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[Francine]

I'm in my 70s and have been on Kliofem HRT pills for many years, with hardly any side effects.  I was happy to continue until my new GP said I should have a patch instead of taking a pill, because of the risks associated with pills.  I've not agreed yet, and I'd like to hear from anyone who has made this change, because I'm working on the basis that if it ain't broke, don't fix it, and I'm worried I'll get all sorts of problems with the transition.
I've looked at the options and an Evorel patch of 50 or 70, with oral Utrogestan looks closest to Kliofem, though I know there can't be an exact equivalent. 
Has anyone made this change and how did it go?
Also has anyone decided they'll stick with pills into their 80s?
I'd love to hear from you!

[bombsh3ll]

I personally will be on oral estrogen as long as I can swallow, unless I were to develop a legitimate medical contraindication, of which age is not one.

I will obtain it from the NHS as long as I can, but thereafter would rather pay privately and get the treatment that is best for me as an individual rather than have someone try to dictate that I should arbitrarily switch from an established treatment which I have been stable on for a long time, to something I don't want.

I think if you are willing to try patches, at the very least you should ask for a written agreement from your GP that if the patches don't suit, your first choice treatment can be reinstated.

A couple of things you should be prepared for are the dose shrinkflation that often happens when women switch preparations - the replacement is often prescribed at a lower dose equivalent in the hope you won't notice you have been short changed, the fact that patches often do not stick well and you may need more than the two a week that the prescriber thinks you need, which may or may not be a problem if you get someone who is really rigid and ignorant, and that you may need additional paraphernalia to get the patches to work optimally, such as rubbing alcohol to strip the oils out of the skin before applying, and adhesive dressings/tattoo film to stick over the top.

[Joaniepat]

Some (probably most) of us are fine with patches and need no extra paraphernalia. If you go ahead with the change ask for Estradot, which are the smallest and most user friendly and stick well. Soap and water to prepare the patch site should suffice. I recall Bombsh3ll saying she used Estraderm, which are the least desirable and are huge in comparison. There have been supply issues with Estradot recently, but I was able to obtain my 100s last week. If 50s or 75s are still in short supply you can ask for Evorel until Estradot supplies return.
As to shrinkflation, you should have a review after three months when changing products, and if the dose you are given does not control your symptoms you can ask for the next dose up.
I hope all goes well for you, whatever you decide to.
JP x

[Snowcat]

Hi Francine.  I was on Kliofem until 2 years ago when ‘they’ decided I had to stop when they mistakenly said that the pulmonary embolisms I had were due to the kilogem.  They weren’t, as we soon found out, but as everyone I spoke to was very reluctant to let me go back on them, I opted for the Estraderm patches.  If I could go back to kliofem I would as it worked perfectly for me, alongside some vagifem.  My problem was the 2 year wait to restart on the patches which caused severe atrophy compounded by inappropriate prescribing of strong steroid cream.  Obviously this is where our stories differ but I see no reason why you can’t stay on the kliofem- when I was originally prescribed it by a gynaecologist he said that I’d be on it for life.  The risk is very small but it’s always a case of whether the benefit outweighs the risk or not - well I know that I’d rather have a good quality of life especially where menopause issues are concerned! Incidentally, if my research is correct, and I did a lot of it lol! The Estraderm MX 75 is the equivalent of 2.25 kliofem. (Kliofem is 2g) so a pretty good match I’d say.  The MX 50 is 1.75 kliofem which wasn’t enough for me - I’m doing better now I’m on the MX 75 although I agree with others that the patches are rather like having a small crisp packet stuck to your bottom!

[Francine]

Thank you to bombsh3ll, JoaniePat and Snowcat for your very helpful replies.  I hadn't realised where you have to put the patches.  I was imagining thigh or upper arm.  The prospect of a travelling crisp packet is horrendous!  I'm now wondering if anyone has found any benefit at all (except removing a possible risk) from switching from pills to patches, if you are happy on pills.

[bombsh3ll]

You don't have to put the patches on your arse!

I used them for IVF so the consequences of patch loss would have been much higher, and it was a case of any smooth flat hairless area.

Of course I had more skin that fitted that description in my early 30s.

I mostly used my lower back, but additionally used the front of my thighs and my upper arms.

