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[carolinec]

Hi - Im new to the site and I think its fab. I am 46yrs and prescibed HRT Evorel 50mcg patch to be used for 7 days prior to be period only - in other words, 7 days of evorel once a month. I am peri menopausal. Normal symptoms, panic attacks, hot flushes, anxiety, heart palpitations, insomnia, and mentally I get annoyed and upset more easily. - Would really love to hear of anybody else who is on a cycle like this please....blessings. x

[Chaotic]

Caroline - yep we could shake hands up to the elbow apart from the periods.I am lucky(or unlucky?) if I have 6/7 periods a year and when I do get them you just know they are going to be bad.I don't have a regular cycle and the problem is how to combat this side of it.

[honeybun]

Hi there
 

I have been on the forum a long time and this is a new one on me. I don't see the logic behind it to be honest but that's not to say your GP is wrong.

Was it explained to you why only seven days. Normally at your age you are given a sequi HRT. That would deliver a steady dose of hormones, give you a monthly bleed and stop the troughs that you get when you are peri.

Someone else will be along with their thoughts soon but I can't see why at the moment.


Honeyb
x

[carolinec]

Honeybun and Chaotic thank you for your replies, I am grateful for any help. To be totally honest and I do respect dearly my GP - but I feel he is very very unsure of the menopause section of healthcare, as he advised me to put the patch on my arm, it wasnt until I read the leaflet that I realised it has to be applied below waistline, so that put queries in my mind. I feel that I told him I suffer the symptoms only 7 days prior to my period and I believe that is why is precribed the patches to be worm for that time frame only...I dont feel its correct either to be honest....and I wonder what it will do to my system....

[carolinec]

Honeybun, can you please tell me what a sequi HRT is ?   God Im hopeless as this is all new to me....

[honeybun]

Right.

A sequi patch is for women who should still be having a period. You use an oestrogen only patch for the first part of the month and then a combined oestrogen and progesterone patch for the latter part of the month. You then go back to an oestrogen only patch with no break. When you withdraw the progesterone you then get a bleed. It mimics your own natural cycle. It keeps the oestrogen steady throughout the month.
In my opinion that's what you should be on.

If you look at the green menu on the left it will explain it better than I can.
If you have a good relationship with your GP then print off the details and go back and discuss your options.

A patch seven days a month makes no sense to me at all. You will just start to feel better and then probably worse again. It could also mess up your cycle.

Hope this helps.

Honeyb
x

[Rowan]

I have read about this but it is usually applied after the period until mid cycle. some women in perimenopause get symptoms when the period finishes, their estrogen drops much lower and is slower to build up, using a low dose patch 25 can help, the woman is usually producing enough progesterone of her own to counter the estrogen.

I use to get my symptoms after my period, some get them before.

This method also been used for women who get headaches and migraines if her estrogen drops to low during her menstrual cycle.

It really doesn't matter where you put the patch, (except the breasts) think of the gel, that can be rubbed on shoulders, arms and thighs. The patch trials were done on the stomach and buttocks that's the reason its suggested you use that area.

I have used my patch on the top of my arm and the back of my shoulders  with no ill effect ( I like my baths) I have told my doctor and she never suggested I shouldn't.

Good luck with patches carolinec if you found the 50 patch too much you can always cut it in half.



 

[carolinec]

Silverlady and Honeybun, I dont know how to thank you both. I live in ireland in a beautiful but rural secluded area, it is like the menopause doesnt exist here. It is not discussed at all. I felt so isolated with the questions in my head - I want to thank you both, you have no idea how much your comments help, I dont feel alone anymore - and you both have given me confidence to question myself and maybe my GP also...so thankyou.

[Hurdity]

carolinec

You are right that instructions for the patches say that they should be applied on the lower trunk or below the waist - I've looked at two brands. They also say they should not be applied on or near the breasts. The instructions are the same for Sandrena gel.

Oestrogel is different  from all the others but inconsistent:
The correct dose of gel should be dispensed and applied to clean, dry, intact areas of skin e.g. on the arms and shoulders, or inner thighs. The area of application should be at least 750 cm2. One measure from the dispenser, or half the prescribed dose, should be applied to each arm/shoulder (or thigh). Oestrogel should NOT be applied on or near the breasts or on the vulval region.

