This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting or changing any treatment.
Evorel Sequi is a sequential, combined Hormone Replacement Therapy (HRT) designed to alleviate the symptoms of perimenopause. This prescription-only treatment follows a 28-day cycle: you apply an oestrogen-only patch twice a week for two weeks, then switch to a combined oestrogen and progestogen patch twice a week for the final two weeks.
Understanding Evorel Sequi as a Treatment Option
Evorel Sequi is a prescription-only HRT available in the UK for women experiencing perimenopausal symptoms who still have a womb. It is an MHRA-approved treatment that helps to supplement the body’s declining hormone levels, offering relief from symptoms like hot flushes, night sweats, and irregular periods.
In the UK, where menopause affects a significant number of women, regulated treatments like Evorel Sequi are a common option prescribed by healthcare professionals. You can find more clinical details in the official medication guidance for Evorel Sequi.
How the Two-Patch System Works
The Evorel Sequi pack contains two different types of patches that work together to mimic a natural monthly hormonal cycle. This sequential design is fundamental to its safety and efficacy for women who have not had a hysterectomy.
Here is a breakdown of the four-week cycle:
- Weeks 1 and 2: You will use the Evorel 50 patches. These contain only oestradiol (a form of oestrogen) to address menopausal symptoms directly.
- Weeks 3 and 4: You will switch to the Evorel Conti patches. These patches contain both oestradiol and a progestogen (norethisterone acetate).
The oestrogen component provides relief from symptoms such as hot flushes and mood swings. However, using oestrogen alone can cause the lining of the womb (the endometrium) to thicken, which increases the risk of endometrial cancer over time.
The progestogen in the Evorel Conti patch is introduced during the second half of the cycle to protect the womb lining by causing it to shed. This typically results in a predictable monthly withdrawal bleed, similar to a period. Our guide on Evorel Conti patches provides further information.
The Science of Transdermal Delivery
Evorel Sequi uses transdermal delivery, meaning the hormones are absorbed through the skin directly into the bloodstream. This patch-based method has specific advantages over oral HRT.
By delivering hormones through the skin, the patch bypasses the digestive system and initial metabolism by the liver. This method is associated with a lower risk of certain side effects, such as blood clots (venous thromboembolism), when compared to oral oestrogen.
This steady, direct delivery system helps to maintain stable hormone levels, providing more consistent symptom control. A qualified clinician must assess a patient's medical history to determine if a transdermal patch is a suitable and safe option.
For a deeper understanding of how different hormone therapies work, this Podcast on hormone health and wellness is an excellent resource.
Regulated services, such as a UK-registered online pharmacy, offer a safe and confidential way to access expert menopause care. A prescriber will always conduct a thorough clinical assessment to ensure a prescription-only treatment like Evorel Sequi is appropriate, ensuring patient safety under GPhC governance.
Understanding Your Four-Week Evorel Sequi Schedule
Adhering to your Evorel Sequi schedule is crucial for effectively managing perimenopause symptoms. This is a prescription-only treatment, and it works by following a specific 28-day cycle that mimics the body's natural hormonal fluctuations. Consistency is important for maintaining stable hormone levels and achieving the best possible relief.
Inside each pack, you’ll find two types of patches. Using them in the correct order is essential. For the first two weeks, you will use oestrogen-only patches. Then, for the final two weeks, you will switch to patches containing both oestrogen and a progestogen. This sequential method is specifically designed for women who have not had a hysterectomy.
Weeks 1 and 2: The Oestrogen Phase
Your cycle begins with the Evorel 50 patches. For the first 14 days, you will use these patches, which contain a single hormone: oestradiol (a form of oestrogen).
The purpose of the Evorel 50 patch is to supplement your body’s oestrogen, helping to alleviate common perimenopausal symptoms like hot flushes, night sweats, and mood changes. You will apply one patch and change it twice a week.
Weeks 3 and 4: The Combined Phase
After two weeks on Evorel 50, you will switch to the Evorel Conti patches for the second half of your cycle (weeks three and four). These are combined HRT patches, delivering both oestradiol and a synthetic progestogen called norethisterone acetate.
