Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: hereandthere on December 13, 2018, 11:17:25 PM
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Hi everyone
After one year on Evorel Sequi I'm changing to 2 pumps of Femigel (in SA, UK it's estrogel I see) and 100mg tablet utrogestan daily. I was really happy on the Evorel but asked for a change as I'm worried about hair loss.
My gynae says I have to wait a minimum of 7 days with no HRT before starting the new regime.
I only realized after my appointment that I'm surely going to get my bad flushes and insomnia back. I'm already awake again on the second day past midnight!
Why the seven days? I couldn't find this on a post.
Luckily and unluckily it's Christmas time. :-\
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I presume he said use up the whole packet and then wait 7 days? I imagine this is to allow for a bleed without building up the lining with oestrogen. However I would suggest that stopping for 3 days (after the last of the Evorel sequi combi patches) would be sufficient. Also even if you started the gel straight away you shouldn't get much build up (of womb lining) in 3 days so probably I would do this ie finish the packet. Start the gel and then after 3 days start the utrogestan. You should get your bleed as normal. This is my suggestion however go with stopping completely - but for 3 days - if your gynae gave a specific reason for this?
Also I presume you are over 54 and have been using HRT for a while or post-menopause? The regime you have been prescrobed is for post-menopause whereas Evorel sequi is for peri. If you are not yet at menopause ( but you won't know this probably if you started hRT before reaching menopause) then you could get sporadic bleeding as your natural cycle kicks in if you take progesterone every day.
Hurdity x
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I would be ringing for clarification. Point out that you weren't clear about the necessity of a gap between products - this may trigger his bed-side manner and 'teach' him to be more clear. Many times I had to explain to patients what the SHO had meant ::): they know but that doesn't mean that they are able to be specific :D
How's the weather there ? [I'm so nosey]
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CLKD the weather is very hot! I was sweating yesterday with my Xmas party zip lining. It's around 28 to 30 degrees lunch time, but we have high humidity so it feels hotter. Thanks for your advice guys- really appreciated!
Yes, my gynae provides explanation but he is a very quick talker, though I can be a bad listener-A.D.H.D. and no medication 😆 .
Hurdity, you're right that he wanted the king to shed, which he pointed out on the ultrasound. My period in fact started late yesterday (2nd day after my last conti patch). He said the recommendation is a minimum of seven days no HRT, but it can be more if I want, so he suggested to just stick with seven days. He is a pretty old gynae (older than me 😆),but runs a bone density clinic and his specialty is menopause.
I'm 49 and suffered hot flushes for ten years. When I started on the Sequi a year ago (at 48), I did blood tests and a vaginal ultra sound (in his rooms), and was apparently at the start of the menopause, hence the Sequi as you say Hurdity. I had only missed a few periods and having had tests 6 months before that too, my gynae said there was a very large decrease in hormones since that point, matching my periods going away.
Now a year later I haven't had further blood tests but my gynae did the ultrasound and showed me (not that I could actually see it myself 😂) how my poor ovaries have shriveled, so there's been a lot of change again since then he says. Which is why when I voiced concern about my hair he said he thought I was ready to go on to this regime, which he said the Alzheimers Society (SA/UK/US/global? Not sure), is the most recommended one there is currently.
I have to take the utrogestan every day but he said to just phone if I get unwanted spotting and he will change my prescription to being cyclical again.
So Hurdity and CLKD, I assume that if this prescription is not suitable my body will let me know with the spotting?
One thing I did mention was that I've noticed a tiny bit of flushing lately on my Sequi and did that mean I needed more hormones? He said no, that was interference of my own hormones over the Sequi. He said the Sequi was the highest level of hormones I was allowed, so it's not possible to up it to get rid of all flushing. I assume the estrogen? Find that a bit confusing.
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Hi Hereandthere
I'm thinking he might have meant that 50mcg is the highest oestrogen level on the Evorel Sequi patch.
The good thing about the gel, is that 2 pumps is sort of equal (I believe) to 50mcg patch - so if it's not a high enough dose, you can always go up from there xx
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Thanks NorthArm, that makes sense. Good to know I can increase the estrogen if necessary. I wonder if South Africa has a different guideline for maximum estrogen levels (for persons not at cancer risk). Do you know what it is in the UK?
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I'm not sure - I'm in Australia myself and the only gel equivalent allowed (lucky us!) is Sandrena gel. I myself am on a 100mcg patch, which is marvellous...we're about 20 years behind the eight ball - Utrogestan was only approved for use here in August last year 😂😂
As for maximum dose in the UK, many ladies on here are on as many as four pumps, and a handful are on as many as six...
Isn't it strange how the ‘rules' for ‘women's troubles' are so different in each country - strangely there's no such difference in Viagara or testosterone for men 🙄🙄.....I find it frustrating in the extreme...! Surely we all have the same biology?? Hopefully ours will be the generation that changes this....
When you start the new regime, will you be doing a sequi or a conti regime? If you find the Utrogestan hard going (I do) and you're on a conti regime, you can always ask to go on a sequi...it will give you a bleed, but the reduced amount on the sequi may mean you'll feel a bit better on it. Just remember to take it in the evening as it can be very sedating.
