Hi Peggy
You haven't said how old you are - this would be helpful, as well as knowing whether you have been on Evorel conti all this time and where you were in menopause (re periods, cycle etc) when you first started HRT.
Following the last period (or the last ovulation when the ovaries pack up - if on HRT you may not know when this occurs), oestrogen on average drops dramatically over the next couple of years until it falls to a new low and sometimes at this point women begin to experience symptoms for the first time, or they worsen.
In addition some women find that some of the progestogens interfere with the beneficial effects of oestrogen and this could be worse with a continuous combined HRT type. This wouldn't explain your worsening of symptoms now though - unless it is due to your own body changing.
I have never taken continuous progestogen as part of my HRT ( except very briefly once for a few months) and like some other women on this forum, prefer to remain on a cycle ( even though I am in my 60's) to avoid this - but have to put up with a withdrawal bleed instead as the lesser of the evils!
Depending on your age and inclination you might think of changing your HRT type to one with a different progestogen and see if this helps. I have always been fine with 50 mcg patch from late peri-menopause in my 50's until now.
If you had separate oestrogen and progestogerone it would make it easier to tweak doses. For example you might find an increase to 62.5 mcg (this involves judicious snipping!) might do the trick - but you wouldn't want to do this with a combi patch because the progestogen would increase too.
Definitely avoid the natural remedies - Black Cohosh anyway should not be taken long term.
Hurdity x