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[Gnatty]

Joziel if you Google the Women's health concern and Sandrena you will find the new chart of equivalent doses. It states that a high dose equivalent of 4 pumps of oestrogel is 2-3 mg of Sandrena. x

[joziel]

Not getting anything up when I google that. The WHI was a highly discredited piece of research so not sure I'd pay much attention to what they decide Sandrena equals... 

But yes, 2mg of Sandrena = 4 pumps of gel according to my Newson doctor.

3mg = 6 pumps

4mg = 8 pumps, which is what I've been told to start with.

[Jjumper]

No, I was prescribed the 1mg sachets. I've just got out my consultation letter to confirm what I had been told. It says change from 6 pumps of Oestrogel to 4.5mg Sandrena daily. It does not say to increase my dose, just to change to an 'equivalent dose'. This is what I did.

As I have been reducing my dose slowly since last summer (when I was on 2 x 100mcg patches Evorel plus 3 pumps of Oestrogel daily which made little different to my symptoms) I recently reduced my Sandrena dose down to 3mg (the equivalent of 100mcg patch according to my doctor) and then I finally switched to 100mcg patch  Evorel a couple weeks ago which is what I am on now.

I don't know which doctor is right on this, but I have to say I am frustrated that we have been told different things. I really like my Newson doctor and find her to be very thorough (better than the one I had previously). But I wish the clinic would take more responsibility for this sort of thing. It is hard enough dealing with symptoms, trialling different preparations, titrating doses etc. without being given differing information.

[Banjo1973]

General advice is that 2 pumps of Oestrogel is equivalent to 1mg sachet of Sandrena.

However, in terms of estradiol each pump of Oestrogel has 0.75mg of estradiol so the equivalents are rough.

I was on 3 pumps of Oestrogel, after failing on new Oestrogel (7 8 pumps) I switched to Sandrena. I started on 1.5mg, it was not enough then settled happily on 2.

I could take Oestrogel in 1 dose (am) but with Sandrena I have to split it as it seems to wear off.

Joziel, I would stick with your current regeime until you're back from holiday then try it.

Good luck x

[Hurdity]

You have to remember that there is no exact equivalence because different women vary on how much they absorb of a given dose of a given product, and equally one woman may well absorb more effectively from patches than gel. These amounts are averages - translated from what used to be low, medium and high - but they are averages across a population, not how much each one of you individually will need to achieve, say the same estradiol level as you did on a different dose (and  different women also experience symptoms differently even with the same etsradiol level).

In terms of total estradiol in the amount of gel - then clearly 2 pumps of oestrogel contain more than 1 mg sachet of Sandrena - but Sandrena is not only more concentrated, it is also forumlated differently from oestrogel, so the time pathway for absoprtion is likely to be different generally, as well as being different for different women. I don't know if the pharmacokinetics (the time course of what happens to the hormone levels in the body) are comparable - usually when you look it up you cannot compare as it is not like for like.....

Hope I haven't muddied the waters here!

Hurdity x

[Gnatty]

Not getting anything up when I google that. The WHI was a highly discredited piece of research so not sure I'd pay much attention to what they decide Sandrena equals... 

But yes, 2mg of Sandrena = 4 pumps of gel according to my Newson doctor.

WHI is completely different. It was a report. Dr Juliet Balfour definitely says 3mg is 4 oestrogel according to new table  But as Hurdity  says it is all individual and you have to find your own way/ balance.
Interesting that Banjo found she needed two mg of Sandrena when she had previously been on 3 pumps of oestrogel. This accords with the new guidance.

3mg = 6 pumps

4mg = 8 pumps, which is what I've been told to start with.

[Jjumper]

Thanks Hurdity and yes of course I understand what you are saying about differences between products and individualising treatment.

However I think that it’s important that when we are transferring from one product to another we are informed by our doctors of the correct equivalent dose, or as close as possible to it.

Anyway, apologies Joziel if I’ve confused things for you. I was trying to help with the information I had been given, that’s all! Good luck with the Sandrena. I really hope that it works for you : )

[Moog77]

Oooh following this ladies.

