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[Tempest]

Hi, ladies.

Once again today I've darkened Professor Lumsden's door and once again she was very charming.

As some of you may know, I've limped along this past week on Estrogel despite the blessed rash I've developed. Still no idea exactly what it is, but it definitely went away in the areas I have been avoiding with the gel. As it's not a systemic thing, Professor Lumsden is not unduly worried that anything hugely sinister has taken place other than the gel not agreeing with my skin.

We also talked about how I was absorbing the gel given my recent blood levels, and she feels I was getting a huge 'ramping' of dose as it entered my bloodstream, and then it was dropping again very shortly after. This is something she has seen before, as well as the opposite which is ladies who end up with phenomenally high blood levels on the gel (so this is worth bearing in mind if the gel is problematic for you).

We have also discussed that I do not seem to do well on high levels of estrogen. As I commented recently, this is surprisingly common in ladies in surgical menopause! Added in is the fact that I had been estrogen depleted for a long time, and my body cannot cope with large doses (hence why the ramping and dumping, and feelings of high anxiety that this brings).

Therefore, we have today decided to try the Estradot 25mcg patch. She is cautious about going any higher at this stage. I am, as you would probably expect, nervous as this is now my third HRT and both of those tried previously had limited success. If any of you lovely Estradot ladies can give me tips on how you apply for best adhesion, I would be most grateful (Hurdity, I know you're an old hand at the Estradot)!

I also did take along the two pack types of Estrogel and Oestrodose to show the Professor (especially as the damned Oestrodose dispenser jammed AGAIN this morning and I got a little 'splurt' of gel despite the bottle being three quarters full). I also pointed out that the bulk product is now repackaged in the UK after being imported, and she says this is concerning - she was able to see that this is the case as it's clearly stated on the attached labels.

We did discuss implants again, and she is keen to go down this road (she initiated this conversation again with me). She would, however be very cautious in my case and is suggesting half an implant of 12.5mcg to see if I can tolerate it initially. We will discuss this again in January (hopefully nothing else disasterous happens before then that I need to get in touch with her about)!

She assures me that she is continuing to work to ensure wider media coverage of the new HRT guidelines so that these reach more women, and to ensure all GP's are well informed on the prescribing of HRT. Interestingly, she said that there is a whole generation of younger GP's who have received little or no training in HRT, so there is a lot of catching up to be done!

Once again, she mentioned this forum in glowing terms and said that very good, helpful information is being shared here. 

So, wish me luck please for the umpteenth time. And tips - don't forget! Any info. you have that may help my Estradot experience to be more likely to suceed would be very gratefully appreciated. Thank you!

[Kathleen]

Hello  Tempest.

Sorry I can't help you as I'm an Evorel patch user although my opinion of it changes like the weather.

I just wanted to wish you luck with your new regime and congratulate you on your determination to properly balance your hormones, you are an inspiration to meno sufferers everywhere!

Wishing you well and I'm sure some expert ladies will be along shortly.

K.

[Tinkerbell]

I used the Estradot patch for a few months, they are tiny. If you warm the patch between your palms for a few seconds before applying you will find it sticks well.

[Tinkerbell]

Also I had problems with supply in my area, so put your repeat in early.

[Dawncam]

Hi Tempest - I'm one of the few who have probs with the gel and have recently gone back to estradot. They're great patches, I've never had probs with sticking or staying stuck and i do think they're more even in delivery although possibly a bit of a surge on day 1 and slight tail off on changeover day. My consultant suggested keeping both on for a full 24 hours on change day to 'stabilise' the dose. I know some ladies do this to some extent. It's prob best to work out your own best regime. I've had it with the gel.

All the best, hope they work for you.

Dxx

[Annie0710]

Aw Tempest I'm so wishing all the wishes in the world estradot works for you

I'm on it, these are the best I've used for size and adhesion

Make sure hands/fingers are warm, stick on and press for 10seconds.  If my hands are cold I stick it on and blast the hairdryer on it for a few seconds.  I've swam, sweated whilst sunbathing, bathed and showed and never had one come unstuck yet .  To remove the marks on change over day use cotton pad with make up remover, a always get a little red(ish) mark where it's been but no irritation, change thighs each time

I am on 75 mcg, that is my absolute limit but an happier on 50 but now trying T I want a higher oestrogen dose.  100 sends me into a total nervous wreck

Good luck lovely lady, we're rooting for you that this works

Xxx

[Tempest]

Thank you all so very much for your kind words and great hints and tips! I'm planning on starting the patches tomorrow as today was pretty hectic - phew! We had a very early start today as my appointment was the first of the clinic and driving into Glasgow is a nightmare at that time of the morning - we have to leave at stupid o'clock in order to make it on time.


