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[Nmb]

Hi!

Looking for some advice about my low mood.  I've been on Evorel Sequi (50) since May. They massively improved my symptoms (racing heart, anxiety, flushes, tingling fingers, brain fog). I've also gone from irregular and sometimes very light periods to having regular periods again, starting about four days before the end of an 28-day Evorel cycle.  However, I'm really struggling at the start of a new Evorel cycle, I'm guessing because that's when I begin a fortnight without progesterone. My mood really dips and I feel anxious. Today it's making me feel like I can't begin work - I'm on holiday this week and wanted to do some catching up with work but feel paralysed to begin.

I would love some advice about what to do next. Are there tweaks to my hrt that can be made to help? I don't expect to feel good all the time time but I'm really struggling with this dip.

[bombsh3ll]

If you feel better on the patch with both estradiol and progestin the obvious solution is to go onto evorel conti.

This may (or may not) result in a less regular bleed pattern if you are not fully postmenopausal, but if it were me I would rather feel well and just carry some sanitary towels in my bag.

[Nmb]

Thanks for the reply 🙂

I didn't realise that going onto just Conti was an option. Do you know if there are any risk factors associated with moving onto solely those patches?

[bombsh3ll]

I would say the only "risk" of the combined patches (whether sequi or continuous) is undertreatment, as they only contain 50mcg of estradiol.

Therefore women who start off on this are either stuck with a low dose or have to choose something else to achieve a higher dose of estradiol.

It is perfectly safe to use more than one of the combi patch however this is seldom funded by the NHS.

However if you are happy with 50mcg of estradiol this is not a you problem 😁

[Nmb]

That's really helpful, thank you.

I know I really haven't felt like myself for a long time, and I now realise that my hormones have been playing a big part in that. Starting hrt has helped although it's obviously impossible to know without trying whether a higher dose would be of more benefit.  The fact that I now seem to have a regular period (with all the related pmt symptoms that I used to have) has led me today assume that the dosage is suitable for me, but these lows as I start a new Evorel cycle are so hard to manage.

I've also continued to take a perimenopause supplement that seemed to help me before hrt - doctor said I could just keep taking it. I do wonder if this may mask some symptoms.


Is it ridiculous to try an extra half patch of Conti alongside my estradiol patch?

Thanks again for the advice. It really helps to be able to share 🙂

[bombsh3ll]

No it's not ridiculous to add an extra half patch, just be aware that the NHS won't support this so you may find it difficult to renew your prescription if you end up running out before your GP thinks you should.

Bleed pattern tells you nothing about the adequacy of hormone therapy. Treatment should be guided by how you feel - this is where most guidelines end and do not recommend blood tests.

However not everyone even has symptoms to begin with, and the only way to know you have adequate estradiol levels to prevent the chronic diseases of menopause such as osteoporosis, is to have a blood test once stabilised on treatment.

[Nmb]

So I should probably go back to the doctor to discuss further. I had a blood test when I first went to the GP and she told me this indicated menopause. I was also told that they don't repeat this blood test. Is going to go a private menopause specialist the route today go down if it want another blood test?

If I could purchase additional patches separately, I would consider this just to hopefully regain some sanity. I can't push past this feeling of anxiety today and can't face this every month.

[bombsh3ll]

You can get a blood test without a private consultation.

Reputable companies that I have personally used include medichecks and forthwithlife.

You don't have to use a finger prick, you can book a phlebotomy appointment at many pharmacies.

For obvious reasons the NHS do not like to check estrogen levels on HRT as this would reveal large scale undertreatment.

[Nmb]

That's good to know. Thank you so much for sharing your wisdom 🙂

[Nmb]

Any idea where I can purchase additional patches without having my doctor having to be involved? Thinking this could be a short term option while I determine if an additional half patch could help.

[bombsh3ll]

There are lots of online pharmacies, just type the name of the product you are looking for into Google.

They will tell your GP however you will have the treatment and can trial it, and then decide if it helps you whether to pursue it through the NHS or see a private specialist to continue it.

It can be a good strategy rather than spending months and a whole load of stress and aggro battling for something on the NHS only to find it doesn't suit you.

If you have already tried it you know it is worthwhile pursuing and they also can't tell you "I don't think that will work".

[Nmb]

I know of a couple of online pharmacies that are decent options and noted that they will let your doctor know so I'll consider doing that.

Thanks again. So glad to be able to get advice from others 🙂
 

[Hopeful]

Hi, I am on 1 and a half evoril conti which is prescribed by my NHS doctor. So it can be an option

[bombsh3ll]

That's great that you can get it through the NHS however not all GPs have the same level of knowledge, confidence and willingness to help women with hormone therapy.

Some also manage to get more than 100mcg of estradiol, or to get testosterone on the NHS yet this is a minority and many others have to go private to get anything more than low dose, one size fits all treatment.

[Nmb]

Hi, I am on 1 and a half evoril conti which is prescribed by my NHS doctor. So it can be an option

Hi,

Thanks, that's good to know. My menopause doctor at my surgery was really helpful at my initial appointment though I've no idea whether they will up my dose slightly. Good to know that this is an option offered by some though.

I hope it's helped you. It's exhausting and so frustrating to just want to feel like yourself again but not know exactly how to help yourself.