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[flaxhigh]

Hi everyone,

I wonder if anyone can advise?

I went to see Prof Studd about 2 years ago when I was peri- meno and he put me on the usual regime of 3 pumps oestrogel and 100mg utrogestan for 7 days in the month but only after 3 months of oestrogel.

BUT...I just couldn't get on the oestrogel due to side effects (crazy heart symptoms)

I had a private Q & A with Dr Currie and she said try and get on HRT via Evoral 25 as it's less of a 'hit' than oestrogel because the patch releases oestrogen slowly. I am now post-menopausal and need to use utrogestan every day of every month she says ie. continuously.

I have tried and failed with the patches (due to those heart symptoms) but have started mega-low now with quarter of a patch (yes, I'm hypersensitive!) and hope to build up slowly to a whole patch in a month or two

My 2 questions are:

1.IF I successfully get fully on the Evoral 25 do I take 2 patches or even 3? (or 1 Evoral 50 and one 25) to be equivalent to 3 pumps of oestrogel? I can't find this info anywhere.

2. When do I start the utrogestan? I'm assuming since Studd said I could do 3 months of 3 pumps oestrogel with no utrogestan (though I was peri at the time) I can take no utrogestan until I'm actually on a proper oestrogen dose of at least one full patch (ie. two patches a week which is the Evoral 25 or 50 dose).

I'm really needing to get on this pronto as I have bad osteoporosis from chronic illness (plus major hot flashes but that's secondary nuisance).

I'e be so grateful for your take on this. THANKS!!

[Hurdity]

Hi there flaxhigh

Don't get hung up on equivalence - there is huge variation between women as to how much they absorb from the different methods and you yourself may absorb patches differently from gel. The usual comparison is low medium or high - so 25 mcg patch is low but 3 pumps is high. 50 mcg is medium  as is 2 pumps. It's a very rough guide and you need to go on symptoms. You arrive at the dose that works for you. Having said that you need to be on a medium dose for best osteoporosis protection so that is 50 mcg patch - and in your position I would get your oestrogen levels checked after 3 months on a paritcular dose just to check it's getting absorbed ( re the osteo). No need to go higher than 50 mcg if symptoms are controlled and you are absorbing the oestrogen.

If you are using a 1/4 patch then I can see you won't need prog for some time! There is a patch in US called Menostar which from memory is 14 mcg and no prog is needed with this - although annual scans are recommended as there will be some uterine build-up and I think an annual course of prog is suggested too - haven't looked this up for a while.

Re starting the utro - I would follow the instructions given by Studd - or are you saying you want to do the conti regime as Dr C suggested? If so then yes I would be tempted to wait until you are up to 25 mcg and then start the utro but make sure your doc is aware of this?

Hurdity x

[flaxhigh]

Many thanks Hurdity, that's so kind.

Dr C didn't say go on Conti though another gynae did. It would be more convenient to take both in a patch, but Conti doesn't have the 'natural' progesterone, but the progestin norethisterone which I'm reluctant to go on due to bad effects from synthetic hormones in the past.

Frankly, the whole project scares me big-time as when you look at the leaflet and it says: women who have had history of breast cancer, vaginal bleeding where the cause is unknown and history of Stroke, shouldn't use it....I've had all three (TIA 10 years ago, DCIS 10 years ago)!

I told Prof Studd that (except the bleeding which I've just had a scan for: they couldn't find anything so I'm assuming it's vaginal atrophy or perhaps just a single small bleed a year after the last single small bleed which was a year after my last period! Who knows what this is? Doc doesn't.)

I am aiming to get on a 50mcg patch and then use 100mg utrogestan daily.

I will ask the doc for an annual scan once I'm on this...I'll soon know if I can get up to even one patch which I haven't done yet. And I will ask to get my oestrogel levels checked once I'm on a proper 'preventative dose' for 3 months solid.