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[ByTheSea]

I've been in peri since I was 43, I'm 50 now. I've been on HRT 4 years and in that time my Evorel has crept up and up. Most recently I was at 200 for about a year (I used to have my womb scanned regularly but now I have a Mirena and no periods).

My NHS gynae hates the high dose and goes on about Tachyphylaxis etc, however my bloods have always shown an acceptable level of Oestrogen (600pmol/l was the highest). I feel well at that level. My Newson consultant is happy that I am a low absorber, and the higher dose is required. In the last 2 months all my symptoms came rushing back (flushes, sweats, dizziness, fatigue, electric shocks, joint pain, migraine, alcohol intolerance) and so I decided to increase another 25 (patch cut in 4). My symptoms abated - I went up to 250 and they vanished. So I went to Randox last week to have bloods done and it showed my oestrogen, on the second day of my patch, now sits at 360. I know that's clinically within acceptable guidelines, but I also know I feel my best at a slightly higher level.

I am going to have more patches on me that a sticker book at this rate, so I'm wondering if Evorel just isn't right for me. Should I request to either switch to Estradot, or maybe to go for pills with the increased risks. I was on the pill from age 13 - 40 anyway (PCOS) and I have no family history of blood clots or cancer, I'm a non-smoker with a BMI within the 'normal' range, so I think the risk is low.

Before I either spend a fortune with Newson again or fight with the NHS, does anyone have any advice/experience of this?

[bombsh3ll]

I have only ever used patches for IVF - I must have absorbed what was needed as they worked.

However I wouldn't entertain them long term - they itched, they came off, they were expensive, I had to buy surgical dressings to keep them on, and I didn't like it dictating when I could wash.

I have chosen to use oral estrogen for the rest of my life - I currently take combined pill Zoely which I plan to continue until menopause can be reasonably assumed, and then move to oral estradiol at 2mg.

I would say don't be scared of oral, because the absolute difference in clot risk is absolutely minuscule and not considered clinically significant in healthy women.

Approximately 5000 women would have to take estradiol for a year for one extra clot to occur. That figure includes people who are obese, smoke, have a family history of clots and will also include people with undiagnosed malignancies and thrombophilias.

So whilst I do take preventive measures within my power such as hydration, exercise and a healthy diet, it probably isn't going to be me, and probably isn't going to be you either.

[ByTheSea]

Thank you! That's very good to hear.

I've been on Evorel patches for 4 years. I shower with them etc as normal and while I've had the odd one come off, it's never been a major issue. If anything, I struggle to get them off. The more I think about it, the more I think tablets are the right thing for me. I take daily medication anyway, so it's just another one on top of that.

What's interesting is that my symptoms flooded back 4 weeks after my Mirena was fitted, so I think that maybe it's suppressing ovulation and that's maybe knocked my natural oestrogen down a notch.