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[jacquiellen]

Hi,

I was just wondering if anybody knows what the equivalent mg in HRT would be to 50mg Evorel patches.
I have been using the patches and thinking of asking doctor for HRT in a pill form but wanted to take something similar strength wise to the patches. I know it can't be exact because they work in different ways just wondered.

[honeybun]

I think it's very difficult to get like for like as patches as so much better absorbed.
Can I ask why you would want to change from patch to pill as patches are considered to work better and are safer for longer term use.


Honeyb
x

[Limpy]

Don't know - but presumably it's about 50mg.........
Why don't you like the patches, they appear to be better tolerated?

Hopefully somebody who knows what they are talking about will be along soon.

[bramble]

If you look at the green boxes to the left, you will find listed all the HRT preps divided into low dose, medium dose etc. It will also tell you what category your current patches fall into.

Bramble

[jacquiellen]

Bramble it does say low, medium, high etc. for the pills but nothing for the patches.
The reason I want to try the pills is because I think the progesterone (or maybe the amount of progesterone) in the patch is not working well for me it is making me very tired! I also read that the other patch to choose from does not stick well.
I have had the pill form before but think the ones I had were too low thats why I wanted to compare but maybe it won't be possible because it is absorbed differently. I know the patch is 50mg but that is for 3/4 days so can't work that out 

[Dana]

Evorel contains 50mcg (not mg) estradiol, changed twice a week. This is considered a medium dose. An equivalent medium dose in tablets would be 2mg estradiol.

I recently changed from a 50mcg patch (Estradot) to 2mg estradiol tablets because I wasn't certain the patches were working okay, and the change over has been fine.

[Hurdity]

sohot if you look under oestrogen only patches it does give low medium and high - the reason it doesn't for post-meno is because there are only two patches and both at 50mcg strength http://www.menopausematters.co.uk/treatafter.php - scroll down for the patches. You will see as Dana says this is a medium dose. Each woman will metabolise the pills differently so you may not get the same level of oestradiol into your system with the pills and patches.

I don't see why you need to change from patch to tablet because you don't react  well to the progestogen. The other way to do it, and still use patches is to have oestrogen only patches and separate progesterone - and this would be micronised progesterone sold as utrogestan. However progestogens all have a sedative effects and if you are taking them continuously then whichever type of progestogen you use, tablet or patch - could make you feel tired.

The other alternative ( may have already mentioned this?) is to go back to a cycle and so to keep the progestogens to a minimum. Downside is you have the rise and fall of the hormone and a bleed. You have to decide on the option which makes you feel best overall - there will be a downside to any regime, unfortunately, just as with periods.

Hurdity x

[jacquiellen]

Thank you for all your replies it is very helpful. Dana what pills did you change to? Do you find they are working better for you? Are you on estradiol only?
I don't think I could handle the bleeding again with cycle type HRT, my periods were always unmanagable (so heavy and endometriosis, fibroids) before so I was pleased when they finally stopped 3 years ago but I will have to go back to the doctor and have a rethink!
Thanks again for the help.

[Hurdity]

If you have/had endometriosis/large fibroids then cyclical HRT is not advised since thre oestrogen stimulates the growth/tissue.

Here is what it says on this site about endometriosis, fibroids and HRT:

Endometriosis   
    There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.


Fibroids   
    Fibroids are benign smooth muscle tumours of the uterine (womb) wall and are dependant on estrogen. They tend to shrink after the menopause but shrinkage may not occur, or they may even increase in size with HRT use. Increase is thought to occur in 25% of HRT users and mainly occurs in the first six months of therapy. There is some evidence that transdermal (patch or gel) but not tablet HRT nor tibolone may promote fibroid growth. [ref 24] Fibroid size can be monitored by regular examinations and sometimes by ultrasound scans. There is some evidence that the use of the progestogen releasing intra-uterine system, Mirena may cause fibroids to reduce in size. Mirena is often used in the perimenopause by women who have heavy periods and/or require contraception and can provide the progestogen part of their HRT.

Looks like continuous progesterone is probably the only option for you so the question is finding one that makes you feel best overall. The most natural options is micronised progesterone (Utrogestan) and it may have less of a sedative effect at the lower amount that is taken daily (100 mg) than the 200 mg normally required for cyclical HRT.

