Evorel 500 Gel

Like all medicines, Evorel Gel can cause side effects, but not everyone gets them. The most common, affecting up to 1 in 10 people, are:

• Irregular bleeding or spotting
• Headaches
• Tummy pain
• Nausea
• Itchy skin or a rash
• Changes in weight

Less common side effects include breast tenderness, low mood, dizziness and fluid retention. You'll find the full list of side effects in your Patient Information Leaflet.

Stop using Evorel Gel and get medical help straight away if you have:

• Signs of a blood clot, such as a painful, swollen leg, chest pain or difficulty breathing
• Yellowing of your skin or eyes
• Swelling of your face, tongue or throat
• A migraine-like headache for the first time

Like all HRT, Evorel Gel carries a small increased risk of breast cancer, blood clots and stroke. Your prescriber will explain what this means for you.

Evorel Gel isn't suitable for everyone. Your prescriber will check your medical history before prescribing it to you.

You shouldn't use Evorel Gel if you have or have had:

• Breast cancer, or a cancer sensitive to oestrogen, such as womb cancer
• A blood clot, a blood clotting disorder, a heart attack, stroke or angina
• Unexplained vaginal bleeding or untreated thickening of the womb lining
• Liver disease where your liver tests haven't returned to normal

Tell your prescriber if you have fibroids, endometriosis, high blood pressure, diabetes, migraines, epilepsy, asthma, gallstones or lupus. You may need more regular check-ups.

Other things to be aware of

• Other medicines: some medicines for epilepsy, tuberculosis and HIV, as well as St John's Wort, can affect how well Evorel Gel works.
• Contraception: Evorel Gel isn't a contraceptive. If you're under 50, or it's been less than 12 months since your last period, you may still need contraception.
• Check-ups: see your prescriber at least once a year to review whether Evorel Gel is still right for you.

Active ingredient: Estradiol

Other ingredients: 96 percent ethanol, purified water, propylene glycol, diethylene glycol monoethylether (TRANSCUTOL®), carbomer (CARBOPOL® 1382), trolamine, edetate disodium.

You apply Evorel Gel to your skin once a day, ideally at around the same time. Your prescriber will tell you how many pumps you need.

Before first use, press the pump a few times to get the gel flowing. This may not be a full dose, so discard the first bit that comes out.

To apply:

• Press the pump into your palm as many times as you've been prescribed.
• Spread the gel over clean, dry skin on your tummy, thighs, arms or shoulders, covering an area about twice the size of your hand. Never apply it to your breasts or genitals.
• Leave it to dry for 2 minutes. You don’t need to rub it in.
• Wash your hands.

Don't wash the area or put any other creams on it for at least an hour. Once the gel is dry, cover it with clothing so it can't pass to anyone else, especially children.

The usual dose is 3 pumps (1.5g of gel) once a day. Your prescriber may adjust this to anywhere between 1 and 6 pumps, depending on how you respond. The aim is always the lowest dose that controls your symptoms.

Most people use it for 24 to 28 days of each month, followed by a break of 2 to 7 days. Some people are prescribed it every day without a break.

If you’re taking progestogen alongside Evorel Gel, you’ll do so for at least 12 days of each cycle.

If your dose feels too strong or not strong enough, speak to your prescriber rather than changing it yourself.

At a dose of 3 pumps a day, one bottle of Evorel Gel lasts about 4 weeks. Each bottle contains 84 doses, so how long it lasts depends on how many pumps you've been prescribed.

In a clinical study, women using Evorel Gel went from around 10 hot flushes a day to fewer than 3 after 4 weeks. By 3 months, it was down to 1 or 2 a day.¹

These are averages from a study of 145 women, so your results may differ. Most women found the usual dose of 3 pumps a day gave them effective relief.

Evorel Gel contains oestrogen only. If you have a womb, taking oestrogen without a progestogen can cause the lining of the womb to thicken over time, increasing the risk of womb cancer.

The good news is that adding a progestogen provides protection against this increased risk. Your prescriber will prescribe it separately and explain how to take it alongside your Evorel Gel. With Evorel Gel, a progestogen should be taken for at least 12 days of each 28-day cycle.

Putting the risk into perspective

Around 5 in 1,000 women aged 50–65 who have a womb and don't take HRT are diagnosed with womb cancer. With oestrogen-only HRT, this is around 10–60 in 1,000, depending on the dose and how long it's used. Taking a progestogen alongside your oestrogen helps prevent this additional risk.

If you've had a hysterectomy, you may not need a progestogen. Your prescriber will discuss whether you need one based on your individual circumstances.

You can switch to Evorel Gel from another type of HRT, and when you start depends on what you're using now:

• If your current HRT doesn't give you a monthly bleed, you can start Evorel Gel on any day that suits you.
• If your current HRT does give you a monthly bleed, finish your current pack first, then start Evorel Gel.

Your prescriber will set your dose, and it isn't a direct swap. The number of pumps you need won't simply match your current patch or tablet strength. It may be adjusted over the first few months by your prescriber, depending on how your symptoms respond.

If Evorel Gel doesn't suit you, there are other types of HRT that contain estradiol, including another gel, a spray and patches.

You can also find out about the best menopause supplements here.

Evorel Gel vs Evorel Patches

Evorel Patches are the same estradiol as Evorel Gel, released through a patch you change twice a week. There's nothing that can pass to others through skin contact the way gel can.

Evorel Gel vs Oestrogel vs Sandrena

Evorel Gel, Oestrogel and Sandrena are all oestrogen-only HRT gels containing estradiol, and applied to the skin once a day. The main differences are how the dose is measured (via a pump or a sachet), how much estradiol each dose contains and where on your body you apply it.

Your prescriber will help you choose based on your dose, your routine and any previous HRT.