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[Trixiebell]

Hi ,
I’m experiencing spotting on hrt and my meno Dr has advised reducing my patch to 62.5 which is currently 75

Any advice on how to do it please ?

[bombsh3ll]

Ok firstly what about you, is there a clinical reason for reducing your dose such as side effects, or do they just think estrogen is dangerous or you're too old?

Assuming you do need a lower dose, the difference between using a 75mcg patch and cutting off a sliver to approximate 62.5mcg is absolutely negligible.

A 75mcg patch will be delivering less than 75mcg estradiol anyway after the first 12 hours or so, and less than 50% of that if it is still attached after 3 days.

However if you are very keen on achieving 62.5mcg as the initial dose delivered you can simply get a ruler or just estimate it and cut one sixth of the patch off with clean, sharp scissors along one edge.

If not using adhesive dressings over the top, you may find it helpful to round the sharp corners slightly which helps stop it lifting off at the corners.

Alternatively you could wear a 50mcg patch plus half of a 25mcg, which may be easier to split precisely.

However it really, really doesn't matter clinically between 75mcg and 62.5mcg.

If that made a meaningful difference they would sell patches in smaller dose steps.

[Trixiebell]

Thankyou for the time in replying , I’ve been on HRt for 4 years and can’t find a balance . I was doing ok since the beginning of the year until 3 weeks ago with spotting ,I had a pelvic scan which showed a fibroid very tiny near my womb
My meno Dr said my womb is 4mm and she advised reducing the patch to 62.5
What you say makes a lot of sense  I’m at a loss

[bombsh3ll]

The best approach to hormone therapy is to find the dose of estrogen that meets your needs, ie adequately treats all hypoestrogenic symptoms and achieves other goals such as osteoporosis prevention and cardiovascular health etc.

Then, you titrate your chosen progestogen to achieve endometrial control.

Reducing a therapeutic dose of estrogen in an attempt to control spotting is generally not good practice - it leads to an undertreated patient and often doesn't solve the issue.

I would therefore review the dose/type/schedule of progestogen that you are taking.

[sheila99]

As above, first find the oestrogen donde that controls your symptoms then increase progestogen if it isn't sufficient. Given that your lining is thin (4mm is fine) it seems to me the progestogen is doing it's job so perhaps it's the fibroid causing the bleeding. Oestrogen makes fibroids grow so perhaps that's why your gp is suggesting reducing it. You can cut a piece of cardboard to the required size then cut the patches using it, it may not be exactly 62.5 but at least you'll get the same dose each time.