Evorel Sequi side effects ... to continue or not? (2nd attempt post)

[Teaseall]

Hello all.

Sorry for the long post, but a bit of background for context ... I am 51 and definitely in Peri-Menopause. I don’t really have any horrendous symptoms but my periods have become much more erratic over the last 3 years, I have been suffering from really, really painful joints sometimes which takes awhile to wear off, occasional low mood when I really can’t be bothered to do anything and crashing fatigue too, usually late afternoon.

My main issue has been that I get really emotional for no apparent reason, it’s so unlike me and I find it really unsettling, I’m guessing it’s when my oestrogen level is low but I get teary at television programs, large groups of people all cheering, if I suspect a perceived slight from someone which when I’m rational again I realise isn’t there!

Having read up on it, I decided to give HRT a go primarily to ease the above symptoms and also to protect my bones for the future. Both my mother and aunt have arthritis issues.

Having finally got an appointment with the GP I have been on Evorel Sequi for the last month. The first two weeks were fine (Evorel Sequi 50) and I felt pretty good, I did have a breakthrough bleed in the 2nd week but guess my hormones are still fluttering to life, started the 3rd week Patch (Evorel Conti) on the Sunday and then on the Monday morning had explosive diarrhoea!

Since then I’ve had it every day, even had to get up at 4.40am for a particularly nasty bout. I’ve had cramps, foul smelling flatulance , nausea, headaches and generally feel below par for two weeks.

I’ve just come to the end of the Conti patches and am having what I guess is a withdrawal bleed .... unlike any period I’ve ever had! I’m flooding, have soaked the bedsheets and no sign of it stopping just yet.

Trying to get another appointment with this GP as she’s a women’s health specialist is like pulling hens teeth but in the meanwhile does anyone on here have any experience of Evorel Sequi. I’m trying to work out if I should continue or not. It’s recommended that HRT be given about 3 months to settle down with any side effects but I’m not sure if I can last that long especially as my original symptoms weren’t that bad.

Maybe I could change to a different type of progestogen as I’m thinking that that could be the issue?

Any advice/ anecdotes gratefully received?

No idea why that posted twice sorry

My main issue has been that I get really emotional for no apparent reason, it’s so unlike me and I find it really unsettling, I’m guessing it’s when my oestrogen level is low but I get teary at television programs, large groups of people all cheering, if I suspect a perceived slight from someone which when I’m rational again I realise isn’t there!

But it's not for no apparent reason is it- you've listed various scenarios that would tug at anyone's emotions. This sounds 100% normal to me! I've been emotional over all of that all my life and still am despite 11 years on HRT.

Being emotional isn't a bad thing unless it's temper-related and anger, upsetting people.

Having read up on it, I decided to give HRT a go primarily to ease the above symptoms and also to protect my bones for the future. Both my mother and aunt have arthritis issues.

HRT won't help protect against arthritis- that's wear and tear. It will help bone density and fracture risk.

I'm confused as you say in your subject line it's sequi but half way down you say it's conti. If you have a bleed, it's sequi.

I think you should be tested first for a tummy bug/ virus. It may be nothing at all to do with HRT. That's a very odd reaction.

Lots of women now are using estrogen gel and micronised progesterone. With gel you can adjust the dose - start low and work up. Going straight in at 50mcg might be too much.

Maybe talk to your dr on this?

I had the profuse bleeding on these,on the second round realised that the first wasn't a one-off(couldn't even go to work and used tena pads and super-duper tampons,it still got through).
Im now on gel and a marina,all is calm.I got very achey joints too these have subsided.

Thanks for replying @JinglingHellsBells. Being emotional may be normal for you but trust me it really isn't for me. I am an an outwardly logical, rational and quiet character so what I mean is that public displays of emotion really unsettlle me and being unable to stop the tears when often there really is no real justification is definitely a new symptom for me.

Probably didn't explain properly about protecting my bones, I realise HRT doesn't protect against arthritis but yes protecting my bone density and benefits to my heart are one of the reasons I decided to try HRT in the first place.

I'm honestly not meaning to dismiss all your suggestions and It is of course possible that I have some sort of stomach bug but I very much doubt it. My diet hasn't changed and my default state is to have the constitution of an Ox. The fact that the diarrhoea started pretty much as soon as I started on the Evorel Conti Patch with contains both progestogen and oestrogen leads me to suspect that it is the cause - one of the side effects listed is 'gut disturbances'

Again sorry as probably didn't explain myself properly. GP has prescribed me Evorel Sequi Patches as I still get periods. There are 8 in each box; for weeks 1 & 2 I use the 4 Evorel 50 Patches which only contain oestrogen changing them every 3.5 days; for weeks 3 & 4 I use the 4 Evorel Conti Patches which contain both oestrogen & progestogen.

