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[warwick01]

Hi - I was told 4 pumps of Oestrogel is equivalent to a 100mcg patch.......

Dancing girl - do you mind me asking how many pumps you use? Also it makes sense to me that a post menopause woman may need a higher dose to feel well. However I'm also told post meno woman require less?

Wx

[orchid]

Liz...when ladies are given progesterone with oestrogen it's usually to protect the endometrium the lining of the womb from building up and allowing it to shed. As you are still having regular periods (you are aren't you...monthly?) then why were you put on Utrogestan? Quite often, like me, women don't fair very well with progesterone's. If you are a person that suffers bad PMT when progesterone is at its highest level within your cycle, it's likely that extra is going to make you feel unbalanced. It's when periods have ceased that it's important to have progesterone to oppose the oestrogen and protect the endometrium? On the other hand if your periods are getting few and far between, well that's a different matter. Just a thought. Keep strong! X

[Liz]

I was put on Utrogestan because I was having periods but every two/three weeks so I couldn't have Oestrogen without the progesterone and this was the most "natural".  Obviously that was a couple of years ago now, so I don't know what my own cycle is doing now naturally.

Anyway, I've used 1.5 pumps today and feel much better, so I reckon this is probably enough for me at the moment.

[Dancinggirl]

Hi Liz - they have put you on the right regime - even if you are peri meno and still getting periods you must have some progesterone to counter the oestrogen and stop the endometrium from building up. I expect your bleeds will become more regular as you get deeper into meno and your own hormones stop having such an influence.

warwick01 - I think the amount of oestrogen one uses will vary very greatly from one women to another.  My theory is that many women believe a higher dose to be better but in my experience I have found high doses give me headaches and actually don't make things any better. As long as my flushes and night sweats are under control and I get some sleep that is all I ask. I have used oestrogel on and off for 20 years now (due to early menopause). I started out in my late 30s with just one pump per day then even in my late 40s, when I had gone into post meno, I only increased to 2 pumps per day. 
I tried going up to 2 pumps a day when I went back on HRT last year but didn't find I felt good so dropped it to one pump per day which seems to be perfect for me now at 59. I am also trying Utrogestan 100mg continuously to see if this sorts my erratic bleeding.  I had a scan so know all is fine but I think that Utro does sometimes give some problematic bleeding as it is not as powerful as the synthetic progesterones. True progesterone intolerance I think is quite rare - many women do fine of synthetic progesterone - Norethisterone made me want to kill people - no good!!!!
It's all trial and error but I do think one should give a low dose plenty of time to work before increasing. DG x

[orchid]

Liz...when ladies are given progesterone with oestrogen it's usually to protect the endometrium the lining of the womb from building up and allowing it to shed. As you are still having regular periods (you are aren't you...monthly?) then why were you put on Utrogestan? Quite often, like me, women don't fair very well with progesterone's. If you are a person that suffers bad PMT when progesterone is at its highest level within your cycle, it's likely that extra is going to make you feel unbalanced. It's when periods have ceased that it's important to have progesterone to oppose the oestrogen and protect the endometrium? On the other hand if your periods are getting few and far between, well that's a different matter. Just a thought. Keep strong! X

[Liz]

Thanks Dg - I'm going to stick with the dose, not thinking of increasing again, I couldn't bear to feel like I did last night. 

Thanks Orchid - Replied to your post above (think this is a double post??)

[orchid]

No probs Liz, you'll get there....

[Hurdity]

Hi Liz sounds to me you are getting to much oestradiol. Especially as you're peri, not menopausal.

X 2 measures (pumps) = 2.5grams = 1.5mg of oestradiol

Depending on make of patch, but roughly 75mcgs =  1.17mg of oestradiol

Just to clarify that you cannot compare the TOTAL amount of oestrogen in a dose of gel and a patch - it is the delivery and ultimate systemic concentration that is the crucial factor ie the daily average amount in your blood-stream after absorption. Also the patch is usually changed twice weekly and the gel applied daily so there is no comparison whatsoever!

So the fact that a 75 mcg patch contains 1.17 mg oestradiol has no relation to the total amount in a gel dose. The 75 mcg patch is so called because it is designed on average to deliver 75 mcg estradiol per day into the system and according to the product info for estradot each patch size leads to on average the same value in pg/ml. so 75 mcg patch would lead to 75 pg/ml.

