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[Uptick]

Hi warwick01, I would apply 3 pumps am OR pm. I never understood why some doctors tell patients to split the dose when all studies have tested a single daily application. Have you already tried patches?

[warwick01]

H
i Uptick

I tried everal and estrodot but only managed a couple of weeks as I felt dizzy so never stuck with it.

Wx

[Flan747]

Hi Uptick
I didn’t know you could apply all in one go! I use 3mg Sandrena and where it is such a small amount I may try it all at once. I did think it builds up gradually therefore it shouldn’t make a difference if split but had never heard it mentioned before
Thank you

[Uptick]

Hi Flan747, it's not that you can't split the dose, it's just that the pharmacokinetic (what the body does to the drug) and pharmacodynamic (what the drug does to the body) studies regarding estradiol gel didn't investigate how the drug behaves when the dose has been split, at least not the ones that are quoted in the patient information leaflets and summary of product characteristics. It's all trial and error really, every woman can react differently. I just think it's advisable to follow the instructions before changing doses and dosages, so you can have a better idea of what's going on, and more important, give any new regime sufficient time to settle.

[Flan747]

Oh ok I see what you mean! Makes sense really
Thank you

[Uptick]

You're welcome, Flan747. Are you going to try this?

[Flan747]

Yes I think I will give it a go as far as I’m aware it builds gradually anyway so shouldn’t matter which I never thought of before! One less thing to remember if I do it all at the same time thank you Uptick
I am thinking of giving it all up soon so won’t matter too much

[Uptick]

Good luck, I hope it works for you 

[Hurdity]

When you apply gel systemic levels do initially rise to a peak and then gradually tail off over the 24 hours, so applying twice a day should theoretically give more stable levels to those who are sensitive to this - not sure this has been studied specficially though.

The mian thing is to apply the daily dose in whatever way suits you ie your body and is convenient to your lifestyle - I would suggest it doesn't matter whether it is applied all on one go or three times a day I would say!

Hurdity x

[Grheliz1]

I split my dose and have done for some time. One and a half in the morning and one and a half in the evening.

I am very interested in this efficacy in the last half of the pump question as I am at the end of my pump and actually dropped off to sleep. I was worrying that I needed to increase my dose back up to the full three pumps again. But perhaps it is just the end-of-the pump issue.

Hi
joesmum

Isn't it just?  How do you find splitting the dose rather than all in one go.  Ive been toying with the idea of doing two first thing (I'm up at 6am), then two about tea time, so that its not a problem for my partner by the time we go to bed. 

Currently (because I WFH now) I do all at about 10am

Thanks D 

[Uptick]

I can't find any studies regarding other dosages of estradiol gel apart from one single daily dose. If I opt to use the gel I will do exactly as instructed in the PIL, one single daily dose. Splitting the dose might work or not, but I don't like to play with my health without scientific evidence. I'm interested in personal experiences regarding this issue. If you have felt better after splitting the dose, please let me know.

[Hurdity]

Scientific evidence is of course the basis for everything we discuss on here re HRT and it is fundamental to everything we understand. This is especially important in the case of "do no harm" and the precautionary principle. However in this instance it is not going to hurt and therefore if someone wants to try varying the regime by splitting the dose then that's surely fine although recognising that any personal experiences are by definition ancedotal and may also be placebo.

Louise Newson suggests it for larger doses and I imagine this is for practical considerations ie because it is more difficult to spread eg 4 pumps of gel on a larger area of skin maybe? https://www.menopausedoctor.co.uk/media/files/Fact-Sheets/FAQs-about-HRT.pdf . She doesn't say though.

The point is re levels is that the pharmocokinetic profile over a 24 hour period clearly shows an initial rise to a peak (in systemic estradiol levels) and then a gradual decline and therefore even without studies it would seem logical that splitting the dose might prevent this decline and maintain levels. Having said that I did understand that estradiol exists in dynamic equilibirum with estrone ( this is from memory!) which may minimise any effect of falling estradiol levels in the bloodstream.

How any of this translates into symptom control - who knows?!!!


Hurdity x

[Uptick]

Thanks for your input.

I'm not convinced 'it is not going to hurt', I'm extremely sensitive to drugs and spreading a highly concentrated alcoholic solution on my skin twice daily, probably for the rest of my life, is not exactly my idea of a healthy habit.

It isn't difficult to spread 4 pumps, outer arms from shoulders to wrists and inner thighs (as per PIL).

Dr. Newson has been doing an excellent job regarding menopause awareness, but I won't follow doctor's instructions unless they can provide me some good scientific or clinical evidence and, as you have pointed out, she doesn't mention why splitting the dose is necessary.

Pharmacokinetics is just one side of the coin. Pharmacodynamics is also important. Moreover, a linear response is not always the case with hormones. It's a tad more complicated. That's why, given the lack of proper studies, personal experiences are so important. I will create a more specific thread, because I'm really interested to know how ladies on 2 daily doses of estradiol gel are doing.

Thanks again.

[Hurdity]

I was responding to warwick who was talking about splitting the dose.

It goes without saying that anyone with sensitive skin would need to be especially careful with application of any transdermal HRT - but in principle "It's not going to hurt" with respect to the actual active ingredient - still stands, and of course the peak levels (and troughs?) are likely to be lower when the dose is split.

The metabolism of estradiol in the body is going to be exactly the same whenever you apply it - just the levels of the metabolites will of course vary. Of course it would be interesting to read studies of this but it is not essential to know thany of these details before women try out different times of application to see how they feel on slightly different regimes.

Hurdity x