Good luck with it all xx
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Thanks NorthArm. The variation between countries is interesting. Obviously still so much everybody is not 100% sure of. So many South African friends and family have emigrated to Australia. Sounds like there is one reason not to though😉
I'm going on the conti after the Sequi for evorel so a bit daunting I must say. My gynae said to change to Sequi if I get spotting. But what do you mean by being hard going? Thanks for the tip about when to take it. I'm also worried about feeling nauseous on the tablet as I'm sensitive to that.
The Evorel Sequi was so perfect for me, I must say I'm wondering if crazy to switch. This is all on account of me trying to avoid the norethisterone in the evorel conti part, due to my hair thinning.
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Oh lol, hereandthere, we also have awful biting things..yuck! But our marsupials are rather sweet...
The Utrogestan makes me feel a bit down and anxious, I get flushing (but nowhere near as bad as it was pre hrt!) and find it a bit tough to stay asleep. Apart from that, the sedative effect means I literally crash when my head hits the pillow. I was having a bit of breakthrough bleeding on it, but that seems to be settled now...basically I feel very pms whilst taking it. I have been taking it orally, but next time I'm going to try it vaginally and see how I go - it's a capsule and is also quite effective when used this way apparently.....loads of ladies on here find it better tolerated.
Best thing about it - I haven't lost any hair lol...
Keep us updated, and I hope it all goes well, sounds like your gynae knows his stuff xx
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Thanks for the support 🤗
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I don't do heat ::) - it was 7 weeks straight with no rain in our garden this year, fortunately we face East/West so could escape the intensity.
How R U today?
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I just stuck to the recommendation as I was ok. However five days probably would have been better than seven as it was the last couple of days I noticed sleep trouble.
I had a few night sweats starting with this gel and concerned I've no idea how much not to overly rub into my legs and how much to pump out- a total depression? How should I know how much gel is 1.25g per pump?!!
I'm also wondering if this tingling in my arms coinciding with the gel and the utrogestan can have nothing to do with the HRT. I hope not! Going to see a GP about it after my holiday and will mention the HRT.
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I haven't used pump packs of gel but from what I understand one full ( ?metered) pump gives a standard amount of gel ie 1.25 g containing 0.75 mg estradiol - so yes that would be a total depression - bloop!
The general advice is to apply rather than rub as it (estradiol) needs to soak in before it dries (alcohol evaporates) and also not to spread on too large an area - however rubbing won't do any harm if the formulation enables you to rub it in ( if it's like Testogel - and is a similar formulation - then it's very slippy so spreading out may be the best way), provided you apply it consistently and to the same body part (!) each day - as this will give you the most stable and consistent dose.
Hurdity x
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Thanks Hurdity, I'm trying to spread less. Mine has no way of measuring except a full pump, but my gynae did say to just swipe and not rub in. Just because I'm having flushes again, wondering if I'm doing it right.
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Hi Hurdity
I'm not sure if I'm supposed to start another thread here, but after 7 weeks I had a blood test- oestrogen only, as my flushing has got pretty bad again. I'm in summer, which hasn't helped.
So my gynae said my oestrogen level is low at 113 (photos/ml I'm not sure in SA?),
so I'm not absorbing well. I asked what was good and he said should have been 170. Since my hair fell on the Evorel patch, he suggested a pill, although that has an increase of 12% for blood clots. (which he said is not bad).
I asked about trying one more pump (so three in total) and he said I could try first.
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Hi here and there
Do they have oestrogen only patches in SA? Because you could try that before a pill, it gives a more consistent dose.
About gel application I'm not so sure - some say to just apply but no rub in, whilst others say differently. How are you going on the three pumps?
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Thanks NorthArm
I'm not sure about an estrogen only patch, but I will definitely ask thanks for the tip, as the patches seemed to work well except for my progesterone hair loss problem. I've only done two days with the extra estradiol pump so not sure. I did feel some flushing at one point last night, but slept quite well. Probably got to give it a while.
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In the UK you can go up to 4 pumps of the oestrogel. I am post meno and I need 4 pumps. On the forum here there are ladies who have posted that they have been advised 6 but I think this group of women are quite in the minority. Conventional prescribing is usually up to 4. One of the things I like about the gel hereandthere is that you can play around with it without asking the GP all the time. Obviously when you up the dose you need repeat prescriptions more frequently but at least you can see how you feel uping it yourself and then go back to the GP and say "well I increased my dose and it's working so can you increase my prescription...". Or you will be abele to say uping the dose doesn't make any difference.
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Thanks ladybt28. I asked my gynae when he called with my results if I should try 4 pumps and he was ‘no, that would be double!' but I see here as you say that others are doing 4.
I'm a bit confused about my result of 113 for oestrogen, as it seems incredibly low compared with others, but maybe it's a different measure. At least I'm getting no spotting, which supposedly going off Evorel Sequi was maybe going to do. My periods are well and truly gone!
