Evorel Conti
PACKAGE LEAFLET: INFORMATION FOR THE USER
Evorel® Conti
(estradiol hemihydrate, norethisterone acetate)
In this leaflet
Read all of this leaflet carefully before you start using this medicine.
• Keep this leaflet. You may need to read it again
• If you have any further questions, ask your doctor or pharmacist
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours
• If you get side effects and they become serious or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist
This medicine is called Evorel Conti but will be referred to as Evorel throughout this leaflet.
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1. |
What Evorel is and what it is used for |
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2. |
Before you use Evorel |
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3. |
Safety of HRT |
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4. |
How to use Evorel |
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5. |
Possible side effects |
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6. |
How to store Evorel |
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7. |
Further information |
1. What Evorel is and what it is used for
The name of your medicine is Evorel. It belongs to a group of medicines called hormone replacement therapy (HRT).
Evorel contains two medicines:
• An oestrogen (estradiol)
• A progestogen (norethisterone)
They are both hormones.
Evorel comes in a ‘memory pack'. This can be used to help you remember when to change your patches. Each pack contains eight or twenty-four patches.
The hormones are spread evenly in each patch. They pass slowly into your body through the skin.
What Evorel is used for
Evorel is used:
• For the symptoms of the menopause (see ‘What is the menopause?'). It is suitable for women who have not had a period (menstrual bleed) for at least 18 months
• To prevent osteoporosis (weakening of the bones) in women who have had the menopause and are most likely to have bone problems. Evorel is only used if other medicines for osteoporosis have been tried first and they have not worked
What is the menopause?
Women produce oestrogen hormones from their ovaries throughout their adult life. These hormones are important in sexual development and control of the menstrual cycle.
The menopause happens when the level of hormones produced by the ovaries goes down. This is a gradual process. During this time the levels of oestrogen can go up and down. This can cause:
• Hot flushes, night sweats or mood swings
• Vaginal problems such as dryness or itching
• Uncomfortable or painful sexual intercourse
You may get the same symptoms if you have had your ovaries taken out in an operation.
This is called a hysterectomy.
How Evorel works
Evorel is known as ‘continuous combined' HRT. This is because both hormones in the patch are released all the time.
Evorel patches replace the oestrogen that is normally released by the ovaries. However, in women who still have a womb, taking an oestrogen hormone regularly may cause the lining of your womb to build-up and get thicker.
• This means it is necessary to add a progestogen hormone to the oestrogen
• This helps shed the lining of the womb and stop any problems happening
Most women do not have a regular monthly period with Evorel. However, bleeding or spotting does often occur in the first few months until treatment settles down.
2. Before you use Evorel Do not use Evorel if:
• You are allergic to anything in the patches (listed in section 7)
• You have (or have ever had), or think you may have, breast cancer
• You have ever had a cancer that was made worse by oestrogens (such as endometrial cancer)
• You have a thickening of the lining of the womb which has not been treated
• You have ever had blood clots (thrombosis) or a blood clot that has travelled to your lung (pulmonary embolism)
• You have problems with your blood which increases the likelihood of developing a blood clot (thrombosis)
• You have ever had blocked arteries (arterial thrombo-embolic disease) that gave you angina or a heart attack or resulted in a stroke
• You have a blood problem called ‘porphyria'
Do not use this medicine if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before using Evorel
Take special care with Evorel
Check with your doctor before using Evorel if:
• You have ever had vaginal bleeding which you could not explain
• The lining of your womb has ever got thicker (endometrial hyperplasia)
• You have ever had liver problems
You may still be able to use Evorel, but you should discuss this with your doctor first.
Evorel should not be used by children.
Medical check-ups
Before taking HRT, your doctor should ask about you and your family's medical history.
Your doctor may decide to examine your breasts or your tummy, and may do an internal examination. They will only do this if it is necessary for you, or if you have any special concerns. Once you have started on HRT, see your doctor for regular check-ups (at least once a year).
At these check-ups, your doctor may discuss the benefits and risks of continuing to take HRT.
Make sure that you:
• Go for regular breast screening and cervical smear tests
• Regularly check your breasts for any changes such as dimpling of the skin, changes in the nipple, or any lumps you can see or feel
Tell your doctor if you have ever had any of the following. You may need these checks more often.
