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[ellie66]

I am sure I use to have a conversion table re tablets to gel and patches.

This is probably a question for Hurdity?

What is the equivalent dose 2mg Femston in Oestrogel. I thought it was about 3 squirts of Oestrogel which I am doing brilliantly on. My GP keeps putting 1 squirt on my prescription. I have raging hot flushes on anything less than 3. I am obviously taking Ultrogestan too and Ovestin cream. 

I have lost my medical reference conversion table.

 

[Briony]

This thread might be of interest (well, the links within it!). B

http://www.menopausematters.co.uk/forum/index.php'topic=29477.msg470017#msg470017

[Hurdity]

I get embarrassed if you ask me in the title because I really am not an expert on this. Finger in the air comes to mind    I don't profess to be able to answer any better than anyone else who looks stuff up - and I feel embarrassed for all the other women who are so helpful! Could you take my name out of the title please - no offence whatsoever ellie66 and I appreciate your asking me 

There are various tables of equivalents but really it's a question of suck it and see and go on low medium or high. As I've probably said numerous times on other threads - there is considerable variation between women in how much estradiol from a particular dose and product actually gets into her system. The amounts quoted in the trials (looking at all the pharmacokinetic data produced by the company making that particular HRT) are an average of a certain number of women. Not only that individual women vary in their own response to different types, brands. delivery methods - so that one woman may get a high dose from 50 mcg patch but not a lot from 3 pumps of gel and another may get the reverse.

There are various tables but we have contradictory results both on the web and even on this site where 2 mg oestrogen in tablet form can be medium or higher depending on where you look.

All I can say is - whatever your doc says - I am sure that 1 pump of gel is far less than 2 mg Femoston - in anyone's book! I mean if your doc just looks on here s/he will see that! Even here 2 mg estradiol is given as medium ....
http://www.menopausematters.co.uk/treatafter.php

The standard dose for Oestrogel is two squirts so can assume that is medium ( since there are women who are OK on 1 pump = low). I presume any more could be a bigger medium or higher - whatever you like to call it! Basically it comes down to the amount that will eliminate your symptoms.

The tables I have found from elsewhere seem to suggest otherwise but the products may be different:
http://portal.mah.harvard.edu/cms/content/B7ACBE692D3340DD9CD308883BC9750B/C8FBA664C44E4E9797A5069E4A8FF7F4.pdf

https://www.menopause.org.au/for-women/information-sheets/426-ams-guide-to-equivalent-hrt-doses

I would go on the broad categories on this website

Hurdity x

[ellie66]

Thanks ever so much Hurdity. I did not mean to offend anyone sincere apologises if I did. It was purely a case I remembered Hurdity was very good on the pharmokenetics etc or to my brain the complicated tables etc relating to HRT. Yes this is what I am looking for.

Once again many thanks and I did not mean to offend anyone.

2 pumps I severe meno symptoms on. My old GP had me on Femstom 2mg which was okish .Gel/Ultrogestan is so much better. 3 pumps seemed roughly the same to 2mg Femston yes slightly more but then gel is messy to use was my logic. My current GP is trying to reduce me down to 1 pump argh..........................................

So any good medically referenced/backed up arguments relating to this gratefully received?

[ellie66]

For some reason my GP has done a U turn on HRT. I keep getting leaflets on risks etc. I have had major issues. Plus I am an early meno patient and have been on it since I was 44 I am now 49 so am at risk of cardiovascular disease and osteoporosis.

He keeps sending me leaflets re natural alternatives insert bad language. Hence why I looking for medical references.

[Hurdity]

Aaaaaaagh! ellie! Your doc! You are not even at the natural average age of menopause so your doctor should not even be discussing it with you! OK when you get to the age of 51 or 52 it's fair enough for him to make you aware of the risks - as they are currently quoted. However it's generally accepted that you don't count the early meno years anyway as part of the risks associated with HRT so even by the old fashioned thinking you would have 5 more years after that before they should start grumbling. Even after that,  once you let him know that you understand the risks and will accept them, he should let you continue - perhpas at some point thinking about slightly reducing the dose (not yet though...).

Medically referenced articles to what specifically? As I said re the doses and equivalents, and Stellajane said about the packet - 1 pump is never the standard medium dose! If you mean the actual values for serum concentrations of estradiol from the various formulations - my brain is not up to that at th mo' - also would need some hunting down. Also have tried to do it before but the data are not comparable and I don't really understand the pharmacokinetics - it's all things like C max, C average, time averaged serum values, steady state etc - I can't work out how each has been arrived at.... 

