What are Evorel patches?
Evorel HRT patches are a form of hormone replacement therapy used to alleviate menopause symptoms.
Key features of Evorel HRT patches include:
- Gradual hormone release: Ideal for those who have difficulty swallowing tablets or remembering daily doses.
- Twice-weekly application: Patches need to be replaced only twice a week.
- Contains estradiol: Mimics the female sex hormone oestrogen.
- Available strengths: 25mcg, 50mcg, 75mcg, and 100mcg.
- Symptom relief: Provides relief from menopausal symptoms within a few weeks of regular use.
As your body adjusts to Evorel, you may experience breakthrough bleeding or spotting. If this persists beyond a few months, consult your GP. HRT is typically a short-term treatment to help your body transition through menopause. It is essential to review your HRT with your GP annually and have regular gynecological checkups.
HRT does not prevent pregnancy in fertile women. Women under 50 are considered fertile until two years after their last menstrual cycle (one year for women over 50). Do not use hormonal contraceptives while undergoing HRT.
What are Evorel patches used for?
Evorel is used to treat:
- Symptoms of menopause (see ‘What is the menopause?’ below)
Evorel 50, 75, and 100 can also be used to:
- Prevent osteoporosis (fragile bones) in postmenopausal women who are at high risk of bone problems. These strengths are used if other osteoporosis treatments have been tried first and have not worked.
What is the Menopause?
Women produce oestrogen hormones from their ovaries throughout their adult life. These hormones are crucial for sexual development and control of the menstrual cycle.
The menopause occurs when the production of these hormones by the ovaries decreases, a gradual process. During this time, oestrogen levels can fluctuate, causing symptoms such as:
- Hot flushes
- Night sweats
- Mood swings
- Vaginal problems such as dryness or itching
- Uncomfortable or Painful Sexual Intercourse: You may experience the same symptoms if you have had your ovaries removed in an operation.
Relief of symptoms occurring after menopause:
- During menopause, the amount of oestrogen produced by a woman’s body drops, which can cause symptoms such as hot flushes (hot face, neck, and chest).
- Evorel helps alleviate these symptoms after menopause. You will only be prescribed Evorel if your symptoms seriously hinder your daily life.
Prevention of osteoporosis:
- After menopause, some women may develop fragile bones (osteoporosis). Discuss all available options with your doctor.
- If you are at an increased risk of fractures due to osteoporosis and other medicines are not suitable for you, Evorel can be used to prevent osteoporosis after menopause.
How do Evorel patches work?
Evorel patches replace the oestrogen that is normally released by the ovaries. However, in women who still have a womb, 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 from happening
Evorel is not a contraceptive.
Understanding menopause and Evorel treatment
During menopause, the production of oestrogen in a woman’s ovaries gradually decreases. This deficiency can lead to various symptoms, including hot flushes, depression, sleep problems, dryness, and osteoporosis. If these symptoms are severe, you may be prescribed Evorel to supplement your body’s oestrogen levels. Evorel should only be used to treat osteoporosis if other treatments have already been tried and proven ineffective.
Post-hysterectomy and oestrogen replacement:
- If you have had a hysterectomy (an operation to remove the uterus), oestrogen is the only hormone you will need to replace.
- If you have not had your uterus removed, you will be prescribed a progestogen medicine alongside Evorel. This is because increasing oestrogen levels alone can cause the lining of the uterus (the endometrium) to grow excessively, significantly increasing the risk of complications such as endometrial cancer.
Combined HRT for women with intact uterus:
- If you have not had a hysterectomy, you may be prescribed another medicine that provides combined HRT, which includes both oestrogen and progestogen, to mitigate the risk of endometrial overgrowth and related complications.
How to use Evorel patches
Follow your doctor's instructions precisely when using this medicine. If you have any doubts, consult your doctor or pharmacist.
Available Sizes: Evorel patches come in four different sizes: Evorel 25, Evorel 50, Evorel 75, and Evorel 100. Each size contains varying amounts of the oestrogen hormone, estradiol. Your doctor will prescribe the lowest effective dose to alleviate your symptoms for the shortest duration necessary. The maximum dose should not exceed 100 micrograms of estradiol per day, which is provided by the Evorel 100 patch.
Starting Evorel: You can start using an Evorel patch at any time if:
- You have not used HRT before menopause and no longer have menstrual periods.
- Your menstrual cycles are irregular, and you are not pregnant.
- You are switching from HRT that does not cause withdrawal bleeding.
If you are not currently using HRT and still have regular periods, apply an Evorel patch within 5 days of the start of bleeding.
