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FemSeven® Sequi,
50 micrograms / 10 micrograms /
24 hours, transdermal patch
(estradiol / levonorgestrel)
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 any of the side effects gets serious, or if you notice any side effects not
listed in this leaflet, please tell your doctor or pharmacist.
 The name of this medicine is FemSeven® Sequi, 50 micrograms /
10 micrograms / 24 hours, transdermal patch but it will be referred to as
FemSeven Sequi, patch throughout the remainder of this leaflet.
In this leaflet:
1. What FemSeven Sequi, patch is and what it is used for
2. Before you use FemSeven Sequi, patch
3. How to use FemSeven Sequi, patch
4. Possible side effects
5. How to store FemSeven Sequi, patch
6. Further information
FemSeven Sequi, patch is a sequential combined Hormone Replacement
Therapy (HRT). It contains an oestrogen (estradiol) and a progestogen
(levonorgestrel). FemSeven Sequi, patch is suitable for postmenopausal
During the menopause, the amount of oestrogen produced by a woman’s
body drops. For some women this can cause symptoms such as hot face,
neck and chest ("hot flushes"). FemSeven Sequi, patch alleviates these
symptoms after menopause.
The experience treating women above the age of 65 is limited.
You should fully inform your doctor about your personal medical history and
that of your immediate family, before starting with hormone replacement
therapy (HRT).
Medical examinations and tests
Your doctor will ask you to undergo a medical examination before beginning
treatment then regularly during the treatment (at least once a year) to check
whether your body is tolerating the medication.
Your breasts will be regularly examined by your doctor, especially if you
have any lumps (cysts or nodules) or if anybody in your family has already
had breast cancer.

 If you currently have or have previously had a liver disorder. You must
not use FemSeven Sequi, patch for as long as the liver function has not
returned to normal
 If you have a (herediatary) disorder in the composition of the blood
pigment (porphyria).
Take special care with FemSeven Sequi, patch
Tell your doctor if you have or have previously had any of the following
disorders and/or if these conditions have been aggravated during
pregnancy or previous hormone therapy, before you start using FemSeven
Sequi, patch.
 If you have high blood pressure,
 If you have an increased risk of developing blood clots (see “HRT and
effects on heart or blood circulation”),
 If you have a high blood sugar level (diabetes) with or without vascular
 If you have a disease leading to the presence of uterine mucosa outside
your uterus causing pain and bleeding (endometriosis),
 If you have a benign tumour in your uterus (uterine fibroma),
 If you have a history of excessive proliferation of cells in the inner lining
(endometrial hyperplasia),
 If you have an increased risk of developing tumours related to the levels
of oestrogens in the blood (such as having a close relative with breast
 If you have liver or gallbladder disease (hepatic adenoma, gallstones),
 If you suffer from epilepsy,
 If you have severe headaches or migraines,
 If you have asthma,
 If you have a serious immune disease that affects your skin in particular
 If you have a disease causing loss of hearing (otosclerosis).
Stop using FemSeven Sequi, patch immediately
If you experience any of the disorders mentioned under “Do not use
FemSeven Sequi, patch”, or if any of the following situations occurs:
 you experience a yellowing of the skin (jaundice) or your liver function
 your blood pressure suddenly becomes much higher;
 you get a migraine-like headache for the first time;
 you become pregnant.
Note: FemSeven Sequi, patch is not a transdermal contraceptive and does
not prevent you from becoming pregnant.
You must also inform your doctor if:
 You are to undergo surgery.
 You have to remain immobilised for a long period.
 You have contracted another disease.
What risks are associated with the use of FemSeven Sequi, patch?
HRT and effects on heart or blood circulation
Blood clots (thrombosis):
Immediately inform your doctor if you have painful swelling of one of
your legs, sudden pain in the chest, or shortness of breath while using
FemSeven Sequi, patch. This could be a sign of venous thrombosis or
a lung embolism while, in which case you must stop using FemSeven
Sequi, patch immediately.

