Sequential Combined HRT Patches
Sequential combined HRT patches contain both oestrogen and progestogen, but the hormones are delivered in a cycle. Oestrogen is given continuously, while progestogen is added for part of the month. This mimics the natural menstrual cycle and usually results in a monthly withdrawal bleed.
How are sequential combined patches used?
- Applied directly to the skin (buttocks, thighs, or lower abdomen).
- Changed once or twice a week depending on the brand.
- Oestrogen is released continuously, while progestogen is included in the patch for part of the cycle.
- Common NHS brand: Evorel Sequi® (provides a monthly cycle with oestrogen patches followed by combined patches).
Benefits
- Convenient two‑in‑one option: Provides both hormones in one patch, avoiding separate tablets.
- Lower clot risk: Transdermal oestrogen does not increase blood clot risk in the same way oral tablets do【NHS】.
- Stable hormone levels: Steady release may reduce side effects compared to oral forms.
- Mimics natural cycle: Suitable for women who prefer to have a monthly bleed, especially in the early years of menopause.
- Effective symptom relief: Proven to reduce common menopause symptoms and improve quality of life【NHS】.
Potential Drawbacks
- Monthly bleeding: Withdrawal bleed occurs, which some women may find inconvenient.
- Skin irritation: Redness or itching at the patch site can occur.
- Adhesion issues: Patches may peel off in hot weather or after bathing.
- Visible on skin: May be less discreet than tablets or gels.
- Breast cancer risk: As with all combined HRT, there is a small increase in risk with long‑term use, which rises with duration.
Who might benefit from sequential combined patches?
- Women in the early years of menopause who are still having some natural periods.
- Those who prefer a monthly bleed to mimic their cycle.
- Women who want a non‑oral option with both hormones included.
- Those with clotting risk factors or liver disease, where oral tablets are less suitable.
Key Safety Message
If you have a uterus and are prescribed HRT, you must remain on progestogen alongside oestrogen.
Sequential combined patches provide both hormones in a cyclical pattern, offering womb protection while mimicking a natural cycle.
Do not stop or change your HRT without speaking to your GP.
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