If you are switching from an HRT medicine that causes withdrawal bleeding, apply an Evorel patch at the end of your treatment cycle or one week after you finish using the other HRT product.
Using the patches:
- The patches need to be changed twice a week.
- Start a new pack of Evorel immediately after finishing one without a break.
Important Notes:
- Always adhere to your prescribed dosage and schedule.
- Consult your doctor if you are uncertain about which type of HRT you are using or when to start Evorel patches.
Changing your Evorel patches
- Frequency: You must change the patches twice a week to maintain a steady supply of hormones. Each patch contains enough hormone to last for several days.
- Consistency: Change your patch on the same two days every week. This means one patch will be on for three days, and the next patch for four days.
Example Schedule: If you apply your first patch on a Monday, change it on Thursday, and then again on the following Monday. Refer to the table below to determine your change days:
| If you put your first patch on: |
Change on: |
Change again on: |
| Monday |
Thursday & Monday |
Thursday & Monday |
| Tuesday |
Friday & Tuesday |
Friday & Tuesday |
| Wednesday |
Saturday & Wednesday |
Saturday & Wednesday |
| Thursday |
Sunday & Thursday |
Sunday & Thursday |
| Friday |
Monday & Friday |
Monday & Friday |
| Saturday |
Tuesday & Saturday |
Tuesday & Saturday |
| Sunday |
Wednesday & Sunday |
Wednesday & Sunday |
- Follow this schedule to ensure you are changing your patches on the correct days each week.
To help you remember your two “patch change" days:
- Mark them here or on the pack. The days are listed on the pack like this:
Where to Apply the Patch:
- Stick the patch onto a hairless area of skin below the waist. Most women prefer to wear the patch on the thigh or bottom.
- Avoid the following areas:
- Do not apply on or near the breasts.
- Do not put it on top of cuts, spots, or any irritated skin.
- 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.
- Do not wear a patch under elasticated areas or a tight waistband.
- Application Tips:
- Apply the patch to clean, dry, cool skin as soon as you open the protective pouch.
- It can be worn under loose areas of clothing.
- Applying the PatchDo not use a patch if its protective pouch is already open.
Applying the patch
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 and remove the patch.
- With the protective backing facing you, bend and peel off half the backing. Avoid touching the sticky side to ensure proper adhesion.
Step 2: Apply and Press
- Apply the exposed half of the patch to your skin.
- Remove the remaining backing and press down the rest of the patch.
- Press the patch firmly with the palm of your hand to ensure it is securely attached.
Removing a patch
- Peel: Gently peel an edge of the patch away from your skin.
- Fold: Fold the patch in half, so the sticky sides stick together.
- Dispose: Dispose of the used patch in household rubbish, keeping it out of reach of children and pets. Do not flush used patches down the toilet.
If some glue remains on your skin after removing the patch, it will disappear over time or can be removed with baby oil.
If a patch falls off
- Replace: Apply a new patch but continue with your original 'patch change' days. If you have just bathed or showered, wait until your skin is cool and dry before applying a new patch.
- Consult: Speak with your doctor if you need more patches.
If you use more Evorel than you should
- Overuse Symptoms: It is unlikely to overdose on the hormones in Evorel. Symptoms of excessive oestrogen include:
- Tender or painful breasts
- Nausea or vomiting
- Unexpected vaginal bleeding
- Stomach pain or bloating
- Action: Removing the patch can reverse the effects of too much oestrogen. Consult your doctor or pharmacist before using more patches. Your doctor may adjust the patch size.
If you forget to use Evorel
- Missed Patch: Apply a new patch as soon as you remember, then continue with your original 'patch change' days. You may experience some bleeding and spotting, similar to a period, during this time.
Contraception while using Evorel
- Effectiveness: The hormone levels from the patches are too low to serve as contraceptives. Use non-hormonal contraceptive methods (such as condoms, diaphragms, or coils) until your periods have completely stopped.
Everyday activities
- Bathing and Showering: You can bathe or shower as usual, but avoid scrubbing too hard as this may loosen the patch edges.
- Swimming: Swimming is fine; the patch will remain unaffected.
- Exercise and Sports: You can engage in exercise and sports. However, avoid placing the patch under tight clothing or waistbands.
- Sunbathing: You can sunbathe, but keep the patch covered and out of direct sunlight.
If you have any further questions about using this product, consult your doctor or pharmacist.
If you need to have surgery
If you are scheduled for surgery, inform the surgeon that you are using Evorel. You may need to stop using Evorel 4 to 6 weeks before the operation to reduce the risk of blood clots (see section on "Blood clots in a vein"). Ask your doctor when you can resume using Evorel.
