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[Liz]

Went to GP yesterday and she was going to prescribe a 75mcg patch but decided to increase the gel instead to 3 pumps.  Is this equivalent to a 75 patch, does anyone know?

Bit nervous today, as used an extra pump of gel this morning (3 instead of 2) so wondering how the effects will manifest? 

[Dancinggirl]

Hi Liz - I'm not sure what exact dose 3 pumps would be but it is a good idea to spread the applications when doing more that 2 pumps per day - so use 2 pumps at night and one in the morning - this will give better absorption and will spread the dose more evenly.  My gynae suggested I do this if had wanted to increase my dose of Oestrogel.  Also, you don't have to increase so much so quickly - perhaps try squeezing out a half dose extra for a few days so the increase in gradual? This is the beauty of using Oestogel - you have so much control and flexibility.  DG x

[Liz]

Thanks, I must admit it did seem a lot of gel to use in one go, took quite a while to dry and even later in the morning when I'd got dressed I'm sure I felt my trousers "sticking" a bit to it...... I did wonder afterwards if I should have increased it more gradually.  I feel OK today, though, so will probably just try a little bit more tomorrow then.

[Liz]

I am fretting today, though....... about the higher dose.  I don't like the idea of being on 3 pumps if it's a high dose.

[Dancinggirl]

Liz - don't worry. I can't remember how old you are or whether you have had a hyster - I assume you have - but 3 pumps is not that high. I'm sure that the increase from 2-3 will make a positive difference.  dg x

[Joyce]

I was told by meno consultant 3 pumps was equivalent to Estradot 50. Maybe depends on patch.

[Liz]

Thank you both of you.....I'm almost 48, not had a hysterectomy, still peri, so using Utrogestan for 12 days per month.  Been all over the place though - having periods every 2 weeks or so, not bleeding at the right time after the Utro, so think it can safely be said that hormones are up the creek! x

[Liz]

I was told by meno consultant 3 pumps was equivalent to Estradot 50. Maybe depends on patch.

It's not that high then really, is it?  3 pumps, I mean.  I started out on Estradot 50 but had allergy to them.

[Hurdity]

Just to say this equivalence thing is really tricky - and I'm sure I've found different answers in different places. The point is there is huge variability between women in how much is absorbed from the different formulations so the equivalence is only an average. For example some women absorb better from patches than gel or vice versa so equivalence would be higher (pumps to patches) in this case. I think it best just to look at broad categaories of low medium and high dose and just try it and see. Also different gels come in different concentrations ie Sandrena vs Oestrogel.

Cubagirl - all 50 mcg patches are designed to deliver the same dose ie 50 mcg per day. They are physically different sizes so may absorb differently depending on an individual woman's skin and also what she has put on it!

The main thing is that you are increasing the dose Liz - which is what you want? Can't remember why you are increasing and therefore what you are expecting in terms of your Q "how the effects will manifest?" . eg if you are still getting flushes and sweats and the 2 pump dose you would expect these to be eliminated. Most women also feel better on a higher dose of oestrogen - but of course replacing it exogenously (from outside the body) is a different matter than endogenous production ( from the ovaries etc) so doesn't feel quite the same.

Let us know how you feel anyway, and hopefully an improvement soon!

Hurdity x

[Liz]

Hi Hurdity, GP suggested I increase as I was having low moods again.  Mind you, this evening I feel absolutely shattered, as though I've been sedated.  Had a headache all afternoon too, so think I may have used too much, or too quickly.  Think I'll drop back to the 2 pumps tomorrow.

[Dancinggirl]

Liz - Like you I am using Oestrogel and Utrogestan.  I think the problem with Utrogestan is that it isn't as strong as the synthetic progesterones so not as good at controlling the bleeds.  I am 59 so have been advised to try taking Utro continuously as I am post meno and this may get the spotting under control.  You are peri meno and your own hormones may be still kicking in and out so causing your erratic bleeding a mood swings.  I have to say that at this stage 2 pumps per day for you may be sufficient and the problems with the bleed is because your endometrium is building too much due your own hormones rising and falling.
You could possibly try Provera, a slightly stronger progesterone, which is often well tolerated and this might sort out the erratic bleeding.
Dealing with mood swings in the peri stage is very difficult because hormones won't be balanced - even with HRT.
I do find that I get more headaches with higher oestrogen. If your flushes and night sweats are under control then stick with 2-3 pumps and 12 days of Utro for a few months yet.  Sadly we can't expect HRT fix everything.
Keep us posted.  DG x

[Liz]

Thank you, Dancing girl........ Just after I'd posted last night, I had to almost crawl up the stairs to bed.  I felt absolutely sedated and barely managed to clean my teeth.   Think I overdid the oestrogel yesterday by upping it to 3 pumps!  Going back to basics today and using the 1 and a half pumps that I was originally using before I increased.  I was getting some flushing on the lower dose, hence GP suggesting I try the higher dose, but I think it's too much for me. 

Still feeling very zonked this morning, hope it wears off soon! x

[orchid]

Hi Liz sounds to me you are getting to much oestradiol. Especially as you're peri, not menopausal.

X 2 measures (pumps) = 2.5grams = 1.5mg of oestradiol

Depending on make of patch, but roughly 75mcgs =  1.17mg of oestradiol

[orchid]

Liz...just to add, the probable reason for you having a bleed every two weeks will be 1. The withdrawal bleed from the utrogestan after taking it for 12 days. Then your own endogenous progesterone dip monthly bringing on your natural period. Unless they work concurrently you are going to have irregular bleeding. Same happened to me in Peri. It's difficult to get a balance until you actually stop menstruating unfortunately. I know how awful it is, take care.

[Liz]

Thanks Orchid, that's very helpful.  So....according to your calculations 3 pumps of gel is more than a 75 patch?? No wonder I was zonked then!  I'm going back to basics today and just going to use 1 pump of gel and see how I go.  If I feel I need more, I will gradually increase is very slowly over days..... 

You're right - this Peri stage is a total nightmare!  People keep telling me that things calm down when you get over this stage - I hope so!