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[Tinkerbellj]

Anyone taking the mini pill in peri and using oestrogen gel with it. I asked meno clinic if this was an option but they said it wouldnt be enough to protect my womb. Something has shifted recently and I actually feel better on days taking progesterone anxiety is a lot less so wondered why I cant just do this???

[Hurdity]

Which mini pill do you use shortie and is this from a private consultant?

Some definitely do have less progestogen in them than HRT - so Noriday for example contains 0.35 mg norethisterone, but for cyclical HRT this should be 1 mg per day for 12 days or for continuous - 0.5 mg per day. However if you are under medical supervision and being scanned then it's great to be able to try lower doses such as with some mini pills

Tinkerbellj - did you see a consultant at the meno clinic? I would have thought that this could be approved off licence but depends on the doc. I presume the cost implication of additional scanning and supervision prevents this individualised approach that we would all benefit from.

Hurdity x

[wombat62]

Hi

1/2 a Noriday was prescribed to me alongside oestrogen 75 patches, when I couldn't get my combined patch. Seems it's ok to prescribe this in Oz...

Problem was it caused havoc with my boobs! At first I thought it was the extra oestrogen as I'd gone up from 50 to 75 so as flushing was okay cut the patch down to around 50. Boob problems still continued but got better over the weeks...so not sure now what it was all about. Doc said tablets cause a spike as you are getting dose in one go whereas patches are slow release. Now back on patches and boobs much better although mind had become obsessed with them lol...guess the mind has to be obsessed with something!

You'll just have to try it and see if you get on with it ok!

[Hurdity]

That's very low dose wombat! Are you still peri-menopausal and having your own cycle regularly do you think - and therefore producing your own progesterone?

Hurdity x

[Tinkerbellj]

Should habe been clearer lol im not taking the mini pill I am.on oestrogen gel and utgesterone vaginally for seven days but this is my seventh attempt and this is far from perfect vyt the best so far. Its just this month I felt better during the progesterone bit. Less joint pain and better mood. My period has just ended and the anxiety is back with the pain and fatique hit me like a train.  I was on four pumps a day but now down to two cuz I actually thought the oestrogen was making me worse!! Would love some input. Thanks everyone.

[wombat62]

Hi there

Yes, the half Noriday would be 175, my patches are 140 so are they not measured in the same units then?

I'm post and on conti regime. Fortunately I've been able to go back to patches although they are in very short supply so have the e patch and pills as back up.

From the sounds of it if I have to go back to patch & pills then it should be a whole tablet? Although I want to avoid that because of the problems I had last time with the boobs.

P sounds like good stuff so it's a shame that it seems really hard to find a product that is suitable as that's the part of hrt everyone seems to have trouble with!

[Katia]

I have read that over the years the hrt estrogon dose has been much reduced, however the progesterone has not changed. For some of us I think the ratio just isn't right. I too like utrogrstan for a couple of days even though I'm so tired thin after about a week I get sad and feel like crying. I have a find under the skin rash which seems to be my bodies way of saying there's an imbalance

[Hurdity]

Hi there

Yes, the half Noriday would be 175, my patches are 140 so are they not measured in the same units then?

I'm post and on conti regime. Fortunately I've been able to go back to patches although they are in very short supply so have the e patch and pills as back up.

From the sounds of it if I have to go back to patch & pills then it should be a whole tablet? Although I want to avoid that because of the problems I had last time with the boobs.

P sounds like good stuff so it's a shame that it seems really hard to find a product that is suitable as that's the part of hrt everyone seems to have trouble with!

Hi there - they are measured in the same units! However you cannot compare a patch dose to an oral dose! Oral doses are much much higher because of being lost in digestion and going through the liver. Also the patch dose is given as the average delivery amount per day through the patch - not the total amount on the patch. The best way of comparison is as I said before - look at the dose for example for norethisterone on the Evorel patches for HRT (the daily delivery dose) - which is 170 mcg per day ( total amount on patch is 11.2 mg), and the amount for oral use of HRT which for Elleste is 1 mg daily - and you have the comparison.