If you stop using Evorel
If you have any additional questions about the use of this medicine, ask your doctor.
Who should not use Evorel patches?
Do not use Evorel if any of the following conditions apply to you. If you are unsure about any of these points, talk to your doctor before using Evorel:
- You have or have ever had breast cancer, or if it is suspected that you have it.
- You have cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if it is suspected that you have it.
- You have any unexplained vaginal bleeding.
- You have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated.
- You have or have ever had a blood clot in a vein (thrombosis), such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism).
- You have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency).
- You have or have recently had a disease caused by blood clots in the arteries, such as a heart attack, stroke, or angina.
- You have or have ever had liver disease and your liver function tests have not returned to normal.
- You have a rare inherited blood problem called porphyria.
- You are allergic (hypersensitive) to estradiol or any of the other ingredients of Evorel (listed in section 6, Further Information).
If any of the above conditions appear for the first time while taking Evorel, stop using it immediately and consult your doctor.
Important information before using Evorel
Evorel should not be used by children.
When to use special care with Evorel
Before starting treatment with Evorel, inform your doctor if you have ever experienced any of the following conditions, as they may return or worsen during treatment. Your doctor may need to monitor you more frequently:
- Fibroids inside your womb
- Growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
- Increased risk of developing blood clots (see “Blood Clots in a Vein (Thrombosis)”)
- Increased risk of developing an oestrogen-sensitive cancer (such as having a mother, sister, or grandmother who has had breast cancer)
- High blood pressure
- Liver disorder, such as a benign liver tumor
- Diabetes
- Gallstones
- Migraine or severe headaches
- Systemic lupus erythematosus (SLE), a disease of the immune system that affects many organs
- Epilepsy
- Asthma
- Otosclerosis, a disease affecting the eardrum and hearing
- Very high levels of fat in your blood (triglycerides)
- Fluid retention due to cardiac or kidney problems
- Hereditary and acquired angioedema
- Mastopathy
Regular check-ups and self-exams
- Go for regular breast screenings 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
If you notice any changes or have concerns, contact your doctor promptly.
Stop using Evorel and seek medical attention immediately
If you experience any of the following while taking HRT, stop using Evorel and contact your doctor right away:
- Any of the conditions mentioned in the 'DO NOT take Evorel' section
- Yellowing of your skin or the whites of your eyes (jaundice), which may indicate liver disease
- Swollen face, tongue, and/or throat, difficulty swallowing, or hives, accompanied by difficulty breathing, which are suggestive of angioedema
- A significant increase in your blood pressure (symptoms may include headache, tiredness, dizziness)
- Migraine-like headaches occurring for the first time
- If you become pregnant
- Signs of a blood clot, such as:
- Painful swelling and redness of the legs
- Sudden chest pain
- Difficulty in breathing
For more information, see 'Blood clots in a vein (thrombosis)'.
Note:
- Evorel is not a contraceptive. If it has been less than 12 months since your last menstrual period or if you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice.
Considerations when taking HRT
While HRT can provide benefits, it also carries some risks. It's important to consider these factors when deciding to start or continue HRT. If you have any concerns or questions, consult your doctor for guidance.
HRT and cancer
Excessive Thickening of the Lining of the Womb (Endometrial Hyperplasia) and Cancer of the Lining of the Womb (Endometrial Cancer)
Using oestrogen-only HRT can increase the risk of excessive thickening of the womb lining (endometrial hyperplasia) and endometrial cancer. Taking a progestogen alongside oestrogen for at least 12 days of each 28-day cycle helps mitigate this risk. Your doctor will prescribe a progestogen separately if you still have your womb. If you have had a hysterectomy, discuss with your doctor whether you can take oestrogen-only HRT safely.
In women aged 50 to 65 who do not take HRT, about 5 in 1000 will be diagnosed with endometrial cancer. Among those who take oestrogen-only HRT, between 10 and 60 in 1000 will be diagnosed with endometrial cancer, depending on the dose and duration of HRT use.
Evorel 100 contains a higher dose of oestrogens than other oestrogen-only HRT products, and the risk of endometrial cancer when using Evorel 100 with a progestogen is not known.
Breast cancer
Evidence shows that both combined oestrogen-progestogen HRT and oestrogen-only HRT increase the risk of breast cancer. The extra risk depends on the duration of HRT use, becoming apparent within three years of use. After stopping HRT, the additional risk gradually decreases, but it may persist for 10 years or more if HRT has been used for over five years.