My symptoms started in week 3 and are on going. I have just started on a new box I.e. week 1 again so it'll be interesting to see if my symptoms disappear soon.

thanks @Hotterthanahotthing that's interesting to know. I've never ever had heavy periods so this bleed has been a bit of a shocker for me.

I think I'm going to preserve with the second month to see if I have the same issues whilst trying to get another appointment with the GP to discuss other options ... which is no easy task.

It's not unusual to try a few different ones until you find one that suits you.

I’m on the same as you - 3 months in. I think I did get some doirehea during first month but not now. I now have some bloating. I don’t think it’s diet but could be. My emotions are less crazy (was really upsetting me, anxiety etc) my sleep is SO much better. Was also worried about bone density as osteoporosis in family and weirdly felt my wrists were getting thinner (watch strap evidence) tho not losing weight? On whole I think very positive so maybe stick with them?

started on the Evorel Conti Patch with contains both progestogen and oestrogen leads me to suspect that it is the cause - one of the side effects listed is 'gut disturbances'

It's a continuous sequi regime you are on.
Evorel comes as a continuous combined patch and a continuous sequential patch.

It's rare to get gut disturbances from patches- usually applies more to pill form.

You have started on quite a high dose of estrogen. Estrogen-only patches are available in 25 and 37 mcgs. Some women use these and add in a progestogen such as micronised progesterone or the Mirena coil. Might be worth dropping your dose to a low dose to start.

@JinglingHellsBells Erm, I'm a bit confused by what you've written.

I'm currently looking at the box prescribed by my GP. The box is called Evorel Sequi, it says on it.
'This pack contains 8 transdermal Patches.
4 Evorel 50 Patches
4 Evorel Conti Patches'

The instructions said to use the Evorel 50 Patches (contain oestrogen only) for the first two weeks. I did this and had no problems at all apart from a small breakthrough bleed which I assume was because of my own natural cycle kicking in.

After 2 weeks the instructions were to use the Evorel Conti Patches (which contain the same oestrogen amount but also contain norethiserone, a progestogen) almost within 12 hours of putting this patch on I developed all the symptoms I described previously including a heavy withdrawal bleed at the end of week 4.

Are you saying that it's the oestrogen causing my symptoms as to me it looks like the progestogen phase is the problem?

Ah it's clear now.

What I didn't realise but do now from your post, is that on a sequential patch regime you are given a certain quantity of patches- for 2 weeks- that would also be given to women using continuous combined every single day. I assumed that a sequi regime on Evorel would be 2 weeks of estrogen only patches, followed by 2 weeks of 'Evorel Sequi ' with 2 hormones in them.

Does that make sense?

In other words I didn't know that Evorel Conti patches were marketed as part of a sequi regime. It's the way the manufactures have packaged the product.

I'd expect them to be labelled as
4 Evorel estrogen only
4 Evorel Sequi patches (containing estrogen and Norethisterone.)

Look at it this way- if women use tablet form HRT, the tablets are in one blister pack. Even though the 3rd/4th weeks contain both hormones, the whole packet is still marketed and labelled as 'sequential' . It's not 2 packets with estrogen only for 14 days and another packet with continuous (2 hormones) in it.

Going back to your question, it may be you are not suited to 50mcgs estrogen straight off. It's a medium dose. Guidance is start on the lowest dose .

Your GP could give you an estrogen only patch like Estradot, which comes in a wider range of doses, including a low dose, and then you would use a separate type of progestogen such as 5mgs Norethisterone for 12 days, or 200mgs Utrogestan for 12 days. These are two separate products, don't come in 1 package, but lots of women use this type of thing if their GP is savvy.

If Norethisterone doesn't suit you, you could try Femoston which is a pill, or as above- single estrogen patch and Utrogestan.

Ironically, most progestogen cause constipation rather than the runs. But everyone is different.

Thanks again @JinglingHellsBells that clears things up somewhat 
I guess my next task is to try an see the gp again to discuss other options, not an easy task when they are not making any appointments because it's the school holidays!

I think I need to weigh up whether these side effects are worth riding out for the recommended 3 months to see if they settle down or not.

Thank you too @Newgirls your similar experience gives me hope.

Explosive diarrhea is not 'normal' and I'd stop taking it or swap asap. The usual side effects of Norethisterone are feeling ratty, feeling bloated, sore boobs, maybe the odd skin eruption, maybe a bit headachy- PMS symptoms, basically.

The bleed is directly related to the estrogen dose too. Sounds to me as if you need a more gentle intro to HRT- less estrogen and maybe a different progestogen.

After waking up with very grumbly & painful insides and barely making it to the bathroom I've come to the same conclusion.

I think that this HRT regime is not for me, and I've taken the patch off and will see if the everything calms over the next 24 hours.