Your doctor may ask you to have a mammography.

HRT increases the risk of VTE 1.3-3 fold, especially during the first year of
taking it.

From time to time, at least once a year, the risks and benefits of HRT
treatment should be carefully reassessed to determine if the treatment
should be continued.

Looking at women in their 50s who are not taking HRT, on average, over a
5-year period, 4 in 1000 would be expected to get a blood clot.

Do not use FemSeven Sequi, patch
 If you are allergic (hypersensitive) to one of the active substances
(Estradiol or Levonorgestrel) or any of the other ingredients of FemSeven
Sequi, patch (see also section 6).
 If you have, have had or your doctor thinks you might have breast cancer.
 If you have previously had a blockage of one of your veins in your leg or
lungs (deep venous thrombosis or lung embolism), or if you currently
have such a blockage
 If you have thrombophilic disorders (e.g. protein C, protein S, or
anthithrombin deficiency)
 If you currently have or have recently had a blockage of an artery, for
example, angina pectoris (heart cramp due to an oxygen deficiency) a
heart attack or stroke
 If you have, or your doctor thinks you might have, breast, uterine or any
other cancer requiring a hormone to develop (oestrogen-dependent
 If there is excessive proliferation of cells in the inner lining (endometrial
hyperplasia) that has not been treated yet.
 If you experience unexplained vaginal bleeds.

For women in their 50s who are taking HRT over 5 years, the number of
extra cases will be 5 in 1000 users.
The risk of venous thrombosis is greater:
 If you use oestrogens;
 With older age;
 If you have a cancer;
 During pregnancy and postpartum period;
 If there is venous thrombosis in your immediate family;
 If you are severely overweight;
 If you have systemic lupus erythematosus (a disorder of the immune
 If you have any blood clotting problem that needs long-term treatment
with a medicine used to prevent blood clots;
 If you are immobilised for long periods (e.g. when you must have bed
rest), have an accident or a major surgery. In these circumstances it
might be necessary for you to stop using FemSeven Sequi, patch
temporarily. You may need to stop as early 4-6 weeks before planned

It is unclear whether having varicose veins leads to an increased risk of
venous thrombosis.

For women aged 50-65 who are taking oestrogen plus progestogen HRT
over 5 years the number of extra-cases will be 6 in 1000 users.

If any of these situations apply to you, please inform your doctor. If you are
using an anticoagulant, the risks and benefits of using HRT have to be
carefully evaluated.

Looking at women aged 50 to 79 who are not taking HRT, on average 14 in
1000 will be diagnosed with breast cancer over a 5 year period.

