Evorel Sequi side effects: what to expect from this HRT

When a woman makes the choice to ask for help to manage the symptoms of menopause, she is usually at a point at which she can no longer cope with the symptoms she is experiencing. Seeking help is an incredibly brave and positive move and will undoubtedly yield positive results in terms of long term physical and mental health. However, the first few months can be a little challenging, with some women saying that they started HRT and feel awful for a few months. 

Every person is unique and although there is good data to tell us which medications tend to work best for different people, deciding on the right menopause and HRT treatment can, like many medication choices, involve a case of trial and error as well as personal preference. 

Just as different medications work differently for each person, different people may experience a range of side effects; in general terms it is not possible to predict who will experience which side effects, or though some risk factors have been identified. 

For those on HRT, it can take a few months for the impact of the treatment to be felt; it can also take around three months for HRT patches side effects to subside. Prescribers will, therefore, usually advise that you persevere with your treatment for at least three months before deciding whether it is the most appropriate treatment for you. 

If you are currently on HRT or considering going onto HRT, it is important to know what the side effects may be so that you know what to look for and understand what is normal, and what may be a cause for concern. 

What causes HRT side effects?

Just as a reduction in hormone production causes symptoms, such as hot flushes, insomnia, mood swings, brain fog, dry skin and sore breasts, replacing those hormones can also cause side effects. 

The side effects of HRT are not dissimilar to those of pregnancy. Evorel 50 patches side effects come from the fact that your body is being given more oestrogen and more progesterone in a cycle that mimics the natural reproductive cycle. 

This new level of Oestrogen, while it may help to ease the symptoms of menopause in the longer term, can cause a range of physical effect, including:

• bloating
• breast tenderness or swelling
• feeling sick
• leg cramps
• headaches
• indigestion and bloating
• vaginal bleeding

Taking progesterone can cause the above as well as depression, mood swings, acne, stomach cramps and back pain. 

Summary list of Evorel Sequi side effects 

Most women who use Evorel Sequi patches experience minimal or no side effects. However, a few women – around 10% will experience some kind of side effect. 

These will usually be short-lived, with the impact easing as the body becomes to the new hormone balance. 

Because Evorel Sequi involves providing a cycle of oestrogen and oestrogen and progesterone, side effects can include:

• Acne
• Alopecia (hair loss)
• Anxiety
• Blood pressure elevated
• Blood clots in the blood vessels
• Breast tenderness or pain
• Chloasma (discoloured skin patches)
• Digestive issues (such as diarrhoea, gas, bloating, indigestion)
• Dizziness
• Epilepsy worsens
• Fibrocystic breast disease (breast pain or lumps)
• Fluid retention
• Gallbladder disease or gallstones
• Headache
• Heart palpitations
• Hypersensitivity
• Insomnia
• Itchy or inflamed skin at application site
• Joint pain
• Liver function impairment and jaundice
• Migraines
• Mood swings
• Muscle pain
• Nausea
• Painful periods
• Pancreatitis (inflammation of the pancreas)
• Premenstrual syndrome (PMS)
• Spotting (bleeding when not on your period)
• Stomach pain
• Swelling of the legs
• Uterine fibroid/cyst growth
• Vaginal infections (thrush)
• Vertigo

More common side effects and symptoms 

For women who are struggling to cope with the short-term symptoms of menopause and perimenopause, or those who want to prevent the long term implications, such as the development of osteoporosis, the complete list of possible Evorel 50 patches side effects can seem incredibly daunting. 

It is important to remember that 90% of women won’t experience any side effects of HRT patches. However, of the 10% that do experience side effects, the following are more likely:

• Anxiety
• Breast tenderness, pain, or enlargement
• Depression
• Digestive issues such as nausea and vomiting, abdominal pain, bloating, flatulence, indigestion
• Dizziness
• Fatigue
• Headache or migraine
• Insomnia
• Muscle and joint pain
• Oedema (swelling) caused by fluid retention
• Painful or heavy periods
• Sensitive skin – rashes or itching
• Weight gain

Less common and serious side effects and symptoms 

In rare cases, people can experience other side effects of HRT patches. These include:

• Numbness or tingling in extremities (hands and feet)
• Palpitations
• Premenstrual-like symptoms
• Sex drive changes
• Skin sensitivity decreases
• Uterine fibroid enlargement
• Vaginal thrush

Does HRT cause weight gain? 

When considering which HRT treatment will be most appropriate for you, one of the factors that you and your prescriber consider could be the best HRT for weight loss, particularly if you have experienced weight gain during perimenopause and menopause. 

Weight gain is one of the more common symptoms of HRT, including Evoral Sequi patches, affecting up to one woman in every ten. However, for some women, including those using Evorel 50 patches, weight loss, or the slowing of weight gain linked to the menopause, could be a more welcome side effect.  This is because HRT could help to prevent insulin resistance and the natural slowing down of the metabolism that many women experience as part of menopause.  

While some people using HRT may lose the weight they gained during menopause and perimenopause, it is not a given and there is a risk that the weight will be gained again when treatment ends. 

If weight loss or gain is your biggest concern around which HRT treatment to use, speak to your prescriber. There is not a huge amount of data about the links between HRT and weight, and associated weight gain could be a natural part of ageing, just as the weight loss could be down to a reduction in sugar cravings and anxiety eating thanks to freshly balanced hormones. 