• A problem caused by growth of the womb lining:
• Inside the womb (fibroids)
• Outside the womb (endometriosis)
• Increased risk of blood clots (see ‘Blood clots’ in section 3 overleaf)
• A family history of increased risk of cancers related to oestrogens (see ‘Breast cancer’ in section 3 overleaf)
• High blood pressure (hypertension). Your doctor may tell you to stop using Evorel if your blood pressure goes up
• Diabetes
• Gallstones
• Migraine or severe headaches
• Systemic lupus erythematosus (SLE). This is an allergic condition that causes joint pain, skin rashes and fever
• Epilepsy
• Asthma
• Bone formation in the ear (otosclerosis)
• Liver, heart or kidney problems
• High levels of triglycerides in your blood as you may have a higher risk of pancreatitis (inflammation of the pancreas, which causes severe pain in the abdomen and back)
• Any breast problems
Tell your doctor if these illnesses return or get worse while you are using Evorel
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines that you buy without a prescription or herbal medicines.
In particular, tell your doctor or pharmacist if you are taking any of the following:
• Medicines for epilepsy such as phenobarbital, phenytoin or carbamazepine
• Medicines for infections such as rifampicin, rifabutin, nevirapine or efavirenz
• Bosentan - for high blood pressure in the blood vessels of the lungs
• St. John’s Wort - for depression
Taking these medicines with Evorel can stop Evorel from working as well. Because of this you may get some bleeding, like a period, when you are not expecting it.
• A medicine for epilepsy called lamotrigine. Using Evorel with lamotrigine could affect control of your epilepsy
Operations or tests
Tell your doctor if you are going to have surgery. You may need to stop taking HRT about 4 to 6 weeks before the operation to reduce the risk of a blood clot. Your doctor will tell you when you can start taking HRT again.
If you visit a hospital or your family doctor for a blood or urine test, tell them that you are taking Evorel. This is because this medicine may affect the results of the tests.
Pregnancy and breast-feeding
Do not use this medicine if you are pregnant, think you may be pregnant or might become pregnant. This is because it may affect the baby.
If you become pregnant, contact your doctor straight away and remove the patch.
Do not use this medicine if you are breast-feeding.
Ask your doctor or pharmacist for advice before taking any medicine if you are pregnant or breast-feeding.
Driving or using machines
There is no information about whether Evorel affects your ability to drive or use machines. See how this medicine affects you before you drive or use any tools or machines
3. Safety of HRT
As well as benefits, HRT has some risks. Consider the following when deciding to take or continue HRT.
Heart disease
HRT is not recommended for women who have had heart disease recently. If you have ever had heart disease, talk to your doctor to see if you should be taking HRT.
HRT will not help to prevent heart disease.
Studies of HRT (containing oestrogen and progestogen) have shown that women may be slightly more likely to get heart disease.
If you get a pain in your chest that spreads to your arm and neck
• See a doctor as soon as possible
• Do not take any more HRT until your doctor says you can This pain may be a sign of heart disease.
Stroke
Research suggests that HRT slightly increases the risk of having a stroke. Other things that can increase the risk of stroke include:
• Getting older
• High blood pressure
• Smoking
• Drinking too much alcohol
• An irregular heart beat
If you are worried about any of these things, or if you have had a stroke in the past, talk to your doctor to see if you should take HRT.
How likely is a stroke?
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT - 3 in 1000 would be expected to have a stroke
• In women 4 in 1000 would be expected to have a stroke
Looking at women in their 60s, on average, over 5 years:
• In women not taking HRT -11 in 1000 would be expected to have a stroke
• In women 5 in 1000 would be expected to have a stroke
If you get migraine-type headaches which you cannot explain:
• See a doctor as soon as possible
• Do not take any more HRT until your doctor says you can These headaches may be an early warning sign of a stroke.
Blood clots
HRT may increase the risk of blood clots in the veins (also called deep vein thrombosis, or DVT), especially during the first year of taking it.
These blood clots are not always serious. However, if a clot travels to the lungs, it can cause chest pain, breathlessness, collapse or even death. This is called pulmonary embolism, or PE.
