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[Gilla999]

Hi all, happy new year!

There are two different "official" opinions about the equivalent doses between oral and transdermal Estrogen. The BMS says that 1mg (biodentical, eg Elleste solo) equates to a 25mcg patch, but many other official sources (eg Louise Newsom, my meno doctor and the 'official' leaflet for the medicines) say that 1mg is equivalent to a 50mcg patch.

I'm currently in the middle of a switch over from Evorel 25 to Elleste Solo, and just wondered if anyone here has switched in either direction and what their experience was? I realise everyone is different of course, just thought it couldn't hurt to hear if there was a general consensus!

[dahliagirl]

I'm currently moving from Femoston 1mg/5 dydrogesterone (continuous type) onto evorel patches (25) and utrogestan.

I thought 1mg was equivalent to a 50 patch at first so it is good to know I didn't pluck it out of mid air!!

I had a bit of a disastrous first attempt before Christmas and am just starting another go.

I would think, because of the different methods of administration, that it would vary between people.  Some are 'better' at metabolising the oral oestrogens as they pass through the liver, and some people absorb the transdermal better than others.

I have also discovered that there is a 4 hour delay with the patch as it gets 'up to speed' which may be more of a problem at low doses.  I am doing a half day overlap - I remember a friend on just patches had this problem when she was switched from Estrodot.

[Gilla999]

Yes I'm sure you're right - I know for example that I'm a bit of a "super absorber" when it comes to all things transdermal, but don't know about oral yet. My meno doctor was really surprised when I pointed out the BMS's literature, it seems like 1mg= 50mg is more of the standard (or maybe less up to date??) thinking. Guess I've just got to wing it and hope for the best, as with all things menopause related!

Interesting on the 4 hour delay - I haven't heard about that at all?

[dahliagirl]

It was on a pharmacy site when I googled about it.  I wish I could find it again.  It also said not to cut them in half because it damages the matrix - the practice nurse said this was a good way to cut down 🤔

[Gilla999]

My understanding was that the old advice of not cutting patches was for the old type of patches but isn't valid for the ones we use now. There are quite a lot of studies out there showing the viability of patches once cut and they all passed fine. The only thing I do remember the studies pointing out was that Estradot wasn't viable when cut and stored at 30 plus degrees. It didn't say if 30 plus degrees when whole was also a problem, but I opted never to have a hot bath with one on in case!

[pastie supper]

If the patches degrade quickly at 30'C, they must do that while attached to us as well. I'd imagine the temperature on my skin under my clothes where the patch would be must be around 30'C.

The newer matrix patches can be cut, older reservoir types can't be cut because it runs out of the reservoir.

I've not tried oral HRT but I know my rate of absorption from Estradot was much greater than my absorption from Everol and both were handily beaten by oestrogel. I found one pump of oestrogel felt stronger than double the equivalent in patches (50 strength patches).

Yes, it's very individual and seems very unscientific for a medical solution to be so vague about the dose received by the patient.

[Gilla999]

Apologies it was 35 degrees, not 30 - an excerpt from the study is below. But yes still valid, pastie supper! I used to think about it regarding sunbathing too.

"Design and methods: Estraderm MX 50 mu g, Systen 50 mu g and Oesclim 25 mu g matrix patches were cut into eight pieces while Estradot 50 mu g small patches were cut in half. The cut patches were stored in their respective pouches at +21 degrees C or at +35 degrees C for up to 1 month. The estradiol drug was extracted from the patch by ethyl acetate n-hexane and determined by radioimmunoassay.

Results: Storage at +21 degrees C or +35 degrees C up to 1 month did not reduce the estradiol concentration in Estraderm MX, Systen and Oesclim patches. However, although the estradiol in Estradot patches was not affected by storage at +21 degrees C, at +35 degrees C, estradiol decreased by 57% (+/- 1%) in cut pieces."

I previously took Estradot before switching to Evorel and I also absorbed MUCH more from the Estradot, matching what I've seen many women on the forum say.

it is an odd thing about the oral to transdermal equivalents, considering the difference in advice is literally double!