To my mind the shoulder or upper arm is near the breast and frankly, I wouldn't apply it there.

Your doctor clearly does not understand menopause and HRT dosing. For start he is giving you extra oestrogen - which is great but normally you do need extra progesterone too to ensure your uterus lining does not build up too much. Added to this women experience anovulatory cycles during peri-menopause - ie no ovulation therefore no progesterone that month - which leads to heavier bleeding anyway.

I can understand the reasoning behind extra oestrogen as silverlady mentions and it is used as a treatment for pms - Prof John Studd has done a lot of work in this area. However as you will see from his article you would nee extra progestogen too. here is one of the pages - but there is a lot of info on his site.
http://www.studd.co.uk/pms_treatment.php

I agree with honeybun - you would probably benefit from a low dose sequi HRT - although you may still experience heavier bleeds if you are still having regular periods, but it will definitely be of great benefit if you have started missing periods.

There is a good article about the biology of the peri-menopause here:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

Hope this helps

Hurdity x

[Rowan]

It all goes into the blood stream wherever is applied and whatever make or brand of estrodiol and is dispersed around the body, or the transdermal method would not work.

Some women in perimenopause do have dips in the estrogen before the progesterone start to decrease. 

caroinec didn't mention period problems but " panic attacks, hot flushes, anxiety, heart palpitations, insomnia, and mentally I get annoyed and upset more easily" and this is how her GP has chosen to treat it, full HRT at this time could be too much and may well have been his thinking. The only thing I would question is that her GP should have prescribed as 25 patch instead of a 50.

I am sure she will go back to discuss things with her GP if she has problems with his treatment.

[carolinec]

Ladies, I took all your advice and headed to a lady doctor yesterday evening. Like you, she never heard of somebody taking evorel patches for just 7 days a month prior to period. She prescribed the evorel conti patch which has both hormones in it (just as ye advised). So Thank you. I have my patch applied to my bum today - feeling light headed - but OK. Thank God. Its now 7 days before my period - fingers crossed, I wont get headaches, palpitations, hot flushes, anxiety, numbness, loss memory, aggitation, insomnia etc etc.... Let the good times roll please....X

[Hurdity]

Good news carolinec - I do hope these work for you and you feel better! There may be side effects initially but hopefully these will subside soon.

It all goes into the blood stream wherever is applied and whatever make or brand of estrodiol and is dispersed around the body, or the transdermal method would not work.

Not sure what you meant by this silverlady? Were you querying the instructions on application site?

Yes of course it goes into the bloodstream wherever it is applied but the instructions for several brands are explicit re not on upper trunk or near the breasts.

I imagine this will be because there is a concentration gradient of estradiol emanating from the application site, where it will be at its highest. The point is if it is applied far from the breasts the serum concentrations will have stabilised at the levels expected for that particular dose and not be artificially higher ( which they will be at the application site).

It is a possibilty that the pharmacokinetics for Estrogel are slightly different from Sandrena and the patches, although I would be surprised....

So just to emphasise, in this respect (re application site) it is very important to follow the instructions and could be risky to disregard them

carolinec - do keep us posted and let us know how you get on

Hurdity x

[honeybun]

Sorry to throw this into the mix but why a conti. It's usually a sequi for someone your age especially as you are still having a period. This type stops you bleeding (in theory ) completely.
I think you may have a few problems with random bleeds as you still have some of your own hormones rattling around.
To my mind you should have a sequi HRT and a bleed every month.
At least with a sequi you will know exactly when to expect a period.


Honeyb
x

[carolinec]

Honeybun, you are right, I just checked the leaflet, evorel conti is for ladies, normally into their 50s who havent had a period for 18 months....

Oh god thats two doctors that I feel have mis prescribed for me. I had the patch on from 8am this morning and I just pulled it off now....will have to ring the clinic AGAIN in the morning....

Its very upsetting to know that such confusion in the clinic can occur.....

[carolinec]

it was a lady gp this time Honeybun, I automatically assumed she knew what she was prescribing, this is the second gp I have gone to re the matter this week.......