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[Autumn Daze]

Hi everyone, I was on a 75 patch with mirena coil but not feeling great and struggling with small bleeds (had an ultrasound and all ok) mood swings and anxiety so my private menopause doctor has started me on half an oral tablet to go with a 50 patch which I’ve taken for about a month and I do feel a bit more stable and haven’t had a bleed.
I asked my gp surgery to prescribe the new HRT and they refused saying someone over 60:(I’m nearly 62) should never be on oral HRT and it’s too dangerous as it causes blood clots and not licensed etc. The menopause nurse I spoke to has been really supportive of me for the last few years so I was surprised and a bit shocked with her extreme (and horrified!) reaction. Is she right though?
The nurse wants me to go onto the gel ( the one you spray on your arm starting at a low dose which I’m not too confident about as I tried a different gel a few years ago and it didn’t help. I just don’t think I absorb patches or gel properly.
What should I do? Is anyone else on oral oestrogen please?  I’m worried about blood clots now, especially as I seem to be having a tingling feeling down one leg when I sit down for a while, could it happen that fast if it was?
I am booked to see a GP about my leg.

[sheila99]

The risk of blood clots increases the older you get, you can look up the details for yourself but they say it doubles every 10 years from age 55. Transdermal is safer because there's no increased risk. You could get a blood test done privately to measure your oestrogen levels so you can see how much you're absorbing. The NHS will normally prescribe up to 100mcg patch so is there a reason this hasn't been tried?  It's quite possible you will absorb differently from gel, spray or a different brand of patch but I'd share your reluctance at reducing the dose. I was in the same boat, still symptomatic on 100 patch so the NHS meno clinic thought I should try half the dose of lenzetto. I booked an appointment at Newson instead (video, you don't need to travel) and now have sufficient estradot to control my symptoms. Unless you absorb next to nothing transdermally increasing whatever transdermal you absorb best would be a better and safer option than oral.

[Autumn Daze]

Thank you very much for your reply. I’m so glad it worked for you, I might do that too, definitely safer.  I did go up to 100 patch but was angry all the time and had quite a lot of bleeds. Came back down to 75 and calmed a bit but still had bleeds and felt ‘wrong’. I was on testosterone but stopped that because of the angry moods, that made a slight difference.
My doctor thinks it’s too much progesterone…I have the Mirena coil. I just don’t know. I’ve been on HRT for 8 years and although it stopped the awful flushes and physical pains I’ve never really felt like me again and become more anxious, moody and a bit ‘meh’ about things.🤷🏼‍♀️ I know it’s a lot of trial and error but eight years of it is getting a bit waring!

[bombsh3ll]

I would listen to your private specialist who is treating you as an individual rather than the arbitrary "computer says no" one size fits all NHS policy of discouraging oral estrogen after 60, as if it is perfectly safe at 59 years and 11 months then turns lethal at midnight on your birthday.

Studies showing an increased clot risk with oral estrogens generally looked at premarin or ethinylestradiol, not 17 beta estradiol, and these estrogens were often paired with a thrombogenic progestin. Doses in that era were also significantly higher, and far more people smoked.

This has not been conclusively demonstrated with natural estradiol in oral form either alone or with natural progesterone.

Many providers do not understand the difference between these oral estrogens or that the progestogen component also influences clot risk, and even in the worst case scenario assuming the risk is increased, they could not accurately describe its magnitude (which is in the order of one extra clot per several thousand women taking the absolute worst combination of equine estrogen and provera, for a whole year).

Even Louise Newson who is evangelical about transdermal estradiol has also recently stated publicly that any thrombotic risk is not really seen with oral 17 beta estradiol.

[Autumn Daze]

Oh thank you so much….I’ve been going around in circles with this. You have really helped clear things up.

I’m on Elleste Solo 1mg tablet, is that the oral 17 beta estradiol that you are talking about?

I’m on 1/2 a tablet and a 50 patch but will be moving up to one a day with 25 patch and then coming off patch.

Thank you again for your reassurance.