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[Liz]

Hi ladies - been lurking around here reading and learning, but not posted in a while.  Thought I was quite settled on the Oestrogel/Utro combination, but been feeling very tearful and sad these past few weeks.  Thought it was just around my period time or the Utrogestan, but it seems to be lingering.  Hard to explain, just emotional and having "morbid thoughts"....  

I am on 1.5 pumps Oestrogel per day and Utrogestan for days 15-26 of my cycle.  I am supposedly in peri, but obviously don't know what my own cycle is up to at the moment.

Is the 1.5 pumps gel a very low dose?? I'm wondering if I need a bit more and if that would help with my grumpy/sad mood.  The Utro knocks me out each month - I'm using the 200mg dose for 12 nights per month, but I suppose I need this high a dose to offset my Oestrogel......... which leaves me wondering if my Oestrogel dose is not high enough for my 12 x 200mg Utro dose??

Not due to see my GP for a couple of months yet and she's on holiday at the moment, so unable to call her for advice, so wondering if anyone has any thoughts/advice re. my dosage amounts??

Thank you!

[Galadriel]

Hi Liz,
I don't have any advice on your doses etc but wanted to let you know you're not alone

I'm peri too and on Estradot 25 and MPA. I had a bleed last week and have been down in the dumps ever since. Yesterday was a nightmare as the tears kept appearing while I was at work  Everything seems to set me off.

The trouble with peri is the fluctuations... sometimes we are running on our HRT only and sometimes a combination of our own hormones and HRT.

I have a feeling that when our own hormones kick in for a cycle and then go into hiding, it leaves us feeling very unsettled, hence the emotional states and other horrible symptoms.

With a bit of luck, someone with more knowledge will be along soon.

Galadriel x

[Dancinggirl]

Hi and welcome to MM Liz
You are on a good HRT combination and actually you could increase to 2 pumps per day as this is actually the recommended dose and you might find this improves things. If you are in the peri stage of meno then your own hormones will be fluctuating and declining in the background, so often women have to slightly increase the oestrogen as they get deeper into meno.
Having said this, I don't think we should expect HRT to solve everything - low mood can hit us all at times and I find using some Mindful Meditation very helpful to help me through times when I feel a bit rough.
I know exactly what you mean about 'morbid thoughts' - they can be really haunting and horrible - I was sceptical of Mindful Meditation when my GP suggested it but I do find it helps a lot of the time. I think as we get older our minds do change and anxiety can easily take hold, so fighting this can be tough.
Kee posting DG x

[Liz]

Thank you both of you!  How lovely of you to offer such kind advice and sympathy!

Galadriel, I notice you're on a low dose of oestrogen too, do you find this low dose helps you?  I'm wondering whether to increase (as Dancing Girl's suggested) and see if that helps.

I'm up and down - last week I felt really great and was really looking forward to our holiday in two weeks time, this week I've gone down, am hoping that I'll soon pick myself up and think I will try upping the gel a bit.  Seems as though I'm on less than I thought..... I thought two pumps of gel were equivalent to a 50 patch, but apparently not.

Thanks again ladies - there are certainly a lot of us in this boat!!! x

[Galadriel]

I wondered the same thing Liz - am I on enough? I'm due for a review in a couple of weeks time so I might suggest trying the 37.5 to see how I go.

Fun isn't it?!

Galadriel x

[Liz]

Yes, great fun!   Well, I've upped the dose to 2 pumps gel this morning, which I have been reading is equivalent to 37.5 patch (correct me if I'm wrong!), so will see how I go on this, still think it's quite a low dose?

Hope you get something sorted at your appointment.  Would love to keep in touch - haven't really got any friends going through similar at the moment, so lovely to share with someone. xx

[Dancinggirl]

Liz - I've never used more that 2 pumps per day and in fact when I used 2 pumps per day my oestrogen levels went up to 600 which is quite high!!! My understanding is that 2 pumps would be between a low and medium dose if compared to other forms of HRT (a 37.5 patch is quite low actually) so I would increase a bit to the 2 pumps for a few weeks and see how you feel. You must bare in mind that if you are peri meno then your own hormones will be fluctuating and this will definitely have an effect on how you feel. DG x

[Liz]

Thank you Dancing Girl!  I've upped to 2 pumps today and feel much better (not sure if it's placebo but not complaining!) Will stick with 2 pumps and see how I go.  Think you're right - 2 pumps = 37.5 patch is what I've read, so it's not too high, is it?

