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[bear]

Hi girls,

Sorry if this has already been posted elsewhere.

https://www.medicines.org.uk/emc/product/11175

BeaR.

[Tc]

Thank you BeaR.  Very interesting.

Its probably totally irrelevant but I  was reading through it and this caught my attention.

'When the degree of the woman's menopausal symptoms is not reduced after a dose increase, the patient should be back-titrated to the previous dose"

I wondered, (Not specifically related just to this treatment)  if back titration is  different to cutting back dose.   I understand the idea that if a dose increase controls symptoms one might cut back in increments to find the point of lowest effective dose between the previous dose and the increase. . But I cant fathom how,this works if the dose increase was ineffective.  I wonder Why would one cut back to the lower dose which was also ineffective rather than increase again  or change treatment.

I looked up back titration and suffice to say chemistry is not my strong point 😁

Xx

 

[Hurdity]

Thanks bear I've bumped the other thread about it. We knew it was to be launched in UK in early 2020 after I wrote to the manufacturers who said this: "This product is licenced in the UK, but not launched.  Launch is expected early in 2020, so watch this space" but of course we've all forgotten about it recently with other things on our mind! 

Back titration is just a fancy way of saying reduce the dose bit by bit! This is really no different from any other HRT ie tweaking until you find your sweet spot. Sometimes women increase too much eg go from 50 mcg to 100 mcg patch for example which may be too big a jump - so then need to reduce back down again until they find the level which works so an intermediate dose might be preferable. Do you see what I mean?

I haven't read the product info not since looking it up months ago but will do so when it;s not sunny

Why not see if you can give it a try Tc if you can get a GP/meno specialist to prescribe it?

Hurdity x

[Tc]

I might just do that hurdity. Thanks.

I understand the idea of dosing backwards if symptoms are controlled at the higher dose because it might have overshot the mark and dosing back will, as you say, find the sweet spot.

I just didnt get the reasoning behind decreasing back to previous dose when the increased dose hadnt worked.

But it's a very interesting.. Any expansion of our options can only be a good thing.

Enjoy the sun hurdity☀️x



 

[bear]

Hi Tc,

I also don't understand the term 'back-titration' in this context because one cannot reduce the dose bit by bit when the only option is to decrease one spray...

Tbh I think this is just a mistranslation from Hungarian and it might be corrected in the future. It happens a lot to PILs.

Regarding the reasoning behind reducing back, I think there are 2 possibilities.

1. Estradiol (an other steroids) usually exhibit an inverted U or U-shaped dose-response curve in the hippocampus, amygdala and hypothalamus, meaning low doses and high doses might elicit the same response whereas medium doses might give a different (and usually better) response.

2. One can't keep increasing the dose, so the only way forward is to go back to previous dose and give more time so the body can adjust to hormone levels or switch to a different treatment.

Bottom line: trial and error and everyone is different 😁

BeaR.

Edited: not 'pump', 'spray' 

[Sammiejane]

i agree more choice progesterone and lower doses x

[Tc]

Thanks beaR. 

Here  here about choice. 👏

[sheila99]

Thanks for posting bear.
Any idea why it's for post menopausal women? Seems to be a new definition of menopause as it says 6 months from last period.

[Hurdity]

Thanks for posting bear.
Any idea why it's for post menopausal women? Seems to be a new definition of menopause as it says 6 months from last period.

I would ignore that completely - it's wrong and doesn't fit with our definitions. There are quite a few anomalies in some of the product info leaflets. For example Femoston says the same:

"Hormone replacement therapy (HRT) for oestrogen deficiency symptoms in postmenopausal women at least 6 months since last menses."

It is just a replacement oestrogen to be used like any other.

I might just do that hurdity. Thanks.

I understand the idea of dosing backwards if symptoms are controlled at the higher dose because it might have overshot the mark and dosing back will, as you say, find the sweet spot.

I just didnt get the reasoning behind decreasing back to previous dose when the increased dose hadnt worked.

But it's a very interesting.. Any expansion of our options can only be a good thing.

Enjoy the sun hurdity☀️x

I think what it's saying, now I've had a chance to read the product info (remembering this is not the patient leaflet but the info for health professionals is always more in depth), is that you should take the lowest effectvie dose so if a higher dose doesn't work any better then go back to the lower dose. Not that I agree with that because logically if the higher dose doesn't work you might want to go higher, if we're talking about flushes and sweats, which are the easiest symptom to judge effectiveness of a particular dose.

Maybe there is less variation in absorption of this preparation than with other oestrogen preparations? It's a while since I read  the blurb I must say!

It does sound very convenient compared with the faff of gel but I would only think of changing if the present method wasn't working for some reason?


Hurdity x