Is Evorel Sequi 50 right for a 42‑year‑old with fatigue, brain fog and migraines?

[PM2026]

I’ve been advised to start HRT for perimenopause symptoms. My GP has been suggesting I’m in peri for the past 2-3 years, but I kept pushing back until now 😬

I’ve just been put on 50 mcg patches (Evorel Sequi).

My key symptoms over the past 2–3 years:

• Fatigue
• Brain fog
• UTIs
• Joint pain
• Accelerated skin ageing

More recently:

• Increase in migraines (I used to get hormonal migraines 4–5 days around my period, now they’re almost daily)
• Feeling hot at night (but not remotely close to full night sweats)
• Decrease in libido

Sleep has always been bad. Anxiety comes and goes but isn’t too bad at the moment. I still have fairly regular periods. Mum has osteoporosis.

The 50 patch is giving me nausea. I’ll give it more time (it’s only been 3 days), but I’m starting to feel like my treatment plan might not have been well thought out. Since starting HRT, I’ve been reading more about it and I’ve noticed that many young-ish women like myself seem to start on lower doses (25 mcg patches or 1 pump of gel).

Also, my GP didn’t tell me there were two types of patches in the box. I’m only finding out now as I’m typing this and checking for nausea in the leaflet! 😳 I was just told to put a new one on every 3.5 days. Insane!

Now I’m wondering whether the treatment I’ve been prescribed makes sense. Has anyone else started on 50 mcg? How did it go for you? 😊

After 3 months you will have a review and you can say yay or nay. They can tweak it, up it, drop it based on how you are feeling etc not for me it was life changing. My sister had crushing anxiety with palpitations and rages and she’s 42. Got the hrt on a morning day , by Wednesday, palpitations pretty much stopped and she’s like a different calmer person already. Her hot flusters have reduced already too.

and the information leaflet in the box tells about the patches. It’s in the patient to read the info leaflet. You must have a uterus still so yes you need or oestrogen daily and then prog for 10-12 days I think? But your patches are all set up in the box to take care of that so you just take the front one and that’s it.

Off I was you odd defo do more research and then raise your concerns at your review at 3 months

And I started on the same as you at 41, now on a higher dose of gel and prog . I preferred the ease of the patches!

Those symptoms can absolutely be peri.
Have you started though with paying attention to sleep hygiene, exercise, nutrition, stress, fluids etc etc.
So many ‘peri’ symptoms are also just ‘life in your 40s can be really fricking tiring and stressful, and I ended up eating shit and doing no exercise as a result’ symptoms and HRT is sometimes being seen as the cure to everything.
Good luck.

I started HRT at 45, it was an initial rough ride and it needed a tweak - the progesterone, not the Evorel 50- but now it's great and in hindsight I can see that I needed it earlier, but I didn't know why I was having so many migraines and poor decisions!

I get migraines and going straight to 2 pumps made them worse so I came off for a few more months . Started again with 1 pump of gel and 1 progesterone tablet and it was fine and I felt better for about 6 months. Now on 2 pumps and it’s all good.

I got terrible nausea when starting on estrogen patches (50), I basically felt like I was in early pregnancy with morning sickness. But it only lasted 2 weeks and then I felt much better in general

When going up a dose my GP told me the nausea meant it was too bigger increase at once so I could cut the patch (diagonally) in half and just use half until it settled, then add the other half after that. It's a way of minimising side effects when starting/ increasing.

I also get menstral migraine, and when they started to run amok it is how I knew I'd entered perimenopause.

Younger women in peri often need higher levels of estrogen replacement due to greater fluctuations in hormones. I found a high dose controlled my migraines better. Obviously not true of everyone though.

I do also agree with the pp that not everything in your 40s is menopause related, so maybe it's not necessary. But I wouldn't let the side effects be your guide of whether that's true or not. Side effects can happen to anyone at any age/stage.

Try also a perimenopausal supplement if there are no contraindications with any meds you are taking. They will also state if the can be used alongside hrt.

My GP won’t allow me HRT as my blood tests indicate I’m nowhere near perimenopause? I’ve had oestrogen , FSH, LH , progesterone and some others and they are saying my symptoms are not peri and instead psychological or to do with my thyroid (underactive but well controlled ?) I’m 45 - I have anxiety, low mood, PMDD and exhaustion at a level I’ve never known before, I often wake up too hot at night too. They say as my periods are still 28 days and I ovulate that it’s not peri but I feel sure it is is there anything I can say or do?