You are more likely to get a blood clot if:
• You are very overweight
• You are getting older
• You have had a blood clot before
• Any of your close family have had blood clots
• You are pregnant or have just had a baby.
• You have had one or more miscarriages
• You have any blood clotting problem that needs treatment with a medicine such as warfarin
• You are off your feet for a long time because of major surgery, injury or illness
• You are going on a long journey and will not be moving about for some time
You have a rare illness called SLE (Systemic Lupus Erythematosus)
If any of these things applies to you, talk to your doctor to see if you should take HRT.
How likely is a blood clot?
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT - 3 in 1000 would be expected to get a blood clot
• In women ' in 1000 would be expected to get a blood clot
Looking at women in their 60s, on average, over 5 years:
• In women not taking HRT - 8 in 1000 would be expected to get a blood clot
• In women 7 in 1000 would be expected to get a blood clot
If you get painful swelling in your leg, sudden chest pain or have difficulty breathing:
• See a doctor as soon as possible
Do not take any more HRT until your doctor says you can These may be signs of a blood clot.
Breast cancer
Women who have breast cancer, or have had breast cancer in the past, should not take HRT.
Taking HRT slightly increases the risk of breast cancer. The risk is also slightly increased if you have a later menopause.
• Postmenopausal women taking oestrogen-only HRT for 5 years - the risk is about the same as for a woman of the same age who is still having periods over that time, and not taking HRT
• Women taking oestrogen plus progestogen HRT - the risk is higher than for oestrogen-only HRT. However, oestrogen plus progestogen HRT is beneficial for the endometrium
(see ‘Endometrial cancer')
For all kinds of HRT, the extra risk of breast cancer goes up the longer you take it.
However, it returns to normal within about 5 years after stopping HRT.
Your risk of breast cancer is also higher if:
• You have a close relative (mother, sister or grandmother) who has had breast cancer
• You are very overweight
How likely is breast cancer?
Looking at women aged 50, on average, over the next 15 years:
• In women not taking HRT - 32 in 1000 will get breast cancer
• In women taking oestrogen-only HRT at age 50 and take it for 5 years, between 33 and 34 in 1000 will get breast cancer
• In women taking oestrogen-only HRT for 10 years - 37 in 1000 will get breast cancer
• In women taking oestrogen plus progestogen HRT at age 50 and take it for 5 years -38 in 1000 will get breast cancer
• In women taking oestrogen plus progestogen HRT for 10 years - 51 in 1000 will get breast cancer
If you notice any changes in your breast, such as:
• Dimpling of the skin
• Changes in the nipple
• Any lumps you can see or feel
Make an appointment to see your doctor as soon as possible.
Endometrial cancer (cancer of the lining of the womb)
Taking oestrogen-only HRT for a long time can increase the risk of cancer of the lining of the womb (the endometrium). Taking a progestogen as well as the oestrogen helps to lower the extra risk.
If you still have your womb, your doctor will usually prescribe a progestogen as well as oestrogen. These may be prescribed separately, or as a combined HRT product.
If you have had your womb removed (a hysterectomy), your doctor will discuss with you whether you can safely take oestrogen without a progestogen.
If you have had your womb removed because of endometriosis, any endometrium left in your body may be at risk of cancer. This means your doctor may prescribe HRT that includes a progestogen as well as an oestrogen.
Your product, Evorel, contains a progestogen.
How likely is endometrial cancer?
Looking at women aged 50 who still have a womb, on average, over the next 15 years:
• In women not taking HRT - 5 in 1000 will get endometrial cancer
• In women taking oestrogen-only HRT, the number will be 2 to 12 times higher, depending on the dose and how long you take it for
The addition of a progestogen to oestrogen-only HRT substantially reduces the risk of endometrial cancer.
If you get breakthrough bleeding or spotting, it is usually nothing to worry about, especially during the first few months of taking HRT.
But if the bleeding or spotting:
• Carries on for more than the first few months
• Starts after you have been on HRT for a while
• Carries on even after you’ve stopped taking HRT
Make an appointment to see your doctor. It could be a sign that your endometrium has become thicker.