Tinkerbell - you're right! I knew there may be a problem getting Estradot but was assured by my pharmacy they could get them - only to get a phone call early afternoon to say that their order didn't go through and that their wholesaler only had an expected restock date of 'early November'.  I rang around and Boots at a large shopping centre nearby had them in stock and the lovely pharmacist also placed an order to make sure that there is more stock available to them. It still makes me nervous though! I do wish this issue could be resolved - Professor Lumsden said that Estradot is the best tolerated patch available regarding skin sensitivity and is therefore very popular (if her patients can get it)! G.P.'s are also reluctant to prescribe it due to cost she finds, but should not limit prescribing it when it's the best option available for the patient.......

I jolly well hope my skin likes these, as it was very unhappy about the Estrogel (not to mention my system, which didn't like it at all)! We had an interesting chat about how all types of HRT's work, and Professor Lumsden told me about a nasal spray HRT that used to be available but was discontinued. This one was notorious for having a 'slam' effect with the dose and this was the cause of its demise. I like to think that drug companies will work to think about how best to deliver HRT to our systems, and that we might see new and more effective delivery systems in the not too distant future. If this happens, getting GP's to actually prescribe them might be another matter though.....

[Dawncam]

Morning Tempest - I hope you get on well with starting today - I moved into patches 3 days ago and already feel better, hope that happens for you.

One thing that comes through really clearly from your posts is how wonderful your consultant is. She sounds the perfect combination of empathetic and knowledgable and 'in your side'. I think I mentioned I'd been to see a certain someone who rhymes with 'mud' who certainly didn't have any listening skills albeit very qualified! Consultants at that level should have a range of skills, not least interpersonal.

I really hope she gets you back to you again.

Good luck

Dxx

[Tempest]

Thank you so very much, Dawncam! Yes, Professor Lumsden is very, very good. She is the Chair of the group that formulated the current NICE guidelines.

I had to apply the gel last night, so I'll be showering shortly and then starting the patch. I'm so glad it's working out better for you! Isn't it ironic that a certain gentleman's name rhymes with mud? Boy, did that make me chuckle! I know some women love him, but for quite a few just lately his 'name seems to be mud' around here!

[CLKD]

Thanks for the update.  Let us know how you get on!

As for GP Trainees not knowing about HRT - well it is unlikely to be covered in their training due to the lack of Menopause Clinics so they don't get the opportunity of a 6-months rotation there.  They may well come across the necessity when they do 6 months in a GP Surgery …… however.

You could let Professor Lumsden know about the lady on here who recently saw a 'consultant' who suggested drinking linseed oil will ease symptoms ……….

[Tempest]

Hi, Stellajane! Yes, she did day that she's seen all kinds of responses to different HRT's and it's unpredictable how any individual with respond but she did say she had met ladies who had experienced the same as me, as well as those who did not. The only one that particularly caused a consistent  problem for all was the nasal spray, which has now bit the dust!

CKLD, true! But I think Professor Lumsden feels all GP's should be updating their knowledge of HRT prescribing given the now not so new guidelines, and that there is a lot of disparity out there.

Good grief! Linseed oil?? Is this for real?!? 

[Hurdity]

Hi Tempest

Thanks for updating us again - it is so helpful to hear in detail about your appointments and especially seeing a top specialist too

Yes I am a long term Estradot user (9.5 years) and have always got on well with them. The recommended change time is 3.5 days. For years I changed every 3 or 4 days (ie Mon and Fri evenings) but a year or two ago changed to nearer 3.5 so I change it Fri mornings and Mon evenings. Some prefer every 3 days. I don't leave the patch on after changeover as I found it sometimes gave me a headache. There may be a dip in levels after 6 hours or so because it takes approx 12 hours to get to the optimum level after application, and approx 12 hours to reduce to baseline after removal - on average, so I've read.

