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[joziel]

Since I'm now on 12 pumps of gel    I am probably going to need to switch products.

Given some severe night time symptoms I'm dealing with, I'm thinking about trying oral HRT. This would bypass the absorption issues I have. It's that or spend endless more months trying other transdermal options when I know that I didn't absorb from patches well either.

So I'm interested to hear from people who are on oral HRT. Has it worked for people where transdermal options haven't? What dosage are you on, and how does this compare to the transdermal dose if you were previously on that...?

I know there is a slightly increased blood clot risk but I have no other risk factors.... 

[laszla]

Have you considered an implant - they can resolve absorption problems.

[joziel]

I'm not sure how to get one of those in the UK. I don't want to wait ages for an NHS menopause clinic. And if the dose is wrong, I'm stuck with an implant in me... I also seem to remember reading they are not offering implants anymore.

[Uma17]

I think it’s really worth a try if you are not absorbing through the skin. I’m assuming that you also tried patches and have optimised how you apply the gel by letting it dry, applying it with for example a spoon rather than your hands. Im finding that the inner thighs is the best place for me. I’m on 5 pumps a day.

A friend moved to oral as she was not absorbing gel nor patches she was prescribed 2mg straight away and had a bad headache for a week but that settled and she is now really happy. So perhaps ask for 2mg in 2x 1mg form so you can start slow.

Both of us had a hysterectomy with BSO.

[Furyan]

Hi Joziel - Oral HRT does not by-pass the gut as you have ingested it so it is processed by the liver. However, there is a way around this if you take body identical oestrogen buccally. You’d have to take a fraction of the tablet though, there is more guidance and lots of information at:

https://surmeno.blogspot.com/2006/03/route-considerations.html

I have tried it, and it does work.
You’d obviously have to take a separate progesterone.

[bombsh3ll]

I'm on Zoely, which is marketed as a contraceptive pill but frequently used for HRT in perimenopausal women who also need menstrual suppression and/or birth control.

1.5mg estradiol, 2.5mg nomegestrol (progestin)

I know this is not the product you are considering but it is oral estradiol and I love it.

I have only ever used patches for IVF, and they were a pain in the ass - only really suitable for short term as they kept bunching up and coming off, and I had to buy adhesive surgical dressings to stick over the top.

Equivalence charts cite a 50mcg patch as roughly equal to 1mg oral, however individual absorption varies greatly and in my personal opinion 1mg oral is closer to 100mcg patch.

When I graduate from Zoely I plan to take either 2mg oral estradiol plus a progestogen or tibolone.

[Ana21]

Hi joziel!

I'm taking oral estrogen, 2 mg estradiol and 200 mg progesterone (po) x 12 days.  I also use Vagifem and Premarin Cream, as well as 5mg finasteride for hair loss due to a relative rise in androgens.

I'm postmeno, 60 yo.  I'm on sequential MHT to control unscheduled bleeding.  This is a good balance for me.

I'm getting excellent symptom control on this regimen.  I have not suffered from nightsweats for many months, since settling on sequential. I have the occasional hot flash but it's manageable.  No  bladder/urinary or vaginal issues so far.  No anxiety/mood issues.  No weight gain. My hair has recovered.

It's easy and convenient, a tiny tablet once a day.

Furyan mentioned taking estradiol buccally (placing tablet between gums and cheek).  More about sublingual and buccal administration of E2:

"Unlike oral E2, sublingual E2 is thought to bypass the first pass effect by the liver, making it less likely to impact hepatic clotting factor synthesis, and thus decreasing the risk of thromboembolic events posed by oral administration, such as VTE and ischemic stroke. Additionally, studies in cisgender women have demonstrated a 13-fold higher peak serum concentration and a decreased estrone (E1) to estradiol ratio with sublingual administration, suggesting that sublingual E2 is more a physiologically potent route."

The downside is that this method can result in more rapid peaks with greater overall periodicity. However, there is no data demonstrating that increased periodicity is harmful.  Dividing your dosage (multidaily dosing) would help, but if you don't do well with fluctuating estrogen levels, then this method may not be the best for you.

Much of the current research on sublingual administration of E2 is geared to transgender women.

For the sake of experimentation, I've tried sublingual E2.  There was no taste and I wasn't bothered by the estrogen fluctuations, but the experiment was too short to say whether it would work for me in the long term.  It's something I'll discuss with my doctor.  At this stage, I would need multidaily dosing to suppress testosterone and prevent hair loss.  I'm very sensitive to androgens.

My previous meno doctor preferred to prescribe Premarin (CEE), so my first oral estrogen was Premarin 1.25 mg.  In terms of relief of vasomotor symptoms, this worked the best for me, better than my current 2 mg of estradiol.

Hope you find something that works well for you.

[joziel]

Thanks everyone. I'm not sure if I should try Sandrena first or just go for oral.....

[bombsh3ll]

Only you can decide, but given the amount of faff, mess and difficulty not to mention the cost and time spent every day, having it dictate when you can wash, what you can wear and what you can/can't do or touch for however long after applying it etc, you have to decide if that level of disruption to your life long term is worth a theoretical 0.0001% decreased risk of anything.

It's sad that there's so much fear mongering about oral estradiol that people feel they have no option but to incorporate something so tedious and restrictive into their daily life.

In the time spent washing off moisturiser, applying the goop and waiting for it to dry you could have had a walk, jog, bike or swim which would have more than negated any perceived increased risk with oral.

[joziel]

That is definitely true when it comes to 12 pumps. However I'm vaguely hopeful I will need much less Sandrena....

At the moment I leave my lower half naked except for knickers (tucked into butt on one side where gel is) whilst I make my breakfast, it takes so long to dry  Then the doorbell goes and it's the postman and I'm half naked, or even worse, if he comes when the gel is still wet I can't even get dressed to answer the door 

And then at night, I have to lie on my side with one leg out of the duvet and the relevant butt cheek not touching the bed until I'm dry 

[Ana21]

joziel,

I would try the Sandrena.  I would use transdermal if I could.  I've tried patches and gel and I've never had a measurable amount of E2 on any blood test.  I'm a non-absorber.  That's why I have no choice but to take oral.  If you have to take oral, I think you'll feel more comfortable with your decision knowing you've exhausted your other options.

[joziel]

Good tip! Thanks