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[Twinmummi123]

Hi all,

I had got to a point where I was needing to use 4-5 pumps a day to keep symptoms under control (hot flushes being the most noticeable) along side daily utrogesten. I started HRT for peri in 2020.

I had my meno clinic appt 7 weeks ago (NHS, 2.5 year wait) and the nurse prescriber recommended trying patches as I was needing to apply so much gel…I was a little resistant as I’m terrified of symptoms returning, but agreed to give it a go…she sold it to me by explaining that I may be on this for a long time to come, but if I didn’t like it I could swap back. She prescribed Estradot 100m patches with the expectation that I will reduce (by cutting the patch) over a few weeks to find the lowest possible dosage.

I’ve now been using them for approx 7 weeks and the changeover was good, it’s lovely not to have to put the gel on and wait for it to dry…I have reduced the patch to just over half now and am still symptom free, I have got slightly tender breasts and noticed a little blood on wiping over the last couple of days.

Do you think this is just an adjustment period 😬 I’m so scared of bleeding again. I had a big bleed last November and was diagnosed with adenomyosis and a couple of cysts, the Dr said it’s a balancing game and basically if I want to have the benefit  of HRT I need to put up with the oestrogen triggering the adenomyosis and cysts.

I’ve also started on Testogel and I think I’ve felt a difference with that…but def had a few big spots on my chin! Oh the joys of being a woman!!

[Dotty]

Hi good to hear the change to patches is working 😊. Any change in hrt can lead to bleeding and it can take a while to settle, but keep an eye on it.

[joziel]

Normal to bleed within the first 3 months of changing any HRT dosage. Forget about it and only pay attention after that.

However, what is this with starting you on 100mcg patch and then persuading you to reduce....?!?! This isn't just about managing symptoms, it's also about making sure you have sufficient estrogen for bone protection and other health benefits of HRT. The NHS is frigging obsessed with the now OUTDATED stuff about 'lowest dose for shortest time' BULL. (Sorry but this is really angry-making.)

If you previously needed 4-5 pumps of gel, in all likelihood you need 100mcg patch which is the equivalent. None of these are 'high' doses, they are within what is licensed. There is no need to reduce down, you are not making anything any better or safer. Obviously if you have symptoms of high estrogen or your bloods show it is ridiculously high, then yes - you would need to try to reduce. But menopause is hard enough without introducing this idea of encouraging you to reduce, when you've only just got started...

By the way, I am on 12 pumps of gel - with serum estradiol of 325pmol, which wasn't high enough at all to help my symptoms. I have now added a 75mcg patch (soon increasing to 100mcg) along with the 12 pumps of gel - the idea is to reduce the gel back down to 6 pumps - because I was able to absorb more at 6 than at 4 (but I haven't absorbed any extra up to 12) - and to increase the patches to even 300 or 400mcg of patches if needed. All this is via Newson Health because the NHS is useless.

I can't believe you had to wait 2.5 YEARS for this. Your own GP should easily have been able to switch you to 100mcg patches. It's a licensed dose. It's nothing you need a meno clinic to approve. Yet again, the NHS proves completely inadequate...

[Mary G]

joziel, I agree with every word of that.

Twinmummi123, it's incredible to think you had to wait 2.5 years just to get a patch and then he told to crab about cutting bits off knowing you have problems with absorption.  It really is a load of pants.  What reason did this woman give?  What was the thinking behind it? 

I assume that being a dedicated menopause clinic, they have offered you an oestrogen blood test in a few months and they will also be giving you a uterine scan to check that everything is ok?   If your blood results reveal high levels of oestrogen, you can then start cutting bits off the patch if you feel you need to.

[Twinmummi123]

Hi good to hear the change to patches is working 😊. Any change in hrt can lead to bleeding and it can take a while to settle, but keep an eye on it.

Thank you! Yes it’s made life a lot easier not having to mess about with so much gel!!

[Twinmummi123]

Normal to bleed within the first 3 months of changing any HRT dosage. Forget about it and only pay attention after that.

However, what is this with starting you on 100mcg patch and then persuading you to reduce....?!?! This isn't just about managing symptoms, it's also about making sure you have sufficient estrogen for bone protection and other health benefits of HRT. The NHS is frigging obsessed with the now OUTDATED stuff about 'lowest dose for shortest time' BULL. (Sorry but this is really angry-making.)

If you previously needed 4-5 pumps of gel, in all likelihood you need 100mcg patch which is the equivalent. None of these are 'high' doses, they are within what is licensed. There is no need to reduce down, you are not making anything any better or safer. Obviously if you have symptoms of high estrogen or your bloods show it is ridiculously high, then yes - you would need to try to reduce. But menopause is hard enough without introducing this idea of encouraging you to reduce, when you've only just got started...