Disorders of the coronary arteries:
Stop using FemSeven Sequi, patch and contact your doctor
immediately, if you get a pain in your chest that spreads to your arm
or neck. The pain may be a sign of a heart disease.
There is no evidence that HRT will help to prevent heart disease. Women
taking oestrogen-progestogen HRT are slightly more likely to get heart
disease than those not taking any HRT. As the risk of CAD strongly
depends on age, the number of extra cases of CAD due to oestrogenprogestogen use is very low in healthy women close to menopause, but will
rise with more advanced age.
Risk of stroke:
Stop using FemSeven Sequi, patch and contact your doctor immediately if
you get: unexplained migraine-like headaches, with or without disturbed
vision. Such headaches can be an early sign of a stroke.
Combined oestrogen-progestogen and oestrogen-only HRT increase the
risk of stroke up to 1.5-fold. The risk of users compared to non-users does
not change with age or time since menopause. However, as the risk of
stroke is strongly age-dependent, the overall risk of stroke in women who
use HRT will increase with age.
Looking at women in their 50s who are not taking HRT, on average, over a
5-year period, 8 in 1000 would be expected to have a stroke.
For women in their 50s who are taking HRT over 5 years, the number of
extra cases will be 3 in 1000 users.
HRT and risks of developing cancer:
Overgrowth of the lining of the womb (endometrial hyperplasia) and cancer
of the womb lining (endometrial cancer).
Long-term use of estrogen increases the risk of overgrowth of the lining of
the womb (endometrial hyperplasis) and the risk of endometrial cancer in
women with a uterus. To reduce this risk it is necessary to take the
estrogens in combination with progestogen tablets for at least 12 days of
each month.
During the first months of treatment irregular bleeding may occur. Contact
your doctor if
 such bleeding carries on for more that the first few months of treatment
 starts after you have been on FemSeven Sequi, patch for a while
 carries on even after you have stopped using FemSeven Sequi, patch
Your doctor will examine what the cause is which may include a biopsy of
the womb lining in order to find out whether you have cancer of the womb
Looking at women who still have a womb and who are not taking HRT, on
average 5 in 1000 will be diagnosed with endometrial cancer.
For women who take oestrogen-only HRT, the number of extra-cases will
be between 5 and 55 in 1000 users between the ages of 50 and 65
depending on the dose and for how long it is taken.
The addition of a progestogen to oestrogen-only HRT substantially reduces
the risk of endometrial cancer.
Breast cancer:
Evidence suggests that taking combined oestrogen-progestogen and
possibly also oestrogen-only HRT increases the risk of breast cancer. This
depends on how long you take HRT, and the extra risk is visible after about
3 years. However, it returns to normal within a few (at most five) years after
Contact your doctor if you notice changes to your breasts, such as: dimpling
of the breast, skin changes in the nipple, lumps that you can see or feel.
Your doctor may advice you to undergo a check up including
Looking at women aged 50 to 65 who are not taking HRT, on average 9-12
in 1000 will be diagnosed with breast cancer over a 5 year period.

For women aged 50-79 who are taking oestrogen plus progestogen HRT
over 5 years the number of extra cases will be 4 in 1000 users.
Ovarian cancer:
Ovarian cancer is much rarer than breast cancer. Long-term (at least 5-10
years) use of oestrogen-only HRT products is thought to carry a slightly
increased risk of ovarian cancer. Some studies suggest that the long-term
use of combined HRTs may carry a similar, or slightly smaller, risk. For
women who are taking HRT over 5 years there will be one extra case per
2500 users.
HRT and other disorders:
 If you suffer from cardiac or kidney dysfunction you will have to be
monitored while using FemSeven Sequi, patch
 If you have very high triglyceride levels in your blood
(hypertriglyceridaemia) you will have to be monitored when using
FemSeven Sequi, patch.
HRT will not improve thought processes. There are hints of an increased
risk of probable dementia in women who start using HRT after the age of
Consult your doctor if one of the above-mentioned warnings should apply to
you, or if it has previously applied to you.
Taking or using other medicines
Some medications can alter the effectiveness of FemSeven Sequi, patch in
particular if you are taking:
 a medicine to treat epilepsy (carbamazepin, phenobarbital, phenytoin),
 a medicine to treat tuberculosis or other infectious diseases (rifampicin,
 a medicine to treat AIDS (ritonavir, nelfinavir, nevirapine, efavirenz),
 a medicine containing St. John’s Wort (Hypericum perforatum).
Please tell your doctor or pharmacist if you are taking or have recently
taken any other medicines, including medicines obtained without a
Pregnancy and breast-feeding
You should not use FemSeven Sequi, patch if you are pregnant or
If you discover that you are pregnant while using this medication, stop the
treatment and discuss the situation with your doctor.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
No specific side effect is expected.

Always use FemSeven Sequi, patch exactly as your doctor has told you.
You should check with your doctor or pharmacist if you are not sure.
You should apply the patch once a week i.e. replace it every 7 days without
a break in treatment: as soon as you remove one patch, you should apply
another one to your skin.
There are 2 types of patches in the box, depending on when you apply one:
 Phase 1 patches (1st and 2nd weeks of your cycle): they contain only
one active substance (Estradiol).
 Phase 2 patches (3rd and 4th weeks of your cycle): they contain both
active substances (Estradiol and Levonorgestrel).
If you are not taking HRT or you switch from a continuous combined HRT
product, treatment may be started on any convenient day.
If you are transferring from a sequential HRT regimen, treatment should
begin the day following completion of the prior regimen.