Thanks again - really appreciate the support. xx

[Mary G]

Liz, you were definitely on a very low dose (not sure about the half measure with the pump!) and I think that the high dose of Utrogestan has been pushing your oestrogen levels too low hence the problems.

I use 3 pumps of gel everyday which is supposed to be the equivalent of a 75mg patch BUT following a blood test, it would appear that I absorb the gel much better than the patch because the 75mg patch just wasn't cutting it.

If you still get problems with the two pumps of gel, you could adjust your oestrogel doses to 3 pumps when taking the Utrogestan. 

[Liz]

Funny you should say this, Mary. I was just thinking about the possibility of this in the bath just now!  Was wondering whether I was getting too much Utro with the lower amount of gel and throwing my system off balance even more - seems to be what you're suggesting.  Going to definitely stick to 2 pumps for a while and see if I feel better. 

Thank you for your thoughts - really appreciate it.

[Hurdity]

Hi Liz

It's difficult to work out exact equivalence because of course this is based on an average of several women and none of us are average - and of course we also differ as to how well we absorb a patch compared to gel - and also from one women to another - so you can only go on what you feel!

As the others have said hormonal fluctuations make you feel out of kilter anyway and HRT is the best there is to help with this. In terms of dose I have only ever been on 50 mcg patch and have never had a problem - never had return of sweats and never had to increase my dose. I started when I was in late peri though so probably makes a difference - my own hormones weren't fluctuating in the same way.

However I feel wiped out on the Utrogestan too - especially after a few days in - and that's using it vaginally - I know I would feel much worse if I took it orally. If the low mood is persisting throughout the month - then good that you've slightly increased your dose as per the others and hope it does the trick!

The dose of utrogestan is weird really as it's a one-size fits all treatment - and for example doses (of utro) do not specify the maximum dose of oestrogen. It is logical that a lower dose of oestrogen will not require so much progesterone but there is no more specific prescribing information. I also read that progesterone interferes with the oestrogen receptors - this is how it works to prevent endometrial thickening - but I am a bit hazy as to whether it also has this effects elsewhere in the body. Several of us have noticed though a temporary return of flushes when on the progesterone part of HRT.

Hurdity    x

[Liz]

Thanks Hurdity!  That's really nice of you to take the time to explain that to me.........

You said you used 50 patch, from what I've been reading it seems that the 1.5 pumps gel I've been using is equivalent to around 25 patch and that if I increase to 2 pumps, this is equivalent to a 37.5 patch, so it seems I am on the fairly low side.  When I first used patches I used a 50, so I'm thinking I have taken a bit of a drop....... and combined with the Utro 200mg over 12 days, perhaps it's just making me a bit more "progesterone dominant".  I don't do well on Progesterones, tried a couple of different HRT pills with the synthetic progesterones and ended up a depressed mess every month.... hence trying Utro.  I agree with you, the Utro does wipe me out and I have considered using it vaginally, but am worried about causing thrush.  I used to suffer terribly and thankfully it has calmed right down (haven't had an attack for a good year now) so am concerned about using the Utro vaginally in case it sets it off.  May have to re-consider in the future though.

I am going to delay my Utrogestan this month by about six days as we're going to Menorca in two weeks time and I certainly would rather not have a bleed whilst there (sometimes they can be heavy), so will wait until the night I get home to take my Utro this month.

Thank you for all your help. x

[GypsyRoseLee]

Hi

My GP first started me on a 25mg patch with separate Utro. It was useless. When I got to see a consultant she told me that at my age (44) and with fluctuating hormones needed far more oestre than that, at least 50mg or higher. She seemed to think that 25mg was an irrelevant dose really.

[Liz]

Wow - thanks for this!  I'm actually 47 and have been "fluctuating" for about 3 or 4 years now, so what you've told me has really helped.  I am feeling better already and have used 2 pumps the last couple of days (which I think is still only equivalent to 37.5mg patch) so perhaps I was far too low in oestrogen???

I also remembered I have been using a new "Butter Shower Cream" which is really thick and am wondering if this is hindering absorption of the gel.... so got the bar of soap out this morning instead (I apply gel after my morning shower).

Thanks again, ladies. x

[GypsyRoseLee]

Hi Liz

A few months ago I had a spray tan. Placing a new patch onto spray tanned skin interfered with the absorption from my patch. Consequently the last few days of my holiday were ruined.

I contacted the spray tan manufacturers but they were no help.