Evorel Conti

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Evorel Conti on Prescriptsy

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Evorel Conti is a continuous combined hormone replacement therapy (HRT) patch containing estradiol and norethisterone acetate, used to relieve menopausal symptoms and protect the endometrium in postmenopausal women who still have an intact uterus.

Each patch releases estradiol 50 micrograms and norethisterone acetate 170 micrograms per 24 hours when applied to the skin.

Manufactured by Theramex (formerly Janssen), Evorel Conti is a prescription-only medicine (POM) in the United Kingdom.

It is designed for women who are at least 12 months past their last menstrual period and who wish to avoid a monthly withdrawal bleed.

The menopause marks the end of ovarian oestrogen production, causing a range of symptoms that affect the majority of women.

Hot flushes, night sweats, vaginal dryness, mood disturbance, sleep disruption, and joint aches are among the most common complaints.

In the longer term, oestrogen deficiency contributes to accelerated bone loss and increased fracture risk.

Continuous combined HRT provides both oestrogen replacement and endometrial protection in a single formulation, without the cyclical withdrawal bleeds associated with sequential HRT regimens.

Transdermal delivery offers additional safety advantages over oral HRT, particularly regarding venous thromboembolism risk.

This page provides a comprehensive clinical guide to Evorel Conti for patients in the United Kingdom, covering how it works, who it is suitable for, how to use it, side effects, safety information, and how to obtain a prescription.

Important safety information about Evorel Conti

Before reading further, note the following essential safety points. Evorel Conti is a prescription-only medicine and must be used under medical supervision.

• Evorel Conti is for postmenopausal women with a uterus who are at least 12 months past their last period.
• It must not be used in women with known or suspected breast cancer, oestrogen-dependent tumours, undiagnosed vaginal bleeding, or active thromboembolic disease.
• Combined HRT is associated with a small increase in breast cancer risk with prolonged use. Benefits and risks should be reviewed annually.
• Transdermal HRT carries a lower risk of venous thromboembolism than oral HRT.
• Report new breast lumps, persistent vaginal bleeding, or symptoms of blood clots immediately.

Why combined HRT is necessary for women with a uterus

Oestrogen stimulates growth of the endometrium (the lining of the uterus).

In premenopausal women, this growth is balanced by progesterone produced after ovulation, which causes the endometrium to shed during menstruation.

After the menopause, if oestrogen is given without progestogenic opposition, the endometrium may proliferate unchecked, leading to endometrial hyperplasia and a significant increase in the risk of endometrial cancer.

NICE guideline NG23 and the British Menopause Society strongly recommend that all women with an intact uterus who take oestrogen-containing HRT must also receive progestogen for endometrial protection.

Evorel Conti provides this protection by incorporating norethisterone acetate alongside estradiol in the same transdermal patch. The continuous progestogen delivery maintains a thin, atrophic endometrium, eliminating the need for a monthly withdrawal bleed and reducing the risk of endometrial pathology.

How Evorel Conti works

Evorel Conti is a matrix-type transdermal patch. Estradiol and norethisterone acetate are dispersed within an adhesive polymer layer.

When applied to the skin, both hormones diffuse through the epidermis into the dermal capillary network, entering the systemic circulation directly.

Transdermal delivery bypasses first-pass hepatic metabolism, meaning the hormones are not extensively processed by the liver before reaching target tissues.

This results in more stable plasma hormone levels and avoids the hepatic effects associated with oral HRT, including increased production of clotting factors, elevation of triglycerides, and induction of sex hormone-binding globulin.

The clinical consequence is a lower risk of venous thromboembolism with transdermal compared with oral HRT, a finding supported by multiple observational studies and meta-analyses.

Estradiol relieves menopausal symptoms by restoring oestrogen levels to a range sufficient to suppress vasomotor instability (hot flushes, night sweats), reverse urogenital atrophy, and maintain bone mineral density.

Norethisterone acetate, a 19-nortestosterone-derived progestogen, counteracts the proliferative effect of oestrogen on the endometrium. Its continuous administration aims to produce endometrial atrophy, avoiding cyclical bleeding.

Clinical evidence and UK prescribing guidance

NICE guideline NG23 recommends that combined HRT be offered to women with menopausal symptoms who have an intact uterus.

The guideline states that transdermal preparations should be considered for women at increased risk of VTE, including those with a BMI above 30.

The British Menopause Society supports these recommendations and notes that for most women under 60 who start HRT within 10 years of the menopause, the benefits outweigh the risks.

Clinical trials of Evorel Conti have demonstrated effective symptom relief, endometrial safety, and acceptable tolerability.

The incidence of endometrial hyperplasia with continuous combined transdermal HRT is comparable to that seen in untreated postmenopausal women (less than 1%), confirming effective endometrial protection.

Breakthrough bleeding rates decline progressively over the first 6 to 12 months, with the majority of women achieving amenorrhoea (no bleeding) by the end of the first year.

Who is Evorel Conti suitable for?

Evorel Conti is designed for postmenopausal women who are at least 12 months past their last natural menstrual period and who still have an intact uterus.

Starting continuous combined HRT before the menopause is fully established (before 12 months of amenorrhoea) increases the likelihood of unpredictable irregular bleeding.

Women who are perimenopausal or less than 12 months postmenopausal should use sequential (cyclical) HRT, such as Evorel with a separate cyclical progestogen, and switch to continuous combined therapy later.

