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[menomummy]

I hope that someone can explain why after years of successful HRT (evorel sequi patches), I have suddenly for the first time started having hot flushes.  At first it was only at night, but now I am getting the occasional one during the day too.   

Is there anything I can do to stop it, so I can get a good nights sleep?

[Cocobra]

Dear Menomummy,

thank you for posting this. You know, I realise this is also happening to me: had terrible hot flushes before I started HRT (also with Evorel sequi patches with an interlude of Novofem pills when the patches were unavailable last year); they then disappeared and now, years after starting HRT, I realise I get a bit of hot flushes in the night (it gets worse with alcohol consumption). Nothing during the day, at least so far!

I'd also like to hear anyone who's experiencing this and has any tips/advice.

[emma5131]

I've heard of this happening a lot.  I work as a nutritionist and see many women in menopause. It seems to be that a dose that has worked for years can suddenly become inadequate and it is a sign your need for oestrogen have gone up.  This is quite common when this happens at the typical menopause age (early - mid 50's) in a patient who has been on HRT since slightly younger than typical menopause age.   You may need to raise your dose or trial a new form to cover your new (changed) needs. Its frustrating but surprisingly common.  Once anxiety creeps in alongside the regular signs like hot flushes/night sweats/dryness/tinnitus/sinus issues/ etc you really are too low in oestrogen (normally).

[Cocobra]

Dear Emma5131,

thanks so much for this: it is really helpful to hear a nutritionist's perspective! I suspected this much: I went onto HRT aged 44 and now I'm into my 49th-year. I'll get a gynaecologist's referral to see how to proceed.

All best to you all

[Hurdity]

The thing is if you start HRT when you are peri-meniopausal then you don't know when your natural menopause would have occurred. As you approach menopause oestrogen levels fluctuate but overall begin to decline and then after your last ovulation they declone rapidly over the next 2-3 years until they reach the low level they will remain at for the rest of your life. This is where HRT comes in - to replace that. Some women then experience symptoms for the first time once this low level has been reached (in the absence of HRT) and others may experience a worsening of symptoms or resumption, due to this decline in their own oestrogen.

If there is no other reason for your flushes Cocobra ( other metabolic issues can cause them) then I would suggest you ask to try an increase in dose. You don't need to see a gynaecologist for this - just your regular GP or whoever you get your hRT from.

Menomummy if you are on Evorel sequi unfortunately there is not higher dose so you would need a separate oesrogen and a progestogen if you want to increase oestrogen.

Hurdity x

[Cocobra]

Dear Hurdity,

thank you so much for this: as you say, it depends from woman to woman. My poor Aunt who is over 80 still suffers hot flushes. I just hope I'm not like her!

I'll speak to my GP in the first instance to discuss this although I remain Italian in my habits to consult a gynaecologist too (I've noticed an interesting cultural difference here: we consult a gynaecologist almost yearly for general check-ups, a habit which I have not found here in the UK).

I'm also on Evorel Sequi and I did not realise one would have to increase doses by mouth if needed - very disappointing. Oh well ... Thanks again and have a good evening

[Sophie20]

Very interesting information from Hurdity and Emma. I have recently felt quite anxious during the night, but put it down to too much progesterone, but as you say this could be too little estrogen!

[menomummy]

Thank you for the replies.

Does anyone know if there are alternative patches with increased oestrogen? When I could not get the evorel patches last year, I was put on estrodot patches and progesterone tablets, but this combination did not seem to work at all, I then had to cut the 100 patches in half as they had no 50 patches.  So I have many estrodot patches left, could I add in one of the 50 patches alongside the evorel or is this a big no-no?

[shrosphirelass]

As far as I understand it you can't add estrogen to evorel ( without adding progesterone) as your lining wouldn't be protected. You need the estrogen and progesterone to work together. I asked the same at the menopause clinic and they said it is possible to cut the patches in half and add another half (of both evorel 50 and conti) however it isn't recommended as this often leads to increased side effects. Another solution is to have an evorel 75 patch and have utrogeston. Or to use gel and utrogeston or the estrogen in the above and provera (tablet)

[jasmine5]

This has recently happened to me, after nine years of using patches I now suddenly have very painful leg and hips pains/dry eyes/dry itchy skin and the odd sweat at night also with a bit of forgetfulness thrown in for good measure!

I realise there isn’t a higher dose for Evorel Conti patches so I’m now considering changing to a different preparation although I’m finding the options a tad confusing.  Does anyone know if I can I use Estrodot patches with a progesterone gel instead of tablets?  I used this patch/tablet combination years ago but found the tablets upset my stomach so would prefer not to add another problem into the mix!   x

[sheila99]

You could use utro vaginally or a mirena. Have a look at the Treatments tab for options. There's no logic to it. Utrogeston is the same dose for any amount of oestrogen so why do you have to add more progesterone to evorel?

[Hurdity]

I'm also on Evorel Sequi and I did not realise one would have to increase doses by mouth if needed - very disappointing. Oh well ... Thanks again and have a good evening

Cocobra you don't need to take oestrogen orally if you want to increase the dose, but like I said you would need separate oestrogen and a progestogen as there is no higher dose combi patch. You would increase the patch dose and the progestogen would be taken separately of which there are several options as per sheila99's post.

Hurdity x

[Hurdity]

I realise there isn’t a higher dose for Evorel Conti patches so I’m now considering changing to a different preparation although I’m finding the options a tad confusing.  Does anyone know if I can I use Estrodot patches with a progesterone gel instead of tablets?  I used this patch/tablet combination years ago but found the tablets upset my stomach so would prefer not to add another problem into the mix!   x

The progesterone gel available is Crinone but is not licensed for use as part of HRT, but for fertility. Some, mainly private, gynaes or menopause specialists do sometimes prescribe it for HRT and there is research showing its efficacy in protecting the uterus lining. As far as I know there is no other progestogen gel generally available in UK anyway (ie not even another one for fertility) but I might be a bit out of date?

Hurdity x

[Cocobra]

Dear Hurdity and Sheila,

thanks so much for the further info and clarification. Having just got a pinched nerve on my back, my attention now is so focused on that unbelievable pain I'm not getting hot flushes at night any longer! 

However, I'll come back to this once my shoulder is back into form; meanwhile, I should say the gynaecologist I had consulted and who put my on the patches some years ago had originally suggested Mirena and oestrogen gel. I never went for Mirena because the idea of having something implanted in me made me cringe, but now I'm coming round to the idea ... Quite a few options available, anyway, which can only be good.

Have a good afternoon!