1. What is EVOREL CONTI and What
Is It Used For?
EVOREL CONTI is a combined continuous hormone replacement
therapy (HRT) patch that delivers both estradiol (an oestrogen) and
norethisterone acetate (NETA, a progestogen) simultaneously through the skin.
The continuous combined regimen means both hormones are delivered every day
without interruption, so no monthly withdrawal bleed occurs.
EVOREL CONTI is designed for postmenopausal women with an
intact uterus who are at least 12 months past their last menstrual period. The
progestogen component (NETA) protects the endometrium from oestrogen-induced
hyperplasia and carcinoma while delivering the hormones transdermally
(bypassing hepatic first-pass metabolism, thus reducing VTE risk compared to
oral HRT).
It is used for the relief of postmenopausal symptoms: vasomotor
symptoms (hot flushes, night sweats), urogenital atrophy symptoms, and
prevention of postmenopausal osteoporosis in women with significant risk and
symptom burden where other agents are unsuitable.
2. How to Take This Medicine
Apply one EVOREL CONTI patch twice weekly (every 3–4 days)
to clean, dry, intact skin, rotating application sites. A 24-patch pack covers
12 weeks (3 months) of treatment.
Application
• Apply to lower abdomen,
buttocks, or upper outer thigh — avoid breasts, waist (elastic waistband), and
irritated skin.
• Rotate sites
systematically — avoid using the same site within 7 days.
• Press firmly for 30
seconds to ensure adhesion. Check edges are well-sealed.
• Fold used patches
sticky-side-together and dispose of in household waste (not toilet —
environmental contamination risk).
Expected
Bleeding Pattern
EVOREL CONTI is intended for amenorrhoeic use. Most women
experience no scheduled bleeds, but irregular spotting is common in the first
3–6 months as the endometrium adjusts. Persistent or heavy bleeding beyond 6
months requires investigation. If you have not yet reached 12 months since your
last period, use a sequential regimen (Evorel Sequi) to avoid irregular
bleeding.
3. Side Effects
Common
Side Effects
• Application site
reactions: erythema, pruritus, skin irritation.
• Breast tenderness.
• Irregular vaginal
bleeding or spotting — common in first 3–6 months.
• Headache, nausea,
abdominal bloating.
• Mood changes
(depression) — associated with progestogen component.
Serious
Risks (Long-term combined HRT)
• Breast cancer —
combined oestrogen-progestogen HRT carries a higher relative risk increase than
oestrogen alone. Annual breast awareness and regular mammography are essential.
• Venous thromboembolism
(DVT, PE) — risk is lower than oral HRT due to the transdermal route.
• Stroke — lower risk
with transdermal than oral HRT.
• Endometrial cancer —
the progestogen in EVOREL CONTI provides endometrial protection when used
continuously as directed.
4. Contraindications — Who
Should NOT Take This Medicine
|
Do not use EVOREL CONTI if: •
You have a known, suspected, or history of breast
cancer. •
You have known or suspected oestrogen-dependent cancers. •
You have unexplained genital bleeding. •
You have active VTE, acute arterial thromboembolic
disease, or severe thrombophilic disorder. •
You have severe liver disease or a history of liver disease
where function has not normalised. •
You are pregnant or breastfeeding. •
You have not been postmenopausal for at least 12 months
(use Evorel Sequi instead). |
5. Safety Warnings and Special
Precautions
Unsuitable
for Perimenopausal Women
EVOREL CONTI should only be used in fully postmenopausal women (at least 12 months since last natural period). In women who are
still in the perimenopausal transition, using a continuous combined regimen
results in unpredictable bleeding. Use the Evorel Sequi (sequential) patch
regimen instead until menopause is established.
Unscheduled
Bleeding Investigation
Any unscheduled bleeding beyond the first 6 months of
continuous combined therapy must be investigated by transvaginal ultrasound
and/or endometrial biopsy to exclude endometrial pathology. Do not assume
bleeding is benign without investigation.