Do make sure the area is clean and dry and free from any creams or lotions. Absorption may vary with application site. I have always applied mine to alternate butt cheeks (out of sight!) but i read a paper about Intrinsa patches which said absorption was higher on midriff. However I think Andius also found a paper which said that absorption of oestrogen patches was higher on the butt so as long as you stick to one place (literally!) for consistency, you should be OK.

I have a fairly sensitive skin so I was very careful initially when removing them to avoid setting off an allergic reaction. Always peel them off very slowly - never rip them off. Also if you feel it itching ( as has happened with me) try to scratch adjacent to the patch and not immediately round it - which seemed to work with me. Finally - for many years I just left the black marks ( fluff from black nix!) after removal, again to avoid setting off an allergic reaction by rubbing too hard so I looked a bit stripy ( who cares?). However now, after reading on here, I found that baby oil worked a treat and only needed to be left to soak in and then wiped off.

Incidentally I don't clean off the patch site immediately where/when I've removed it - in case there is still some residual oestrogen being absorbed from the sticky patch - but do it later!

It's also important not to put by waistbands or knickerline etc so you don't remove it inadvertently. I find in the summer sometimes when sitting in the sun it comes a bit unstuck as it also does in a bath ( although I don't have one of these very often these days!). Also get in the habit of feeling that it's still there and if necessary pressing down with warm fingers just to make sure it's still stuck!  Best to try to avoid doing this in public 

Hope this helps and good luck

Yes it's up to GPs to keep themselves informed. CPD anyone?

Hurdity x

[Tempest]

Thank you so very much for taking the time with these invaluable tips, Hurdity! As you are a long term user, I know this is information I can rely upon.

I hope it's going to be relatively easy to obtain them if they do suit - at least Boots will order in and hold the patches by for when I  fill a prescription for next time. Professor Lumsden is also sending a detailed letter to my GP very shortly to explain the 'plan' at the moment and insist that they co-operate if I need to change patches more regularly and to contact her if they have any queries.

Interestingly (and I have to say that she is very generous with her time - we've had a couple of long chats now) she says she is very flexible in how she helps ladies to get good coverage with their HRT's and sees girls who are in their teens with premature ovarian failure (isn't this heartbreaking)? Particularly in their case, she is happy to cut patches to tailor  fit a good dosage and in some cases advises patch dose change daily. She said that pharmacists and GP's often raise their eyebrows at this - especially GP's as they get rather irritated by the extra cost but she feels it is quite appropriate if the women's needs are being met properly. She is definitely good at looking at the individual and their needs - in my case, possibly going for a half of a 25mcg implant initially to see if I respond favourably to it. She said it may work or it might not do anything much but at least I won't be overdosed and this seems to be the thing that causes me particular problems. But this is a consideration for the future!

I am so very grateful for your advice, and sharing information that I didn't know such as how long it takes for the patch to reach optimum dose. This helps me to get a 'feel' for how this type of delivery works. Thank you again!

[Hurdity]

Hi Tempest - some of the info varies re the serum concentrations and the pharmacokinetics (what happens over time to the hormone in the bloodstream) -  I have just checked. The 12 hours I read in a paper, but have just looked at the Estradot and it says 24 hours to return to baseline so takes a bit longer after removal - which is a good thing!

I also meant to say in all the years I've been using it I've only once had a problem with supply and that was many years ago. The key thing is to put the order in as soon as you start the last box (I get 3 months supply) and hope for the best. I have lost the odd one in the summer or after bath as I mentioned too so sometimes run out a bit sooner.

Hurdity x

[Tempest]

That is good news about the extended life of the Estradot 's effectiveness after removal, Hurdity! It just goes to show that is has the 'edge' over other patches.

I must admit when I woke up this morning, I panicked a bit going 'where is it?!? Has it fallen off'?? It's so wee, that I really had to feel around in the dark under my nightie to find that it was still there - phew! I'm being a bit of a lay about in my lounge clothes today catching up on paperwork - and I must admit putting off my shower a bit because I'm nervous about it curling in the shower. I know I shouldn't get in a tizz like this about things but it's been such a rollercoaster lately that I don't want anything to go awry. AND I know my GP would have a fit if I put in my prescription early as they did mump and moan about the cost of these. I will be seeing them in a couple of weeks to catch up if things are going ok to reiterate that these were prescribed by my Consultant, and I should receive whatever supply I need and to phone her if there's a problem. I hate having to do battle at my GP surgery!