Evorel® 50
What is Evorel® and what it is used for?
The name of your medicine is Evorel 50 micrograms per 24 hours Transdermal Patch. Evorel is a Hormone Replacement Therapy (HRT). It contains the female hormone oestrogen. Evorel is used in postmenopausal women with at least 18 months since their last natural period.
Evorel is used for:
- The relief of symptoms occurring after the 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. You will only be prescribed Evorel if your symptoms seriously hinder your daily life.
- Prevention of osteoporosis. After the menopause some women may develop fragile bones (osteoporosis). You should discuss all available options with your doctor. If you are at an increased risk of fractures due to osteoporosis and other medications are not suitable for you, you can use Evorel to prevent osteoporosis after menopause.
How does it 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 happening
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. Speak to your doctor for advice.
How to use Evorel
Always use Evorel exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. Your doctor will aim to prescribe the lowest dose to treat your symptoms for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough.
Evorel comes in a ‘memory pack’. This can be used to help you remember when to change your patches. Each pack contains eight patches. The hormone is spread evenly in each patch. It passes slowly into your body through the skin.
When to start using Evorel
Put an Evorel patch on at the end of a treatment cycle if:
- You are changing from an HRT medicine that gives you a withdrawal bleed
You may put an Evorel patch on at any time if:
- You have not used HRT before your menopause
- You are changing from HRT that does not give you a withdrawal bleed
Talk to your doctor if you are not sure which type of HRT you are using.
Using the patches
The patches need to be changed twice a week. Start a new pack of Evorel as soon as you finish one. Do not leave a break between packs.
Changing your patches
- 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.
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.
- 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
What happens 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 shower, wait until your skin cools before applying a new patch.
Talk to your doctor if you need more patches.
What happens if I forget to change the 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.
Frequently asked questions about Evorel®
Can I use Evorel as a contraceptive?
The levels of hormone from the patches are too low to act as a contraceptive.
Talk to your doctor for advice on contraception.
What happens if I get breakthrough bleeding or spotting?
Breakthrough bleeding or spotting is usually nothing to worry about, especially during the first few months of using HRT.
But if the bleeding or spotting:
- Carries on for more than the first few months
- Starts after you have been on HRT for a while
- Carries on even after you have stopped using HRT,
make an appointment to see your doctor as soon as possible. It could be a sign that your endometrium has become thicker.
What happens if I use more Evorel than I should?
It is unlikely that you will have too much of the hormones in Evorel. The most common symptoms of having too much oestrogen in your body are:
- Tender or painful breasts
- Feeling sick (nausea) or being sick
- Unexpected vaginal bleeding
- Stomach pain or bloating
Removing the patch can reverse the effects of too much oestrogen. Talk to your doctor or pharmacist before using any more patches. Your doctor may decide to change the size of patch.
What side effects may I experience?
Like all medicines, this medicine can cause side effects, although not everybody gets them. Some side effects may be due to any progestogen that is being taken at the same time.
The following diseases are reported more often in women using HRT compared to women 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 further information, please consult the Patient Information Leaflet.
Am I at risk of developing endometrial hyperplasia or endometrial cancer?
HRT is not recommended for women who have ever had cancer of the lining of the womb.
Using oestrogen-only HRT will increase the risk of excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the womb lining (endometrial cancer).
Taking a progestogen in addition to the oestrogen for at least 12 days of each 28-day cycle protects you from this extra risk. So, your doctor will prescribe a progestogen separately if you still have your womb. If you have had your womb removed (a hysterectomy), discuss with your doctor whether you can safely take this product without a progestogen.
How likely is endometrial cancer?
Looking at women aged 50 to 65 years, who still have a womb, on average, over the next 15 years:
- In women not taking HRT – 5 in 1000 will get endometrial cancer
- In women taking oestrogen-only HRT, the number will be 2 to 12 times higher (an extra 5 to 55 cases), depending on the dose and how long you take it for.
The addition of a progestogen to oestrogen-only HRT substantially reduces the risk of endometrial cancer.
Breast Cancer
- Women who have breast cancer or have had breast cancer in the past should not have HRT.
How likely is breast or ovarian cancer?
Evidence shows that taking combined oestrogen-progestogen or oestrogen-only hormone replacement therapy (HRT) increases the risk of breast cancer. The extra risk depends on how long you use HRT. The additional risk becomes clear within 3 years of use. After stopping HRT the extra risk will decrease with time, but the risk may persist for 10 years or more if you have used HRT for more than 5 years.
Women aged 50 to 54 who are 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 16-17 cases in 1000 users (i.e. 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 (i.e. an extra 4-8 cases).
- Women aged 50 to 59 who are 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 (i.e. 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 (i.e. an extra 21 cases).
If you notice any changes in your breast, such as:
- Dimpling of the skin
- Changes in the nipple
- Any lumps you can see or feel
Make an appointment to see your doctor as soon as possible.
Additionally, you are advised to join mammography screening programs when offered to you. For mammogram screening, it is important that you inform the nurse/healthcare professional who is actually taking the x-ray that you use HRT, as this medication may increase the density of your breasts which may affect the outcome of the mammogram. Where the density of the breast is increased, mammography may not detect all lumps.
Ovarian cancer
Ovarian cancer is rare, much rarer than breast cancer. The use of oestrogen-only or combined oestrogen-progestogen HRT has been associated with a slightly increased risk of ovarian cancer.
The risk of ovarian cancer varies with age. For example, in women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be about 3 cases per 2000 users (i.e., about 1 extra case).
