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[andius]

DG:

Is this what your pump device says?:


1 pump depression of EstroGel 0.06% delivers 1.25 g of gel containing 0.75 mg estradiol. Taken once daily this is 0.75mg/day.

If so, here is the pkg insert levels info:

"EstroGel 1.25 g (containing 0.75 mg of estradiol) was administered to 24 postmenopausal women once daily on
the posterior surface of 1 arm from wrist to shoulder for 14 consecutive days. Mean maximal serum concentrations of estradiol and estrone on Day 14 were 46.4 pg/mL and 64.2 pg/mL, respectively. The time-averaged serum estradiol and estrone concentrations over the 24-hour dose interval after administration of 1.25 g EstroGel on Day 14 are 28.3 pg/mL and 48.6 pg/mL, respectively."

I tried to post the graph but cannot copy it individually to paste it, but estradiol level hovers around 30pg/ml. Conversion tables pg/ml to pmol/l show:

46.4 = 170.3 pmol/l                                            28.3 = 103.9 pmol/l

64.2 =235.7 pmol/l                                             48.6 = 178.4 pmol/l

I am with Hurdity!!!  I am assuming your guess is a little high if the 300-400 number you guessed is in pmol/l. This is probably because you had your own estrogen from ovaries in the mix back when 2 pumps gave 600, and now that is gone in post menopause.

The reason I looked this up is I haven't tried the estrogel type of hrt myself and was curious if we have it in US and what the data showed.
I think these blood levels are quite similar to what you get with a .05 mg patch. At first I was thinking if it gives .75mg day and you can take with 100mg utro, it sounds like something I would like to try. In US .075mg/day patch is considered high dose and usually the utro is pushed up to 200mg/day for continuous pattern. Wonder why estrogel gives .75mg/day but blood levels are similar to the .050mg patch? Clearly the answer is different technology between gel and patch....NOTICE .75mg/day gel and .075mg/day patch!!!!! IN CASE ANYONE ELSE WAS CHECKING THIS OUT ALSO!

The Minivelle (like estrodot) estradiol only patch gives a max conc of 56.6 pg/ml for the .050mg/day patch and for .1mg/day patch it is 117pg/ml (429 pmol/l). They don't give the info for the .075 patch in the package insert. I tried the .050 patch with 100 utro for a while and the utro burned my bladder/urethra. It would be nice to try a higher estrogen patch or gel without having to up the progesterone!!! (what I thought this might be, but apparently isn't)

Havw I succeeded in confusing myself and everyone else too??? 

Andius

[Dancinggirl]

Hi andius - Thank you for the feedback - very interesting info about the actual dose received with Oestrogel.  When I quoted my level at 600 with approx 2 pumps per day (I usually applied slightly less) this was at the age of 57 and I had been post menopausal since my early 40s!!!! I believe that one pump of Oestrogel daily would give an approximate equivalent of between a 25 to 37.5 patch but again this is just my guess.
Maybe I absorb and store more oestrogen than most??!! There does seem to be a problem with absorption with many women; I often read on MM of women on as much as 4 pumps per day still showing very low oestrogen levels when tested!!! Your info only shows levels after 14 days and I also assume that levels within the body will build over time as we surely store some oestrogen?

I had had a one year break from HRT before I started back on HRT last autumn and my gynae recommended I start with one pump per day for 2 weeks and then increase to 2 pumps per day after that; he then wanted my GP to test my hormone levels soon after 4 weeks on Oestrogel and the blood test at this stage showed a level of 475. He then wrote to me and said I could increase if I needed, as he wanted me to be at around 600!!!  I want to be on HRT for the long term and thought I should keep to as low a dose as possible provided my symptoms were under control so actually reduced down to one pump per day and I feel good on this amount.  I can only guess what my levels are so maybe I'm one of those women who feel good on an oestrogen level of only 200-300!!
The other issue for me ( that I think is slightly baffling my gynae )is the fact I am spotting so much.  I had a scan and biopsy taken a month ago and everything was fine. My gynae has recommended I increase to 200mg daily on a continuous basis if the spotting doesn't stop in the near future.  Why do I get spotting when on such a low dose of Oestrogen??? I have only been on conti Utro for just over 4 weeks so I don't feel I should increase my Utro dose just yet - after all, when first starting any conti HRT regime it is quite normal to get spotting for the first few weeks or even months.
Previously, in my mid 50s, I had had a Mirena with Oestrogel - this was OK but did give me fatigue, occasional stomach cramps and I did get some spotting as well.  So maybe I am more prone to spotting?? I also realise I got more headaches when on other progesterones or even without HRT  - since being on Utro continuously I haven't had a headache!!!
I do think that there are real issues around the absorption of Utro but fortunately it does seem to suit me even on a conti basis. I am reluctant to use it vaginally due to my bladder problems and urethral pain, although I will give this a go if I feel I must.
My post is titled "Finding the balance" - I think this is the key thing. If my spotting stops in the next few weeks, I really feel I have found the perfect balance.
Thank you all for your feedback and support - I am so keen to keep feeling this good - I can really feel my confidence growing now I don't get so many rough days. DG x

