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[jillyrich]

I've been struggling to find an HRT regime that suits me (aren't we all?!) as I don't get on well with the progesterone side.

Before I went thru the meno I used to be on the mini pill called cerezette. This only contained progesterone and I was absolutely fine on it for years with no horrible side effects.

So my silly question is..................is there a reason why can't I use the estradot for the oestrogen side of HRT and the Cerazette for the progesterone side?

I cant seem to find anyone on this regime so I assume there's a good valid medical reason why not. I just don't know what it is!

Thanks for reading and I'm hoping someone will come along and tell me why!

[wombat62]

Hi there

I'm on a similar regime at the moment. I was on combined patch but we can't get it anymore so doc has given me oestrogen only patch with mini pill for the progesterone. I used to be on Cerezette years ago but can't get it over here. The only thing is that the progesterone mini pills are a much higher dose than in the patches because they are for contraceptive use, therefore my doc has said I can cut the tablet in half and it's still slightly more than in the patch.

I would like to know if taking a higher dose of progesterone than you actually need, especially if post would have any effect on you, could it be potentially bad? I assume the patch doses are worked out in balance to the amount of oestrogen.

So yes, you can do two different products!

[jillyrich]

Ooh wombat62, thanks for your reply, maybe there's hope for me then! Can I ask what mini pill you're on if you can't get the cerezette over there?

[wombat62]

Hi

It's called Noriday so the progesterone is a Norethisterone one, which some ladies can't get on with but I seem to have been okay with it as it's the same on in the patches. I can't remember which one is in Cerezette. Noriday maybe unique to Oz, I'd need to read the packet.

Not doing too well on this new regime 5 weeks in, think things are out of kilter. Not sure if one things is too high for the other?

Are you peri or post as that may make a difference in doses.

[dangermouse]

When I briefly tried oestrogen HRT I asked my GP if could use the minipill for the progesterone but she said that as it wasn't licensed for HRT, she couldn't prescribe it. I ended up buying it online as a contraceptive but didn't get on with the oestrogen so can't say how well they complemented each other.

[Hurdity]

In fact wombat, the progestogen dose in at least one of the mini pills (micronor = norethisterone) is lower than used for HRT, not higher, which is why it is not licensed for this purpose, as dangermouse has found. However a doc who understood dosages would possibly be able to prescribe it separately off licence depending on the oestrogen dose.

Doses of progestogen are worked out to ensure protection of the uterus in the majority of women at a given oestrogen dose. Most women would not want to have a higher progestogen dose than needed because of the undesirable side effects that can occur. Too high a progestogen dose can cause over-thinning of the uterus which can lead to ulceration and then sometimes sporadic spotting. However it is an over-thickened uterus which is more of a risk for cancer.

Unfortunately jillyrich - as you say, desogestrel, the progestogen in Cezarette, is not used for HRT.  It will undoubtedly work to oppose oestrogen to protect the womb but a doctor would have nothing to guide them on the appropriate dosage. It might be possible to use double the dose of Cezarette - depending on whether you are on continuous combined HRT or sequential - but this could cause side effects.

Hurdity x

[wombat62]

Thanks for your insights Hurdity but I'm now even more confused!

I was on a combined patch 50 oestrogen /140 progesterone. This is one of the ones that is no longer available  so GP said I can either have combined pill or oestrogen patch and a daily progesterone tablet. I was concerned about taking a pill for oestrogen as having had gallbladder issues I particularly want to be careful of my liver, although would it affect it that much? I overhauled my diet when the gallbladder first started playing up so hopefully my liver is benefitting!

Anyway, I opted for patch and pill and as hot flushes had increased we tried going up to 75 patch. The progesterone pill is 350 micrograms but the GP said that was a much higher dose than in the patch so I could cut it in half which I have been doing.

However, I think the 75 oestrogen is too much for me now as getting a lot of boob/nip tenderness. The first 3 patches it was just a couple of days a week and I thought it would settle but by week 4 it was everyday and driving me crazy. Last week I cut a bit off the patch and they've been better this week but not completely normal. I've also started feeling a bit like I did a couple of months after my op when I went back to a full patch, the jitters etc. I thought it was low oestrogen at the time but having read lots of things on here I'm now think it was high! It did settle but then dreadful night sweats returned a few months later, then they got better but still more flushes that I had been having.