Comparing the risks of breast cancer
Women Aged 50 to 54
- For women not taking HRT: On average, 13 to 17 in 1000 will be diagnosed with breast cancer over a 5-year period.
- For women aged 50 who start taking oestrogen-only HRT for 5 years: There will be 16 to 17 cases in 1000 users (an extra 0 to 3 cases).
- For women aged 50 who start taking oestrogen-progestogen HRT for 5 years: There will be 21 cases in 1000 users (an extra 4 to 8 cases).
Women Aged 50 to 59
- For women not taking HRT: On average, 27 in 1000 will be diagnosed with breast cancer over a 10-year period.
- For women aged 50 who start taking oestrogen-only HRT for 10 years: There will be 34 cases in 1000 users (an extra 7 cases).
- For women aged 50 who start taking oestrogen-progestogen HRT for 10 years: There will be 48 cases in 1000 users (an extra 21 cases).
Regular breast checks
It is important to regularly check your breasts and see your doctor if you notice any changes such as:
- Dimpling of the skin
- Changes in the nipple
- Any lumps you can see or feel
Mammography screening
You are advised to join mammography screening programs when offered. Inform the nurse/healthcare professional taking the x-ray that you use HRT, as this medication may increase the density of your breasts, potentially affecting the mammogram's outcome. Increased breast density may make it more challenging to detect all lumps during mammography.
Ovarian cancer
Ovarian cancer, or cancer of the ovaries, is relatively rare compared to breast cancer. The use of both oestrogen-only and combined oestrogen-progestogen HRT has been linked to a slightly increased risk of developing ovarian cancer.
Risk Comparison
- Women aged 50 to 54 not taking HRT: About 2 in 2000 will be diagnosed with ovarian cancer over a 5-year period.
- Women aged 50 to 54 taking HRT for 5 years: About 3 in 2000 will be diagnosed with ovarian cancer, which equates to approximately 1 extra case per 2000 users.
Effect of HRT on heart and circulation
Blood clots in a vein (thrombosis)
The risk of developing blood clots in the veins is about 1.3 to 3 times higher in HRT users compared to non-users, particularly during the first year of treatment. Blood clots can be severe; if one travels to the lungs, it can cause chest pain, breathlessness, fainting, or even death.
Increased risk factors
You are more likely to develop a blood clot in your veins as you age, and the risk increases if any of the following apply to you. Inform your doctor if:
- You are unable to walk for an extended period due to major surgery, injury, or illness (see section 3, "If you need to have surgery").
- You are seriously overweight (BMI >30 kg/m²).
- You have any blood clotting disorders requiring long-term treatment with anticoagulants.
- Any close relatives have had blood clots in the leg, lung, or another organ.
- You have systemic lupus erythematosus (SLE).
- You have cancer.
For signs of a blood clot, refer to the "Stop using Evorel and see a doctor immediately" section.
Risk Comparison
- Women in their 50s not taking HRT: On average, 4 to 7 in 1000 would be expected to develop a blood clot in a vein over a 5-year period.
- Women in their 50s taking oestrogen-progestogen HRT for over 5 years: There will be 9 to 12 cases in 1000 users (i.e., an extra 5 cases).
- Women in their 50s who have had their womb removed and are taking oestrogen-only HRT for over 5 years: There will be 5 to 8 cases in 1000 users (i.e., 1 extra case).
Heart disease (heart attack)
There is no evidence that HRT will prevent a heart attack. Women over the age of 60 who use oestrogen-progestogen HRT are slightly more likely to develop heart disease than those not taking any HRT. However, for women who have had their womb removed and are taking oestrogen-only therapy, there is no increased risk of developing heart disease.
Stroke
The risk of having a stroke is about 1.5 times higher in HRT users compared to non-users. The number of extra cases of stroke due to HRT use increases with age.
Risk Comparison
- Women in their 50s not taking HRT: On average, 8 in 1000 would be expected to have a stroke over a 5-year period.
- Women in their 50s taking HRT: There will be 11 cases in 1000 users over 5 years (i.e., an extra 3 cases).
If you experience unexplained migraine-type headaches, it could be an early warning sign of a stroke. In such cases:
- See a doctor as soon as possible.
- Do not take any more HRT until your doctor advises you can continue.
Other conditions
If you have or have had brown patches on your face or body (chloasma), you may need to avoid sun exposure and sunbeds, as these patches may not fully disappear.
Dementia
Evorel and similar medicines will not prevent memory loss (dementia). Women who start using medicines like Evorel after the age of 65 may have a slightly increased risk of developing dementia.