Evorel Conti may be particularly suitable for women who prefer transdermal HRT (due to lower VTE risk, avoidance of hepatic first-pass effects, or difficulty swallowing tablets), women who want a bleed-free HRT regimen, and women switching from sequential HRT after at least 12 months of amenorrhoea.

How to use Evorel Conti

Apply one patch to clean, dry, non-hairy skin on the lower trunk (buttock or hip) twice weekly, changing every 3 to 4 days. Press firmly for 10 seconds.

Rotate application sites, allowing at least 7 days before reusing a site. Do not apply to the breasts, waistline, or skin treated with lotions or oils.

The patch should remain in place during bathing, swimming, and exercise.

Use Evorel Conti continuously, without a patch-free interval. If a patch falls off, apply a new one immediately. If a patch change is forgotten, apply the replacement as soon as you remember and resume your usual schedule.

Side effects of Evorel Conti

Common side effects

Application site reactions (redness, itching, irritation) affect approximately 10 to 15% of users and are usually mild.

Breast tenderness, headache, nausea, bloating, weight fluctuation, and breakthrough vaginal bleeding or spotting are common, especially in the first 3 to 6 months.

Irregular bleeding typically settles as the endometrium adjusts to the continuous hormone levels.

Uncommon and rare side effects

Uncommon effects include mood changes, depression, dizziness, migraine, leg cramps, fluid retention, changes in libido, vaginal discharge, acne, and pruritus. Rare effects include venous thromboembolism (lower risk than oral HRT), arterial thrombotic events, gallbladder disease, and hypersensitivity reactions.

Breast cancer risk

Combined HRT is associated with a small increase in breast cancer risk after prolonged use (more than 5 years).

The absolute additional risk is approximately 1 extra case per 1,000 women per year.

This risk is higher with combined HRT than with oestrogen-only HRT and decreases after stopping treatment.

Attend regular mammography screening and report any new breast changes to your GP.

When to seek urgent help

Call 999 or attend A&E if you experience sudden severe chest pain, breathlessness, painful swelling of a leg, sudden severe headache, visual disturbance, or weakness on one side of the body.

Contact your GP if vaginal bleeding persists beyond 6 months, if bleeding starts after a bleed-free period, if you find a breast lump, or if your mood deteriorates significantly.

Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Evorel Conti must not be used in women with known or suspected breast cancer, other oestrogen-dependent tumours, undiagnosed abnormal vaginal bleeding, untreated endometrial hyperplasia, active or history of venous thromboembolism (unless on anticoagulant therapy), active or recent arterial thromboembolic disease, active liver disease, porphyria, or known allergy to any component of the patch.

Venous thromboembolism

Transdermal combined HRT carries a lower VTE risk than oral preparations. Nevertheless, women with VTE risk factors (obesity, personal or family history, prolonged immobilisation, thrombophilia, active cancer) require careful assessment. Consider temporary discontinuation before elective surgery requiring prolonged bed rest.

Cardiovascular considerations

HRT should not be initiated solely for cardiovascular protection. The risk of stroke may be slightly increased. Women with cardiovascular risk factors should be assessed individually.

The timing of HRT initiation is relevant: starting within 10 years of the menopause in women under 60 is associated with a more favourable cardiovascular profile than later initiation.

Endometriosis

Oestrogen-containing HRT may reactivate residual endometriosis. Women with a history of endometriosis should be monitored for recurrence of symptoms, including pelvic pain.

Conditions requiring caution

These include hypertension, diabetes mellitus, migraine (especially with aura), epilepsy, asthma, gallbladder disease, hepatic or renal impairment, systemic lupus erythematosus, otosclerosis, and uterine fibroids.

Drug interactions

Hepatic enzyme inducers (carbamazepine, phenytoin, phenobarbital, rifampicin, St John's wort) may reduce the efficacy of both hormone components by increasing their metabolism.

Oestrogens may increase lamotrigine clearance and alter thyroid hormone requirements. Warfarin anticoagulation may be affected; INR monitoring is advised when starting or stopping treatment.

How to get Evorel Conti in the UK

Evorel Conti is a prescription-only medicine available on the NHS from your GP, a specialist menopause clinic, or an authorised online prescriber.

A clinical assessment including personal and family medical history, blood pressure, and breast awareness review is required before prescribing.

The NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

An HRT prepayment certificate may be cost-effective for women using multiple HRT products.

Living well during the menopause

HRT is one component of menopause management.

Regular physical activity, a balanced diet rich in calcium and vitamin D, maintaining a healthy weight, limiting alcohol and caffeine, and managing stress all contribute to overall wellbeing.

Cognitive behavioural therapy (CBT) has evidence for improving hot flushes and sleep quality.

The NHS and organisations such as the British Menopause Society provide reliable information and support for women navigating the menopause.

When to seek medical advice

Contact your GP or NHS 111 if menopausal symptoms are not adequately controlled, if you experience persistent vaginal bleeding, if you develop new or concerning symptoms, or if you wish to review your HRT.

Seek emergency care (call 999 or attend A&E) for sudden chest pain, leg swelling, breathlessness, severe headache, or one-sided weakness.

Report suspected adverse reactions to the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Evorel Conti, Summary of Product Characteristics (EMC)
• Estradiol with norethisterone, British National Formulary (BNF)
• NICE NG23: Menopause: diagnosis and management
• British Menopause Society
• Menopause, NHS
• MHRA Yellow Card Scheme