I did use hypafix over the top, which required assistance to position on my lower back, something to consider if you live alone.

Some providers discourage upper arms in favour of the lower body for fear of breast cancer but this is not evidence based, and the birth control patch which is a much higher dose is commonly worn on the arm.

[Francine]

That's a relief! Thanks for the geography tour, Bombsh3ll.
I've just asked an AI to find me case studies of women who moved from Kliofem with no side effects, to patches, and found improved results & quality of life.  It couldn't find any.    Most examples are where there were problems with Kliofem, or the risk was high, which prompted the move.
If I thought patches would be better in any way, I would consider them, but at best they seem to do the same as pills, just with the decreased risk.

Has someone got a good news story to tell me about patches being better than pills, where pills have no side effects?

[Dotty]

If it’s not broken…don’t try to fix it 😊. I’d say if you’re happy on Kliofem then stick with it.

[Snowcat]

Hi again Francine.  Just wanted to clarify that I was fine of kliofem until I had blood clots in my lungs (later found out to not be caused by kliofem) but I am now on Estraderm MX 75 patches and they’re starting to work fine now too.  I preferred taking a small daily pill to having to remember to change the patch every 3.5 days but that’s not really a problem worth changing back for.  I’m used to it now.   The Estraderm leaflet says to stick to hairless skin on lower stomach, buttocks or hip.  I think they all say slightly different things but all below the waist.

When I asked my gynaecologist about the comparison she said she’d speak to my haematologist if I really wanted to go back on kliofem and ask his opinion with regard to the blood clot issue but that, in her experience, the patches are just as effective, so I said I’d stick with the patch.  The patches are lower in risk of blood clots but the risk is tiny anyway, depending on family history etc.  seems to be it’s more of a personal preference otherwise, rather than anything - I’ve not had any side effects on either. 

[Francine]

Thanks very much Dotty and Snowcat,  you've helped me to decide to stay with Kliofem. 
I thought there might be other advantages with patches, but clearly there aren't.  The best I can hope for is that it will be the same. 
All I have to do now is convince my GP that I'm prepared to take the small risk of clotting in order to maintain my quality of life!

[sheila99]

I tend to look at it the other way round. The risk of blood clots is higher the older we get and oral hrt carries a higher risk than transdermal so to me it makes more sense to use the lower risk product unless there's a good reason not to. Most people do perfectly well on patches once they settle on the correct dose for them so why wouldn't you want to reduce your risk? Personally I'd try them as long as your GP agrees you can go back to oral if you have too but it's very unlikely you won't find something that suits you just as well but is also safer. Estraderm are the the only 'crisp packet' type and quite unpleasant imo but evorel or estradot should be fine.

[Francine]

Thanks for this sheila99.  You're the first person to suggest patches could work for me as well as pills do.  Is that your experience?

[sheila99]

I haven't used oral, it's rarely prescribed for hrt now because transdermal is safer. I currently use estradot but have used evorel and femseven. I wouldn't recommend estraderm but the others are fine. Then there's estrogel which is a gel and lenzetto which is a spray, both are applied daily. Patch, gel or spray is just personal preference. I've used estrogel which was fine for symptom control but I find patches easier. If you have problems it's more likely to be because the dose needs tweaking as you may absorb differently. Or the progestogen may not agree with you in which case  you can try a different sort. It sounds as though your new GP is a bit more up to date on hrt so should be able to help you through the transition.

[sheila99]

Just one other thing that might influence your decision. If you need an op in the future they're likely to tell you to stop oral hrt because of the clot risk. If you're using transdermal you shouldn't have to ask there isn't an increased risk (though those without much knowledge of her may tell you to stop anyway). When you're having problems because of the op isn't just the ideal time to go cold turkey on hrt.

[Francine]

Many thanks for all this information, Sheila, I really appreciate a different perspective.  Can I ask if, as well as fixing your menopause symptoms, does your present HRT regime aid your mental and physical wellbeing in addition?   

Your comment about operations is interesting, because I've had 3 fairly major ones in the past 4 years, and didn't have to stop HRT.  They did consider it, but because I'm in good shape physically, they were happy to let me continue.  I did have to wear the dreaded compression stockings though, but I think everyone gets those these days.