For levonorgestrel - the Femseven sequi patch contains 1.5 mg L and delivers at 10 mcg per day - so as L is more potent than Noreth in thinning the womb you could take less of it in tablet form. It would need a specialist to calculate this for you although it is easily done ( mathematically anyway!). This would have to be done off licence.

Think I've gone a bit off topic but it's an important principle re mini pill dosage!

Hurdity x

[wombat62]

Hi Hurdity

It's valuable information as you just get told to take something and have no idea if it's right or wrong sometimes! It's all a bit confusing anyway with doses as you say you don't know how your body digests them.

This is what I found on the schedule of available HRT preparations in Aus:

Low dose progestogen-only contraceptive pills (Microlut (30mcg levonorgestrel), and Noriday (both 350mcg norethisterone) are used by some clinicians in various doses but there is limited data for dosages of these pills required for endometrial protection. 1 mg norethisterone was considered the minimum dose (cyclical or continuous) for adequate endometrial protection in the Cochrane Review (Cochrane Database Syst Rev. 2009 Apr 15;(2):CS000402).

These are the recommended medium dose progesterones to be used with separate oestrogen (patches or pills)

Primolut N (1/4 of 5mg tablet)   tablet   1.25 mg norethisterone
Provera, Ralovera   tablet   5mg medroxyprogesterone acetate
Prometrium*   capsule   100 mg micronized progesterone
Mirena*   device (5 years)   20mcg/24hrs levonorgestrel

So what I'm reading is that the 350mcg in the Noriday isn't actually enough it needs to be 1mg. I think I was getting confused between mg and mcg's.

So if when you are on the mini pill for contraception (thins the lining etc) why do you need a bigger dose for HRT or is it because you are taking extra oestrogen whereas on the mini pill you are just relying on your own natural oestrogen? If progesterone is the nasty with a possible elevated risk of BC in post-meno situations then why are we given such a high dose? Sorry so many questions but it just gets you thinking!

Hopefully I can continue to get my hands on patches as it's just so much easier!

Thank for your wonderful knowledge on the subject!

[Hurdity]

If wombat has been prescribed 175 mcg then this is way lower than protocols anywhere! Of course if possible dosage can and should be individualised but only within certain limits and with appropriate monitoring. There are sometimes mistakes made by the medical profession, especially from general partcitioners, as reported on here, and several of us have helped members get these corrected.

As I understand it, The mini pill suppresses ovulation in some women - so then there is no oestrogen surge as follicles do not develop - so the progestogen is sufficient to keep the lining thin from your background level of oestrogen. If ovulation is not suppressed then you will produce your own progesterone which should be sufficient to protect the lining (in addition to the progestogen from the mini pill). This is why it is a lower dose (I believe!). If HRT you need to take the progestogen dosage that is sufficient to protect the lining from the additional dose of oestrogen - as you said. Of course when women ovulate their own progesterone is also added to the mix but this cannot be assumed in peri-menopause which is characterised by skipped or longer cycles, hence the dosage.

The risks are taken into account with age. If you look at the scales on this page - balancing risks and benefits: https://www.menopausematters.co.uk/balance.php - although this is a crude measure you can see the risk/benefit ratio varies with age. Therefore although there are risks - the benefits are thought to outweigh them for women aged under 60 and equal them between 60 and 70. Every woman needs to be counselled about the risks especially when over 60. In any case as I understand it the absolute risk of BC is still very small, when taking HRT and lifestyle factors (body weight, alcohol consumption etc) are equally if not more important: https://www.menopausematters.co.uk/risks.php

Thanks wombat - I only have some general knowledge about the subject - and it's just a question of reading about it - which takes time and not everyone has this to spare!

Hurdity x