Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: LuLu71 on September 14, 2019, 02:39:36 PM
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Hi Everyone,
I'm wondering if there's people on here who have been advised by their doctor or gyno to increase the estrogel pumps to more than two times per day? If so, for how long?
I recently started to increase my estrogel pumps to four times a day because I was so sick of not sleeping and feeling hot and being dry down there...it really was working in every area and I was finally sleeping again and like magic I was feeling so much better down there. When I went to see my gyno almost two weeks after increasing the gel, she advised that I was giving myself too much and that the amount I was using increases the risk for breast and uterus cancer. So, I am back to just two and my symptoms are coming back.
A little background on me-today I am officially postmenopausal, yay (no period in a full year)! However, what a horrendous year of health struggles that I am now so sick and tired of. I am on the continuous HRT with 100 mg progesterone and two pumps of estrogel (17 estradiol 0.06%) per day. This week I started vagifem 10mg for my dryness.
I am asking on here because after searching the forum I read that a few ladies on here had their doses increased but it wasn't clear if they did this on their own or if a doctor had prescribed more than 2 pumps. My gyno is quite respected in women's health and hormonal related issues so I really take her seriously when she warns against more than 2 pumps a day. However, I did read in the estrogel pamphlet that sometimes women need more than two pumps...it's so confusing!
Thanks so much for reading and I would be so grateful to hear from people about this subject.
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Hi you can use up to 4 pumps. I use 4 pumps.
Some ladies use more than 4 pumps under specialist guidance x
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Dottie, thank you, that's great you use 4 pumps. What does specialist guidance entail? ie. extra blood testing, some restrictions in other aspects of your daily living? Did the specialist warn you about any risks by increasing the dose?
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Hi there are no further risks using up to 4 pumps. I asked if I should try decreasing the amount and was told not to. The instruction leaflet says you can use up to 4 pumps x
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Hi
I use 4 pumps per day , hrt clinic put me on this dose abd didn't mention anything about 4 pumps being higher risk to cancer
Kaz x
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Hi Lulu71, I use 4 pumps a day. Agreed by my GP. 2 in the morning on thighs (each thigh) and then 2 more, one on each arm in the evening. 2mg of zumenon/ progynova just wasn't doing it for me.
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Hi Everyone,
Thank you for letting me know that doctors do prescribe this much. Just to confirm, are you all using estradiol 17, .06% estrogel? And 100 mg of progesterone (if you still have your womb)?
Also, sorry to be a pain but where are all of you in your menopause journey? ie. beginning peri, mid peri, late peri, menopausal/ postmenopause? Thank you so much everyone!
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Hi Lulu71, I think it's the same, I'm using Oestrogel, green/ turquoise capped bottle with swirly pattern on it.
I'm using Utrogestan 12 x200, shortly to switch from oral to vaginal delivery. (See my thread- thank you Hurdity!)
I'm 49, been on forms of HRT for 2 years; in hindsight, should have started a couple of years prior. I reckon I'm post now. Still got womb and ovaries.
Tried a conti programme, but prog symptoms were too much; I prefer a sequin cycle. Good luck, hope you get it sorted out x
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Hi Annedenmark,
Thanks again for responding. Interesting that you are on 200mg of a progesterone (utrogestan) and I'm only at 100 mg of progesterone. I wonder if this is why your doctor thinks it's okay to use twice as much estrogel? I will check out your post on Utrogestan, thanks again.
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Hi LuLu you are fine on 100mg per day. This is the post menopausal dosage . If you are in peri then you take 200mg for 12 days of every month.
I'm post meno and use 100 mg of Utrogestan and 4 pumps of Oestrogel.
You are on the correct dose x
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I use 3 pumps per day. I increased in 0.5 increments and both gynae and dr are aware of the 3 pumps. I did this all off my own back but told them x
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I'm peri and use 3 pumps, specialist said I could use 4 if I needed to. You should use the least amount that controls your symptoms and advisable to increase gradually.
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Thank you so much everybody for answering my questions! I really am truly grateful for this site and the caring members on it.
I am going to go back to 3 pumps every day for a couple of months and then perhaps taper down to 2.5. If I notice swollen boobs and a headache I will adjust as needed sooner.
I guess I will have to make something up to my gyno if she asks why I need estrogel prescriptions quicker than in the past ;) I get the feeling she is much more on the conservative side of all of this but I have to sleep and be able to work again darn it!
