Menopause Matters Forum
General Discussion => New Members => Topic started by: carolinec on January 14, 2014, 06:33:02 PM
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Hi - Im new to the site and I think its fab. I am 46yrs and prescibed HRT Evorel 50mcg patch to be used for 7 days prior to be period only - in other words, 7 days of evorel once a month. I am peri menopausal. Normal symptoms, panic attacks, hot flushes, anxiety, heart palpitations, insomnia, and mentally I get annoyed and upset more easily. - Would really love to hear of anybody else who is on a cycle like this please....blessings. x
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Caroline - yep we could shake hands up to the elbow apart from the periods.I am lucky(or unlucky?) if I have 6/7 periods a year and when I do get them you just know they are going to be bad.I don't have a regular cycle and the problem is how to combat this side of it.
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Hi there
:welcomemm:
I have been on the forum a long time and this is a new one on me. I don't see the logic behind it to be honest but that's not to say your GP is wrong.
Was it explained to you why only seven days. Normally at your age you are given a sequi HRT. That would deliver a steady dose of hormones, give you a monthly bleed and stop the troughs that you get when you are peri.
Someone else will be along with their thoughts soon but I can't see why at the moment.
Honeyb
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Honeybun and Chaotic thank you for your replies, I am grateful for any help. To be totally honest and I do respect dearly my GP - but I feel he is very very unsure of the menopause section of healthcare, as he advised me to put the patch on my arm, it wasnt until I read the leaflet that I realised it has to be applied below waistline, so that put queries in my mind. I feel that I told him I suffer the symptoms only 7 days prior to my period and I believe that is why is precribed the patches to be worm for that time frame only...I dont feel its correct either to be honest....and I wonder what it will do to my system....
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Honeybun, can you please tell me what a sequi HRT is ? God Im hopeless as this is all new to me....
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Right.
A sequi patch is for women who should still be having a period. You use an oestrogen only patch for the first part of the month and then a combined oestrogen and progesterone patch for the latter part of the month. You then go back to an oestrogen only patch with no break. When you withdraw the progesterone you then get a bleed. It mimics your own natural cycle. It keeps the oestrogen steady throughout the month.
In my opinion that's what you should be on.
If you look at the green menu on the left it will explain it better than I can.
If you have a good relationship with your GP then print off the details and go back and discuss your options.
A patch seven days a month makes no sense to me at all. You will just start to feel better and then probably worse again. It could also mess up your cycle.
Hope this helps.
Honeyb
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I have read about this but it is usually applied after the period until mid cycle. some women in perimenopause get symptoms when the period finishes, their estrogen drops much lower and is slower to build up, using a low dose patch 25 can help, the woman is usually producing enough progesterone of her own to counter the estrogen.
I use to get my symptoms after my period, some get them before.
This method also been used for women who get headaches and migraines if her estrogen drops to low during her menstrual cycle.
It really doesn't matter where you put the patch, (except the breasts) think of the gel, that can be rubbed on shoulders, arms and thighs. The patch trials were done on the stomach and buttocks that's the reason its suggested you use that area.
I have used my patch on the top of my arm and the back of my shoulders with no ill effect ( I like my baths) I have told my doctor and she never suggested I shouldn't.
Good luck with patches carolinec if you found the 50 patch too much you can always cut it in half.
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Silverlady and Honeybun, I dont know how to thank you both. I live in ireland in a beautiful but rural secluded area, it is like the menopause doesnt exist here. It is not discussed at all. I felt so isolated with the questions in my head - I want to thank you both, you have no idea how much your comments help, I dont feel alone anymore - and you both have given me confidence to question myself and maybe my GP also...so thankyou.
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carolinec
You are right that instructions for the patches say that they should be applied on the lower trunk or below the waist - I've looked at two brands. They also say they should not be applied on or near the breasts. The instructions are the same for Sandrena gel.
Oestrogel is different from all the others but inconsistent:
The correct dose of gel should be dispensed and applied to clean, dry, intact areas of skin e.g. on the arms and shoulders, or inner thighs. The area of application should be at least 750 cm2. One measure from the dispenser, or half the prescribed dose, should be applied to each arm/shoulder (or thigh). Oestrogel should NOT be applied on or near the breasts or on the vulval region.
To my mind the shoulder or upper arm is near the breast and frankly, I wouldn't apply it there.
Your doctor clearly does not understand menopause and HRT dosing. For start he is giving you extra oestrogen - which is great but normally you do need extra progesterone too to ensure your uterus lining does not build up too much. Added to this women experience anovulatory cycles during peri-menopause - ie no ovulation therefore no progesterone that month - which leads to heavier bleeding anyway.
