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[Night_Owl]

Hi All

My current estrogen dose is HALF of 25 Estraderm patch (ie. 12.5), twice weekly (Utrogestan every six weeks).

I'm attempting to reduce this even further with a view to maybe, just maybe coming off HRT altogether due to severe progesterone intolerance, tried many types and none suit me.

My next meno clinic appointment is not until end March so in the meantime, I'll just try and see how I go. 

Question is:  In terms of absorption, is it better to (a) use one half of 25 Estraderm for the whole week and hope that it stays on (as per Menostar); or (b) use a quarter patch twice per week.

Hope that makes sense.  Can't work out the absorption rate. 

Wondering if by keeping a half patch on for a whole week, there be zero absorption after, say, three days - so using one quarter twice weekly would offer more consistent distribution. 

Menostar regime is just one patch of 12.5 per week.

Recently I've opted for the half patch on for a week and surprisingly have felt okay, dare I say it, slightly better.

With thanks for any comments/advice about weaning off patches.


Night_Owl
x

[Joyce]

I'm on Estradot 25 & have cut mine in half. Tried this time last year, but with
little success. My meno consultant said that was best way to reduce it, but agreed that  at that stage I wasn't ready to be on just 12.5, so started using full 25 again. Early days for me, but 12.5 twice a week seems the best. I'm hoping to have greater success this time. Think for best absorption, twice a week is preferred.

[Trey]

I and my gynaes cut the patch in half and keep it on for one week.  Have done this for years.  It think cutting it into a quarter would expose too many edges to air.  Just a guess.

[andius]

The pharmacokinetics show peak the first day and trough on day 3-4....I assume it would be lower as the week went on....the a spike with new patch. All doses are designed for 2 x weekly dosage for a reason.  If it were me, it would do the 2x weekly with the smaller portion for a while for consistent blood levels even though it will be lower.  The full round ones have "edges" too   ....but it is true that the "points" tend to roll up as I myself have experienced. Fluctuation in levels is not good for me but may not bother you. 

Andius

[Night_Owl]

Thanks for comments and suggestions, ladies.

So after day 3 or 4 there's not much going on.

I wonder if the design of Menostar once weekly patch is different somehow - I got it wrong by the way, the dose is 14.  Shame we don't have Menostar available here on prescription, I'd definitely give it a try, you only have to take progesterone every 6 or 12 months, plus yearly endo scan.

In a few weeks I'm going to try the 2 x weekly quarters and see how I fare by comparison.  Night sweats have already begun to worsen though, dammit.

Somehow my instinct is telling me that I don't want to keep taking HRT, can't explain it in words, it just feels wrong - if only my body would adjust naturally.  Previously when I've come off HRT cold turkey I've crashed badly and had to quickly scurry back on, so will have to see how this approach works.

This HRT game is never easy!


Night_Owl
x

[Joyce]

Let us know how you get on. I too would like to be off HRT, however not prepared to put up with flushes/sweats. The odd one or two yes, but not umpteen times a day.

[Taz2]

I cut my patches in half but they did no good at all. After around six weeks the flushes and then sweats were awful so I went back onto full HRT for a further two years. Now four months without any again and I am floundering. My brain is mush - so much so that I couldn't remember which was my locker at work today. I've had the same locker for five years. It is very frightening how lack of oestrogen can affect the brain.

The body is designed to need the hormones to function properly so it will adjust to losing them which may result in less mood swings but it wont give you back your life as it was as far as I can tell. I feel like a shadow of who I used to be but then, as we have discussed before, nature has no reason to keep us feeling good or looking good once there is to be no more furthering of the species!

Taz x

[Rosebush]

This is the very thing Taz that makes me mad & sad, its as if we are no longer needed for breeding, so sod off and just cope on your own, god forbid we should need help, I presumed at 55-58 to be free of all periods sweats etc, peace of mind with no money worries, family & g.children all doing well and hubby and i free to travel and do our on thing, but due to Menopause everything just changed now I just feel old and don't know how that happened, trying to push myself to be a bit more positive but had a very crap 2013, still have health probs pending, clinic's hospitals, physio's..BUT off 2 Spain for 2mths end of March so just try to focus on that and not the negative stuff...Why does Meno have to be so hard on us all..   xx

[Trey]

Oops, I should have mentioned my patches are meant to be once a week, not twice.