Frequency of application:
1. Apply a Phase 1 patch once a week for the first 2 weeks of your cycle.
2. Remove the Phase 1 patch and apply a Phase 2 patch in its place, once
a week for the following 2 weeks.
You must apply the patches in the correct order.
Bleeding similar to periods usually occurs at the end of the use of the Phase
2 patches. The bleeding is light and lasts for 4 to 5 days on average.
If the bleeding is heavy or irregular, consult your doctor.
Method of administration
This medicine should be applied to the skin.
How to apply a patch?
Each sachet contains one patch.
FemSeven Sequi, patch must be applied immediately after being removed
from its sachet.
1. To open the sachet, tear the two edges in the
direction of the arrow.

2. Remove the patch from the sachet. A patch has two
sections: the patch itself, which must be applied to
the skin, and the protective liner.

During the course of treatment:
 You must not expose the patch directly to the sun once you have applied
it to your skin.
 You can shower or take a bath with the patch on your skin.
 If the patch becomes unstuck before the end of its use i.e. before the 7th
day (for example if you have undertaken intense physical effort or
perspire abundantly or the skin is rubbed by clothes), use a new patch
(from the same phase) and remove it at the initially scheduled date.
Duration of treatment
Your doctor will decide on the duration of treatment.
Contact your doctor if you want to stop the treatment.
If you take more FemSeven Sequi, patch than you should
Overdose is unlikely but it can cause the following:
 pain in the breasts,
 bloating in the abdomen, flatulence, nausea and vomiting,
 irritability, anxiety,
 vaginal bleeding.
No specific treatment is required. The signs will disappear when the patch is
If you forget to take FemSeven Sequi, patch
 If you have forgotten to change the patch on the scheduled day, replace it
immediately then follow the treatment normally, changing the patch again
on the initially scheduled day.
 Do not use 2 patches at the same time to make up for the single dose
that you have forgotten.
 If you have not used FemSeven Sequi, patch for several successive
days, you may get stop bleeding. If you are in doubt, consult your doctor.
If you stop using FemSeven Sequi, patch
The postmenopausal signs linked to a lack of oestrogen may reappear.
If you have any further questions, ask your doctor or your pharmacist.

3. Remove one-half of the liner, starting at the Sshaped notch and taking care not to touch the
adhesive side of the patch with your fingers. If you
do, it may not adhere correctly and you may alter
the active ingredients.

4. Apply the patch immediately, using the palm of your
hand, to a dry, clean area of skin. It should not be
red or covered with cream or lotion. The location
should not have any significant wrinkles and it
should not be rubbed by clothing (avoid placing at
the waist and do not wear very tight clothing). The
patch may be applied, for example, to the buttocks,
thighs, abdomen etc.
5. Remove the other part of the plastic liner and press
down on the corresponding area of the patch.

6. Keep the palm of your hand on the patch for at least
30 seconds to ensure that it is adhering correctly,
especially round the edges. The pressure and heat
of the hand are essential to ensure maximum

How to remove the patch?
To remove a FemSeven Sequi, patch, simply free up one edge and pull it
off gently so as not to irritate the skin. If any of the adhesive remains on the
skin, you can remove it by rubbing the skin gently with a cream or an oily
After use, the patch still contains active substances, but in too small a
quantity for it to remain effective. Fold the patch in half (adhesive to
adhesive) before discarding it.
Precautions for use
Do not apply a FemSeven Sequi, patch:
 To your breasts.
 Twice in the same place: leave at least 1 week between 2 applications in
the same place.

