HRT patch.

During week 1 of treatment, on average patients experienced:

• 15.5 mild hot flushes
• 19.0 moderate hot flushes
• 10.8 severe hot flushes

During week 12 of treatment, on average patients experienced:

• 5.0 mild hot flushes
• 3.0 moderate hot flushes
• 1.1 severe hot flushes

During week 52 of treatment, on average patients experienced:

• 4.1 mild hot flushes
• 2.3 moderate hot flushes
• 0.9 severe hot flushes

Menopause can increase the risk of osteoporosis (a disease that can lead to weak bones and fractures) because it causes a decrease in bone density. HRT like Evorel Sequi can help reduce osteoporosis risk. A 2-year clinical trial comparing Evorel 50 (the estradiol-only patch) to a placebo found that it increased bone mineral density (BMD) in the spine by up to 4.46%.

The study also showed that the percentage of women who maintained or gained BMD in their lumbar spine while using Evorel 50 was 84%.

Evorel 50 also improved the density of bone in the hip with 93% of women gaining or maintaining BMD.

Evorel Sequi should only be used exactly as your doctor has prescribed.

Evorel Sequi patches need to be changed twice a week and the patches must be applied in the right order:

• Weeks 1 and 2: Apply the 4 Evorel 50 patches, one at a time. The patch should be changed every 3 to 4 days.
• Weeks 3 and 4: Use the 4 Evorel Conti patches one at a time, replacing them every 3 to 4 days. When you remove the fourth Evorel 50 patch, replace it with the first Evorel Conti patch from a new pack. There are no breaks between Evorel Sequi patches.

To apply Evorel Sequi patches:

1. Choose where you are going to stick the patch to your skin. Choose a hairless area of skin below your waist, such as your thigh or buttocks. Never stick the patch to your breasts or irritated skin or anywhere where it could be irritated by tight clothing.
2. Open and peel the patch: Using the notches to guide you, tear along the 2 edges of the pouch and remove the patch. With the protective backing facing you, bend and peel away half of the backing, being careful not to touch the sticky side.
3. Apply and press: Stick the open half of the patch to your skin. Remove the other half of the backing and press down firmly on the rest of the patch. Use your palm to press the whole patch to make sure it is fully stuck to your skin.
4. Removing a patch: Peel an edge of the patch smoothly away from your skin. Once removed, fold the patch in half so the sticky side sticks to itself and throw it away in your household rubbish. Never flush the patches down the toilet.
5. Removing residue: Sometimes, a small amount of glue may remain on your skin. It will disappear on its own after a while or you can use baby oil to remove it.

If you find any of this process difficult, get someone to help you.

When to apply Evorel Sequi

You can apply an Evorel Sequi patch anytime if:

• you have not used HRT before your menopause and you no longer have periods
• your menstrual cycles are irregular and you are not pregnant
• you are changing from a type of HRT that does not cause a withdrawal bleed

You should apply an Evorel 50 patch on days 1 to 5 of your period if you still have regular periods and are not currently using HRT.

Apply an Evorel 50 patch at the end of a treatment cycle or 1 week after you finish using another HRT product if you are changing from a hormone replacement therapy that gives you a withdrawal bleed.

Your doctor will also give you detailed instructions on when to start using Evorel Sequi before you start treatment.

How often to apply Evorel Sequi

Evorel Sequi patches must be changed twice a week to ensure your body is getting a steady hormone supply.

Your patch change days should be the same 2 days each week, so one patch will be on for 3 days and the other for 4. For example, if you apply your first patch on a Monday, change it on Thursday, and then again on the following Monday.

How long do you need to use Evorel Sequi for?

Many women take HRT for 2 to 5 years to treat menopause symptoms. How long you will need to take it for will depend on your symptoms.

How long will an Evorel Sequi patch last?

Each patch contains enough hormones to last 3 to 4 days before needing to be changed.

An Evorel Sequi cycle lasts for 28 days . For the first 14 days, you’ll use a patch that only contains estradiol and then for a further 14 days you’ll apply patches that contain estradiol and norethisterone.

Evorel Sequi patches are only available on prescription, so you will need a doctor's approval before obtaining them. You can request Evorel Sequi patches from reputable online services like Superdrug Online Doctor or you may get them on the NHS.

Can I buy Evorel Sequi online?

Yes, Evorel Sequi patches can be requested from Superdrug Online Doctor by:

1. Filling in a brief questionnaire about your health and lifestyle.
2. Ordering your preferred choice of treatment and making payment.
3. One of our doctors will review your order and questionnaire answers.
4. If your order is approved, your treatment will be posted directly to your address or made available for collection at a Superdrug Pharmacy.
5. If your order is not right for you, one of our doctors will contact you via your account with other suitable options.

Can I buy Evorel Sequi over-the-counter?

No, Evorel Sequi is not available to buy over-the-counter as you need a prescription from a doctor to get it. Gina is a type of HRT tablet that is available to buy without a prescription. It’s different to Evorel Sequi as it only treats vaginal symptoms caused by menopause because it’s inserted directly into the vagina with an applicator.

Can I get Evorel Sequi on the NHS?

Yes, Evorel Sequi patches are available on the NHS but you will need to make an appointment with your GP to find out if they are suitable for you to use.

Like all medications, Evorel Sequi patches can cause side effects but not everyone will get them.