Hurdity x

[Dana]

Thank you for all your replies it is very helpful. Dana what pills did you change to? Do you find they are working better for you? Are you on estradiol only?
I don't think I could handle the bleeding again with cycle type HRT, my periods were always unmanagable (so heavy and endometriosis, fibroids) before so I was pleased when they finally stopped 3 years ago but I will have to go back to the doctor and have a rethink!
Thanks again for the help.

I changed to Progynova 2mg, which I already had in the cupboard from previous use. The reason I changed was because I started to get symptoms (insomnia, heart palps and some flushes at night), but I also had other things going on at the same time, because I'm tapering off another medication, so I wanted to be sure that the estradiol patches weren't the cause.

Things resolved after about a week or so, and my other medication taper has finished now, so when this lot of estradiol tablets are finished in the next few days I will be going back to the patches to find out if they really were to blame or not. I hope not because I would much rather be on patches than tablets.

My other issue is that I have had to make the switch away from Utrogestan because I was just not getting on with it at all, with really severe insomnia that could go on for about 2-3 weeks every time I used it. I was almost getting to the point where I was wondering if I would have to consider either stopping HRT altogether, or having surgery, neither of which I was thrilled about. However, I decided before I took either of those drastic steps I would trial Medroxyprogesterone. I have used it for one cycle, and so far I have to say I feel 100% better with it than with the Utrogestan. I'm currently using 5mg of medroxy for 10 days a month (as per my doctor's recommendation), but if things keep going well over the next few months I may try it as a conti method of 2.5mg per day. If that works I might then try Norethisterone as I can get that in patch form.

Interestingly, friend of mine who lives in America, was also having exactly the same problem I was having (she was using Prometrium) and her ob/gyn told her that even though he had never seen it himself, he certainly was aware that there are reports of a small percentage of women having a paradoxical reaction to micronized progesterone. He has just prescribed her a progestin too, so I hope she does okay with it as well, otherwise she is also considering surgery.

Most women seem to do well on Utro, but not everyone. It was okay when I first started using it, but over the last 6-12 months or so each month just seemed to get worse and worse. Of course this may happen with the Medroxy too, but for the time being I'm happy with what I taking. Maybe I'll find that I need to rotate different progestogens every so often. I'm still not ruling out surgery at some point in the future, but it will have to be the last resort if I can't find anything else to work.

[jacquiellen]

If you don't mind me asking ! What surgery would help the menopause? I find the problem with all the things I try is that you have to give them all so long, then they take so long to give any results and by that time you have undesirable side effects and then you go again on the merry go round back to square one.
All fun and games 

[honeybun]

By having a hysterectomy it would mean there was no need to take progesterone which some women find difficult to tolerate. Also if there was a lot of heavy bleeding and fibroids it would get rid of that too.

I think it's a huge step to be honest but as I don't have either of those problems I would find it difficult to consider that but for some I guess it would be an option.


Honeyb
x

[Hurdity]

I agree - if I had severe problems with progestogens and severe menopausal symtpoms that were preventing me getting on with life I would seriously consider hysterectomy, and then happily take oestrogen only for ever!

Hurdity x

[jacquiellen]

Hurdity, i'm not sure if progesterone only would do anything to help my meno symptoms, as I was getting hot flushes when I had the merina coil which is progesterone only, hence why I had it removed as I was never using it for contraception reasons and couldn't see any point in having it or is the other kind you mention micronised progesterone (Utrogestan) different? I will try anything, this weather isn't helping  every time I do anything I feel like I need a shower and I just never sleep anymore so of course grumpy and irritable next day 

[Hurdity]

Hi sohot

Sorry if my post wasn't clear.

What I was suggesting before was to take the progesterone part of your HRT on a cycle if the continuous progestogen was making you feel tired.

When you said you had endometriosis and fibroids what I meant was that cyclical progestogens would not be an option because the medical consensus (which I quoted from this site below) is that taking oestrogen is likely to make these conditions worse, therefore you would need continuous progestogens as part of your HRT which would include oestrogen to control your other menopausal symptoms.

The Mirena coil is not only used for contraception but to provide the progestogen part of HRT as it delivers progestogen directly to the uterus lining which stops it thickening due to the oestrogen. I'm not sure whether it would also deal with endometrial tissue outside the uterus as well? Perhaps oral progestgoen would be recommended?

Yes Utrogestan (micronised progesterone) can also be given - but is licensed for oral use - some of us use it vaginally but you might not want to do this every day.

I hope I've explained better? Do let me know if not!

Hurdity x