Like all medicines, FemSeven Sequi, patch can cause side effects,
although not everybody gets them.
The following side effects may occur the most frequently (in more
than 1 in 10 patients treated).
 Skin reaction (itching, irritation, redness) in the area in which the patch is
applied. These signs are not serious and usually disappear 2 or 3 days
after removing the patch. If they persist, place the patch in a different
The following side effects may occur frequently (in 1 to 10 people in
 Tightness or pain in the breasts.
 Headaches.
 Nausea, vomiting.
 Irregular bleeding, spotting.
 Increase or decrease in sexual desire.
The following potential side effects are less frequent (in 1 to 10 people
in 1,000):
 Benign breast tumour.
 Painful periods.
 Abnormal development of the lining of the uterus (endometrial
 High blood pressure.
 Bloating or pain in the abdomen.
 Fatigue.
 Weight gain or loss.
 Migraine.
 Vertigo.
 Cramp in the legs.
 Swelling (water retention, oedema).
The following side effects may occur but are rare (1 to 10 people in
 Yellowing of the skin and whites of the eye (jaundice).
 Benign tumour in the uterus (uterine fibroma).
 Gall stones.
 Depression.

The following side effects can also occur:
 Breast cancer or uterine (endometrial) cancer.
 Formation of a blood clot in a vein in the leg (phlebitis) or lungs
(pulmonary embolus).
 Formation of a blood clot in brain (stroke) or heart (heart attack).
 Gallbladder problems.
 Mental disorders (dementia).
 Disorders of the skin, or subcutaneous disorders such as:
 Formation of brown spots on the face after exposure to sunlight, also
referred to as a mask of pregnancy (chloasma).
 Skin disease with spots in the form of red marks and blisters filled with
liquid (erythema multiforme).
 Skin disease with the formation of lumps under the skin that are red
and painful (erythema nodosum).
 Minor skin bleeds (Henoch-Schönlein purpura).
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:
By reporting side effects you can help provide more information on the
safety of this medicine.
 Keep out of the sight and reach of children.
 Do not store above 30°C.
 Do not use FemSeven Sequi, patch after the expiry date which is stated
on the label and carton. The expiry date refers to the last day of that
 If your medicine shows any sign of deterioration, return it to your
 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.
What FemSeven Sequi, patch contains:
Phase 1: Each patch contains 1.5mg of estradiol hemihydrate in a patch
size of 15cm2, releasing 50 micrograms of estradiol per 24 hours.
Phase 2: Each patch contains 1.5mg of estradiol hemihydrate and 1.5mg of
levonorgestrel in a patch size of 15cm2, releasing 50 micrograms of
estradiol and 10 micrograms of levonorgestrel per 24 hours.
The other ingredients are:
Backing layer: transparent polyethylene terephthalate (PET) foil.
Adhesive matrix: styrene-isoprene-styrene block copolymer, glycerine
esters of completely hydrogenated resin acids.
Protective liner: siliconized transparent polyethylene terephthalate (PET)
What FemSeven Sequi, patch looks like and contents of the pack
Each Phase 1 or Phase 2 transdermal patch is octagonal, transparent,
flexible, round-edge transdermal matrix patch located on an oversized
removable protective liner contained in an individual sachet.
FemSeven Sequi, patch come in packs of 4 patches (2 Phase 1 patches
and 2 Phase 2 patches) or 12 patches (6 Phase 1 patches and 6 Phase 2

Manufactured by
Swensweg 5, 2031 GA Haarlem, The Netherlands.
Procured from within the EU by the Product Licence Holder:
MPT Pharma Ltd, Westgate Business Park, Unit 5-7 Tintagel Way,
Aldridge, Walsall WS9 8ER.
Repackaged by MPT Pharma Ltd.
PL: 33532/0724


Leaflet dated 17 February 2017
Leaflet coded xxxxxxxxx
FemSeven® is a registered trademark of Merck KGaA.

To request a copy of this leaflet in
Braille, large print or audio please call
01922 745645 and ask for the
Regulatory Department.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.