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[Mojo-swaptop]

Hello all

This is my first post, though I have been looking around for a little while after my GP suggested this forum.

I'm hoping for a bit of advice, reassurance, personal experience.

As the title says I'm changing from oestrogel and utrogeston to evorel sequi.

I started on oestrogel and utrogeston in May, and it didn't really help with my symptoms (hot flashes,  night sweats, insomnia) and also gave me longer, heavier periods that came with quite painful cramps.

I saw my GP on Monday for my 3 month review and she said that it seems I wasn't absorbing the oestrogel very well so not getting enough oestrogen, and gave me a prescription for evorel sequi, which I will be starting on Saturday.

I would love to hear from any ladies who have also switched from gel and tablets to patches and also ladies experiences, good and bad, with evorel sequi.

Thank you in advance
Mojo-swaptop x

[sheila99]

Oh dear, another GP who will do anything they can except to increase the dose so that you have enough to stop your symptoms. Yes, it's possible you will absorb more (or perhaps less) from the patches but it's equally possible you'll spend another 3 months on an inadequate dose. I've used evorel sequi (fine but developed an allergy to the glue, gel and utrogestan (gel fine, side effects with utro), estraderm patches (enormous and absorbed very little, currently estradot and mirena. I absorb most from estradot, evorel and gel the same and hardly anything from estraderm but we are all different and it may be different for you. If you find you don't absorb more from evorel I'd see the GP after a month instead of 3 months. I wouldn't advise estradot until the supply problems are sorted out. If you don't get on with the norethisterone in evorel conti patches you can use utro with evorel oestrogen only patches. Good luck.

[Mojo-swaptop]

Thank you for your reply Sheila99 and for sharing your experience with both the gel and tablets, and the different patches.

I am hoping that I absorb better with the patches so I won't need to try a different method or up the dosage.

My GP was very nice and understanding and said that if my symptoms don't improve after the first month to 6 weeks I can go back and see what else we can try, rather than sticking it out for the full 3 months. 

I am trying to stay positive and hope that the patches work for me but I realise it can be a lot of trial and error before hitting on the right treatment for me

[bombsh3ll]

How old are you?

If you are under 50 a combined oral contraceptive pill (or patch or Nuvaring) can be a more convenient and accessible way to get a therapeutic dose of estrogen plus this can get rid of your periods if taken continuously ie no dummy pills or hormone free days.

This can be a better option in perimenopause as it shuts down your own cycle and adds a stable and consistent dose back.

The combined pill also reduces risk of ovarian, endometrial and colorectal cancers.

[Mojo-swaptop]

Hi bombsh3ll, thank you for your reply.
Sorry, I forgot to put in my OP that I'm 47 and quite early on in my peri-meno journey (about a year or so in)

I hadn't considered the pill, I used to take it in my teens and twenties before I got sterilised, so thought it was just for contraception but thinking about it now, it makes sense that it is also a hrt of sorts.

If I don't get on with the patches I will suggest the pill when I next see the GP

Thanks again
Mojo-swaptop x

[Mojo-swaptop]

I put my first patch on this morning.

I was pleasantly surprised at the size of the actual patch, I thought it was going to be bigger.

 I'm not expecting anything to happen today but I'm feeling kinda of extra vigilant, on the lookout for any tiny changes.

Mojo-swaptop x

[Mojo-swaptop]

Day 3 with the patch on. Still no improvement with the hot flashes or night sweats. I know it's early days but I really hope I see some sort of improvement soon, the flashes are not helping with my irritability.

I'm also wondering when my period is going to appear. For the first 2 months on oestrogel/ utrogeston my period started before finishing the utrogeston stage (days 24 and 25).
I finished my last utrogeston stage last Wednesday so was expecting to start a period either Monday or Tuesday last week, but it still hasn't appeared.
It's disconcerting when you are used to being so regular and then it doesn't appear when you expect it.

Mojo-swaptop x

[joziel]

The problem is that Evorel Sequi only comes in a set amount of estrogen, 50mcg.

If you were not getting enough estrogen from the gel, how much gel were you on? Were you on the max licensed amount (4 pumps)? If not, that should have been the first thing to try, as well as increasing the utrogestan at the same time to help with periods.