[honeybun]

I always thought/hoped that as your body becomes accustomed to less hormones it adjusts and settles to a point where things are stable and you can function.
The trouble is it can take so long. It's difficult to figure out what's meno and what's the aging process. Obviously the flushes which are so draining is meno but what about the rest. I never thought that it would be like this.
Just when you need more energy to deal with kids and aging parents the plug is pulled and down you go.

Maybe we all get better in the end. It just seems to take such a long while to happen. Even being on HRT does not solve all the problems and we all seem to be conditioned to want to come off what helps a little.


Honeyb
x

[Night_Owl]

Meno speeds up the aging process for sure, the two are so entwined, difficult to work out what's what - even more so if you have an early meno.

If I didn't suffering so badly with the progesterone intolerance issues I wouldn't always be pondering coming off (my system rejects any prog, almost as if toxic). 

What is troubling (and bugs me when I read articles or hear women saying they're "through" meno) is:- post-menopause follows menopause and lasts the rest of your life, loss of estrogen is forever and for some, severe symptoms can go on indefinitely.  Ugh.  What a thought.

It's as if your life is divided into two halves and you yearn for the pre-meno self.  As discussed on here many times, in past times life expectancy was much shorter. 

What will intrigue me forever is the huge variance in how, without estrogen, our bodies adjust or don't adjust, as the case may be. 

I also feel a shadow of my former self, when I look at photos of 3 years ago, good grief how I've aged and changed so much in all ways.  So true, Mother Nature has no reason to keep us looking good and takes away the libido too - why on earth would you need that now she says!

Lately I've been thinking that maybe ADs do have a role to play (as serotonin levels are naturally lower post meno) - in getting through the rest of post meno life, in coping with living in such a different body, in coping with the loss of self, the acceptance of the loss of self, the disintegration, the loss of control, the loss of brain function, the different woman who you see in the mirror, the stringy hair, vag and bladder problems, the loss of dignity, etc etc - all while trying to work and coping with life's other problems - agree HRT only partially (and minimally in my case, as I've tried all types, high to low) solves symptoms.

Sorry if this is a bit depressing, just saying how it is for me personally (we're all different).


Night_Owl
x

[Hurdity]

Hi night_owl

So sorry to hear you are feeling miserable 

Re the patch cutting thing - I've looked at some papers re the pharmacokinetics too (I'm interested in your info andius - do you have a link?) and those I saw showed a gradual regular decline from the initial peak and not a sudden dip. The reasoning for changing on Day 3 or 4 is to keep the levels as high as possible - as I understand it they do not run out, but you change the patch before they get too low to be of benefit. If you keep the patch on for 7 days you will still be getting hormones  ( if it's still stuck!) but not so much. 

So a 25 mcg patch is designed to deliver certain level of hormones through the skin and if you leave it on for a week the levels will be somewhat lower - but it won't run out as such.

My view is if the patch is meant to be changed twice a week then best to do so - they tend to come unstuck more after a longer time and especially the smaller ones. I also agree with andius about cutting them - when I cut mine the pointy bits tended to come unstuck. Maybe you can make a lower dose one by cutting down a 50 and rounding the corners ( that's what I did when I tried to make a 37.5 mcg - I think it helped a little)?

Presumably the Estraderm is sufficiently large to be manageable at a quarter patch size? I know Estradot wouldn't - it would be invisible and there would be more edge than patch!

In your position, suffering from extreme progesterone intolerance - it is a difficult one and you need to go with the decision that makes you feel as well as you can for as long as you can. If you think you might be able to do without oestrogen because the progesterone makes you feel so ill then maybe try a mild AD for a short while? There is no point suffering if there is a way to make yourself feel better and you have tried many things!