Very common (affecting more than 1 in 10 people):

• itchy, red skin where the patch is applied – this may be reduced by applying your patch to a different part of your skin each time and avoiding areas that seem sensitive or are in contact with tight clothes

Common Evorel Sequi side effects (affecting less than than 1 in 10 people):

• depression
• nervousness
• difficulty sleeping
• headache
• itchy skin or rash
• feeling sick (nausea)
• stomach pain, upset, or wind
• breast pain
• back, muscle, or joint pain
• feeling generally unwell
• weight gain
• heavy vaginal bleeding or painful periods
• water retention

Uncommon side effects (affecting less than 1 in 100 people):

• difficulty concentrating
• dizziness
• changes in sex drive
• tiredness
• heart palpitations
• thrush
• numbness or tingling in your hands or feet
• larger breasts
• irregular vaginal bleeding
• thickening of the womb lining

If you experience any of the following serious Evorel Sequi side effects, remove the patch and call 999 or go to A&E immediately:

• swollen face or throat that causes difficulty swallowing or breathing, swelling of the hands and feet, and stomach cramps (severe allergic reaction symptoms)
• yellowing of the skin or whites of the eyes (jaundice)
• migraine-like headaches
• increase in blood pressure
• widespread rash with peeling or blistering skin
• seizures
• signs of cancer

You can find a full list of side effects in the patient leaflet that is supplied with your medication.

How long do Evorel Sequi side effects last?

Evorel Sequi side effects are usually mild and will go away on their own. They are more common during the first 3 months of treatment as your body gets used to the hormone changes.

What to do if you get Evorel Sequi side effects?

If you experience side effects while using Evorel Sequi patches and they are difficult to manage or they have lasted longer than 3 months, speak to your doctor for advice.

Mild side effects like pain or headaches can usually be managed with over-the-counter medications, such as paracetamol.

Do not use Evorel Sequi if you:

• are or think you might be pregnant
• have or have ever had breast cancer
• have cancer that is sensitive to oestrogen, such as endometrial cancer
• have unexplained vaginal bleeding
• have a thickening of the womb lining that is untreated
• have or have ever had a blood clot in a vein in the legs, lungs, or other organs
• have a blood clotting disorder
• have angina or have had a heart attack
• have or have had liver disease
• are allergic to any of the ingredients in Evorel Sequi
• have a condition called porphyria

Before using Evorel Sequi, tell your doctor about any prescription, over-the-counter, or herbal medications you are taking, including those used to treat:

• epilepsy
• tuberculosis
• HIV
• hepatitis C
• high blood pressure in the blood vessels of the lungs

Evorel Sequi and alcohol

You can drink alcohol while using Evorel Sequi but it is recommended that you cut down on alcohol during menopause. That’s because it can disrupt your sleep and contribute to flushing symptoms.

There is also some evidence to suggest that drinking alcohol and using hormone replacement therapy (HRT) increases the risk of breast cancer. If you are concerned, speak to your doctor or nurse.

There are several different forms of HRT available to treat menopause symptoms. If Evorel Sequi isn’t right for you, we also offer:

Other HRT patches

Patches that are applied directly to the skin to replace declining hormones. They are available as oestrogen-only, such as Evorel Conti and Estradot, or in combined forms like Evorel Sequi.

HRT pills

Combination HRT tablets contain oestrogen and progesterone. They are taken once daily and can treat the short term effects of menopause. Examples include:

• Elleste Duet Conti
• Femoston Conti
• Kliofem
• Kliovance
• Tibolone

Progesterone only pills

• Utrogestan: A progesterone-only pill also known as ‘micronised progesterone’. Usually taken alongside oestrogen patches to treat menopause symptoms in women who still have their womb intact.

Vaginal tablets

These are inserted directly into the vagina, usually to help relieve the symptoms of vaginal dryness. Examples include:

• Vagifem and Vagirux
• Gina: An over-the-counter, low-dose, oestrogen-only pill available to buy at a pharmacy.

Creams and gels

• Estriol cream: Applied using an applicator directly inside your vagina. It is useful for treating menopause symptoms that are linked to the thinning of the vaginal wall or can be taken with other HRT to treat wider symptoms.
• Ovestin: A vaginal cream that contains estradiol, a type of oestrogen, that’s used to relieve vaginal dryness.

Non-hormonal menopause treatments

Veoza tablets are a non-hormonal menopause treatment that relieves hot flushes and night sweats. Rather than using hormones to treat symptoms, Veoza targets the area of the brain that controls the vasomotor symptoms.

Evorel Sequi vs Evorel Conti

Evorel Conti is a continuous combined HRT which means oestrogen and progesterone are released continuously while you wear the patch. Whereas Evorel Sequi is cyclical and delivers oestrogen for 14 days and then a combination of oestrogen and progesterone for 14 days.

What are the benefits of Evorel Sequi?

Evorel Sequi is a type of HRT that’s effective for treating menopause symptoms. The benefits of Evorel Sequi include:

• effective treatment for hot flushes, night sweats, vaginal dryness and mood swings
• suitable for women who have their womb intact
• preventing osteoporosis

Find out more about the benefits of using HRT before starting treatment.

Do you still get periods on Evorel Sequi?

When you use Evorel Sequi, you will likely have a withdrawal bleed which is similar to having a period. That’s because oestrogen can thicken the lining of the womb, so progesterone can help to shed it to stop any complications.

Does Evorel Sequi cause weight gain?

Although weight gain is listed as a common side effect of Evorel Sequi, there is no good evidence that sequential combined HRT causes you to put weight on. This may be more due to the changes that happen in your body during menopause – as oestrogen levels reduce, studies show that visceral (belly) fat increases by 5% to 7%, metabolic rate slows and muscle mass reduces. These all contribute to weight gain.

How strong is Evorel Sequi?

The strength of the 2 patches in Evorel Sequi are as follows:

• Evorel 50: 3.2mg estradiol hemihydrate
• Evorel Conti: 3.2mg estradiol hemihydrate and 11.2mg norethisterone acetate