Adding progestogen at this stage is vital. While oestrogen manages the symptoms, using it alone can cause the lining of the womb (the endometrium) to build up. The progestogen in the Evorel Conti patch protects your womb by signalling the lining to shed, which usually leads to a predictable, period-like bleed at the end of your 28-day cycle.
This diagram illustrates how the two-patch system is designed to work.
The system is designed first to relieve symptoms with oestrogen, then to protect the womb by adding progestogen.
Creating a Simple Patch-Change Routine
To maintain stable hormone levels, each patch should be worn for approximately three to four days. The most effective way to stay on track is to choose two "patch change days" each week and adhere to them consistently.
A popular and easy-to-remember routine is a 'Monday/Thursday' schedule. By changing your patch on the same two days every week, you ensure consistent hormone delivery and reduce the chance of forgetting.
For example, if you apply your first patch on a Monday morning, you would change it for a new one on Thursday evening. Your next change would then be on the following Monday morning. This simple pattern makes it easier to remember.
A clear schedule is essential when using this prescribed medication. This table provides a simple, visual guide to follow for your 28-day cycle.
Evorel Sequi 28-Day Patch Application Schedule
Here is a clear breakdown of which patch to use and when during your four-week cycle.
| Week | Days of Cycle | Patch Type to Use | Example Patch Change Days |
|---|---|---|---|
| Week 1 | Days 1–7 | Evorel 50 | Monday & Thursday |
| Week 2 | Days 8–14 | Evorel 50 | Monday & Thursday |
| Week 3 | Days 15–21 | Evorel Conti | Monday & Thursday |
| Week 4 | Days 22–28 | Evorel Conti | Monday & Thursday |
Following this structure ensures you receive the correct hormone at the correct time. Consistency is the most important aspect of using Evorel Sequi patches correctly. If you have any questions about your schedule, you should consult a healthcare professional.
Applying Your HRT Patch for Best Results
Correct patch application is key to ensuring your Evorel Sequi treatment works effectively. A well-placed, securely attached patch delivers a steady, consistent dose of hormones, which is necessary to manage perimenopause symptoms.
Always start with clean, dry hands. Only open the patch sachet immediately before use to maintain the medication's stability.
Preparing Your Skin for Application
Proper skin preparation is the most important step for good adhesion. For the patch to be effective over the next 3 to 4 days, it must stick properly.
- Start with clean, dry skin. The area must be completely free from oils, moisturisers, creams, or powders, as these can prevent the patch from sticking securely.
- Choose a hairless area. A smooth surface is best. Avoid areas with dense hair. Do not shave the area immediately before applying a patch, as this can cause skin irritation.
Many people apply their patch after a bath or shower. If you do this, ensure your skin is completely dry before application. Even slight dampness can compromise the adhesive.
Choosing the Right Application Site
The location of the patch is as important as the application technique. Choose a spot where it can lie flat and will not be wrinkled or rubbed off by clothing.
The best place for your patch is always below the waist. The buttocks, hips, or upper thighs are ideal because they have a good layer of fatty tissue that aids hormone absorption and are less likely to be disturbed by tight waistbands.
Important: Never apply an Evorel Sequi patch to your breasts or near your armpits. Also, avoid the waistline, as friction from clothing can cause the patch to peel away.
A good starting routine is to apply your first Evorel 50 patch on day 1 of your cycle (or within the first 5 days of your period). Apply it to a clean, dry, hairless area on your lower torso, thigh, or buttock, then press down firmly for about 30 seconds to ensure a good seal. You can find more detailed user information in this Menopause Care medication guide.
The Patch Application and Rotation Technique
Once you have selected and prepared the site, it is time to apply the patch.
Tear open the sachet and remove the patch. It has a clear protective backing that is split down the middle. Bend the patch slightly and peel off one half of the backing, being careful not to touch the sticky, medicated side.