.

Try and see a different GP if possible. Mine let me try hrt for 3 months to see if it helped, no tests prior except blood pressure, and after 3 months I continued taking the hrt as it helped every one of my symptoms.

Keep a diary every day of what’s better and what’s not or any changes for the review. It helped me to notice when there were more good days than bad and at what point in the cycle.

It’s a perfectly acceptable starting regimen for a woman who’s still been having periods. Oestrogen can cause nausea, bloating and breast tenderness at any dose, but more likely at higher doses - 50 isn’t “high” though and younger women tend to need more oestrogen when starting than older women. We can always reduce the oestrogen after a month or so if side effects aren’t settling or improving. (But then you couldn’t have Sequi as it’s a fixed dose, and would need to switch to a different regimen).

Despite me going through how to use Sequi, they are often more confused though until they see the product, so I tell them to read the leaflet carefully!

You may just need your dose tweaked. I did think it was normal to start on a lower dose and work your way up.

The thing that has most helped my sleep is taking the progesterone pill before sleep - also helps my anxiety.

So you may just need to try other forms. It does take a while to settle but I think it would be better to reduce the dose rather than stop altogether.

It doesn’t sound like it was explained to you very well.

@GreenGodiva

Good it was life‑changing for your sister! I used to have crushing anxiety too, between age 35 and 40. I was sleeping 2 hours a night and having horrible palpitations. I had to stop working. It’s been much better for the past 2-3 years. HRT might take the final edge off 😊

@101trees

It was the non‑stop migraine that made me agree to HRT 🤯 I was still on the fence about whether my other symptoms could be explained by ageing.

Good to know patches should be cut diagonally. Can I keep the other half and use it later, or once the wrapper is open does it not keep long? I used to cut my nicotine patches but I’m not sure it’s the same.

50mcg is a standard starting dose. 25mcg would be considered low dose. Most side effects do settle down but if yours don’t it might be worth stepping down to the 25mcg patch for a whil.

Same experience OP, and Im suffering confusion and memory loss so she didnt explain anything and just said 'its all explained in the pack', well the pack information is enormous and overwhelming. I didnt even realise about the changes of pack and progesterone

Also I found out the progesterone bit of the patches is not body identical and contraindicated for low mood, which isnt helpful

Also I was told to expect my migraines to get worse as estrogen makes them worse, dont know if thats true.

Also my anxeity is worse since starting the patches, Im on week 2 now, moving to the conti on Tuesday

@GainOfFunctionTories

Blood tests for sex hormones aren’t really meaningful in peri. You seem very similar to me. I also have hypothyroidism. There’s a large overlap in symptoms, and I was convinced mine were due to my poorly functioning thyroid. So I initially refused to start taking HRT and asked for a levo increase instead. That only helped for a few months...

In my case, I was told several times by two separate GPs that it was peri. Both are women around my age. They proposed HRT but didn’t overly push. I felt I was given agency. I’m not sure what might help you get the support you need. Any other GP at your practice? 🩵

@Sidge

Thanks for the reassurance 😊 It’s all well explained in the leaflet, but I do feel the GP could at least have mentioned that the pack contains two different types of patches. I’d said I knew nothing about HRT beyond needing progesterone to protect the uterine lining. Luckily I figured it out quickly enough. No harm done...

@soupyspoon

It’s quite a big piece of information for the GP to leave out, right! I hope your HRT journey is now smoother 🩵

From what I understand if you have the progesterone in a patch then you get the necessary protection for the uterus it you don’t get the sleep
or anti anxiety benefits some women get. But equally some women can’t tolerate it orally.

HRT really is a case of tweaking until
you find what works for you.

Are you saying the progesterone in the patch form doesnt not help anxiety symptoms?

From what I understand it needs to be processed through the liver to have the extra benefits for sleep and anxiety but it’s absolutely fine for the uterine protection.

Though for me the sleep and anxiety went hand in hand in that my anxiety was in the middle of the night and it stopped this

I’m guessing a more general anxiety (linked to the drop in serotonin and dopamine following hormone reduction) would be helped by the oestrogen in the patch.

But personally I found oral progesterone hugely beneficial.

The oral micronised progesterone is body identical and not synthetic. Ustrogen it’s called. I have this with a oestrogen (Estradot) patch.