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[KaraShannon]

Hi all

I'm on the final combined Evorel Sequi patch, to be changed back to Estradiol only on Thursday.

Always this last patch is a troublesome time. 

I have prolapse symptoms, always this last combined patch.  Only they are a little worse this time, I feel like my insides are lower than they should be.  I also get far worse fatigue and low mood at this time, although for the moment that's not here.


I'm going to speak to the doctor about the prolapse symptoms but almost always that I'm worried about them they start to go away again, either just before I change back to estradiol or shortly after I've changed back. 


My face is slightly flushed tonight too, and was last night, prompting me to change to a fresh combined patch in case the one I had on wasn't sticking.  But it's happening a bit tonight too.

Time for more estradiol?  I'm only on 50 with Evorel Sequi.  I've not been able to increase it without horrible migraines etc, and my blood levels were sky high, but that was a year ago now.  Maybe it's time for an increase?  I will ask the doctor before increasing but I'm just trying to understand and especially as if I can prevent these prolapse symptoms which seem temporary, from getting worse, by an increase then all the better.

Thanks for reading. 

[bombsh3ll]

Progestogens (like the norethisterone in the combined patch) can make muscles, ligaments and other tissues more lax. This can aggravate any mild prolapse that MIGHT be there, and can lead to a heavy, bloated dragging feeling in the pelvis even without any actual prolapse.

They can also cause constipation which can add to this.

This is also why many menstruating women feel better in their follicular rather than luteal phase, and those on sequential HRT typically prefer the estrogen only time.

I would definitely get checked by your GP, however if it is tied closely to the progestin it may be worth looking at alternatives.

You could also consider whether the estrogen is adequate, and I don't know how easily you could access it but testosterone is really good for muscle and ligament strength. Anecdotally women with hypermobility syndromes report improvement with androgen replacement and even androgenic vs non androgenic progestins.

Of course if you wanted to try it on the NHS you would have to say it was for low libido.

[KaraShannon]

bombsh3ll

thanks, you've really done your homework.  I was thinking about what you said on another of my threads and think at the very least I probably need an estradiol increase, 50 is half the standard dose I've been told.

Unfortunately I missed my blood test, long story, so will have to rearrange.

I do currently have low libido anyway, so it would be the truth and I've long wondered if I need testosterone, but I also suspected that the progesterone (norehisterone in these patches) was doing something.  I might have mild prolapse that I'm not aware of usually but it does seem to have occurred since hrt and always in the combined months, and always on the last few days of the last combined patch.

Another thing I'm grappling with is that I need something like vagifem but I'm scared of it because of the effect, migraines, tinnitus, which it's not supposed to do but it always occurs when I use it, within a few hours and it becomes a bad day.  I need to function (how many menopausal women are saying that!  everyone around you still expects you to function like you always did, I can't go to bed with a migraine and say sorry but my pelvic health depends on it)

Interesting what you've said about progesterone though, it helps to fully understand my cycle because then I can speak to the doctor about intervening. 

[bombsh3ll]

If you were to get on a therapeutic dose of systemic estrogen and testosterone (the vagina and genital tissues have androgen receptors too) you may not need to use vaginal estrogen.

[KaraShannon]

If you were to get on a therapeutic dose of systemic estrogen and testosterone (the vagina and genital tissues have androgen receptors too) you may not need to use vaginal estrogen.

thanks bombsh3ll, about 2 years ago I was on a really high dose of oestrogen (or might have been partly my own body's surge) at that time I still had mild prolapse symptoms when using the combined patches. 

But I'm hopeful as it does become a LOT better at other times of the month, this could be reverted back to something less of a problem with the right treatment. 

You've given me hope. 

[KaraShannon]

Update, last night I put a tiny (cut) square of extra estradiol on with the combined patch.

I know this would have to be monitored, the doctor did say I could do that sort of thing as long as it's monitored and it's much smaller than previous. 

I will make sure this is thoroughly checked as I understand the need to protect the uterus.


But to note, this being my last week of the combined patch, I always feel awful, fatigue, prolapse symptoms, weak muscles, feeling that my insides are somehow 'lower' even in the lower abdomen.

I've had a deeper sleep, I've woken with more energy to function, prolapse symptoms are still there but slightly less bothersome.  I expect it's the oestrogen because I always get a deeper sleep when I'm back on estradiol only, so it's likely the extra estradiol patch.  I know there's always oestrogen even in the combined patches, but it must be the mix with progesterone that affects it's effectiveness.

I'm so close to changing back to estradiol on thursday I'm going to keep this up.  It's a tiny extra amount and I have a huge workload this week that now feels easier to get through.

The combined patches didn't make me feel so bad in the beginning, back in 2020.  I just felt really chilled on them.  But maybe that was because my estradiol levels were naturally higher then, so my body could take the extra progesterone in the patch?

[bombsh3ll]

You might have had naturally higher estrogen and testosterone then than you do now.

If it definitely seems to be the progestin in the patch that is upsetting you it would be worth trying something different.

Have you ever tried any other progestogens?

[KaraShannon]

I need to try again Bombsh3ll, I didn't give utrogestan much of a chance.  I was bloated and a bit asthmatic quite quickly on it, but it was also hayfever season.

I'll get my blood tests done.  Then have a think about where to intervene.  Meanwhile these next few days feel like they will be easier x

[KaraShannon]

Update now, I'm on second Estradiol only patch, but evorel wasn't given at first so I had Estradot on for 3 days. 

Fine at first but then last night really flushed face and I don't get that and palpitations.  I changed over to an Evorel patch and after a little while it all started calming down.

But now tonight the flushed face is back.  I don't get hot flushes, I'm not hot, but my face is red and burning.  The Evorel patch is secure and new on from last night. 

Could it still be from having had the Estradot for a few days? 

Or could it be that I used a tiny extra estradiol patch to mitigate the effects of the combined patch (a week ago, and it worked well), leading to my body not happy with the extra estradiol?

Another thing, it's when I'm into my second estradiol only patch that my teeth feel at their weakest.  A funny thing to say but I'm more aware of them and sensations coming from them.  It makes me wonder the effects of all this on my bones.  But again, would have thought it would be when on the combined patch that these things would occur, not once the oestrogen is climbing again (I know oestrogen is present in all the patches but get the feeling that the combined patch, with the norehisterone progesterone in it, somehow weakens the effect of estradiol / oestrogen)

Need to rebook my blood test.