According to the product leaflet 2 pumps of estrogel containing 1.5 mg oestradiol gave average estradiol level of 76.8 pg/ml - but there will be great variability as some women will get much less, others more, from the same dose applied.

However I'm not sure if the information/figures given for both of these is even comparable as it is not clear exactly what they are based on - at least I am not a pharmacist/biochemist and can't interpret them properly.

Liz - as i said before, below, the thing is not to get hung up on an exact comparison - but an approximation of low, medium and high and if it's not working for you - then with docs agreement, to try to increase.

One thing is certain - high oestrogen should not make you feel either "zonked" or sedated" - this is not a property of oestrogen - more likely the opposite. It is progestogen that has a sedative effect, but low oestrogen can also lead to dip in mood and energy. Not sure what a sudden spike in externally applied oestrogen would do though?

Are you still peri-menopausal? Your own hormones could be coming into play. I wouldn't have thought you would need to reduce from 2 pumps - this dose is not going to lead to low mood ie it's not too much!

Anyway hope you feel better soon!

Hurdity x

[Liz]

Thanks Hurdity.....yes, I am still perimenopausal (I think!).  Before I started HRT I was having periods every 2-3 weeks (having gone from a regular 28 day cycle) along with many other symptoms, in fact practically every one of the 34 symptoms of perimenopause!

I am going to continue with the 2 pumps of gel and see how I go, if I feel I need to increase, as per the GP's recommendation, I think I will do it gradually over a couple of weeks rather than one big hit. 

[Hurdity]

If your periods were close together before you started HRT (and you hadn't skipped any) then officially you weren't even in peri-menopause but in what is known as the late reproductive phase (according to the official stages of reproductive ageing). I can post the link if you're interested - have done recently elsewhere. There are hormonal changes which occur then, but if you went onto HRT then, as you say you won't know what is happening to your underlying cycle.

If it was two years ago then likely you will be somewhere on the peri journey by now, but what is certain is that your own cycle will be coming through and I would suggest that this is what is leading to your change in moods as I said in my earlier post below.  Sometimes your oestrogen will be very high and sometimes will dip - althouigh because you are taking estrogel it won't dip as low as it would without HRT. Because you will still be ovulating even if irregularly - until you reach menopause your progesterone levels will also be going up and down - and the prog you are taking will add to it. If your own cycle goes out of sync then no wonder you will be feeling like you do from time to time.

I'm not sure actually if there is anything you can do at this point although when your cycle becomes very weak a consistent increase in gel might make you feel better for most of the time.

Sorry that probably doesn't help but it will get better!!

Hurdity x

[Liz]

Thanks Hurdity!  It was recommended by my GP that I start the HRT then though - are you saying that  I may not have been in peri when I started, I'm concerned that I may have started the HRT too early then?  Hope I wasn't advised to start HRT before I should have been!

[Mary G]

Liz, tagging on to what Hurdity has said, I found that I reacted very differently to the gel.  I had been on the 75mg patch and, looking back, it was not strong enough and I was not getting enough oestrogen.  I am now taking 3 pumps of oestrogel every day and not only do I feel much better (completely back to normal in fact), my blood tests prove that much more oestrogen is entering my blood stream.  I was told that 75mg patch is roughly equivalent to 3 pumps of gel but as Hurdity says, it depends how well you absorb it and I obviously absorb the gel much better. 

It's all about trial and error and finding out what works best for you.

[Liz]

Im a bit worried that I started the HRT too early now, after what Hurdity said about me not being in peri when I started. 

Used 2 pumps today and been feeling fine, so perhaps 3 was too much for me.

[Briony]

Im a bit worried that I started the HRT too early now, after what Hurdity said about me not being in peri when I started. 

Used 2 pumps today and been feeling fine, so perhaps 3 was too much for me.

I wouldn't worry too much, Liz. If you had been on the pill, you'd have been taking more hormones than you have been,regardless of where  in peri menopause you are- or are not.

It sounds like your own fluctuations could be impacting on the HRT. If that's the case, have you thought about trying something more controlling like Qlaira or the pill? It is a personal choice, and I can understand why many prefer HRT, but if you search on here, you'll spot a number of ladies in their late 30s/early 40s finding that having the pill - which prevents ovulation - stops the fluctuations. I switched from Evorel 50 to Qlaira and feel better for doing so. I do still have blips, but they are far less severe / frequent.

B

[Liz]

Thanks Briony - I'm almost 48 now, so my GP ruled out the Pill for me, unfortunately.