Topping up patches

Topping up combination patches with additional oestrogen is not recommended.

This is because the progestogen dose would not be increased in line with the oestrogen dose which might increase the risk of endometrial hyperplasia or carcinoma.

If using a combination patch, these patches can be cut to predictably increase both the oestrogen and progestogen dose. For example, 1.5x Evorel Conti can be prescribed. Although this is off-license, this would increase the progestogen in line with the oestrogen dose. See the section on cutting patches for more information.

Alternatively, a patient's preparation can be switched to using oestrogen with a separate progestogen, which would be a licensed regime.