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[CrispyChick]

Hi ladies.

If I'm only absorbing 72 pmol from a 50mcg patch. Instead of doubling to 100mcg patch would i be better trying oral. 1/5mg femoston??? For potential better absorption.

Any thoughts.

I'm desperate. This is the end of my chemical menopause trial if I can't get this right. And I know it's really stabilised all my hellish peri fluctuatuons. But right now I need to prove, or otherwise, if I feel so ill because of genuine low E.

P.s I know I'm only absorbing 72 pmol as my hormones are totally zero underneath (as shown in previous bloods).

[bombsh3ll]

I wouldn't have anything but oral myself so I'm probably biased but I think it is definitely worth trying.

I don't know what you are doing progesterone wise at the moment but just in the short term I would suggest an estradiol alone rather than femoston.

If you immediately go on to a combined product you can't tease out what's what in terms of effects - good or bad.

Also be aware that blood levels can be more variable across 24 hours due to the peaks and troughs with oral. This is still less than with gels, and clinically makes no difference to most people (and those who do feel it can of course split their dose) but it can make blood tests harder to follow.

They can still give meaningful information though especially if tested at the same interval after taking the estradiol pill. Mine are pretty consistent.

[CrispyChick]

Thanks bomb

I should've said, I'm on combined products for P as I do not tolerate utro or cyclo. So I'm using conti patches so it'll have to be femoston or elleste duet.

I've doubled my patches. See what happens there first. I've ordered my own blood kit. Any idea of how soon I could test. I know officially it's 2/3 weeks for blood levels to stabilise, but Google tells me that's oral and that patches are pretty instant, given the  continuous delivery system.

In terms of oral. If I try femoston conti (my preferred due to a kinder progestin). It's only 1mg E. Which seems to compare to 25mcg patch. But 50mcg patch was doing nothing. But then, that's clearly an absorption issue - so 1mg oral might be fine. 🤔

Also. I have 0.5mg/2.5mg femoston in my hands. It looks like 2 x 0.5mg/2.5mg equates totally to the 1mg/5mg femoston Which I'd want to try.

Can I just take 2??? Saves wasting a GPs time. Anyone know?

[bombsh3ll]

Yes taking two 0.5/2.5mg tablets is exactly the same as one 1/5mg tablet. It just costs more.

If you don't mind bleeding there's also a 2/10mg, which is only available in sequential.

[joziel]

crispy, I think it's probably jumping the gun a bit to move to oral if you've only tried a 50mcg patch. My levels would be about the same on that...

The thing about oral, is you can't reliably test estrogen at all once you start it. Because oral E is broken down by the liver into metabolites, so when you test you will get a falsely high result due to all those metabolites, which doesn't reflect the estradiol which is available to your body. (It's the same with oral P. We can test women accurately using regular P tests only if they use all their P vaginally or rectally. We can't reliably test women in the UK who take oral P. In the US they have a P test called LC MS P which avoids this, but no where in the UK offers it - to my knowledge, even privately.) So you really don't know what you are getting at all, if you switch to oral.

Plus, you increase the risk of clotting so will come under pressure to get off oral HRT as you get older. Plus if you need surgery, you'd need to stop oral HRT and not transdermal.

As you  might know, I'm on 200mcg patches and (now) 3 pumps of gel at night. I will test on this in the new year but I have been on 200mcg patches and 6 pumps of gel - and my levels were 893pmol, so I reduced the gel to get me around 650pmol as that was a little high if I didn't need to be up there. But, before this, I couldn't get higher than 330pmol even on 12 pumps of gel (which was the same on 6 pumps of gel).

Which is all to say, you don't know yet if you can't get higher if you use a higher dose. The most common solution for poor absorbers seems to be a patch-and-gel combo because the two different routes seems to allow for more absorption than just using a high dose of only one.... (as me with the gel).

I get prescribed this from my Newson doctor but my NHS GP is happy to then give me the meds. Which is good as I couldn't afford this dose, privately.

[Dramy3]

Hi

I didn’t absorb the patch (Estradot or Evorel) well at all. Tried everything from half a 25mcg up to 100mcg over a year. My Estradiol never moved more than 75 at any time (I tested 6 times in that year).
Then I switched to oestrogel and just 1 pump took me to 400. I’m peri, so it a bit different for me, but just to add to the counter that patches are pants for some people.

[bombsh3ll]

I think with oral, the goal would be to just increase stepwise until hopefully you found a point where you felt well, and then think about a blood level, more from the point of having a reference level that you know works for you.

On 1.5mg estradiol (Zoely) I am reliably around 390pmol/L. As others have said there will be some other metabolites such as estrone that are not being measured and this may not be as pure a result as I might have on patches.

But what it means is when the time comes to swap from a birth control pill to a licensed HRT product, if I choose an estradiol based pill I can aim to replicate the value that I know works for me.

[CrispyChick]

Thanks all.

I doubled my patches to 100mcg. Having a very low threshold as I need out of this hell. And I'm about to stop it all. So I'm testing later this week as I've read levels pleateu on patch immediately. Obviously that's not how we feel it.

Anything in my blood is pure patch, as I was at zero on cm.

Interesting comparison with zoley bomb. I always thought it was 2.5mg E. But I see that's the progestin.

I can't swap to gel or spray as I can't take bio progesterone. So it's progestin for me.

So if not much improvement in blood, I may try 1mg femoston. I mean I always used to absorb contraceptive pills. So assuming patch might be the issue here.

Thanks all. It really is my last chance. It still looks like I have extreme bodily reactions to hormones rather than levels themselves. But I need the damn E to get to a sufficient level to be sure. Sigh. 

[bombsh3ll]

You do have the option of desogestrel 150mcg daily or slynd as your progestin, if this is what is keeping you from trying a gel.

Even provera if it allows you to take an estradiol product that works for you.

[CrispyChick]

Thanks. But I can't take Slynd or desogrstral any more either. 

Think it's quite obvious now that hormonal levels are not my main issue - more my body is overreacting to them all, especially external sources.

No idea why?! Been going on so long, but this year is the one cerazette turned on me when I tried it again, after taking it for years before.

Endocrinology is my next step. 

But thanks for all the advice as I do need to finish this test with a decent add back E level. Sigh.

I do think my joints are feeling mildly better today, so hopefully I'm absorbing enough from the 100mcg patches to conclude.

[joziel]

Crispy, I got so fed up with the very-slowly-slowly approach and never getting where I wanted to, that I decided to increase relatively speedily (like every week) until I really felt different....

You can always overshoot and then come back down if you test ridiculously high.

[CrispyChick]

Yip. That's my current plan. 

[CrispyChick]

I'll just add, in light of Dr Currie's latest post - I took advice from my BMS gynae (having to pay for) and I was told to up the patch.

The swapping to oral is my own idea, but I will go back through my gynae if I want to pursue this.

I appreciate blood tests are unreliable in peri. But I'm in chemical menopause with none of my own E. So I think it's highly valuable. I think if my joints are in agony on a high dose patch it's very much worth a blood test. What's the point in sitting it out in agony if I'm not absorbing. 

[bombsh3ll]

I think most providers would support a blood test if someone is still symptomatic on a 100mcg patch.

Where to go with that is less agreed upon eg wearing multiple patches vs changing methods vs combining methods.

Do you think your specialist, might support topping up the combi patch with gel, with endometrial monitoring?

This is off label but is being done by some private providers.

[CrispyChick]

I'm not sure to be honest.

So you mean, add a pump of gel, but not take any further prog?

I guess I need to see where this double patch takes me first. But it'd be something to ask.

I still believe in the blood test and will be doing my own tomorrow.