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[GetStuffedPeri]

Evorel Conti has 50mg of Estrogen as well as the progesterone element (which I'm sure all of you know!).

If it looks as though MORE estrogen is required, is this possible on a conti patch regime?  Or would it mean going onto a sequi regime with a 75mg patch plus utrogestan etc...... keen to keep to the conti patch and not change to sequential but can't see how more estrogen can be added this way? 

Thank you!

[shrosphirelass]

I asked this question at the menopause clinic and the dr said the only way of increasing would be to add in another half a patch, but this was not advised as likely to cause an increase in symptoms due to the progesterone increase.

[GetStuffedPeri]

Thanks shropshirelass.  I guess there doesn't exist a conti patch that contains any more than 50mg estrogen......we have considered adding an extra half a patch but I'm sure I read somewhere that you shouldn't cut a conti patch in half.  Also, we're only 10 weeks in so can't really justify messing around with it - it does seem though that more estrogen is needed (not ignoring the huge positives of course - i.e. improvement in flushes, sweats and brain fog etc).  I'd like to hope that by 3 months in it will suddenly massively improve all other symptoms but after 10 weeks I doubt another fortnight will bring much change....bloody hormones 

[sheila99]

Add a pump of gel or a 25mg oestrogen only patch? Or 75mg patch and some other form of progesterone such as utrogeston or mirena.

[Hurdity]

It's fine to cut patches in half (in terms of what it does to the patch) but if you are doing this to a conti/combi patch then it is off-licence. Dr Currie herself has approved this in the past for Evorel conti - in the magazine in response to a questions some years ago. As shropshirelass says this also increases the progestogen component which is necessary to ensure the womb is protected. However the dose for Evorel conti is the same as the conti patch for Evorel sequi so it could be argued that some women may get away with adding extra oestrogen to the conti patch and still remain protected (since conti regimes generally have less progestogen than the equivalent cyclical regimes). However this would be very much off-licence and would need to be monitored carefully by the docs since the response ( of your uterus lining) to this will be very individual.

Hurdity x

[Mary G]

I topped up Angeliq oral HRT (1mg oestrogen 2mg progesterone) with a 50mcg oestrogen only patch and it worked OK for a long time.  I had regular uterine scans and they were all fine.   

I stopped using this regime because I still was not getting enough oestrogen and didn't really get on with the synthetic progesterone component but I'm sure it would work very well for many women.

[GetStuffedPeri]

Thanks all.

Hurdity - this is interesting information, particularly given that the Conti patches appear to have alleviated around 80% of my wife's symptoms - I am convinced that she just needs slightly more estrogen - and she doesn't seem to have the standard "progesterone intolerance" symptoms (although who knows whether some symptoms remain cos of insufficient estrogen or a reaction to the constant progesterone) - we're just reluctant to change the regime entirely.  She has had 2 hours of breakthrough bleeding and nothing else in the 3 months since she started it.  I guess we should ask the GP for the go ahead before we slap on an extra half a patch though.............should she qualify for "routine" scans on her womb lining since she's on HRT, or do they only scan when there's a cause for concern - i.e. heavy/unexpected bleeding etc?  Thank you!

[GetStuffedPeri]

Bumping in case anyone can answer the question ref scans etc. Thanks!

[GetStuffedPeri]

Last bump!

[Uptick]

Hi, I don't know the answer to your question but I thought you would be interested to read this review on transdermal progestogens. Let me know if you have any questions about it.

https://www.intechopen.com/books/hormone-therapy-and-replacement-in-cancer-and-aging-related-diseases/endometrial-histology-and-safety-on-non-oral-routes-of-hormone-therapy-for-perimenopausal-early-meno

[Uptick]

0.25mcg of norethisterone is the comparable dose with 100mg micronised progesterone, according to this article.

https://www.glowm.com/section_view/item/83/recordset/71685/value/83

[Hurdity]

Thanks all.

Hurdity - this is interesting information, particularly given that the Conti patches appear to have alleviated around 80% of my wife's symptoms - I am convinced that she just needs slightly more estrogen - and she doesn't seem to have the standard "progesterone intolerance" symptoms (although who knows whether some symptoms remain cos of insufficient estrogen or a reaction to the constant progesterone) - we're just reluctant to change the regime entirely.  She has had 2 hours of breakthrough bleeding and nothing else in the 3 months since she started it.  I guess we should ask the GP for the go ahead before we slap on an extra half a patch though.............should she qualify for "routine" scans on her womb lining since she's on HRT, or do they only scan when there's a cause for concern - i.e. heavy/unexpected bleeding etc?  Thank you!

Unfortunately routine scans are not available on NHS. They only scan if there is a cause for concern. There will be a well-defined pathway for this which GPs will follow. Typical causes for concern would be abnormal bleeding or pain.

If you can afford it then these are available privately eg around £100 but I realise this willnot be within everyone's budget, hence best to follow medical advice.

Hurdity x

[GetStuffedPeri]

Thanks Hurdity - really helpful!  We're in two minds about just slapping on a half a patch without talking to docco but pretty sure they'll advise against it anyway if it's not licensed etc.  Looking at other conti regimes with higher estrogen - i'm guessing it'll only be gel and utrogestan.........oral meds not an option.....more estrogen definitely needed though - it's been 13 weeks and so I can't see any significant changes imminently.  Other advice is to wait it out until 6 months - what a minefield.  Thank you again