Wishing you the very best of luck with the reduction and hope it doesn't make you feel bad.

I agree nature is not kind to us women..... I long for my old self even though I am still on a reasonable dose of HRT - I just would love to have that excitement and zest for life again instead of going along at an even but uninspiring pace!

Hurdity xx

[andius]

Hurdity:

Yes there is some still being put out if you leave them on for a week, but probably very little.  Sometimes I leave my old one on for 24 hours after putting on a new patch to try to keep more even with old one going down and new one going up.  I have tried to find info that says eventually the spike/trough thing reverts to a steady state graph (straighter horizontal line) but have never been able to.  There is a higher spike with higher dosage level so lower ones like .025 it is more gradual and spike/trough not as pronounced, so maybe there is more of a straighter horizontal line steady state possibility with those.

Scroll WAY down to Figure 1 to see graph: 


http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/203752lbl.pdf


Andius

[Rowan]

This makes confusing reading, I have always tried to keep the amount of estrogen I use in the patch because of stroke in the family.

I do keep the 25 patch on for a week, not to keep symptoms at bay but for the good things that estrogen provides.

On the premise that you stop producing estrodiol after menopause, ( though I have never believes this personally) this article suggests that we don't and it can be problem where stroke is concerned 

http://www.universityofcalifornia.edu/news/article/22971

Dammed if you do and damned if you don't. .

Whether you take homones or not there is always something to worry about. Meanwhile I cross my fingers and take Rutin that a Consultant recommended to strengthen the blood vessels and is a natural blood thinner.

[Hurdity]

Hi andius - thanks for the link. This is the info put out by the company and is interesting as it does show what you say ie the estrogen level drops dramatically after 4 days, in the study quoted. The info I have been using is from this detailed paper I linked too before on another thread:

http://www.cenegenicsfoundation.org/library/library_files/Pharmacology_of_estrogens_and_progestogens___influence_of_different_routes_of_administration.pdf

....the diffusion rate remains relatively constant over 7 days, with an only gradual decline.Therefore, the patch is effective for 7 days, even though some producers recommend a change twice a week.

I did see a graph confirming this on another paper but heaven knows where. It would take me ages to go through all my bookmarks! Seems like the information is not consistent so not helpful to anyone trying to work it out - especially since a sudden decrease at 3.5 days is different from a gradual decrease from days 2-7!!

Yes silverlady - it is all very confusing with different papers and summaries stating different things. For exmaple the recent summary of all the info by the British Menopause Society with the latest recommendations says:

Stroke
Observational studies on the use of HRT and stroke have yielded conflicting results.

The WHI study revealed an overall increased incidence of stoke in women using estrogen and progestogen therapy or estrogen alone.

Re-analysis of the combined data from the estrogen and progesterone study and that of the estrogen alone study revealed a smaller increase in incidence of stroke in women who commenced HRT between the ages of 50 and 59.

The HERS study (the Heart and Estrogen progestogen Replacement Study) found no increased incidence of stroke with HRT.

On current evidence, HRT cannot be recommended for the primary or secondary prevention of stroke.

Caution should be exercised when prescribing HRT in women over the age of 60 particularly when they have a risk factor for stroke or thromboembolism. In these groups, current evidence would suggest that the transdermal route may be advantageous.

The effects of HRT may be dose related and the lowest effective dose should be prescribed in women
with significant risk factors.


Only one paper is given as a reference.

The recent (2012) publication of the re-analyasis of the Women's Health Initiative Study said this re stroke:
Stroke There is a modest increase in stroke risk with HRT use if stated near the menopause.
This risk rises considerably in women who start at older ages.  There is some evidence that
use of HRT patches (as opposed to pills) may not increase stroke risk, but this needs to be
confirmed (Henderson and Lobo).

However this was using the oral Premarin and synthetic MPA.

Sorry Night_owl this is a bit off topic!

Hurdity x