If you could give me some advice on doses Hurdity I'd be really grateful as I think I may have to go back to the GP. Obviously here in Oz, it must be ok to prescribe mini-pills for the progesterone part.

Maybe I should just use the pill version until the patches are available again. I think one or two flushes a day are better than the boob issues.

Thanks in advance!

[wombat62]

Just bumping this up as I'd love some expert advice on these amounts in patches v pills before I see doc again, thanks ...

[Hurdity]

Sorry wombat - been away and also busy, and going away again soon....

To answer your question - tablets always contain a higher dose of the same hormone whatever it is - because so much is lost through digestion and metabolism through the liver when compared to patches - so even with the same hormones ( eg Evorel sequi and Elleste Duet) the doses are not comparable and your doctor should know this! It is best to go by low medium and high and then work out the equivalent. If you look at the HRT preparations in the patches and pills ( top green menu ) then you will see the doses for patches and pills - so Elleste Duet 2 mg contains 2 mg estradiol and 1 mg norethisterone for 12 days. Evorel sequi patch contains 50 mcg estradiol and 170 mcg per day for 14 days. Both of these are medium dose.

The only way to tell if you are receiving sufficient progestogen to protect your womb is though regular scans as women absorb the hormones differently and from the different delivery methods.

Does this help?

Hurdity x

[wombat62]

Hi Hurdity

No worries, thanks for coming back!

I'll have a study of those figures when I get a few moments.

For the last two patches I've cut a bit off and boobs are better but still not back to normal. I was just reading another thread and a lady mentioned she gets sore boobs on oral progesterone plus ibs, my digestion has been a bit all over the place since this new regime so I'm now wondering if it's the tablet? Since the gallbladder issues I'm very careful with my liver which is why I avoided the combined hrt in tablet.

I hope they can get these patches sorted out as at the moment I feel like jacking it all in!

Now I know a little more I can discuss it with the GP who is pretty good, I just didn't know enough to ask the right questions at the time!

Thanks 💐

[jillyrich]

So yes, I went to the docs for a review of my symptoms and results of blood tests.

Last time I went there I saw a locum doctor who was the most informative and clued up one I've ever seen. When I booked the appointment that I've just had, I asked to see the same doctor. But it wasn't her, so I was back to square one with them knowing very little. I'm pretty sure due to the amount of reading I've done on this site that I knew more than the doctor did!

So the blood tests showed my my Vitamin D was very low so she prescribed some tabs for that. The rest of the tests were all "fine". But I thought they were testing for hormone levels, but they didn't. So I requested that they do that and the doc said no! Said it wasn't needed. I could have cried!

So I was hoping to be able to get a mini pill prescribed for the prog side and carry on with the estradot but the doc refused to do anything non standard, and would only issue a prescription for the everol conti.

I wasn't very happy about it as I've tried this patch before and had pretty constant bleeding with it. But it was 3.5 years ago so maybe my body will accept it better this time round. I also asked the doc about maybe only trying half the patch to see if that would control the hot flushes etc and he advised not to do that.

However, seeing as other ladies on here have tried it, I think this is what I will do.

I am still off the HRT for the time being and I am getting a few hot flushes (bearable at the moment) and some insomnia (again bearable) but will put the cut in half patch on when I can't cope with the symptoms anymore.



And Sparkle - thanks for your PM, but unfortunately I can't take that supplement as it had vitamin K2 in it and I am on warfarin so have to be very careful not to eat too much of that particular vitamin ☹️

Jillyrich x

[Hurdity]

Re cutting Evorel conti - whilst it is best only to vary HRT doses and prescriptions under medical supervision, Dr Currie has sanctioned this (cutting Evorel conti in half) off licence and there was a question on this in the magazine a few years ago which Dr Currie replied to.

Many women still get bleeding on conti HRT even after 6 months and for such women a cyclical HRT would be better and then bleeding would be regular and predicatable.

The problem with continuous combined HRT combi patches is that you cannot vary the oestrogen without also varying the progestogen. One alternative which is licensed is to have the Estradot patch and combine this with Provera ( if you prefer the synthetic progestogens) - listed under HRT preparations above. Your doc could not refuse these (especially if you printed off the information).

Have you also thought of a Mirena - or have we covered this earlier in the thread?

Hurdity x