Operations or tests
Tell your doctor if you are going to have surgery. You may need to stop taking HRT about 4 to 6 weeks before the operation to reduce the risk of a blood clot. Your doctor will inform you when you can resume taking HRT.
If you visit a hospital or your family doctor for a blood or urine test, inform them that you are taking Evorel. This is because this medicine may affect the test results.
Pregnancy and breast-feeding
Do not use this medicine if you are pregnant, think you may be pregnant or might become pregnant, as it may affect the baby. If you become pregnant, contact your doctor immediately and remove the patch.
Do not use this medicine if you are breast-feeding.
If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, consult your doctor for advice before taking this medicine.
Evorel is for use in postmenopausal women only. If you become pregnant, stop using Evorel and contact your doctor.
Driving or using machines
There is no information available about whether Evorel affects your ability to drive or use machines. Observe how this medicine affects you before you drive or use any tools or machines.
What are the side effects of the Evorel patch?
Like all medicines, Evorel can cause side effects, although not everyone will experience them. Side effects may occur more frequently with larger patch sizes. Some side effects may also result from any progestogen being taken concurrently.
The following conditions are reported more often in women using HRT compared to those not using HRT:
- Breast cancer
- Abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)
- Ovarian cancer
- Blood clots in the veins of the legs or lungs (venous thromboembolism)
- Heart disease
- Stroke
- Probable memory loss if HRT is started over the age of 65
For more information about these side effects, see Section 2.
Serious side effects
Remove the patch and contact your doctor immediately if you notice or suspect any of the following, as you may need urgent medical treatment:
- Sudden swelling of the face or throat which may cause difficulty in swallowing or breathing (signs of an allergic reaction, though rare)
- Blood clots (thrombosis), heart attack, or stroke
- Yellowing of the skin or whites of the eyes (jaundice) or other liver problems
- Migraine-type headaches occurring for the first time or more frequently (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)
Always consult your doctor or healthcare provider if you have concerns or experience any side effects while using Evorel.
Less common side effects
Uncommon (affects less than 1 in 100 people):
- Vaginal thrush
- Gas (wind)
- Awareness of heartbeat (palpitations)
- Fuller breasts
- Painful periods
- Swelling of hands and feet (peripheral edema)
- Water retention or fluid build-up under the skin (edema)
- Muscle pain
- Allergic reactions (hypersensitivity)
Rare (affects less than 1 in 1,000 people):
- Feeling bloated
- Gallstones
Side Effects Reported with Other HRTs
Common (affects less than 1 in 10 people):
- Weight decrease
- Nausea (feeling sick)
Uncommon (affects less than 1 in 100 people):
- Vision problems
- Indigestion
- Painful reddish skin nodules (erythema nodosum)
- Tender breasts
Rare (affects less than 1 in 1,000 people)
- Feeling anxious
- Increase or loss in sex drive
- Vomiting
- Discomfort with contact lenses
- Excess hair growth
- Acne
- Muscle cramps
- Vaginal discharge, premenstrual syndrome (PMS)
- Feeling tired
Side Effects Associated with Oestrogen/Progestogen Treatment
- Gall bladder disease
- Brown patches on your face or body (chloasma), discoloration of the skin especially on the face or neck
- Rash with target-shaped reddening or sores (erythema multiforme)
- Painful reddish skin nodules (erythema nodosum)
- Bruising on the legs
- Loss of memory (dementia)
Reporting of Side Effects
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.
Do the Evorel patches interact with other medicines?
Interactions with other medicines
Some medicines may interfere with the effect of Evorel, potentially leading to irregular bleeding. This applies to the following medicines:
- Medicines for epilepsy: such as phenobarbital, phenytoin, and carbamazepine.
- Medicines for tuberculosis: such as rifampicin and rifabutin.
- Medicines for HIV infection: such as nevirapine, efavirenz, ritonavir, and nelfinavir.
- Herbal remedies containing St John’s Wort: (Hypericum perforatum).
- Medicines for Hepatitis C virus (HCV): such as combination regimens ombitasvir/paritaprevir/ritonavir with or without dasabuvir, as well as a regimen with glecaprevir/pibrentasvir, which may cause increases in liver function blood test results (increase in ALT liver enzyme) in women using CHCs containing ethinylestradiol. Evorel contains estradiol instead of ethinylestradiol. It is not known whether an increase in ALT liver enzyme can occur when using Evorel with this HCV combination regimen. Your doctor will advise you.
Please inform your doctor or pharmacist if you are taking or have recently taken any other medicines, including those obtained without a prescription, herbal medicines, or other natural products.