[dahliagirl]

Just a thought - Could the bleeding/spotting be because you do not have enough oestrogen to combat the effects of the uterogestan, like you get with progestogen based contraceptives like the implant/mirena/injection/cerezette etc? 

I had to take my daughter to the fpc to have her implant removed because of this and read somewhere recently that Annie Evens said that if mirena makes you bleed, you need more oestrogen.

[andius]

You are right about it only being 14 days, not enough time for a buildup in the tissues.  Also these are usually uncorrected values in these leaflets, meaning whatever your postmenopausal level naturally is PLUS the effect of the drug.  Maybe you just naturally have higher levels. Anyway, I'm happy that it works for you so well.

As to the spotting, maybe you're not absorbing the progesterone as well orally.  Check the leaflet and see if taking it with food (or without) food  might increase the amount of drug in your system, depending on your personal pattern of taking it. Sometimes that can make a difference. I tried 200 oral for a while with a .050 patch and also with the US version of Sandrena gel.  It really made my bladder/urethra  much worse than with the 100 oral, but I never had vag bleeding on either dose. I was given that because  of a timid gyn who was afraid of "low dose" continuous  100 utro not being enough to counteract the estrogen. Most gyns in US don't trust utro (prometrium here), they feel much more comfortable with the synthetic progestins.

Andius

[Dancinggirl]

Thanks andius and dahliagirl
When I was trying a sequi cycle of oestrogel with Utro I was getting spotting when just using the Oestrogel!!!
My gynae did ask me to try increasing the Oestrogel back up to 1.5 to 2 pumps per day to see if this stopped the spotting but it didn't make any difference, I still had spotting. Also, with the sequi regime my withdrawal bleed always started before I had finished taking the 14 days of Utro and tended to last 9-14 days! Whether the spotting would stop with more oestrogen I'm not convinced - my gynae now thinks more Utro may be the answer.
I do think the absorption of Utro could the be issue.  The instructions say to take on an empty stomach before bed which I adhere to very carefully.  I know some ladies use it vaginally which delivers the progesterone more directly to the area where it's needed but as I mentioned I'm worried this would irritate my bladder and urethra.

Back in my mid 40s when I was using a synthetic progesterone with one pump of Oestrogel (sequi) I didn't get spotting - in fact I got quite a light withdrawal bleed.  I'm wondering if it is more to do with my age (59) and perhaps after having a whole year without HRT my uterus is struggling to cope with hormones?  I still hope things will settle in time as it is early days on this conti regime.  Dg x

[andius]

I'd try taking it (100mg) closer to dinner than bedtime for a few days. You might get sleepy earlier though.

Look at this: study from 1993 (small group though)

The absorption of oral micronized progesterone: the effect of food, dose proportionality, and comparison with intramuscular progesterone.
Simon JA1, Robinson DE, Andrews MC, Hildebrand JR 3rd, Rocci ML Jr, Blake RE, Hodgen GD.
Author information
Abstract
OBJECTIVES:
To examine the effects of food ingestion and administered dose on the absorption of oral micronized P (Utrogestan; Besins-Iscovesco, Paris, France) and to compare the bioavailability of intramuscular versus oral routes of administration.
DESIGN:
Prospective, randomized, open label crossover protocol with 7 days between dosages.
SETTING:
Academic institution.
PARTICIPANTS:
Fifteen normal postmenopausal women.
INTERVENTIONS:
All subjects participated in three separate protocols: [1] micronized P (200 mg) or placebo under fasting or nonfasting conditions once daily for 5 days; [2] micronized P (100, 200, or 300 mg) once daily under fasting conditions for 5 days; and [3] micronized P (200 mg) or intramuscular P (50 mg in oil) administered once daily for 2 days.
MAIN OUTCOME MEASURES:
Serum P concentrations were measured in all groups.
RESULTS:
Concomitant food ingestion increased the area under the serum P concentration versus time curve (AUC0 to 24) and the maximum serum P concentration (Cmax) without affecting time to maximum serum concentration (Tmax) (P < 0.05). Micronized P absorption and elimination were first-order processes and exhibited dose-independent pharmacokinetics between 100 and 300 mg. After intramuscular P, Cmax was higher and Tmax occurred later compared with the oral P preparation. Oral P had lower relative bioavailability (8.6%) than intramuscular P.
CONCLUSIONS:
Absorption of micronized P was enhanced twofold in the presence of food. Both absorption and elimination were dose-independent, dose proportionality being confirmed. Bioavailability of the oral P was approximately 10% compared with intramuscular P.

