Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Anjia on October 11, 2015, 08:29:09 AM
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I have changed from a 2mcg oestrogen only tablet to a 50mcg estrodot patch because of IBS issues anyway feeling ok except flushes in the night keep waking me up making me tired the next day, do you think I should cut a patch in half next time I change it and so that I use one and a half patches 75mcg or should I ask my gp first don't no what to do ?
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Hi
My gp is very pro HRT I know I could phone her up and just ask for a different prescription.
If you think you may not get it then it may be worth trying with cut up patches first - then you can tell your gp it works when you ask for new prescription :)
Pollie
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Hi Anjia
I found that a 50mcg patch did nothing for my symptoms - probably because I'm at the younger end of the scale. I switched to a 2-3mg pill and slowly things improved. You have gone the opposite way so I'm not surprised you're getting symptoms. I would give it a little longer, but definitely consider a stronger patch. 50mcg is an average/standard dose, but 2mg pills are classified as a high dose. If your body is used to more estrogen, experimenting with 25mcg extra should not cause you issues.
My GP said a 50mcg patch is equivalent to a 1 mg pill, but I know others have been told differently. If I went back to patches, I would want to build up to 100mcg.
Hope this helps x
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You see I was meant to believe that the 50mcg patch was more than 2mg pill at least Im sure that's what my gp told me! I think I will try the extra half of patch and see hoe I go .
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Anjia, the 50mg patch did nothing for me at all, it was far too weak. The 75mg patch was not great either so I ended up on the 100mg. To be honest, I didn't find the patches much cop and prefer the gel by far - I haven't had many life changing experiences but going on to the gel was one of them.
I can only speak for myself but I find the gel much more powerful and it works far better. Also, I didn't like going around with a patch stuck to my backside. Is there any particular reason why you are using the patch?
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If you look on this site where the HRT info is, you will see that 50mcg is only a standard patch whereas 2mg pill is a high dose pill.
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I went for the patch after reading on here so many people getting good results from it but I don't think its for me I am now thinking of asking for the gel see how I am on that,you never no unless you try.
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Hi Anjia
Although the way we absorb oestrogen from the different modes of delivery varies, as Briony says, a 50 mcg patch is classed as medium dose and 2 mg tablet as high, so this does explain your symptoms especially if you absorbed oestrogen from the 2 mg tablet very well.
I would definitely persevere with the patches for the time being rather than change to gel but contact your GP and ask for a higher prescription. Even reading on here your doc should see that they are not really equivalent. I would suggest your doc might have been trying to see how you would do on a lower dose - as this is the standard post-menopausal patch dose. In the meantime no harm in cutting a patch in half to give yourself 75 mcg.
Hurdity x
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I'm confused now. What is shown on this site is that 50mcg patches, 2mg estradiol tablets and .625 Premarin are medium doses. When did a 2mg estradiol tablet become a high dose? The only "higher" dose tablet that is shown is the 1.25 Premarin or the 75mcg patch.
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This is what I mean Dana its so confusing I dident have flushes like the ones I have now on the tablets though really not sure what to do.
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You're right. I am sure 2 mg used to be classed as high on here!
Speaking from experience, I know that a 50 mcg patch did nothing for me so my doc, who's very clued up on ladies' issues, said let's try something stronger - and moved me to 2 mg pill (Qlaira) which has helped massively. She said you can't directly compare patch and pills, but now I am on roughly double what the patch was.
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This is the source of confusion:
http://www.menopausematters.co.uk/treatafter.php
http://www.menopausematters.co.uk/perimeno.php
- 2 mg oestrogen classed as medium dose
http://www.menopausematters.co.uk/postmeno.php - 2 mg oestrogen classed as higher dose
So - it depends where you look on this site!
Whatever the definition - and it can only be a loose one especially when comparing tablets to patches and gel rather than different doses of the same mode of delivery - the fact is you are experiencing flushes changing from 2 mg tablet oestrogen to a 50 mcg patch so it is most likely that this is due to lower systemic oestrogen levels in your body. Therefore you need a higher dose patch to control your symptoms.
Go for 75 mcg (initially by cutting a patch in two) and make that docs appointment!
Hope you see an improvement:
http://www.menopausematters.co.uk/postmeno.php
Hurdity x
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Well I went to the doctors today and told her what was happening that I thought I should have a higher dose of the patch but guess what she was having none of it! she said that I needed to reduce my hrt not to up it I was fuming I was put back on the tablet 1mg she said the flushes should soon settle at my age Im 55 but if they got to bad take two tablets there was no way she would give me another patch.
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You're right. I am sure 2 mg used to be classed as high on here!
Speaking from experience, I know that a 50 mcg patch did nothing for me so my doc, who's very clued up on ladies' issues, said let's try something stronger - and moved me to 2 mg pill (Qlaira) which has helped massively. She said you can't directly compare patch and pills, but now I am on roughly double what the patch was.
I've been hanging around MM on and off for about 3-4 years now, and 2mg oestradiol has always been considered a "medium" dose, along with the 50 patch. I also always refer to the Australian Menopause Society (which has an excellant site http://www.menopause.org.au/for-women/information-sheets/426-ams-guide-to-equivalent-hrt-doses) and they also regard both of them as a medium dose.
Of course these are guidelines only, and everyone has to make adjustments to suit them depending on the delivery method of the hormone/s, but I would suggest that the part of MM that states it is a high dose could be an error, because it also shows the same dose as medium, and that just doesn't make sense. Perhaps it should be reported to Emma/Dr Currie for clarification because everyone gets confused enough about HRT, without there being added confusion over doses. The bottom line is that HRT always comes down to trial and error, and if what you're using doesn't suit then you either increase the dose or you try something else.