If you were on the max licensed dose of gel and still not absorbing, then a switch to patches would be indicated - but not to the combined Evorel Sequi which comes in only a set amount of estrogen. But instead to the estrogen-only patch so you can then increase it up to 100mcg if needed.

You also don't want to be taking a synthetic progestin if possible (which is what is in Evorel Sequi), you want body identical progesterone. Some people can't control bleeding with this, but you haven't at all explored higher doses or almost-continuous doses with just a break to bleed, before your doctor has switched you to synthetic.

Personally, I'd return to your GP and ask to go on an estrogen-only patch at 75mcg seeing the 50 in Evorel Sequi isn't helping, and utrogestan at higher doses than you've used previously. (I take 700mg utrogestan/day. 300mg orally in the evening, 200mg vaginally in AM and 200mg vaginally in PM.)

[Mojo-swaptop]

Hi joziel
Thank you for your reply and advice.
I understand your reasoning for upping the dose but I personally agreed with my GP that if I wasn't absorbing enough on the gel then trying a different delivery method to see if that was the right dosage was the better option before adding more.
It's only day 3 of the patch so I'm not expecting much change yet though I really hope it doesn't take the full 3 months to take affect.

Thankfully my GP has said if I don't feel any better on this then I can go back in a month to 6 weeks for assessment

Mojo-swaptop x

[joziel]

It's fine to switch and try a different delivery method - but the best switch in that case would have been to estrogen-only patches and utrogestan at a higher dose...

The combined estrogen and synthetic progestin patches aren't really a good first choice for anyone unless you randomly only ever need 50mcg of estrogen and really need a synthetic progestin.

[Mojo-swaptop]

Thank you for the advice joziel.

Why don't you think that the combined estrogen and synthetic progestin patches are a good first choice?

Ideally I would like to be on a more natural progesterone but I didn't really get on with the utrogeston tbh, it gave me a really uncomfortable tummy, kind of a mix between bloating and mild period cramps that lasted all month.
I will see how I go on the combination patch later in the month and then go back to the GP if it doesn't suit.

Mojo-swaptop x

[joziel]

They are not the best first line choice because (as above) of the fixed amount of estrogen at 50mcg. It's very unlikely this will be all you need. So it risks another adjustment later on, and having to come off the patches and go onto something else - or adding in more estrogen on top and then separately having to increase the progestin because the progestin in the patches is designed to work with 50mcg of estrogen only... It just means more changing products in the near future.

Secondly, most people settle down and adjust to utrogestan and if there are side effects from taking it orally, it's best to take it vaginally to avoid those and bypass the liver. That should always be tried first and foremost and increasing doses to deal with bleeding. If you had mild period cramps or bloating (as well as the heavier periods) it sounds like you weren't on enough utrogestan for you - meaning the estrogen was too high in relation to progesterone. The first thing to try would have been to increase the progesterone and to switch to using it vaginally. The best case scenario is giving you your own hormones back. Your own body has never had a progestin deficiency because it has never made progestin. It made progesterone.

In addition, synthetic progestins have a range of not-great health effects: https://www.larabriden.com/the-crucial-difference-between-progesterone-and-progestins/

Whilst some women really do need them to control bleeding, they shouldn't be the first option or reached before you really have concluded utrogestan doesn't work for you.

[Mojo-swaptop]

Thank you for the information and extra advice, I really appreciate you taking the time.

I understand that a lot of women use utrogeston vaginally but for personal reasons it's not something I would be keen to try.

Out of interest can I ask what, if any, HRT you use, if that's not too personal, and how many different ones you tried before getting the right combination?

Mojo-swaptop x

[Mojo-swaptop]

I know that all women are different and what works for one won't necessarily work for another but it would be great to hear from other women who have used evorel sequi and what their experiences were/are.

Mojo-swaptop x

[joziel]

I'm afraid my HRT journey is long and involved and I don't really have time at the mo to type it all up, but it wouldn't really be helpful anyway - because every woman is different, as you say.

But just because every woman is different, doesn't mean that there isn't a best practice order of things to try and to work through. Some people might be suited by the very first thing they try (which in an ideal world would be transdermal estrogen and utrogestan) and others might need to work further down the list.