Place the sticky part onto your chosen area of skin and smooth it down. Then, gently peel off the other half of the backing, allowing the rest of the patch to flatten onto your skin.
Once it is on, press the entire patch down firmly with the palm of your hand. Hold it for at least 30 seconds. The warmth from your hand helps activate the adhesive and creates a strong seal.
Finally, and this is essential: you must rotate your patch sites. Do not use the same spot repeatedly, as this can lead to skin irritation. A simple system is to alternate between your left and right side each time you change your patch. Allow at least one week before reusing the same area of skin.
Dealing with Common Patch Issues
Even with careful use, you may encounter issues with your Evorel Sequi patches, such as a patch coming off or a forgotten change day. Knowing how to handle these situations can help keep your treatment on track.
As Evorel Sequi is a prescription-only treatment, you should always have access to clinical support. A UK-registered pharmacy can provide professional advice when needed.
What to Do If a Patch Comes Off
If a patch falls off before it is time to change it, apply a new patch as soon as you notice. It is important to stick to your original patch-change day. For example, if your patch comes off on a Wednesday but your next change is scheduled for Thursday, apply a new one on Wednesday and then change it again as planned on Thursday.
When You Forget to Change Your Patch
If you forget to change your patch on the scheduled day, remove the old patch and apply a new one as soon as you remember.
Then, resume your normal schedule. For example, if you are on a Monday/Thursday routine and you realise on Tuesday morning that you forgot Monday's change, swap the patch on Tuesday. Your next change remains on Thursday as usual. Never wear two patches at once to compensate for a missed dose.
Managing Minor Skin Irritation
Some redness or itching under the patch is relatively common, often due to a reaction to the adhesive. This can usually be managed by adjusting your routine.
- Adhere to a strict rotation schedule: Always apply your patch to a new area of skin and allow at least a week for the skin to recover before reusing a site.
- Ensure proper skin preparation: Make sure the skin is completely dry and free of any lotions or oils before application. Applying a patch to even slightly damp skin can trap moisture and cause a reaction.
- Be gentle during removal: When removing a patch, peel it away slowly. If any sticky residue remains, baby oil on a cotton pad can help remove it gently. Be sure to wash and dry the area thoroughly afterwards.
If you find the irritation is persistent, worsening, or severe, you should speak to your clinician. They can assess the situation and determine if a different type of HRT might be more suitable for your skin.
Understanding Breakthrough Bleeding
Unexpected spotting or light bleeding can occur, particularly during the first few months of using Evorel Sequi, as your body adjusts to the new hormone cycle.
While this is often temporary, you should always inform your clinician about any unscheduled bleeding. They need a complete understanding of your symptoms to ensure the treatment is working correctly and to rule out other causes. Continued bleeding may indicate that your treatment plan requires a review.
Understanding the Safety Profile of Evorel Sequi
When starting any new medication, it is important to understand its safety profile. This section outlines what you need to know about Evorel Sequi, from common side effects to the more serious, though rare, risks.
Evorel Sequi is a prescription-only treatment in the UK. This is a crucial safety measure, meaning it can only be supplied after a qualified prescriber has assessed your medical history to confirm its suitability.
All prescribed medications, including Evorel Sequi, are MHRA-approved, which means they meet the UK's stringent regulatory standards for safety and efficacy.
Common Side Effects and How to Manage Them
When you first start using Evorel Sequi, your body needs time to adjust to the new hormonal balance. It is common to experience some mild side effects during this initial period, which typically lasts from one to three months.
Most of these effects resolve as your body adapts. Potential side effects may include:
- Breast tenderness or swelling: A frequent initial side effect as the body adjusts to the oestrogen.
- Headaches or migraines: Some women may experience an increase in headaches at the start of treatment.
- Nausea: Feeling sick is not uncommon.
- Mood changes: You might feel more irritable or notice mood fluctuations.
It is important to allow your body time to adjust. However, if these symptoms do not improve or are causing significant discomfort, you should consult your clinician. They can offer advice or review your treatment plan if necessary.
