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[Caggy]

I’ve been taking femseven conti  for a few months and all going well until the last couple of weeks when I started to feel low moods creeping in again, I do usually get quite low at this time of year so I’ve cut a quarter from an Evorel patch and it seems to be doing the trick. I’m only planning on doing this to get me to mid-March when I would normally start to feel brighter but just want some advice on if this will be damaging/possible issues? Also, why are combined patches only 50mg maximum? I didn’t  get on with gel and tablets and after lots of trial and error the progestin in femseven conti suits me the best. I don’t want the coil.

[bombsh3ll]

Adding a little extra estrogen to a combined patch is sanctioned by some specialists - care should be individualised - however as the estrogen then exceeds the dose of progestin licenced to assure endometrial protection, if this is done for any length of time eg a few months, the endometrium should be monitored with a scan periodically.

Unfortunately the fixed low doses in many combination products don't meet the needs of all women, it is simply cheaper to produce and stock than a range, and since the WHI prescribing culture has shifted towards very low doses, which don't achieve the same results as those historically used.

It is however possible to wear more than one of your combi patch, this keeps the E:P ratio the same, but could get expensive.

Alternatively you could use transdermal estrogen alone and take oral norethisterone, which is the same progestin in the patch.

[flo69]

What you have in femseven is the same progestin as in the mirena coil, I don't want a coil either, I know they really push it at you.

I'd guess that you'd be fine. You have a dose of progesterone in femseven and it's enough to cover the oestrogen in femseven. I'd bet money on it being able to combat much higher oestrogen doses than it is manufactured with.

I don't know why they are one dose except it's cheaper to produce that way.

You talk about trial and error with progestin, the recommended first line HRT for women with a progesterone intolerance is tibolone.

Have you tried that?

I love it, after hating all the others passionately.

All other progestins suppress testosterone and one problem post-meno ladies have, is being low in testosterone, it creates a terrible imbalance if done incorrectly.

[Caggy]

Thanks both, that’s very helpful and given me some good points to think over. The Dr has never even mentioned tibalone but I will look into it. And yes, really trying to push me towards the coil despite a very firm ‘no’.

[KaraShannon]

All other progestins suppress testosterone and one problem post-meno ladies have, is being low in testosterone, it creates a terrible imbalance if done incorrectly.

Oh my word, sorry for jumping in, this could be another part of the jigsaw puzzle for me then.

Dreadful fatigue, muscles turn to mush, prolapse symptoms show up, all on the combined patch.  Start to go away on estradiol only. 

I've just put a little extra estradiol with the combined and feel better already.  Maybe body is using some of the estradiol to make testosterone?

Or maybe I just need to see what's happening with testosterone in general too, I had no idea the progestin in the patch could be inhibiting testosterone.  I've long suspected I need it evaluated though.