I can understand the reasoning behind extra oestrogen as silverlady mentions and it is used as a treatment for pms - Prof John Studd has done a lot of work in this area. However as you will see from his article you would nee extra progestogen too. here is one of the pages - but there is a lot of info on his site.
http://www.studd.co.uk/pms_treatment.php
I agree with honeybun - you would probably benefit from a low dose sequi HRT - although you may still experience heavier bleeds if you are still having regular periods, but it will definitely be of great benefit if you have started missing periods.
There is a good article about the biology of the peri-menopause here:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php
Hope this helps
Hurdity x
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It all goes into the blood stream wherever is applied and whatever make or brand of estrodiol and is dispersed around the body, or the transdermal method would not work.
Some women in perimenopause do have dips in the estrogen before the progesterone start to decrease.
caroinec didn't mention period problems but " panic attacks, hot flushes, anxiety, heart palpitations, insomnia, and mentally I get annoyed and upset more easily" and this is how her GP has chosen to treat it, full HRT at this time could be too much and may well have been his thinking. The only thing I would question is that her GP should have prescribed as 25 patch instead of a 50.
I am sure she will go back to discuss things with her GP if she has problems with his treatment.
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Ladies, I took all your advice and headed to a lady doctor yesterday evening. Like you, she never heard of somebody taking evorel patches for just 7 days a month prior to period. She prescribed the evorel conti patch which has both hormones in it (just as ye advised). So Thank you. I have my patch applied to my bum today - feeling light headed - but OK. Thank God. Its now 7 days before my period - fingers crossed, I wont get headaches, palpitations, hot flushes, anxiety, numbness, loss memory, aggitation, insomnia etc etc.... Let the good times roll please....X
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Good news carolinec - I do hope these work for you and you feel better! There may be side effects initially but hopefully these will subside soon.
It all goes into the blood stream wherever is applied and whatever make or brand of estrodiol and is dispersed around the body, or the transdermal method would not work.
Not sure what you meant by this silverlady? Were you querying the instructions on application site?
Yes of course it goes into the bloodstream wherever it is applied but the instructions for several brands are explicit re not on upper trunk or near the breasts.
I imagine this will be because there is a concentration gradient of estradiol emanating from the application site, where it will be at its highest. The point is if it is applied far from the breasts the serum concentrations will have stabilised at the levels expected for that particular dose and not be artificially higher ( which they will be at the application site).
It is a possibilty that the pharmacokinetics for Estrogel are slightly different from Sandrena and the patches, although I would be surprised....
So just to emphasise, in this respect (re application site) it is very important to follow the instructions and could be risky to disregard them
carolinec - do keep us posted and let us know how you get on
Hurdity x
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Sorry to throw this into the mix but why a conti. It's usually a sequi for someone your age especially as you are still having a period. This type stops you bleeding (in theory ) completely.
I think you may have a few problems with random bleeds as you still have some of your own hormones rattling around.
To my mind you should have a sequi HRT and a bleed every month.
At least with a sequi you will know exactly when to expect a period.
Honeyb
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Honeybun, you are right, I just checked the leaflet, evorel conti is for ladies, normally into their 50s who havent had a period for 18 months....
Oh god thats two doctors that I feel have mis prescribed for me. I had the patch on from 8am this morning and I just pulled it off now....will have to ring the clinic AGAIN in the morning....
Its very upsetting to know that such confusion in the clinic can occur.....
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it was a lady gp this time Honeybun, I automatically assumed she knew what she was prescribing, this is the second gp I have gone to re the matter this week.......
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Unfortunately this mistake is made quite often. A phone call will hopefully help.
I am on the conti version. I changed over from sequi at 51 due to spotting. My GP assured me it was ok for someone my age and Dr Currie confirmed it. The difference between us is that when I started HRT at 49 I had not had a period for about seven months. They still started me on the sequi which suited me fine.
Hope you get it sorted out soon. Trial and error but you will get there.
Honeyb
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Thank you Honeybun, I am going to contact the clinic in the morning....I presume I wont have any funny effects now that I pulled off that conti patch....oh god Im hopeless
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Honeybun, thank you for understanding, you have no idea how good you have been to me, I truly appreciate you taking the time to help me out. Wishing you many good blessings. thank you again.
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Don't worry you will be fine. Just a pity they messed up and you can't just get on with feeling better.
I felt a difference, especially with my flushes, within two or three days.
Lots of positives to look forward to when you finally get the right patch.
Let us know how you get on.
Honeyb
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Caroline in no way did you upset me it had nothing whatever to do with you. I really hope you get your treatment sorted out sometimes it takes a while.
Blessings to you too.