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Interestingly it was my GP who said 4 was fine and so did my meno consultant. I believe the starting dose is 2 pumps but the main max prescribing dose is 4 and for special cases as many as 6. Its a bit concerning that the gynae didn't know this. I think that there a doses listed in Professor Studds papers if you go to his website.
Sorry I can't help with blood levels I have never had a blood test. My consultant and GP go on the "control of symptoms". There is a lady on here who is very good with that sort of thing maybe she will be along?
Glad no spotting, at least that is one off the list, you are probably going in the right direction hereandthere.
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Hi there - just a quick question - yes as said it is important to know the units of measurement for estradiol as they are different. In UK it is pmols/l but in US ( I think?) pg/ml and to convert from pg/ml to pmol/l you multiply by 3.67 so results will look very different to what we are used to discussing if in pg/ml. However if your gynae says your result is low at 113 then sounds like it could be pmol/l? Once we have the answer we can advise better if you need any more help?
Hurdity x
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Thanks Hurdity
I've mailed my gynae as I can't work it out and will tell you. He did say 170 would have been ok.
We are normally thesame as the U.K. so the metric system for example applies- properly - we don't say pounds and stone. Some of us oldies like me do say feet for height. 😂
I've done an extra/3rd pump application two days now and I feel even more bloated, but my gynae said this would be the progesterone. So it doesn't make sense if I'm taking in more estrogen and getting bloated, but maybe as only two days and on low levels, this is the relatively high progesterone effect. Does this make sense?
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Just saw this from Dangermouse- ‘When estrogen is surging and progesterone is low, water is diverted away from the bowels to protect more important organs and it causes excessive bloating and slow transit. Apparently in pregnancy this is a good thing as it allows more nutrient absorption due to the slower journey through.'
So maybe the extra pump is having an effect. But I've been bloated just not as bad since starting my new regime where I'm supposedly not absorbing enough estrogen, so all very confusing.
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hang on in there :) hereandthere, if the bloating is not as bad then you may just have to wait for it to settle. I dropped a complete dress size in the first 3 months of my new regime. But the adjustments don't happen quickly but if you are seeing something well...just hang on in there!
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I think increasing oestrogen can cause a bit of bloating (water retention) - so I've read - but would be accompanied by nausea perhaps and tender breasts (?) - and would settle fairly quickly? Bloating due to progesterone tends to stay around more I think. I find I get bloated when on the prog part of my cycle but I'm only ever on it for 12 days at a time so no idea if it would settle.
Hurdity x
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Thanks guys, I'm guessing it is the relatively high progesterone. I'm not nauseous and usually I am quite a bit.
Will see after a week or so if the extra estradiol pump.
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Hi there - just a quick question - yes as said it is important to know the units of measurement for estradiol as they are different. In UK it is pmols/l but in US ( I think?) pg/ml and to convert from pg/ml to pmol/l you multiply by 3.67 so results will look very different to what we are used to discussing if in pg/ml. However if your gynae says your result is low at 113 then sounds like it could be pmol/l? Once we have the answer we can advise better if you need any more help?
Hurdity x
So Hurdity I got confirmation that it is indeed pmol/l that it's quoted in. Do you have any other comments now that you know this?
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I know blood tests are inaccurate but if that result is an approximation to your level then it is low if pmol/l which is what your gynae said anyway. Sounds like you might not be absorbing it that well? Has the extra pump of estradiol gel improved things? If not maybe try patches again - but you would be able to have a higher dose than 50 mcg as you are now doing separate oestrogen and progesterone.
Hurdity x
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Thanks so much for your comments Hurdity xx
It does seem better with the extra pump though still getting some flushes and so thinking of m just trying 4 pumps to see how it goes. Previously on the Evorel Sequi patch the flushes first cleared up immediately but then had crept back slightly, presumably as my estrogen was falling dramatically at that time. Not sure what to do about the bloat which is worse than ever and likely due to the utrogestan capsule. If the estrogen is increased, should this help balance the progesterone? Feeling hopeful ;)
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Just wanted to add I got this awful heads on the weekend sort of shooting pain in the side front of my head whenever I stood up. If this can relate to the estradiol a bit scared to up the pumps. I never had this sort of headache before.
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I just wanted to update that after a month my bloating has been horrendous but just this last week or so it's been much better. No more headaches either. So it seems the advice to hang in there was good, as well as to increase the Femigel (estradiol) from two to three pumps, which wouldn't have happened without this forum. I also found advice to apply to the inside of the leg where skin is thinner and I reckon this also made a difference. 😊
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Really pleased to hear things are going in the right direction hearandthere . The advice to hang on in there does work most of the time but when you are suffering "hanging on" for a couple of months or more seems nearly impossible, doesn't it?!
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For sure!! Bloating got better but I just added a fourth pump for this last leg to gauge the difference, as my flushing is pretty bad again. :'( As the doctor said my absorption of the estrogen gel is not good according to the blood test, I'll probably switch to trying the oral route at my next appointment, same as the utrogestan. I'm soon starting on the last pump of my prescription. Felt really wired a day ago, then better the next day. So far after a few days I'm still getting flushes.