By the way, I am on 12 pumps of gel - with serum estradiol of 325pmol, which wasn't high enough at all to help my symptoms. I have now added a 75mcg patch (soon increasing to 100mcg) along with the 12 pumps of gel - the idea is to reduce the gel back down to 6 pumps - because I was able to absorb more at 6 than at 4 (but I haven't absorbed any extra up to 12) - and to increase the patches to even 300 or 400mcg of patches if needed. All this is via Newson Health because the NHS is useless.

I can't believe you had to wait 2.5 YEARS for this. Your own GP should easily have been able to switch you to 100mcg patches. It's a licensed dose. It's nothing you need a meno clinic to approve. Yet again, the NHS proves completely inadequate...

Hi Joziel,

Thanks so much for all the info.

Well the thinking is…I presume, that as you say she wants me on the lowest dose possible controlling my symptoms as she said there is a risk to higher doses. I agree that the NHS are outdated. Initially I had to go private, in 2020 as my GP wouldn’t even entertain the idea I needed HRT as I was 47. It’s all a joke really. My GP won’t even prescribe more than a months utrogesten so I have to put in a request every bloody month for them.

I have three children at university and a private appts aren’t financially viable at the moment…hence the ridiculous wait for meno clinic. I have plenty of patches to use a whole one each change.

Her reasoning was that she thinks that I wouldn’t be absorbing the full 4/5 pumps so will get more product from the patches. She def didn’t want to prescribe 100’s it was only at my insistence that I didn’t want any return of symptoms.

It is all so very frustrating. Thank you for your advice…I will def take it on board.

[Twinmummi123]

joziel, I agree with every word of that.

Twinmummi123, it's incredible to think you had to wait 2.5 years just to get a patch and then he told to crab about cutting bits off knowing you have problems with absorption.  It really is a load of pants.  What reason did this woman give?  What was the thinking behind it? 

I assume that being a dedicated menopause clinic, they have offered you an oestrogen blood test in a few months and they will also be giving you a uterine scan to check that everything is ok?   If your blood results reveal high levels of oestrogen, you can then start cutting bits off the patch if you feel you need to.

Yes 2.5 years for a telephone appt!! Disgraceful isn’t it.

No, no test for oestrogen, only testosterone. She unwillingly gave me that, as she said it’s not a magic pill (gel). And no scan planned as yet. My next appointment is in 6 months, so I will def request one then, I had a scan in Dec 23 as I had a bleed and lining was ok but I had some cysts and adenomyosis…they wanted me to come off the HRT but that would be catastrophic to be honest.

[joziel]

This is crazy...

Firstly there is zero risk to higher doses of HRT as long as you have enough progesterone and are not having erratic constant bleeding which would suggest not enough P.

Secondly, she's in a menopause clinic and should know that.

Thirdly, waiting 2.5 years for a *phone* appointment is insane.

Fourthly, you don't need to be at a menopause clinic to be on 100mcg patch. If your current GP won't prescribe it, find another GP. You don't need to wait 6 months or be in some menopause clinic you can't frequently get in with. Just find a good GP and a good GP practice with a GP or nurse specialising in menopause care and HRT. They will be fine with you on 100mcg. That is a very standard dose. It's not necessary to be in a specialist menopause clinic for that...

[Twinmummi123]

This is crazy...

Firstly there is zero risk to higher doses of HRT as long as you have enough progesterone and are not having erratic constant bleeding which would suggest not enough P.


Secondly, she's in a menopause clinic and should know that.

Thirdly, waiting 2.5 years for a *phone* appointment is insane.

Fourthly, you don't need to be at a menopause clinic to be on 100mcg patch. If your current GP won't prescribe it, find another GP. You don't need to wait 6 months or be in some menopause clinic you can't frequently get in with. Just find a good GP and a good GP practice with a GP or nurse specialising in menopause care and HRT. They will be fine with you on 100mcg. That is a very standard dose. It's not necessary to be in a specialist menopause clinic for that...

Unfortunately this is the state of the GP surgeries where I live…it’s a small town and I have friends in the other Dr practices who have the same problem, no trained Specialist in the surgeries hence needing a referral to the clinic unless you can afford to pay for a private appt, another 2 years and I will 😬 but for now this is the best on offer. It’s a sad state of affairs but I will put the whole patch in this week and when I have the next appt I’ll just say that’s what I need. I really appreciate your advice…it’s such a minefield and differing information at every turn…but that’s why I come here as I trust women in the same situation as me rather than a dodgy meno nurse.

[joziel]

Gosh, poor you. What region of the UK are you in?

[Twinmummi123]

I’m in the South East, Kent.