Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: violetbat on September 30, 2020, 01:31:53 PM
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I have been using 2 pumps of gel since Jan this year( with 200mg utro 8-10 days a month vaginally depending on what I can tolerate) and having found that it absorbs better when applied to the inside of my arms ( I am careful not to let my arms touch my breasts). I was wondering whether I would also get more benefit from splitting the dose? Or does it make no difference? :)
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That’s interesting I have seen several people apply to inner arms and was thinking of trying that myself as I am a poor absorber! Do you apply upper or lower inner arm and do you rub it in and spread it(I am on Sandrena) although I am on 4 sachets even when on the gel I used to split the dose although I haven’t seen anything to suggest you can’t put it on in one go!
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That’s interesting I have seen several people apply to inner arms and was thinking of trying that myself as I am a poor absorber! Do you apply upper or lower inner arm and do you rub it in and spread it(I am on Sandrena) although I am on 4 sachets even when on the gel I used to split the dose although I haven’t seen anything to suggest you can’t put it on in one go!
it has made a real difference switching to inner arms. I have skinny arms so have to apply rorm the wrist and then high up until I move the last bit over the top of my shoulder - (never on the arm pit, just before as i don't want it to come in contact with my torso)
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Lovely thank you for that! Will give that a try! I too have skinny arms but know you can rub Sandrena in a bit more then the other gel
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If you read the SmPC 5.2 section on Pharmacokinetics Properties, all studies were performed considering one daily application and the patient leaflet says 'Apply the gel once a day, either in the morning or evening'.
Of course women usually don't follow the instructions because we're all different and all that, but I think it's better to follow the instructions and give it time to work before changing anything or you will end up not knowing what's going on or causing random fluctuations.
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It’s so confusing isn’t it! I apply 1mg on each inner thigh twice a day but would love to apply once a day if I’m honest! Will stick with what I do for a little while longer then try inner arms for a while and see if any better!
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It’s so confusing isn’t it! I apply 1mg on each inner thigh twice a day but would love to apply once a day if I’m honest! Will stick with what I do for a little while longer then try inner arms for a while and see if any better!
Sorry, but I don't think it's confusing. Follow the leaflet's instructions and give it a good time to work. If it doesn't, maybe it's not the best product for you, re absorption or convenience, so you can try a patch or the new spray instead. Simples.
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By confusing I meant you read so many people doing it so many different ways! Especially when your specialist has told you to use it twice daily!!
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My consultant told me not to cut the dose, just to use as directed or it won't be as effective.
She said that women are always trying to find their own 'recipe' with hrt, but that it's the worst thing they can do :)
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By confusing I meant you read so many people doing it so many different ways! Especially when your specialist has told you to use it twice daily!!
Sorry Flan747, yes I agree. Can you ask this specialist what's the reason behind splitting the dose? I'd be interested to know.
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My consultant told me not to cut the dose, just to use as directed or it won't be as effective.
She said that women are always trying to find their own 'recipe' with hrt, but that it's the worst thing they can do :)
I agree with her, I despair reading so many women reporting how they tweak doses and dosages without realising that every change will have short and long term consequences that are quite unpredictable if they keep doing this.
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My consultant told me not to cut the dose, just to use as directed or it won't be as effective.
She said that women are always trying to find their own 'recipe' with hrt, but that it's the worst thing they can do :)
I agree with her, I despair reading so many women reporting how they tweak doses and dosages without realising that every change will have short and long term consequences that are quite unpredictable if they keep doing this.
I agree too, it just makes the most sense. Just follow the directions ladies!
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That all really does make sense but when you lay someone so much money and are desperate I suppose you just go with it🙈 so I have to use 4 sachets of Sandrena should I use 2 on each inner thigh then? I was going to start using inner arm but do not want to change 2 things at once!
Thank you both and yes I will email her now and let you know what she says
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Sorry also should I apply AM or PM does it make much difference ?
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Thanks Flan747, sorry if you have already posted this elsewhere, why are you on 4 sachets? It's a lot of gel. Maybe you're not a good gel absorber and could benefit from patches?
If you really need 4 sachets here's the instructions.
How to apply the gel
Sandrena should be rubbed gently on dry and clean skin. It should not be swallowed.