As always, there is no magic formula for weight loss but it can help if you follow a healthy diet and exercise regularly. 

Evorel Sequi patches – no bleeding and withdrawal bleeds

Evorel Sequi is a sequential HRT, which means that you have hormones in a cycle: your first set of patches contain just oestrogen, and for the second half of the cycle, your patches contain oestrogen and progesterone. 

This treatment is appropriate for women who still have a uterus as the progesterone prevents thickening of the uterus lining. As a result, women using Evorel Sequi patches will have a withdrawal bleed, which is like a period. Sometimes, especially in the first few months of using the HRT, women will also experience spotting or breakthrough bleeding throughout the month. If this continues after three months, or if the bleeding is particularly heavy or uncomfortable, speak to your prescriber. 
If while using Evorel Sequi patches no bleeding occurs, there is no need to worry; withdrawal bleeding is the norm, but some women don’t experience it. 

Can Evorel Sequi cause depression? 

The impact of the menopause and perimenopause varies from woman to woman. Some women go through the physical changes without experiencing any symptoms, or with mild symptoms. For others, the time can have a catastrophic physical and emotional impact. 
Depression and anxiety are listed as one of the more common side effects of Evorel Sequi, affecting between one in ten and on in a hundred women. These side effects are down to the type of progesterone used in the patch. 
If you feel low, anxious, depressed, indecisive, irritable, or experience mood swings, try to persevere with the treatment for up to three months, by which time they should settle down. If you experience persistent or severe depression, or thoughts of self-harm or suicide, speak to your doctor. They may try a different type or dosage of progesterone. 

Allergic reactions to Evorel Sequi 

It is extremely unusual for people to experience allergic reactions to Evorel Sequi, because the hormones that are used are designed to replicate those produced by the body. However, different HRT treatments use different types of hormone substitutes, so it is possible (although unlikely) for someone to react to a specific hormone substitute, or even an ingredient in the patches. 
The active ingredient in Evorel Sequi that replicates oestrogen is oestradiol hemihydrate. The ingredient that replicates progesterone is norethisterone acetate. Evorel Sequi also contains guar gum, duro-tak 387-2287, and hostaphan MN19, which help to form the patches and help them to stick securely to the skin. 
If you experience soreness around the patch site and it doesn’t ease over time, or it becomes unbearable, speak to your prescriber who may recommend a different patch. 
Signs that you are experiencing a serious allergic reaction – and that you need to seek immediate medical attention – include:

• Anaphylaxis - swelling of the face, throat, tongue
• Breathlessness
• Dizziness
• Eyes swollen or puffy
• Flu-like symptoms
• Heart palpitations
• Nausea
• Skin discolouration
• Skin sensitivity – persistent rash, itching hives or sores

Mixing Evorel Sequi with other medicines

Before recommending the right HRT treatment for you, your prescriber will talk to you about your lifestyle and symptoms as well as looking at your medical history and any medications that you may already be taking. 

When consulting with your physician it is essential that you give them as much information as you can about your health and all medications – prescribed and otherwise – that you take. 

Medications that could interact negatively with Evorel Sequi include:

• medications taken to control epilepsy, e.g. phenobarbital, phenytoin or carbamazepine; 
• TB medications, such as rifampicin and rifabutin; 
• Medicines used to treat HIV infection (nevirapine, efavirenz, ritonavir or nelfinavir); 
• Herbal remedies containing St John’s Wort; 
• Medicines for Hepatitis C virus (HCV); 
• Telaprevir, a medication used to treat Hepatitis C infection;
• Bosentan which is used to control high blood pressure in the blood vessels of the lungs.

These medications can stop your HRT treatment from working properly. However, there is one drug, lamotrigine, which is used to control epilepsy, which can adversely affect the control of epilepsy. 

Who shouldn’t use Evorel Sequi – and who should? 

Oestrogen is responsible for many things in our body, one of which is the thickening of the uterus lining. For women who still have their uterus, taking oestrogen without progesterone – to cause that lining to shed – can lead to thickening of the uterus lining and increased risk of polyps and cancer. 

All drugs react differently with different people, and your prescriber will have a good look at your medical history before making any recommendations. However, women should NOT use Evorel Sequi if they have, or have had:
breast cancer, currently have it, or are suspected to have it;

• a cancer that is sensitive to oestrogen;
• unexplained vaginal bleeding;
• untreated endometrial hyperplasia – thickening of the womb lining;
• thrombosis, such as DVT or pulmonary embolism;
• a blood clotting disorder;
• a recent disease caused by blood clots, e.g. stroke, angina, heart attack;
• liver disease;
• porphyria – an inherited blood disease;
• any history of allergy to any of the ingredients in Evorel Sequi. 

With so many different menopause and HRT treatments to choose from, and so many terrifying side effects of HRT to consider, it can be tempting to put off seeking a consultation about the right HRT for you. However, regardless of how severe your menopause and perimenopause symptoms are right now, HRT treatment can help you to maintain better physical and mental health in the longer term. 

Speak to a prescriber about your symptoms, your concerns, and your reasons for wanting to consider taking HRT; they will evaluate your situation and make recommendations based on their expensive experience.