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[KarenJ]

Hello I have just changed dose of my patch from 25 then 50 and now to 100, and I am still having symptoms such as night sweats etc. I have always placed the patch on my  cheeks (no not the ones on my face) but have been wondering if the estrogen would be more readily absorbed if I placed the patch elsewhere. I am thinking thigh, or stomach. Any thoughts would be appreciated. I am also wondering if it is possible to take a cream treatment for vaginal irritation and dryness alongside this strength of patch. Thanks in advance of your response.

[Dana]

Generally the advice is to place them somewhere below the waistline. Different women will have preferences for different areas. Some put them on their tummies, others on their thighs or bum cheeks. TBH I don't think the placement of them would really make that much difference.

How long did you stay on each dose? 100mcg is a fairly high dose, so you do need to be careful that by going up to that dose you aren't getting too much estrogen, because the side effects can be similar with too high and too low a dose. So you do need to be certain that you've given yourself long enough on each dose to know that it's not high enough for you.

You might also need to consider that perhaps you aren't absorbing the estrogen in the patch properly. If you aren't maybe you might need to consider tablets or perhaps gel might work better for you.

[andius]

Just wanted to echo the thought that higher estrogen levels can cause hot flashes as the levels  go up as well as vaginal symptoms of burning due to growth of thrush, sometimes that doesn't give the typical discharge.

It is recommended to stay at 1 dose for a couple of months before changing. I'm sure you are following your doctor's advice, but if you are sensitive to the changing of doses it is possible to have symptoms.

Patch absorption is supposed to be highest on the buttocks.

Local estrogen can be given with the patch although you may not need it with the high dose patch of 100...

[KarenJ]

Thank you this information has been really helpful.😊

[Hurdity]

I haven't actually found any information on the effect of different placement sites on the abdomen on absorption of estradiol - so that info would be helpful andius if you could post the link please?

I would have said that the front abdomen would give higher absorption than buttocks ie the soft skin of the stomach area below the waist. The reason I would think this is that the product monograph for the Intrinsa testosterone patches (for women) found 25 % higher absorption on front abdomen than buttocks - so I was extrapolating to estrogen which may be totally incorrect. I did assume it related to the relative thinness of skin on the front vs the buttocks - which I can actually feel. I have always placed them on butt cheeks myself - did try it on stomach a few weeks ago but too many waistbands etc to rub it off and the marks are more visible (if I can't be bothered to remove them each time) but I can happily leave them on my butt!!!

Hurdity x

[andius]

Here you go Hurdity:

http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/20538slr019_vivelle_lbl.pdf

This is the paragraph of interest:

"Absorption
In a multiple-dose study consisting of three consecutive system applications of the original formulation [Vivelle® (estradiol transdermal system)] which was conducted in 17 healthy, postmenopausal women, blood levels of estradiol and estrone were compared following application of these units to sites on the abdomen and buttocks in a crossover fashion. Systems that deliver nominal estradiol doses of approximately 0.0375 mg/day and 0.1 mg/day were applied to abdominal application sites while the 0.1 mg/day doses were also applied to sites on the buttocks. These systems increased estradiol levels above baseline within 4 hours and maintained respective mean levels of 25 and 79 pg/mL above baseline following application to the abdomen; slightly higher mean levels of 88 pg/mL above baseline were observed following application to the buttocks. At the same time, increases in estrone plasma concentrations averaged about 12 and 50 pg/mL, respectively, following application to the abdomen and 61 pg/mL for the buttocks. While plasma concentrations of estradiol and estrone remained slightly above baseline at 12 hours following removal of the systems in this study, results from another study show these levels to return to baseline values within 24 hours following removal of the systems."


There is also a chart which shows avg concentration of estradiol at 89 pg/ml for .1 patch on abdomen and 109 pg/ml for .1 patch on buttocks (but it didn't copy well due to format issues so you will need to check it out).

A