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[Aubrey]

Hi,

I started HRT 5 years ago and have changed from Sandrena gel to patches in the last few months because I couldn't seem to get the gel dose right; every few weeks the worse symptoms, particularly insomnia and restless leg, BO and overheating would return, so I'd increase the dose and so on and so on until I was on 2.5mg of Sandrena gel. Eventually I changed to the patch - 100mg of Evorelle to see if that helped the endless recurrence of symptoms. But I'm having the same problem. When I began using the patch all symptoms stopped but within a few weeks they'd returned, so I've begun the process of increasing the dose again. Now I'm using 1 Evorelle 100 patch and one 1mg sachet of Sandrena gel, this totals 3mg of estrogen.

There isn't a pattern to it, no specific time in the months the symptoms return, but I can guarantee that within 4 weeks or so or increasing the dose, they will return. It's so frustrating that I've never been able to stabilise my symptoms for more than a few weeks at a time.

I appreciate that as I go through the peri- bit my estrogen continues to drop so I must increase my dose, is this all that is happening or has anyone else had this experience and did you find a solution?

[joziel]

You have to realise that the licensed doses of estrogen are miniscule. Even the max dose (100mcg patch) is tiny. And on top of that, many women don't absorb anything transdermal well. You can bathe in estrogen, but if you're not absorbing it, it's not going to raise your blood levels at all.

You haven't mentioned any blood tests there. That would be the best thing to try first of all, so you can see how increases in doses are raising your blood levels.

Personally, I am currently on 300mcg of Estradot patches (3x 100mcg) PLUS 3 pumps of Oestrogel at the moment. I have reduced the gel from 6 pumps, but when I tried 2 pumps I got night time symptoms back - so went back to 3, which is currently perfect. (I would like to come off the gel totally as it's a pain in the butt to do every day but will pause at 2 pumps for longer.)

I last tested on 300mcg plus 6 pumps and was at 850pmol, which is about the highest I'd want to be - but by no means too high. That was on 4x the max licensed dose.

I am also on 700mcg total of utrogestan a day...

You may need to go private to get these higher doses you need. I'm currently with Newson Health...

[Fizwhizz]

I’m in the same boat and constantly tweaking my regime. I started on 25mcg patches and felt ok, then didn’t so upped to 50mcg then stopped absorbing from those so switched to 2 pumps of gel instead. Then stopped absorbing that so upped to 3 pumps then back to a 100mcg patch and now trying 100 mcg patch plus 4 pumps of gel. Even on 3 pumps of gel my oestrogen was only 230 ppmol. I just don’t absorb anything well and as Joziel says some women just need more to feel ok. I’m post menopausal now and blood tests show I have zero hormones of my own.

[Aubrey]

Thanks Joziel, that's helpful to know. Fizwizz, it sounds like you do not absorb well at all. So frustrating for you. Apart from an estrogen IV, what can we do?

I had a blood test on 1.5mcgs of Sandrena, and it was 320pmol. The GP had no opinion about that.... I thought it could be higher.

After I wrote the message and after reading yours, I achieved some clarity, perhaps writing it out helps.. I realise I'm probably only getting enough estrogen to submerge by a mm the peri-mountain, so although the symptoms returning feels massive, it's probably the peri-mountain peeping out of the water again because it has never been truly submerged, just very lightly covered. If you know what I mean.

Your message describing how much estrogen you take makes me think I just need a lot more.

[joziel]

The thing is, another woman would get 320pmol from a 50mcg patch. And would be allowed to increase to 75 or 100. It makes no sense for this to all be about the dosage applied to the skin rather than the serum levels. It discriminates against women who don't absorb well!!

You should be allowed to trial higher levels of estrogen to see if they help. My Newson doctor said many women need to be at 450-650 to be symptom-free. Some need higher. 320pmol is pretty low, especially considering you are in peri and some of that could be your own estrogen anyway.

[Aubrey]

That's true, Newson says it's not about dose but symptoms. Take enough to control the symptoms.

I'll trial a higher dose and see if I explode, or something...