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Ladies you have all been so good. I went back again (3rd time ) to clinic. And they gave me another appointment on Monday evening at same clinic. However I since found out there is a private GP who deals in menopause specifically and he is only 20 mins drive from me.....I wondering will I close the door on the clinic and go to him....oh holy frog. !!!
I know now for all of your advise that I should be on the HRT Sequi - so maybe I should stick with the clinic and just ASK for it....
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I would also suggest that you follow the instructions with the pack as to where to apply it which are
"Method of Administration
A treatment cycle with Evorel Sequi is 28 days. During the first 14 days, one estradiol-only (Evorel 50) patch should be worn at all times, without interruption. During days 15-28, one estradiol + norethisterone (Evorel Conti) patch should be worn at all times, without interruption. A subsequent treatment cycle should follow immediately, without a treatment free interval.
Patches should be applied to the trunk, below the waist. Patches should be changed twice a week, i.e. every three to four days. Application of a new patch should be to a site different from the previous application site. The patch should not be applied on or near the breasts."
I've always put mine on my buttock. One reason not to apply to the upper arm is that the patches react to sunlight so you would have to make sure that your arm is covered should we ever get any sun! The sunlight increases the amount of hormone delivered through the skin so you wouldn't get an even amount. You should also avoid sun beds while wearing a patch for the same reason.
Hope this helps.
Taz x
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I see your point Taz but what happens when you have a hot bath, that's a lot more heat then you would get from the sun, I have a bath morning and evening for as long as I can remember and my bottom and thighs were immersed, the only problem was it loosening the patch, that's when I decided to wear the patch higher. My doctor never said I shouldn't, of cause I was only dealing with one patch estrogen only.
I have sunbathed with the patch on and it the garden with the patch showing and used sun beds with no ill effect. Even abroad where it was really hot.
Of cause women should do what they think best and follow the instructions I am just saying that it has never caused me any problems, and as I have said reading in depth books about HRT and its history (which is eye opening) the original trials were done with the patch on the tummy with the thought that they were near the ovaries, also the original trials on hormone therapy were done on men!!
Instructions to apply the patch below the waist is because is because there is less chance of wrinkling and ruching of the patch therefore altering the dose.
My original post was in reply to the Carolinec's GP telling het to put an estrogen patch on her arm for a week before her period to counteract her symptoms and explaining why he might have come to this conclusion.
carolinec you should follow the instructions for any HRT prescribed , as for your question about about seeing a private GP who deals in menopause, I understand why you feel in a quandary, but maybe you should keep the appointment on Monday evening see how it goes, at least you now know you have another option which is always good :)
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I just assume that the manufacturers have good reasons for the advice given.
Taz x
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The manufacturers dot the i's and cross all the t's to cover themselves, and most women will prefer to put the patch where its recommended.
Other women will get more innovative, the problem is when women get panicky and worried about HRT and following instructions to the letter.
When I have worn my patch higher on the back of my shoulder its hidden anyway, I do move it around so as not to keep using the same spots.
The nicotine patch works on the same basis as the patch ( the drug is in the glue) and men and women wear it on their arms, anyway that's my take on it and I don't expect others to share the same view.
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I found this on another forum which made me chuckle.
"Re: Where do you put the patch?
Wow, this is interesting. I am using estriodal patch. The nurse stuck it to my upper back, blow my shoulder. I asked the Dr at my week post-op follow up where I am supposed to put it, he said anywhere..that it didn't matter. Last week I put it on my upper butt, more like lower back. This week I stuck it a little higher..about mid back. So where am I supposed to put it?! Lol next week I'll stick it to my forehead and be done with it. Lol"
Taz :)
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Shes forgotten underneath her feet on her soles ;D ;D I read on another forum that a woman's husband suggested this, because she was moaning that she did not want her patch on show, it was in America.
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My friend's husband ended up accidentally wearing one of her patches on the sole of his foot - didn't discover it until he took his sock off that night and she hadn't missed it.
Taz x ;D
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Was he more able to get in touch with his feminine side Taz ;D
My place of preference is top of my leg/hip area. It does not get creased and crumpled there and its out of site. It also means I can remove the glue over a couple of days and not have it on view. It doesn't matter in the winter but I would not like it on view in the summer.
Honeyb
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Thank you ladies,you are so helpful and so full of knowledge, blessings to you all...I went to yet again another GP - this time an alternative one. He did bloods, checked my tongue, eyes, skin on my hands, stomach, heart etc.... he did blood tests that are not the norm....guess what....he is a menopausal specialist....yipee at last and he said I am not in the peri menopause yet...but my estrogen is low.... so he said to hold off on HRT - Im back with him tomorrow....he will be giving me estrogen but not HRT - will fill you all in tomorrow on the prescription, he feels its 2 years of severe PMT symptoms....Holy Frog !!!!