[Dancinggirl]

Oh Andius - I wish I understood most of that!!??  It very clearly states in the instruction leaflet that Utro should be taken on an empty stomach before bed.  I think this study implies that more might be absorbed if taken with food so if that is the case surely one could take it with a snack close to bedtime to actually enhance the effectiveness of a lower dose?!
I have to say this is a very old study and perhaps further studies showed different or negative results.

I know that certain drugs/medications need to be taken on an empty stomach while others should be taken with food - one can take most synthetic progesterones with food (probably preferable) but Utro seems unique in this aspect. I know that many women are using Utro vaginally because it gets absorbs more directly to the area that needs it.  This study seems to include an intramuscular preparation as a comparison - what a shame this doesn't exist as an alternative to pills?  This is a french study so maybe there is a transdermal version of Utro there?  The French do seem to be ahead of the game in some respects  when it comes to HRT.

Maybe food encourages not just a faster absorption but also a faster elimination which could also be an issue.
I did question the importance of taking Utro on an empty stomach with my gynae and he actually didn't know that this was how one had to take it!!
I wonder if the dizziness was that much stronger when taken with food? Perhaps it absorbed in the wrong way?
The conclusion doesn't make sense to me really.
Very interesting though.  It might be worth trying a little snack at bedtime.  DG x
   

[Hurdity]

Re utrogestan and absorption with/without food - this has been discussed several times on here!

Here are some threads:
http://www.menopausematters.co.uk/forum/index.php/topic,26651.0.html

http://www.menopausematters.co.uk/forum/index.php/topic,27722.msg433090.html#msg433090

http://www.menopausematters.co.uk/forum/index.php/topic,26334.msg406200.html#msg406200

In one of them I found a study from 1999 (which I haven't read in detail!) and which quotes the 1993 study you found andius.

http://www.mialundin.se/wp-content/uploads/2012/02/Micronized-progesterone-and-endometrial-cancer.pdf

After a very quick skim through it seems that serum levels of progesterone are increased when taken with food which could give rise to more side effects - but this effect is minimised if taken at bedtime so that you are asleep! I don't actually think women need to worry about the empty stomach thing - just be aware that there may be more side effects - you can't overdose on it at this level.

Re the French study - it is licensed for use vaginally in France and the French instructions permit this. I sent for information a few years ago and the manufacturers sent me a couple of papers about it.

Dancinggirl you mentioned also earlier wondering why you are experiencing spotting with such a low dose of gel but I think you might have answered that question yourself! You say you absorb gel very well and achieve high oestrogen levels with only a small amount of gel - so in your particular case - it may not be such a low dose. In a one size fits all scenario we clearly vary and also body size must come into it. If you are small and light with little body fat ( not sure where you fit in here Dancinggirl - I suspect as a dancer you are light!) then I would imagine that a given amount of gel will give higher serum levels of estradiol and therefore deliver more to the uterus.

There was a discussion somewhere about how much is absorbed on another thread so I think I'll take a look there too if I can find it!

Hurdity x

[Dancinggirl]

Thank you everyone.
Hurdity - I'm not that small any more - used to be 7.5 stone ( sometimes less) in my dancing years and probably underweight - I dread to think what I weigh now - I don't believe in weighing scales - I tend to go on the fit of my clothes but I know I'm not much overweight as I think I've just rounded up a bit all over - in fact being back on HRT has improved my muscle structure as I get more exercise and of cause muscle in heavy. 
My spotting has stopped over last few days so maybe things are settling?!!

JoyceBarnaby - interesting that you find you want to kill people on Utro - I got that on the synthetic progesterones but Utro makes me feel really chilled. It struck me the other day that I'm feeling as I did in the mid trimester of my pregnancies - calm, positive and serene - long may this last.
Dg x