Understanding Contraindications and Risks
While Evorel Sequi is suitable for many women, it is not appropriate for everyone. A contraindication is a medical reason why a specific treatment should not be used. Your prescriber will carefully review your medical history for any contraindications.
The main contraindications for Evorel Sequi include:
- A personal or suspected history of breast cancer or another oestrogen-sensitive cancer.
- A history of blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Any undiagnosed vaginal bleeding.
- Severe liver disease.
Discussing risks is a vital part of any consultation about HRT. All forms of HRT carry some risks, which must be weighed against the potential benefits. The Patient Information Leaflet, approved by the MHRA, contains detailed information about these risks. This information is intended to support an informed discussion between you and your clinician.
When to Seek Immediate Medical Attention
Serious side effects are rare, but it is crucial to know the warning signs so you can act quickly if needed.
You should stop using your patches and seek immediate medical attention (contact a doctor or go to A&E) if you experience any of the following: sudden chest pain, difficulty breathing, painful swelling in your leg, or symptoms of a stroke (such as sudden weakness or numbness on one side of your face or body, or sudden problems with speech or vision).
These could be signs of a serious medical event like a blood clot, heart attack, or stroke. While the risk is low, being aware of these symptoms is essential for your safety. For further context, our guide on perimenopause symptoms and treatment may be helpful.
Your relationship with your healthcare provider is paramount. Whether it is your GP or a regulated telehealth service, you must have access to expert advice. All care should be overseen by UK regulatory bodies like the General Pharmaceutical Council (GPhC) to ensure you receive safe and appropriate treatment.
Your Questions on Using Evorel Sequi Answered
Starting a new prescribed medication can raise many practical questions. Here are answers to some of the most common queries about using Evorel Sequi.
Can I Swim, Bathe, or Exercise with My Patch On?
Yes. Evorel Sequi patches are designed to adhere to the skin during normal daily activities, including swimming, showering, and exercising. The adhesive is waterproof and should remain in place for the full three to four days.
As a practical tip, it is advisable to wait at least an hour after applying a new patch before immersing it in a hot bath or engaging in intense, sweat-inducing exercise. This allows the adhesive to bond properly with the skin, helping to prevent the edges from lifting.
What if I Accidentally Use the Wrong Patch?
This is a potential mistake, especially when starting a new routine. If you realise you have applied an Evorel 50 patch instead of an Evorel Conti (or vice versa), there is no need for alarm.
Simply remove the incorrect patch as soon as you notice the error and apply the correct one for that point in your 28-day cycle. Then, continue with your usual patch change schedule.
You may experience some unexpected spotting or light bleeding after this type of mix-up. This is your body reacting to the temporary change in the hormone sequence. While it is usually not a cause for concern, it is good practice to inform your clinician so they have a complete record of your treatment.
How Should I Dispose of Used Patches Safely?
This is an important safety consideration. Even after use, patches still contain a small amount of active hormones that could be harmful if they come into contact with children or pets.
Correct disposal is simple and crucial for safety:
- Fold the used patch in half, with the sticky, medicated side sealed inwards.
- Place the folded patch in your regular household waste bin.
- Ensure the bin is out of the reach of children and pets.
Never flush used patches down the toilet. Following these steps ensures the responsible handling of this medication.
Do I Need to Take a Break from HRT?
The idea of taking a "drug holiday" from HRT is a common misconception and is not supported by current clinical evidence. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines do not recommend taking scheduled breaks from treatment.
Any decision to continue or stop HRT should be made in consultation with your prescriber. Abruptly stopping treatment without medical supervision can lead to a rapid return of menopausal symptoms. Changes to your treatment plan should be based on a regular review of your health and symptoms, with ongoing support from a regulated service, such as an online pharmacy in the UK, to ensure your treatment remains appropriate.
We provide menopause care that is safe, clinician-led, and designed to fit your needs. If you are experiencing symptoms, you can start a confidential online consultation today to find out if a prescription-only treatment like Evorel Sequi may be suitable for you. Start your consultation
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