Something else that needs to be taken into consideration is that some women simply do not absorb transdermal hormones that well. I suspect I'm one of them because I can be on a 50 patch for months and then suddenly it loses its effectiveness and I need to go back to the tablets. After a while I try the patches again and they will be okay for a while, but then they lose effectiveness again, but it never seems to happen with the tablets. Of course I could increase the patch dose, but I'm not sure that my doctor would agree, and the problem seems to be intermittant, and I'm not prepared to increase the overall dose for an intermittant problem.
This could be Anjia's problem as well. I have now probably come to the conclusion that I'm tired of the phaffing around and I will probably stick with the tablets, and just very slowly cut out one tablet a week for a while to see if I can decrease my dose a little.
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Well I went to the doctors today and told her what was happening that I thought I should have a higher dose of the patch but guess what she was having none of it! she said that I needed to reduce my hrt not to up it I was fuming I was put back on the tablet 1mg she said the flushes should soon settle at my age Im 55 but if they got to bad take two tablets there was no way she would give me another patch.
Being on tablets is not the end of the world if they work better. I know there is a tendancy for people to prefer patches, but they simply don't suit some women. I am even considering going back to Premarin, which a lot of people are very negative about, but in all my HRT trials and tribulations, interestingly Premarin is the one that has never given me any problems at all, and according to my pharmacist they dispense far more Premarin than they do any other kind of HRT. Here in Australia Premarin is actually more expensive than estradiol so it can't be because of the price. Maybe it's because, for some women, it just works better.
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Thankyou Dana I have come to the conclusion that you are probably right about the tablet I have IBS and after reading on this site many times that the patch is better the pill I did try the patch and must admit the IBS did seem to settle but that was all, the flushes and night sweats came back three fold in future I will stay on tablets the swapping around just makes problems worse.
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It's all so confusing. It's frightening how even our doctors give us different facts. For instance:
http://www.menopausematters.co.uk/forum/index.php/topic,25243.msg386811.html#msg386811
(Remember to divide by three to account for the three days of patch).
This is near enough what my doctor said too. I was on 50mcg patch and needed more so she suggested to double it, to either a 2mg BCP (which is what I did) or else a 100mcg patch.
I think it's best to conclude that we're individuals and absorb things differently. For me, the 2mg pill is massively better than the 50mcg patch as it is more controlling of my symptoms.
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Also to clarify re that earlier post you referred to Briony - it's completely wrong so not sure where the info came from ( ie re the dividing by 3!). A 50 mcg patch is designed to deliver estradiol into the bloodstream at the rate of 50 mcg per day ( OK there will be variation depending on the woman) so it is irrelevant that Estradot and Evorel contain a different total amount of estradiol - they work in different ways but are designed to deliver approx the same dose of oestrogen!
Whatever the biochemistry of it - Anjia - the fact that your flushes have returned shows that you are absorbing more estradiol from the 2 mg tablets than a 50 mcg patch. Your doc should not refuse to increase your patch size for this reason as you are still experiencing symptoms - because women are so variable. It also takes the body a while to settle - obtaining estradiol form a different source.
Transdermal HRT is definitely recommended for women with stomach problems and for women over 60 so personally I would persevere (with transdermal). As I think others have said - if you used gel you would be able to tweak the dose more easily. However I see you need to use what works best for you and what eliminates your symptoms, but your doc should not dictate to you what you need in terms of dose - if you still have symptoms - how assertive are you feeling?!
Hurdity x
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To be honest Hurdity I am not feeling very assertetive at all these days just fed up ,I really did try to explain to my gp but all she kept on about was the fact that I have been on hrt for three years and because of risks she wants me to start reducing it there was no way she would give me a higher patch I did ask .
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I don't know what to suggest unless you can find another doc in the practice who is more sympathetic or if you can take someone with you? The other suggestion would be to have an e-mail consulation with Dr Currie - costs £25 - which you could then print out and take to your doc - you would need to explain your history, your wishes and the response from your doc and perhaps what outcome you would like if she recommended it -eg a higher dose patch and remaining on HRT? The info on how to do this is on the home page of this website.
I did this myself when my doc recommended I came off HRT prior to an investigation. Once I'd got the answer (that I didn't have to stop HRT) I printed it off and went to a different doc in the practice ( I can't argue with my doc because she doesn't like me because I know more about meno/HRT than she does - she hadn't heard of Utrogestan when I requested it!). It was all fine - the different doc agreed and continued to prescribe the HRT and referred me for the investigation.
Hope this helps.
Hurdity x
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Hurdity, I too questioned the info in the link - I should have made that clearer! I posted it simply to illustrate the confusion/misinformation.
My doc did suggest that a 2mg pill was twice as strong as a 50mcg patch, but I am happy to accept this may or may not have been accurate. What is valid is the fact I felt so much better with the 2mg pill. I think (?) this is what is suggests here too, but apologies if I am wrong:
http://www.earlymenopause.com/hrt_equiv.htm
To add to the confusion, I think one of the many reasons I felt so much better was that on the patch, I had 12 days of progesterone and then horrible withdrawal effects. At least with the pill the dose is slightly more consistent (as it's a BCP). If I ever went back on HRT, I'd ask to take 100mcg patch (which was suggested as an equivalent to the 2mg pill) but I'd try to take the Utrogestan for days 1-25, if she'd let me.