Ovarian cancer
Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose. This is because there are often no obvious signs of the disease. Some studies have suggested that taking HRT for more than 5 years may increase the risk of ovarian cancer.
Dementia
Evorel and medicines like it will not stop memory loss (dementia). Women who start using medicines like Evorel after the age of 65 may have a small increase in the risk of dementia.
4. How to use Evorel
Always use Evorel exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Your doctor will aim to reduce your symptoms with the lowest possible dose for the shortest amount of time.
When to start using Evorel
You may put an Evorel patch on at any time if:
• You have not been using another type of HRT
Put an Evorel patch on at the end of a treatment cycle or one week after you finish using another HRT product if:
• You are changing from an HRT medicine that gives you a withdrawal bleed If you are using another type of HRT:
The day you start will depend on the type of HRT you have been using Talk to your doctor if you are not sure which type of HRT you are using.
Using the patches
The patches need to be changed twice a week.
Start a new pack of Evorel as soon as you finish one. Do not leave a break between packs.
Changing your patches
• You must change the patches twice a week to give your body a steady supply of hormones. There is enough hormone in each patch to last for several days
• Change your patch on the same two days every week. This will mean that one patch is on for three days and the next patch for four days
• For example, if you apply your first patch on a Monday, change it on Thursday and again on the following Monday. You can work out your two days from the following table, starting from the first day of use:
If you put your first patch on: Change on: Change again on:
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Monday |
—*■ |
Thursday |
& |
Monday |
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Tuesday |
—► |
Friday |
& |
Tuesday |
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Wednesday |
—► |
Saturday |
& |
Wednesday |
|
Thursday |
-► |
Sunday |
& |
Thursday |
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Friday |
Monday |
& |
Friday | |
|
Saturday |
_ |
Tuesday |
& |
Saturday |
|
Sunday |
—► |
Wednesday |
& |
Sunday |
To help you remember your two ‘patch change' days, mark them here or on the pack. They are written on the pack like this:
Where to apply the patch
Stick the patch onto a hairless area of skin below the waist. Most women prefer to wear the patch on the thigh or bottom.
• Do not apply on or near the breasts
• Do not put it on top of cuts, spots or anywhere the skin is irritated
• Do not use cream, moisturiser or talc before applying the patch
• Do not apply the patch on the same area of skin twice in a row
• It can be worn under loose areas of clothing
• Do not wear a patch under elasticated areas or a tight waistband
• Apply the patch to clean, dry cool skin as soon as you open the protective pouch
Putting a patch on
Do not use a patch if its protective pouch is already open.
Step 1: Open and Peel
• Using the notches as a guide, tear along two edges of the pouch.
Remove the patch
• With the protective backing facing you, bend and peel off half the backing. Don't touch the sticky side - it may not stick properly if you do
Step 2: Apply and Press
• Apply the open half of the patch to your skin
• Remove the remaining backing and press down the rest of the patch
• Press the patch with the palm of your hand to make sure it is firmly stuck
Removing a patch
• Peel an edge of the patch smoothly away from the skin
• Fold the patch in half, so that the sticky side sticks to itself
• Put it in with the household rubbish, safely out of the reach of children and pets
• Do not flush used patches down the toilet
When you remove the patch some glue may remain on your skin.
It will disappear with time, or you can use baby oil to remove it.
If a patch falls off
Apply a new patch but keep to your original ‘patch change' days. If you have just had a bath or a shower, wait until your skin cools before applying the new patch. Talk to your doctor if you need more patches.
If you forget to change the patch
Change it as soon as you remember and then keep to your original ‘patch change' days.
You may get some bleeding and spotting like a period during this time.
If you use more Evorel than you should
It is unlikely that you will have too much of the hormones in Evorel
The most common symptoms of having too much oestrogen or progestogen in your body are:
• Tender breasts
• Feeling sick (nausea)
• Unexpected vaginal bleeding
• Stomach pain or bloating
Removing the patch can reverse the effects of too much oestrogen and/or progestogen.
Talk to your doctor or pharmacist before using any more patches.
Contraception while using Evorel
The levels of hormone from the patches are too low to act as a contraceptive.