Risk-Benefit
Review
All HRT prescriptions should be reviewed at least annually.
Benefits (symptom control, bone protection) must be weighed against individual
risks (breast cancer, VTE, cardiovascular). The lowest effective dose for the
shortest necessary duration is the guiding principle.
6. Drug Interactions
Drug interactions are the same as for individual oestrogen
and progestogen preparations. See ESTRADOT entry for full interactions list.
Key interactions:
• CYP3A4 inducers
(rifampicin, anticonvulsants, St John's Wort) — reduce HRT plasma levels;
hormonal protection may be inadequate.
• Thyroid hormone
replacement — oestrogen may increase levothyroxine requirements.
• Warfarin — oestrogen
may alter INR; monitor.
• Antidiabetic agents —
monitor blood glucose; oestrogen may impair glucose tolerance.
7. Storage Instructions
• Store below 25 degrees
Celsius. Do not freeze.
• Store in original
sealed sachets.
• Dispose of used patches
safely in household waste — fold sticky sides together; do not flush.
• Keep out of reach of
children.
8. Prescription Status in Kenya
EVOREL CONTI is a prescription-only medicine (POM) in
Kenya. It is prescribed by gynaecologists or general practitioners managing
postmenopausal women.
An annual review of indication, dose, and risk-benefit balance
is required. Do not renew without clinical reassessment.
9. Patient Guidance
|
Important Reminders for Patients •
Apply a new patch twice a week — change on the same two
days each week. •
Rotate application sites — use a different area each
time. •
Spotting in the first 3–6 months is common and usually
settles — if bleeding persists beyond 6 months or is heavy, tell your doctor. •
Attend regular breast examinations and mammography as
recommended. •
Do not use this patch if you still have regular periods —
use Evorel Sequi instead. •
Review your HRT treatment with your doctor every year. |
10. Pharmacist / Prescriber
Notes
Continuous
vs Sequential HRT — When to Use Which
Sequential (cyclical) HRT (Evorel Sequi): oestrogen given
throughout the month, progestogen added for 12–14 days, producing a monthly
bleed. Preferred in perimenopause or early postmenopause to mimic a natural
cycle and avoid unpredictable bleeding. Continuous combined HRT (Evorel Conti):
oestrogen and progestogen every day — no scheduled bleeds. Preferred in
established postmenopause (more than 12 months since last period).
Breast
Cancer Counselling
The MHRA and NICE HRT guidelines confirm that combined HRT
is associated with a small but real increase in breast cancer risk. For a woman
aged 50–59 taking combined HRT for 5 years, approximately 4 extra breast
cancers occur per 1000 women compared to non-users. This must be discussed as
part of informed consent. The absolute risk must be weighed against the benefit
for each patient.
11. Frequently Asked Questions
(FAQs)
Why does EVOREL CONTI not cause a monthly bleed?
EVOREL CONTI delivers both an oestrogen (estradiol) and a
progestogen (norethisterone acetate) continuously every day. Unlike sequential
HRT where progestogen is given for only part of the month, the continuous
progestogen keeps the womb lining thin and stable throughout the cycle. This
means there is no build-up of the lining and therefore no monthly withdrawal
bleed.
I have been on EVOREL CONTI for 2 months and am still
having some spotting — is this normal?
Yes — irregular spotting or light bleeding is very common
in the first 3–6 months of continuous combined HRT as your womb lining adjusts
to the change from a cyclical to a continuous hormonal environment. If the
bleeding is light and gradually reducing, it is usually normal. However, if the
bleeding is heavy, persistent beyond 6 months, or accompanied by pain, you
should see your doctor for further assessment.
Can I use EVOREL CONTI if I am not sure whether I have gone
through the menopause yet?
No — EVOREL CONTI should only be used by women who have
been fully postmenopausal for at least 12 months (i.e., no menstrual period for
12 months). If you are still in the perimenopausal transition and having
irregular periods, you should use a sequential HRT regimen (such as Evorel
Sequi) instead, which is specifically designed for this stage.
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