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[Postmeno3]

Hi,
I'm wondering if anyone experiences a sense of an oestrogen only patch (lowest dose) weakening before it's replaced? I'm starting to notice at week-ends, when I'm off Vagifem (Mon-Fri regime) and my patch isn't replaced till Sunday evening (Wed and Sun regime), that I don't feel so balanced?
Looking forward to thoughts and suggestions as very new to this, but feel it could be an early sign of something working, albeit clunkily? Thanks!

[Wrensong]

There has been shown to be variation in hormone levels over the life of each patch & some of us try to compensate for any tailing off effect by changing patches every 3 days instead of 3.5.  I do this & have found I achieve good overall absorption, at least in terms of blood oestradiol levels & hopefully this method helps keep fluctuations to a minimum.

Not sure whether you mean you use Vagifem only every Mon & Fri or consecutively for 5 nights Mon through Fri, but if you mean you miss 2 nights in a row, could you maybe change one of those Vagifem-free nights so there's not a double gap?  I realise you may be leaving the weekend free for good reason so may prefer not to!  As Vagifem is said not to go systemic after the initial few weeks when the integrity of the vaginal mucosa has improved & forms something of a barrier to systemic absorption, in theory it shouldn't make a difference missing 2 days in a row.  But if you're new to HRT or very sensitive to the effects of medication, maybe dosing as evenly as possible might make a difference for you.
Wx

[Postmeno3]

Oh, very many thanks! Yes, the specialist recommended Vagifem five nights in a row, Monday to Friday. I have an Estring in, too, which perhaps influenced that decision. So, changing patches every three days and not having non-days coinciding with Vagifem non-days might be the answer. Have I got that right? (See "brain fog" thread! 😂)
Otherwise, it works out that this leaves the entire week-end, potentially, without sufficient support due to the directions given and may, in fact, not prove ideal. I am very sensitive to medications. Thank you so much!

[Wrensong]

Oh Estring in too?  That's very interesting  , as I could really do with more than 5 nights Vagifem, having recently reduced systemic oestrogen.  Never thought of asking for both.  So a Cons gynae endorsed the combo?  Can I ask are you happy with the Estring & do you change/will you be changing it yourself?

The patch change timing - before I went to every 3 days (I change each patch early morning, so it's on for 3 days not 3.5), I used to change at 3.5 days, so one patch changed early Mon morning, one Thurs evening, rather than one left on for 3 days & one on for 4. 

Like you, I seem to be very sensitive to fluctuations & it's complicated slightly by combining HRT with two thyroid hormones with very different half-lifes.
Wx

[Joaniepat]

I also change my Estradot patch every three days, I never saw the sense in doing it every 3.5 days or leaving it for 3 then 4 days. It's just not convenient, and regularity is important. FWIW, I use Vagifem every night, and Estriol Cream externally every night, although have to work the cream around using Dermovate at night once or twice a week. If I can't use the estriol at night I might do it in the morning.

JP x

[Wrensong]

Thanks JP.  I do use Estriol externally 5 nights a week as well & will be asking to increase both to nightly at next appt, having had a very painful GSM flare recently.

[Wrensong]

Hi Postmeno, just reread your post & noticed this

So, changing patches every three days and not having non-days coinciding with Vagifem non-days might be the answer.

In case what I posted earlier was confusing, there shouldn't be any day (or part day) without a patch on, so you never have a non-patch day, despite making each patch last only 3 days.  When you remove one, replace immediately with another.   The box of patches will obviously not last quite as long, but the difference made by changing every 3 days is negligible in terms of prescription reorder rate & might significantly improve the way you feel if fluctuations are an issue, as well as ensuring you get max absorption from your patches.
Wx

[Joaniepat]

Thanks JP.  I do use Estriol externally 5 nights a week as well & will be asking to increase both to nightly at next appt, having had a very painful GSM flare recently.

Sorry to hear about the flare up, not nice. Hope you get it under control again soon.
JP x

[Wrensong]

Thanks JP, much better already, having increased VF to nightly for a fortnight & resumed testosterone at same time.  Was taken by surprise by how painful it's been, but almost certainly due to having reduced systemic HRT, as topical has never been enough to control GSM.
Wx

[Postmeno3]

Hi Wrensong.
Thanks again.
Yes, Estring and Vagifem combo approved and prescribed by meno specialist. Gp fits Estring for me, somewhat reluctantly, but I can't do it myself.
Take care!

[racjen]

I've always assumed that, since you can leave a patch on for 3 or 4 days, they must have at least enough estrogen in them to comfortably cover 4 days. I don't think I've ever noticed a tailing off effect, and I do the 3 days/4 days thing - in fact sometimes if I need to make them last a bit longer I change them all after 4 days. It doesn't make sense that this wouldn't be OK.

[Wrensong]

Yes racjen, there is said to be enough to last the full 4 days (or more), but there are papers showing there is a rise & fall in hormone levels over the life of each patch & perhaps with those of us on low dose replacement, there is not enough background oestrogen in our systems to keep us feeling stable at the lowest points.  I'm only on 25mcg & I think Postmeno3 has posted she is also on a low dose.  Plus some of us seem to be more sensitive to hormone fluctuations than others.
Wx

[Wrensong]

Thanks Postmeno for the Estring info.  Can I ask did you find Estring alone wasn't adequate?  Or did you start Vagifem first & have Estring added?  I've not heard of anyone being prescribed both before so it's useful info.

Can I ask also, have you had any probs with the Estring coming out of its own accord?  I am small & childless but understand they can come out unbidden at times, especially in the loo  . 

As I had probs removing diaphragms in later fertile years & had to ask GP for help with that at one point, I've avoided asking for Estring to date as I'd prefer not to need help with fitting/removing it each time!  Had been considering asking for a trial though, so all experience is helpful to know.
Wx

[Jasmine20]

I'm on Evorel 50 and I definitely notice a tailing-off effect on the last day. Usually I feel my energy levels start to drop and sometimes my VA can mildly worsen.

Like others I sometimes just change the patch every 3 days instead.

[Postmeno3]

Hi Wrensong,
I'd been on the Estring for years having been prescribed it for utis recurring. I have never had any problems with it in all this time, never ever being aware of it at all. I, too, have little capacity and no natural childbirths. More recently, in trying to be intimate again, it was quite clear the Estring was no longer enough and the specialist had no issues whatsoever in adding to what it was providing with Vagifem, five consecutive nights. There has never been a single issue with it falling out or not fitting properly. My last gp was ordering in for me and others, keeping a stash in her consulting room drawer! I've only had problems with this gp, inconsistently talking about the fitting "wasting an appointment". Some places have special clinics or set times for fitting by a nurse. I really would highly recommend it. So, yes, do consider a trial and bear in mind it's only every three months which is a bonus in itself!