Use non-hormonal contraceptive methods (such as a condom, diaphragm or coil) until your periods have completely stopped.
Everyday activities
• You can have a bath or shower as normal. Do not scrub too hard as this can loosen the edges of the patch
• You can go swimming. The patch will not be affected
• You can exercise and play sports. However, do not wear the patch under tight clothing or waist bands
• You can sunbathe. However, keep the patch covered, out of direct sunlight
If you have any further questions on the use of this product, ask your doctor or pharmacist.
5. Possible side effects
Like all medicines, Evorel can cause side effects, although not everybody gets them.
Take off the patch and tell your doctor straight away if you notice or suspect any of the following. You may need urgent medical treatment.
• Sudden swelling of the face or throat which may cause difficulty in swallowing or breathing. This may be a sign of an allergic reaction. This only happens in a small number of people
• Blood clots (thrombosis) (affects less than 1 in 1000 people) or stroke (frequency not known)
• Yellowing of the skin or whites of the eyes (jaundice), or other liver problems
• Migraine-type headaches for the first time or more frequent (affects less than 1 in 100 people).
• An increase in blood pressure (affects less than 1 in 10 people)
• Breast or ovarian cancer, endometrial cancer or hyperplasia (long, heavy or irregular periods)
• Widespread rash with peeling skin and blistering in the mouth, eyes and genitals (Stevens-Johnson syndrome) (frequency not known)
• Convulsions or fits (affects less than 1 in 1,000 people)
Tell your doctor if you notice any of the following side effects while using Evorel Very common (affects more than 1 in 10 people)
• Irritated, itchy, red skin and rash where the patch is applied Common (affects less than 1 in 10 people)
• Allergic reaction (hypersensitvity)
• Being unable to sleep
• Feeling depressed, nervous or anxious
• Headache
• Being aware of your heart beat (palpitations)
• Varicose veins
• Flushing, skin reddening
• Breast pain
• Numb or tingling hands or feet
• Feeling sick (nausea)
• Diarrhoea
• Stomach ache
• Pain including pain in the back or joints
• Painful periods
• Discharge from the vagina
• Irregular, heavy or prolonged bleeding from the vagina, including after sex
• Water retention or build-up of fluid under the skin (oedema)
• Feeling tired
• Weight gain
Uncommon (affects less than 1 in 100 people)
• Vaginal infections such as thrush
• Less interested in sex than usual
• Wind
• Itchy skin
• Rash
• Swelling of the hands and feet(peripheral oedema)
• Muscle pain Frequency not known
• Mood swings
• Feeling dizzy
• Bloated feeling
• Gallstones
• Fuller breasts
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard
By reporting side effects, you can help provide more information on the safety of this medicine.
6. How to store Evorel
Keep out of the sight and reach of children.
Do not store above 25°C. Store in the original package. Keep in the original pouch and carton. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
Do not use Evorel after the expiry date which is stated on the label after ‘Exp'. The expiry date refers to the last day of that month.
Do not use the patches if they show any signs of deterioration. Do not use a patch if its protective pouch is open.
7. Further information
The active substances in Evorel are estradiol hemihydrate and norethisterone acetate.
Each Evorel patch contains 3.2mg of estradiol hemihydrate and 11.2mg of norethisterone acetate. Each Evorel patch delivers 50micrograms of estradiol and 170micrograms of norethisterone acetate a day.
The other ingredients are: acrylate/vinyl acetate co-polymer, guar gum, polyethylene terephthalate foil and siliconised polyethylene terephthalate foil which is removed before application.
What Evorel looks like and contents of the pack
Evorel comes in a memory pack containing eight transdermal patches.
Square-shaped transparent patch with rounded corners marked 'CEN1' and with an adhesive backing.
Manufactured by:
Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium.
Procured from within the EU and repackaged by the Product Licence holder: B&S Healthcare, Unit 4, Bradfield Road, Ruislip, Middlesex, HA4 0NU, UK
Evorel® Conti; PL No: 18799/2012 [POM]
Leaflet date: 22.10.2015
Evorel is a registered trademark of Janssen Cilag
Each patch comes in a protective sealed pouch and has a surface area of 16 sq cm.