I was on 3 pumps of old bottle oestrogel (it was soooo good) and then 75 estradot patch. I'm now on 1.5 sachets of Sandrena but I have ectopic heartbeats really bad (big peri symptom for me). Wonder if a wee bump up to 2mcg would be advisable? Hmmm.

[Floral]

Joziel, haven’t been on here in ages and sorry to see you are still not sorted, if any consolation neither am I YET, talk about trying, waiting, changing, suffering, wondering, it’s crazy!

Anyway I know you have same Thyroid doc as me, I am on T4, trialled T3 but felt horrendous!!  I had apt today and he said something else is causing my low thyroid not thyroid itself, he said unbalanced estrogen could be the cause and I think he’s right!  I’m putting up a new post but wanted to wish you well.

[AngelaH]

I had apt today and he said something else is causing my low thyroid not thyroid itself, he said unbalanced estrogen could be the cause and I think he’s right!

You are right, hormonal imbalance somehow affects thyroid hormones, while thyroid itself continues to function properly. When I was in peri I had horrible insomnia, fatigue, anxiety and depression.  My thyroid test result came not looking good despite I never had any problems with thyroid in my life. That time I used Evegreen medical app and when my test results came on it there was explanation that something effected my thyroid hormones, but my thyroid itself was working fine. My estrogen wasn’t properly opposed by progesterone, in fact I was estrogen dominant, so after adding progesterone to my body, balance between hormones was restored and all the symptoms were gone, thyroid hormones were back to normal too.

[joziel]

The thing about the thyroid is it's your body's way of dialling down metabolic function. And sometimes your body might need to do that for other reasons (ie low sex hormones and many other reasons, fasting etc). So whilst we can then try to take thyroid hormone to fix it, because the low thyroid hormone is itself a symptom, it is really best to treat the underlying cause. Of course that's easier said than done sometimes...

Floral, sorry to hear T3 didn't work out for you. At the moment I'm on 50mcg T4 and 45mcg T3 and my last set of labs have plummeted despite having increased T3 since last time. I was really expecting my results to be over range and I've come back below range on T4 and bottom of range (21% of range) on T3. This is because I've been working out every other day, have a fast metabolism back and a body which is now hungry for thyroid hormone. I'm pretty sure if I hadn't put myself on thyroid meds my own body would now be responding and making more T3.

I really want to now get off the thyroid meds and see where I am without them. There might be a case for a very low dose of T3 of 10-15mcg just to bump my own levels up, not to suppress TSH or replace them. But will see how I am without anything first. But I don't want to do that at the same time as making this Sandrena switch or I won't know what is causing what....So I might need to temporarily increase at least my T4 dose whilst I get this Sandrena on board...

[pepperminty]

Yes, exactly sheila    I don't know what to do about the idea of changing to oral now. I think I'm a bit worried about not being able to easily adjust my dose, like I can with a transdermal product. It seems like it's harder to gradually increase the dose because the tablets are 1mg or 2mg (I think) so I'd have to increase by that much each time....

Plus I also worry about having to stop it if I ever need surgery for anything, due to the increased risk of clots with oral.

And lastly oral HRT also can get bound up with SHBG and lead to high SHBG where all your hormones are basically bound and not available to be used. This is a particular concern because I'm also on thyroid meds and T3 is known to do this a lot. I'm supposed to get off the thyroid meds and then this wouldn't be a problem although I might need an adjustment in dose.

So it would be a lot simpler if Sandrena would just work for me. But I'll talk to the doctor on Monday about it and ask her what she thinks about oral vs Sandrena...

Zumenon is the estrogen part of Femosten. The progesterone part is the same for 2/10 amd 1/10 . I have the 1/10 and add half a Zumenon .

PMX

[joziel]

How are you finding it pepperminty? Are you on oral because you couldn't absorb transdermal?

[Uma17]

Not getting anything up when I google that. The WHI was a highly discredited piece of research so not sure I'd pay much attention to what they decide Sandrena equals... 

But yes, 2mg of Sandrena = 4 pumps of gel according to my Newson doctor.

3mg = 6 pumps

4mg = 8 pumps, which is what I've been told to start with.

Gnatty mentioned the women’s health concerns, not WHI.

[joziel]

Oh my bad. Still, just googled that and can't find anything about Sandrena...