Thank you and if anyone wants to share their experience here about estrogel please, jump in! I hope I can offer some help on here too.
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Hi Lulu,
My levels on 2 pumps Estrogel after 3 months was still too low at 91pg/ml and it needs to be around at least 350 to protect heart and bone health which I achieved quite quickly by increasing to 3 pumps. This was under the instruction of menopause GP and could have increased to 4 if necessary under her instruction. My hot flushes and tiredness had gone after the 2 pumps but three pumps helped with my very achy joints and I now don't go down the stairs painfully in the morning lol!
I am on continuous Utrogestan 100mg and am post meno age 53
Grace x
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GP said 4 pumps and meno clinic concur. I have been on 4 pumps for a year now. I use 200mg utrogestan on a cycle 12 days vaginally but I do know 100mg vaginally is also ok. I would stake my life that I read on the forum that one lady uses 5 pumps on the advice of her consultant and the absolute maximum under supervision I have heard is 6! Don't whatever you do, LuLu tell that to your consultant, by the sounds of it, she's so conservative, she'd keel over! x I'm not suggesting that you try anything over 4 LuLu which seems to be the most common "higher dose" - the others are the exception. x
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Hi Gracie and Ladybt,
Thank you for sharing that information about levels of estrogen needed to protect heart and bones. It's such a relief to know I won't be inducing cancer by increasing up one pump. Really, it helps so much with my sleep and sleep has an impact on everything in the body! For instance, last week my blood tests came back saying that I am prediabetic which I read can happen in menopause from lack of hormones and sleep...So glad for you that it has improved how your joints feel. I read somewhere that estrogen is involved in over 400 aspects of the body's functions...no wonder why so many of us feel so terrible through what is supposed to be "natural."
Ladybt, I think my gyno would take my gel away if I told her about 6 pumps a day lol. It's strange how I trust so much what this gyno tells me except for increasing gel - which is actually a huge thing. It's a shame I can't ask her more about why she is against using more because I am a bit afraid that she might stop being my doctor lol. She will never know that I am increasing the gel pumps! Thanks for sharing that both your GP and meno clinic concur on the dose. Sets me at ease.
Best of luck to you both with this "fun" journey!
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Dotty's right: you can either take 100mg for 25 days or 200mg for 12 days depending on whether you are peri or post; although some post women still prefer to go with the sequi regimen. I'm following the same regimen as Ladybt28: 4 pumps daily and then 12 days of 200mg Utrogestan per month- which I am now taking vaginally; interesting you suggest Ladybt28 than 100 vaginally on a 12 day cycle is okay, Something to consider...(under supervision obvs.)
Anyway, 4 pumps is a prescribed amount (And my GP's a 'by the book' type). I think I read that some women have used up to 6 pumps; but I would guess too that this is under supervision.
Good luck,
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annedenmark - the theory goes that 100mg vaginally can be sufficient as it is absorbed immediately into the right area. Obviously if it is taken orally then it is broken down by going through the stomach and the liver and so 100mg would be far too little orally. I do 200mg because I use 4 pumps, but some ladies who have mega mega problems with progesterone only do the 100mg.
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Ladybt28, given I'm on 4 pumps so I'll try 2 or 3 cycles of 200mg x 12 vaginally, to see whether that dissipates the prog symptoms I've been getting when I've taken in orally. Thanks for the info re absorption; I'd rather not drop to a lower amount of Utro without medical supervision.
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Hi Ladybt and Annedenmark,
Thanks for pointing out that the progesterone is taken vaginally at 100 mg with the gel being >2 pumps. I only take 100 mg of progesterone orally a day, every day, no intermittent pauses in any type of cycle...I've started 10 mg of vagifem vaginally but this is estrogen....
So, orally taking progesterone at 100mg isn't enough to take more than 2 pumps of estrogel a day with? Or do you think that is okay?
Thanks so much in advance for answering.
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I'm really no expert, but I would have thought that taking 100mg everyday of the month orally, would result in similar (if not greater) progesterone intake to the 12 days a month at 200mg that I've been prescribed to take orally, (alongside 4 pumps gel daily) -disregarding that I have changed to vaginal delivery. (I've done this to try to reduce uncomfortable prog symptoms, But I still take 200mg for 12 days).