Hurdity x

[ellie66]

Hurdity help yes this exactly what I mean "If you mean the actual values for serum concentrations of estradiol from the various formulations"

He will not take the advice of well informed women on an internet forum. I have sent him NICE Draft Guidelines tonight too. However when I saw him he poo hoo'd the NICE guidelines. Also my Grandmother had severe osteoporosis due to early meno  and lived until 105. She was bed bound for 25 years and fractured her hips about 8 times . She also had severe vaginal atrophy and her 60'S had to have her vaginal walls separated due to bleeding they had stuck together    My GP's comment she would not have lived that long if she was on HRT!!

I am losing the will to live over this Ovestin daily, 3 squirts of Oestrogel and Utrageston and I am brilliant.

If your brain can stand it I could really do with some help 

[andius]

Ellie

If you google the hormone product you are on and read the manufacturers "prescribing or professional info" which is found somewhere on the first page (it is usually a link to another page), you will somewhere find a graph that will tell you what the average blood level is at steady state ( roughly meaning when the amount of hormone you are metabolizing is equal to the amount of hormone you are receiving, so blood levels stay in a close range). Look for the one that is not the single dose, but the one after multiple doses. You can compare the one for Femoston and the one for Oestrogel.  Another way to compare =C max, will be the maximum blood level you get to, usually after 1 dose. Even though that is not a steady level yet, it is a rough comparison of the maximum estrogen you will get with each preparation after 1 dose.

Don't worry about looking up Utro or Ovestin.

A

[ellie66]

Dr Currie is away until the 3rd December. I have emailed Dr Annie Evans and will email Dr Nick Panay. Changing GP's for hugely complex and very unusual reasons is not an option.  Thanks StellaJane reassuring to know others have a similar family history.   

[Hurdity]

Good luck with your responses.

It is very complex looking at the data but you can't be sure you are comparing like with like. For example I found this on the SPC for Sandrena "The mean estradiol exposure at steady state of Sandrena is 82 per cent compared with an equivalent oral dose of estradiol valerate." which would mean that 2 mg Sandrena gel would give approx 80% of the estradiol values of a 2 mg tablet of estradiol valertae. I have found conflicting info re the equivalence of estradiol (as hemihydrate) and estradiol valerate and whether they are exactly equivalent.

Also if you look at section 5.2 of any of the product's SPC this gives the pharmaco-kinetics so here are some data for Femoston, Sandrena and Oestrogel:

Femoston 2/10
The following table provides the mean steady state pharmacokinetic parameters of oestradiol (E2), estrone (E1) and estrone sulphate (E1S) for each dose of micronized oestradiol. Data is presented as mean (SD) in pg/ml
E2 =estradiol
Cmax 103.7 (48.2)     (x 3.671 = 381 pmol/l)
C min 48 (30)      (= 176 pmol/l)
Cav 68 (31)     (= 250 pmol/l)

Oestrogel C average 2 pumps 1.5 mg on Day 12 76.8 pg/ml (= 282 pmol/l)
Sandrena  C average for 1.5 mg over the dosing interval (whatever that is – doesn't say at steady state) = 210 pmol/l for 1.5 g gel

This implies that you get more estradiol from a given dose of Oestrogel than Sandrena (according to a paper I read oestrogel should be applied to the same area of skin each day -  this would then result in the higher levels, but Sandrena the site changes - but the instructions for Oestrogel do not state this ie apply to the same area)

The same paper said this:
"The estradiol levels achieved with 1.5 mg estradiol are similar to those with a 50 mg
estradiol patch" - it's a paper published in Climacteric - and I can send you more info by pm if you want. It's a great but very technical paper which you might want to track down - I think I remember you saying you were in the medical profession or at least working for NHS? Apologies if I'm wrong and mixing you up with someone else!

The point is it takes ages to delve into the data and then try to work out whether C average is the same for each product - and it often doesn't even say - the reading will be different whether it's Day 1 after application or at steady state (when levels will have stabilised. I doubt your doc will be prepared to spend time looking into it all - do you think?

Do you see what I mean?

That's why the crude measures - low medium and high - that are given on this site and on the spcs - are a good starting point. As Stellajane says - Oestrogel says the usual starting dose is 2 measures so any less than this is deliberately giving you as lower dose, and for some it can be adjusted up or down depending on symptoms - in view of the very great variablity.

Anyway - bit of a ramble - but I did do some digging as I have always done before and never come up with anything definitive. Hopefully your gyanes will give you a nice easy comparison for you to show to your doc!

Phew!

Hurdity x

[ellie66]

Thanks ever so much Hurdity. Yes I agree he is deliberately giving me a lower dose  I would love details of that paper if you could be PM me.

You are right I do have an NHS background so technical documents/jargon type documents are fine.

Many, many thanks this is the type of thing I was looking for.