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[Trufflecat]

Thanks. I will make an appointment and ask about the gel. The doc seemed to think that my oestrogen was normal at that level. 

[Mary G]

Trufflecoat, this is where it get complicated, your blood levels may seem to be normal on paper but that doesn't necessarily translate into decent symptom control.  Some women need to have oestrogen blood levels significantly higher than the supposed normal levels in order to get symptom control.  As always, it is not an exact science.  I have had this conversation with my gynaecologist many times and she agrees.  When my level was the same as yours, I didn't feel good at all.  Unfortunately, what works for some women doesn't work for others.  The only way of knowing what really works for you is to get to a level where you feel good. 

By the way, I forgot to mention this before on this thread but my understanding is that 2 pumps of gel is the equivalent of a 50mcg patch but again, when it comes to blood levels, the results for me are wildly different and I get much more into my system from 2 pumps of gel than I did from the 50mcg patch.  Much of it is about how well you absorb each product.

[Hurdity]

Smokey - no-one can say what the equivalent dose of patch to gel is! The dosage of oestrogen for the different delivery methods - tablet, patch, gel is derived from studies of groups/populations of women and the average taken. This is not an exact science!

Therefore what is given on this site under HRT preparations - is low medium and high dose and that's all you can really go on (although there is some inconsistency with this with tablet HRT!). Women vary so much in how much they absorb into their system from each method and the resultant oestrogen levels. Not only that we differ in the level ofestradiol at which we experience symptoms.

50 mcg patch is classed as medium dose. The starting dose for gel is 2 pumps which is also medium I think as it;s the standard post-menop dose.

However some women will get much higher oestrogen levels from 1 pump of gel than a 50 mcg patch! With gel it depends quite a lot on the size of area you spread it on because the estradiol is absorbed before it dries - so too large an area will possibly dry too quickly and less is absorbed? Absorption for both transdermal methods will also vary according to where on the body the product is applied (thickness of skin), and the products you might have used on your skin as well.

Whether you choose patch or gel is a matter of preference - firstly on absorption (for you), and secondly whether you prefer a twice weekly change (most patches) or a daily or twice daily application (gel). Whichever method you use - if your oestrogen dose is too low then you need to try to increase it. This might be easier in small steps with gel since patches only go up in 25 mcg increments - but most women who use them and are happy with them find this OK.

If you are post-menopausal in your 40's then 50 mcg may not be enough but if you are peri-menopausal so much depends on what your own cycle is doing ie whether your own oestrogen levels are not even reaching the peaks at ovulation that they were, if they are dipping really low, or surging really high. What might be the right dose to deal with the lows might be too much when added to the highs? It is so hard to repliclate what our own bodies would be doing - but the best we can achieve is to try to find a regime that makes us feel well for most of the time - and better than we do when not taking it.

Hurdity x

[Trufflecat]

Thank you. Honestly witnout the info gained on here I would know nothing.

[Nina]

Nail polish remover gets rid of the marks from patches. My tip of the day 😀

[Smokey]

Thanks everyone for taking the trouble to reply.

I am seeing my doctor this evening to discuss my Hrt change. I am currently on 75mg patch including (50 prog part.)  I am also eight weeks off antidepressants and am all over the place at the moment anxiety low mood nausea aches and pains scary feelings rushing through me no hot flushes bit warm in bed then goosy etc. Digestive problems lost interest in everything, worrying about everything etc. I feel like I'm going mad!

Gypsyroseleigh what times your docs app today, hope it goes ok.

Ann x

[Dancinggirl]

Somewhere on this thread someone has mentioned equivalent doses.  The absorption of either patch or gel can vary from women to women.  2 pumps per day is the average dose that is recommended but some women find this too little while for me it's almost too much.  On 2 pumps of gel per day my oestrogen levels are around 600!!!! so this is a medium dose.  I clearly absorb and store oestrogen really well.  Other women get far lower readings on 3-4 pumps.  When I tried patches, I got a big boost in the first 24 hours and it tailed off really quickly, so by day 3 my flushes were back.
It's trial and error but at least with the gel you can adjust the dose - even though the application can be a nuisance to get used to.  DG x