As I said, I am new to this forum, (hence my newbie status) so I would strongly suggest you confirm this with your GP, and of course wait for an expert on this forum, too!
Sorry I can't be of more help,
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Thanks annedenmark for responding. It is tricky eh? I wish all of this was written somewhere online by the pharmaceutical companies or professional articles. I wonder why it doesn't seem to be anywhere- that is, how much progesterone to take alongside the estrogen/estrogel.
If anyone out there is taking 100 mg of progesterone daily and more than two pumps of estrogel, I would love to hear about it! I'm thinking I can't really ask my GP because my gyno wrote him a letter explaining what I had been doing and why she feels this is wrong...I think he would side with her. Guess I could try for a second opinion from another gyno if I need to.
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Sorry if I have confused but there is some confusing information around dosages.
The prescribed dose on the leaflets and by GP's is either 100mg every day which is a continuous regime or 200mg for 12 days out of a 28 day cycle. The prescribed dose is also taken orally....this is what is written down and general prescribing but...
in Europe utrogestan can be used vaginally as I described because it gets absorbed direct to the right area and doesn't get broken down by the stomach...therefore some consultants will say you can use 100mg for the 12 days.
The difference in dose between the 100mg continuous or the 200mg 12 days is because the 100mg builds up in the system and is taken as it says "continuously". the 200mg is the higher dose because it has to create a "hit" if you like over a shorter time to fool the body into a false period. So the job of utro in 100mg dose continuously is to "stop" the womb lining building up and creating a balance so there is no bleed and the 200mg dose is to trick the lining into "shedding" what lining has built up.
I hope that clears it up...I don't know how else to explain it... :-\ it depends what regime you are doing continuous or cycle and how you are taking the utrogestan vaginally or orally (also how you get on with progesterone at all!) x
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Thank you so much for sharing all of your knowledge Ladybt. Whew, I feel better now about going up to three pumps again. I know that I should also let my doctors know but honestly, as I said before, I'm scared my gyno may take the gel away from me lol. And it kind of freaked me out that she wrote to my GP about what I was doing, like she's covering her butt in case something goes wrong...
Thanks again for explaining. I understood what you wrote to clarify all of the differences in routes. Have a lovely night :)
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The main thing is that the dose of utrogestan given as the licensed amount (ie 100 mg for conti or 200 mg for cyclical) - is the given as the same whatever the dose of oestrogen - which may not be the case of some of the combi products that have higher progestogen amounts to correspond with the higher doses of oestrogen.
Notwithstanding the fact that you get more progesterone to where it's needed when used vaginally compared to orally - as Ladybt explained very clearly, there is a dose dependent effect of progesterone needed so that ON AVERAGE, higher doses of progesterone are needed for higher doses of oestrogen.
BUT (and a very big but) - this is only an average and won't say how you will respond as it also depends how much oestrogen YOU absorb, what effect it has on YOUR womb and you won't know until you try!
The important thing is that variation from the licensed regime should be done under medical supervision - but with your knowledge and understanding - (so that if necessary you might need to educate them), and that any untoward bleeding should be reported to your GP.
Your gynae should not take your gel away from you!!!!
Hurdity x
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Thanks Hurdity for all of the information. It sounds like what you're saying is if it is too much estrogen to progesterone ratio, then I would bleed? As I write on here and ask questions it does feel like I should, to be on the safe side, get actual medical supervision for this, going forward. I'm going to have a think on doing that or just trying this on my own for a bit...it's shaken my confidence a bit about health professionals who are supposed to specialize in this stuff when my gyno disagrees with something that is noted in the estrogel manufacturing instructions (some women need more than two pumps). Anyway, thanks so much for your knowledge. This stuff is tricky. xo
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Lulu, gynaes are specialists in pregnancy and childbirth, it doesn't mean they know much about meno. A meno clinic might be a better place to go.
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Hi Sheila, Yes, you are right and somehow right about my gyno. What a strange coincidence for you to write that because I just finished a google search on her background/reviews, and yes, I think I was maybe giving her too much credit before (?) She's only been practising for a couple of years as well which is fine but for some reason I thought she'd been around for a lot longer...I'm in Canada and not sure if we have actual menopause clinics out here - that sounds wonderful!- I will look into this. Thanks x