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[Hawthorns]

Hello,

Does anyone know if you can use 1.5 patches of Evorel Sequi to get 75mg of estrogen?

(51 and perimeno with PCOS) I used to be on Estrogel (3 pumps per day; any more than this caused breast pain), with 2 weeks of Utrogestan until about 5 months ago. However, I'm also on Mounjaro (PCOS weight-related problems) and there are some concerns about absorption of oral progesterone due to delayed stomach emptying, so my doctor moved me onto Evorel Sequi.

The patches are equivalent to 50mg of estrogen (2 pumps of Estrogel) and it's not strong enough to control my mood symptoms and joint pain. I'm also losing hair and my nails just flake off - despite me taking enough supplements and marine collagen - but this may also be a side effect of the Mounjaro (although I was fine until about 2 months into the patches).

The doctor has offered patches and Mirena but I'm having difficulties with my pelvic floor prolapse atm (both ends!) so I don't want to make anything more complicated down there (and the last time I had a Mirena, it didn't really suit me at all and I bled heavily for over 6 months).

My doctor (the practice Menopause specialist) tried Googling the patch question but told me she'd have to look into it more and get back to me.

If I can use 1.5 patches, do I use 1.5 patches of Evorel 50 then 1.5 patches of Evorel Conti to balance it all out?

Otherwise, my other GP said to add in a daily pump of Estrogel and not worry about it.

Thoughts?

[bombsh3ll]

Yes you absolutely can add an extra half or full combined patch.

The main problem with this is many GPs are unwilling to prescribe it due to both lack of knowledge and/or cost.

Most women would be absolutely fine adding one pump of estrogen gel without additional progestin, however you already have one risk factor (PCOS) for endometrial hyperplasia and as this regime hasn't been studied and confirmed to provide cast iron endometrial protection in ALL women, my advice would be to have regular scans eg once per year if deviating from standard estroprogestin ratios.

[Abc123]

When I was on those patches and moved from 50 to 75mg, my GP discussed it and ended up adding in an extra 25mg oestrogen patch to the combined patches so the prog dose stayed the same. I don't have PCOS though.

[bombsh3ll]

This would be absolutely fine for the majority, the standardised doses of progestin are those that have been shown to protect everyone including those at the highest risk.

However when additional estrogen is used, it is not possible to know who would be in the unlucky small percentage to develop hyperplasia - some risk factors eg PCOS, obesity, diabetes, family history are identifiable but it can happen in the absence of these, therefore monitoring with periodic ultrasound is a good idea.

Also, particularly in the NHS, the GP is taking a degree of professional risk upon themselves by deviating from what are quite draconian guidelines around endometrial protection.

[sheila99]

The conti patch is balanced so it contains enough progestogen for the amount of oestrogen in the patch. So it's better either to use 1.5 patches or else to change to oestrogen only with a separate progestogen. If you add more oestrogen without more progestogen you should have scans to make sure the lining isn't building up.