Teaseall i was on the Evoral Conti patch for 4 weeks and i had the runs non stop for 2 whole days, and also a couple of times in between starting it and stopping, and i have read about others with the same
No idea why, but strangely the day after i came off it,i had 2 days of runs again,
I stopped it completely and no problem since, also hair loss

Hi there @Teaseall.

I’m not sure if you’ll get this, but I wanted to thank you for sharing.

I’ve just started on the same patches and I have exactly the same symptoms. I’m only on my first round, but I’ll try and stick it out. I did wonder if your symptoms improved?

If they persist too long, I’ll revisit my GP.

Jane

Hi @MumofGrownKids aka Jane

For me the side effects of this particular HRT regime outweighed the benefits and I stopped using it after one month and one week. The diarrhoea continued for another week or so and the GP referred me for an colonoscopy and with some biopsies taken.

The were absolutely no issues found thankfully and I am convinced my gut disturbance was hormone (I.e. HRT) related as I used to get changes in bowel habits during my periods.

I hope things improve for you soon.

Thanks for getting back to me. That’s really helpful to know and I hope you found a way through all this.

@Teaseall hi I've just come across your post and I am at the stage you discussed ie just started evorel sequi two weeks ago so onto the progesterone patch now for two weeks. Feel really bloated and loose stools today. Also had headache since starting the patches. Just wondering did you stick with them and sis size effects ease? Thanks.

@Teaseall sorry new to this. Just noticed you said you came off the patches @MumofGrownKids how are you getting on? I'm not sure whether to carry on. I guess I will see how this first month goes. Bit worried about the anticipated break through bleed during these two wks of the progesterone patch! I have only had one period in the 13 months prior to starting this hrt. I don't want to have bleeds but GP said I had to go on the evorel sequi regime and not the purely evorel conti one as you must have the progesterone as eastrogen only would be dangerous as it thickens the womb lining.

Hi OP!
I am on month three of the exact same patches. I went on it for very similar emotional reasons to yours, but I was also having a crazy week of ANGER like I’ve never known. I’m 47 and still get very regular periods, albeit heavier than when I was younger. The patches are working but -

I had a huge breakthrough bleed in the first month and only for the box leaflet saying it can happen, I would have thought something was very wrong. It went on fro two weeks.

Next month, period came earlier, insanely heavy - need to change the pad hourly. I was late to change it as I was on a work call and I flooded thorough my jeans.

I have no period pain now and I used to be crippled. My moods are settled. I am no longer fatigued. I can’t quite believe it, it’s actually working.

The set of porches (the ones we change to further into the cycle, wk 3&4?) they irritate my skin. But it’s not to the point that I’d stop. They settle down but it’s like a burn/pinch under the patch.

I didn’t get any stomach issues, that sounds very rough.

Are you still using them? I think I’d give it the three months and see if things settle.

Actually I’m lying I do get period pain now but it’s low grade whereas before I was two days on nurofen plus and I’d wake up from the churning cramps.

Interesting to hear how it’s going for you!

Hi @MaBaker51
I really couldn’t cope with the side effects of the patches and insisted with my GP that I tried something else. I’ve since been on utrogestan tablets and oestrogel, which is a gel I rub in. I feel loads better, but was told there are still other options if I need them, e.g the Miracoil. I appreciated the need to give something a good go, but also think we need to listen to our bodies and be confident when speaking to our GPs. I know that’s hard when we’re feeling rubbish, but it’s worth trying other medicines and therapies until you find what’s right for you. Keep persevering, you’ll get there. I do hope you’re feeling stronger and brighter soon.

Hi @MumofGrownKids

Thanks so much for message and the info!! That's really kind of you. I've taken note of the alternatives you mention. I will see how I get on with the evorel sequi. I'm on the third week now so anxious to see what happens regarding bleeding!! I don't want a monthly bleed as I was enjoying finally having no periods for so long. If I had made it to the 12 months without one maybe if have had no more? I don't understand how I willknow if my periods have stopped and I am post menopause if I stay on this hrt with monthly bleeds? It's confusing me.
Thanks again for your kind words...hope you are feeling good on your current regime.

Hi, I'm also 51, been in perimenopause since I was 48. Went straight onto HRT patches once i'd visited my doctor, and we researched what they were !😆. Any way, I was on 50mg patches, and with a few weeks my obvious symptoms went away, after a year, I was getting painful swollen boobs (a symtom of too much estrogen), so after a little research found that you can cut them in half giving you 25mg (and they lasted twice as long !) That solved the problem. I did this for nearly 2 years without issue. But 6 months ago, some of my symptoms started creeping back. So just started using the full patch again. I have also managed to get testosterone gel, but not sure if it's helping 🤔

I literally just started the same patches last week. I'm only on the 2nd Conti 50 patch. I'm now really worrying about all these side effects.