1. What is EVOREL SEQUI and What
Is It Used For?
EVOREL SEQUI is a 4-week sequential hormone replacement
therapy (HRT) pack designed for perimenopausal and recently postmenopausal
women with an intact uterus.
Each pack contains two types of transdermal patches to be
applied in sequence: 4 Evorel 50 patches (oestrogen only, estradiol 50 mcg/24h)
applied for the first 2 weeks of the cycle, followed by 4 Evorel Conti patches
(combined estradiol 50 mcg + NETA 170 mcg per 24h) applied for the second 2
weeks.
The sequential regimen mirrors the natural hormonal cycle:
oestrogen only for the first half, then oestrogen plus progestogen for the
second half. The progestogen in the second half induces a predictable monthly
withdrawal bleed (similar to a withdrawal period in oral contraceptives) when
the progestogen patches are replaced, or the cycle ends.
EVOREL SEQUI is indicated for perimenopausal women or
recently postmenopausal women (less than 12 months since last period) with
menopausal symptoms who have an intact uterus and for whom a combined patch
regimen producing a monthly bleed is preferred.
2. How to Take This Medicine
Apply patches twice weekly (every 3–4 days). Each 4-week
cycle uses all 8 patches in sequence.
Cycle
Schedule
• Days 1–14 (Weeks 1 and
2): Apply the 4 EVOREL 50 patches (oestrogen only — white or light packaging).
Change twice weekly.
• Days 15–28 (Weeks 3 and
4): Apply the 4 EVOREL CONTI patches (combined oestrogen + progestogen —
different packaging/colour). Change twice weekly.
• A withdrawal bleed
usually occurs towards the end of week 4 or at the start of the next cycle when
progestogen is withdrawn.
• Start the next pack
immediately after the current cycle ends — do not take a gap.
Application
Technique
Identical to Estradot/Evorel Conti: apply to lower abdomen,
buttocks, or upper thigh; press firmly for 30 seconds; rotate sites; dispose of
used patches folded in household waste.
3. Side Effects
Common
• Application site
reactions; breast tenderness; headache; nausea; bloating.
• Withdrawal bleed at the end
of the combined patch phase — expected and reassuring of endometrial shedding.
• Progestogenic side
effects (mood changes, fluid retention, breast tenderness) — during weeks 3–4.
Serious
Risks
• Breast cancer, VTE,
stroke, endometrial cancer — same as all combined HRT.
4. Contraindications — Who
Should NOT Take This Medicine
|
Do not use EVOREL SEQUI if: •
You have known, suspected, or past breast cancer. •
You have active VTE, acute arterial thromboembolic
disease, or severe thrombophilia. •
You have severe liver disease. •
You have undiagnosed vaginal bleeding. •
You have known oestrogen-dependent cancers. •
You are pregnant or breastfeeding. |
5. Safety Warnings and Special
Precautions
Appropriate
Patient Population
Evorel Sequi is ideal for: perimenopausal women still
having some periods who want symptom control with a predictable monthly bleed;
women within 12 months of their last natural period; women who prefer a monthly
bleed for reassurance of endometrial shedding. Once established as fully
postmenopausal for 12 months, consider transitioning to EVOREL CONTI for
convenience and amenorrhoea.
Distinguishing
Patch Types
Counsel patients explicitly on which patch to use in which
week. Mixing up the patches (using combined patches in week 1 or oestrogen-only
in week 3) disrupts the sequential regimen and the expected bleeding pattern.
The two patch types can be differentiated by packaging or labelling — advise
patients to read their pack carefully and set reminders.
Absent
or Irregular Withdrawal Bleed
If no withdrawal bleed occurs for more than 3 consecutive
cycles, investigate with a transvaginal ultrasound to exclude endometrial
hyperplasia or pathology. In some women, the endometrium becomes atrophic and
withdrawal bleeds stop — this is not necessarily concerning but requires
investigation.
6. Drug Interactions
Drug interactions are the same as for ESTRADOT and EVOREL
CONTIN — CYP3A4 inducers reduce hormone levels; thyroid hormone requirements may
increase; warfarin INR may be affected; blood glucose control may be affected
in diabetic patients.
7. Storage Instructions
• Store below 25 degrees
Celsius. Do not freeze.
• Store in original
packaging — do not mix patches from different packs.
• Dispose of used patches
by folding sticky sides together — household waste, not toilet.
• Keep out of reach of
children.
8. Prescription Status in Kenya
EVOREL SEQUI is a prescription-only medicine (POM) in
Kenya, prescribed by gynaecologists or general practitioners managing
perimenopausal and postmenopausal women.
Annual review of HRT indication, risks, and benefits is
standard practice.
9. Patient Guidance
|
Important Reminders for Patients •
Use the right patch in the right week — oestrogen-only
patches for weeks 1–2, combined patches for weeks 3–4. •
Apply patches twice a week (every 3–4 days) and rotate
application sites. •
A monthly withdrawal bleed at the end of week 4 is normal — it is a sign that the medicine is working as designed. •
If you do not have a bleed for 3 consecutive cycles,
contact your doctor. •
Attend regular mammography and breast checks as
recommended. •
Review your HRT with your doctor at least once a year. |
10. Pharmacist / Prescriber
Notes
Transitioning
from Evorel Sequi to Evorel Conti
When a woman has been consistently postmenopausal for 12
months (no natural bleeding for 12 months), she can transition from the
sequential Evorel Sequi to the continuous combined Evorel Conti to eliminate
monthly withdrawal bleeds. This transition should be guided by the prescriber.
Note: some spotting may occur in the first months after switching to the
continuous combined regimen.
Counselling
on Patch Management
A common patient error is forgetting which week they are in
or mixing up patch types. Advise patients to: mark patch change days in a diary
or phone reminder; label which patches are oestrogen-only and which are
combined; keep patches in original packaging until use; start the next pack on
the same day as the last patch of the current cycle expires.
11. Frequently Asked Questions
(FAQs)
Why do I use two different types of patches in EVOREL
SEQUI?
The first set of patches (weeks 1–2) contains oestrogen
only. The second set (weeks 3–4) contains both oestrogen and progestogen. This
sequential design mimics the natural hormonal pattern of your menstrual cycle
before menopause. The progestogen in weeks 3–4 protects your womb lining and,
when the combined patches are removed at the end of the cycle, causes a
predictable monthly withdrawal bleed.
When should I switch from Evorel Sequi to Evorel Conti?
Once you have had no natural menstrual bleeding for 12
consecutive months (confirming you are fully postmenopausal), your doctor may
suggest switching to Evorel Conti — the continuous combined patch that
eliminates monthly bleeds. This is a matter of personal preference and medical
advice — some women prefer the monthly bleed as reassurance, while others
prefer the convenience of no bleeds.
What if I accidentally use the wrong patch in the wrong
week?
If you use the combined patch (oestrogen + progestogen) in
week 1–2 instead of the oestrogen-only patch, or vice versa, contact your
pharmacist or doctor for advice. You may experience irregular bleeding or a missed withdrawal bleed, depending on the error. Restart the correct sequence
from the next cycle. To avoid this, keep patches in their original packaging
and label them clearly.
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