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[Konijntje]

I’ve been on Oestrogel for 5 days now. Before I was supplementing Drovelis (drospirenone/estetrol) with oral estradiol. I’m now switching to Oestrogel + dienogest, I’m planning to do 2 weeks oestrogel only before starting dienogest (I’m having an expected bleed now from stopping the Drovelis). Previously, I have been on Lenzetto spray, so not new to transdermal E. I got some breakthrough symptoms on 3 sprays lenzetto toward the end, so I asked for gel now, because of the option for a higher dose (patches give me a rash).

I feel much better on transdermal estradiol than on oral, because I think I might metabolize oral estradiol too fast, I get very nauseous and a bit jittery a few hours after taking it and get hot flushes again about 10 hours later. So, I’m already feeling much more even since switching to the gel.

I started on 2 pumps of gel, 1 in the morning and 1 in the evening. However, I’m still having night sweats, hot flushes and dizziness, they are mild, so I do think I’m absorbing the oestrogel, but my dose might be too low. I’m a bit conflicted if I should stay on 2 pumps for now and maybe go up after I already added the dienogest or already increase to 3 to see if that resolves my symptoms before things get clouded from trying a new progestogen. Since 2 pumps of Oestrogel should be equivalent to about a 50 mcg patch and 3 sprays of lenzetto, it is not unreasonable to expect the 2 pumps to be slightly too low of a dose or do you all think otherwise?

My gynaecologist did prescribe this (dienogest + 2 pumps of oestrogel), but is referring me to a colleague that has more expertise in menopause care, because she felt she wasn’t guiding me very well. (So, there is not a professional I can ask about this, I have my first talk with the expert at the end of November. Which is good, since I should be able to tell if Dienogest is agreeing with me).

[Mary G]

I've just been talking about Dutch menopause treatment on another thread!

If I remember rightly you are early menopause so you probably need to increase to 3 pumps of Oestrogel to get rid of the night sweats.  Day and night sweats can be difficult to shift and I found it took 3 pumps of Oestrogel to finally get shot of them.  Splitting the dose by 12 hours is a good Idea and I find it's very stable - I'm using 2 pumps of Oestrogel but I'm very post menopause.
 
I found Lenzetto to be very weak and even with the maximum dose of 3 sprays I was struggling to get to 80 pg/mL - you really need to aim for about 100 pg/mL.  I find Oestrogel to be much more effective. 

[Konijntje]

Thanks, I’m still in perimenopause, I think probably late peri, since I’ve had symptoms for over 5 years and they just increased a lot over the last 2 years. I actually responded in that other thread just now (about Dutch Calvinism). ;-)

Yes, I think I’ll go up to those 3 pumps, because this does feel just slightly too low. (This is another stupid thing in the Dutch guidelines, it says something like “we don’t recommend increasing dosage over time”, but it also says they should be treating symptoms, so how they can put those things just a few lines apart is another mystery).

[Konijntje]

I have another question about gel (a bit of a stupid one maybe, but can’t really find an answer).

I increased to 3 pumps after my last post and that got rid of my sweats/hot flushes within a few days (the dizziness is still not completely gone, but better than it was). I added the dienogest on day 9, because my bleed stopped and I didn’t want to risk my cycle getting back on track. Besides physical side effects (severe fatigue and mild nausea, headache and cramps), that I hope will subside soon, I’m thinking it might be a good fit. However, I’m now on day 9 (I think) of the Dienogest and I feel like I’m having some breakthough systems again. Dienogest has a very strong progestogenic effect, so not totally unexpected. I also have a cold, so that might be a factor, so I’m staying on the 3 pumps until that is resolved. If I’m then still having these symptoms, I’ll probably increase to 4 pumps.

So, here is my (stupid?) question: if you apply gel twice a day, are you using different body parts for every pump or do you use the same body parts. Does it make a difference? I’m now doing left inner thigh, right inner thigh and belly. Don’t want to use my arms in the Summer, so I’d rather start right away on other body parts, but not sure what would be suited if I need 4 different parts for 4 pumps?

[Mary G]

I split the Oestrogel dose by about 12 hours and always apply it to the inner thighs.  You don't need to rotate it.  With a higher dose you can just spread it out more.

I've never tried Dienogest but I know it's readily available here.  Can you reduce the dose if it's too strong for you?  I don't think it would work for me because it doesn't suppress FSH and LH enough to keep migraine auras away but it sounds like it could work well for a lot of people.

[Konijntje]

Thank you Mary G. Good to know it’s not neccessary to rotate spots, I’ll stick to inner thighs too.

I haven’t checked if I could split the pills, dienogest has a very strong effect on the endometrium, so a lower dose would probably still give adequate protection. However, it’s very important for me that I get suppressed enough to not get a cycle because of the extreme mood effects from the hormonal fluctuations (progesterone is the devil to me, I’m also intolerant to my own). So, I think if dienogest turns out to work well for me, until I reach menopause, I’d probably opt for increasing estrogen before lowering progestin.

I’m going to wait for at least another week before I increase my estrogen dose, as I’m still having too many side effects from the dienogest to know for sure what’s what. Since yesterday evening I also have bad lower back pain, so maybe (also with the hot flushes this morning), I’m going to have a bleed? It does feel a bit similar as the symptoms I had a week before my period when I was early peri.

[Konijntje]

Since the lower back pain turned out not to be a bleed coming on (it was really weird, I got very bad lower back pain, that faded pretty fast and then I had very bad pain in my foot that faded fast too, so probably a pinched nerve. If it comes back (it’s completely gone now), I’ll go to the doctor or physical therapist. It seemed to be unrelated to hormones though), and I kept having some hot flushes, I decided against waiting another week and went upto 4 pumps 2 days ago. I think this might be just a bit high for me though.

What are your symptoms of too high estrogen? I have a bit of a jittery feeling in my stomach I guess, I recognize it from (for me) more fluctuating deliveries (oral and patch give me both fluctuations).
So, I’m going down to 3 pumps again, but I was wondering (if the flushes come back) are others doing half pumps to get somewhere in the middle? And if you do, do you just eyeball it, just not press the pump all the way down on the last pump?