Where to apply the gel
Do not apply the gel to your breasts, face or on irritated skin.
Apply the gel to your lower body or thighs.
Apply the gel to a different side of your body each day.
Follow these instructions:
1. Apply the gel once a day to the skin on your lower body or thighs.
2. Spread the gel over an area 1–2 times the size of your hand.
3. Allow the gel to dry for a few minutes.
4. Wash your hands after applying the gel. Avoid contact of the gel with your eyes. The gel may irritate your eyes.
5. Do not wash the area where you have applied the gel for at least one hour.
Not sure what they mean by 'lower body', though. Buttocks? ;D
AM or PM, whenever is more convenient for you.
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I am not a good absorber hence the 4 sachets! I gave patches a trial of about 2 weeks which unknown wasn’t long enough but they made me very depressed, anxiety was through the roof and just felt awful!
This was the reply from my specialist:
absolutely not on arm -it drains to breast lymph and that is not advised
I wouldnt put it all on in one go as it needs an hour to absorb so you wait an hour and reapply the second lot but not all together
too much for body to absorb
This is why it’s confusing for me and I do read into things 10 times over which doesn’t help my decision easier!
I am really appreciating your replies Britt66 and Uptick so thank you
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I am not a good absorber hence the 4 sachets! I gave patches a trial of about 2 weeks which unknown wasn’t long enough but they made me very depressed, anxiety was through the roof and just felt awful!
This was the reply from my specialist:
absolutely not on arm -it drains to breast lymph and that is not advised
I wouldnt put it all on in one go as it needs an hour to absorb so you wait an hour and reapply the second lot but not all together
too much for body to absorb
This is why it’s confusing for me and I do read into things 10 times over which doesn’t help my decision easier!
I am really appreciating your replies Britt66 and Uptick so thank you
Thanks for sharing the info from your specialist about the dangers of putting it on your arms, that's really important to know!
Did you say that you are paying a lot of money to see your specialist? Do you live in the UK? If so, I'm just wondering if there's any way you can see your own GP or be referred to a gynaecologist? Take the pressure off you a little? :)
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Yes I’ve paid £450 in the last 6 weeks it was £250 for initial telephone consultation then £200 for a half hour follow up telephone call! I had thought about seeing the well woman clinic at the local surgery where I had the coil fitted! I just presumed as I am a complex case it maybe better to see a private specialist although at the minute nothing is working out so may give it a go
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Yes I’ve paid £450 in the last 6 weeks it was £250 for initial telephone consultation then £200 for a half hour follow up telephone call! I had thought about seeing the well woman clinic at the local surgery where I had the coil fitted! I just presumed as I am a complex case it maybe better to see a private specialist although at the minute nothing is working out so may give it a go
I totally get that, you just want help and you want it quick, completely understandable. If you do go to your gp and feel they are limited in their knowledge or disinterested even, you can always ask to be referred, because as you say, you have a complex situation. At least you have options :)
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Definitely going to look into it! I don’t mind paying at all but I’m not getting anywhere even after 16 months and now I’m on my 2nd specialist 🙈 I’m thinking maybe back to basics of this doesn’t work soon! Start from the beginning and see where I am maybe on a low dose? I just don’t know?
Thank you
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Hi Flan747, thanks for asking your specialist. Very interesting. I hadn't thought about lymphatic drainage to breasts. I will have a look at this. Oestrogel instructions are different, you can apply it to outer arms, although some women have been applying it to inner arms. Could that make a difference regarding lymphatic drainage?
Why do you say you're a complex case? Just because you're a poor absorber or is there something else?
What patch have you tried?
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Just because it’s taking so long to try and get some sort of norms again! I generally feel rough every single day! It’s been 16 months now! I tried the Everol patches. I started in June 2019 on Femostan then gel and levels only for up to 234 on 6 pumps then I tried Zumenon now Sandrena 🤞I think I am week 6 but had Mirena fitted last week just to add to the problems! Although I do not appear to have had any different problems since having it fitted so that’s a positive
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You're not a complex case at all. Many women struggle with HRT for years until they find a suitable regime. I think you could try other patches, Estradot, Estraderm, Progynova, and even Femseven when it becomes available again. There's also the spray, Lenzetto. Plenty of options. I think 4 sachets of Sandrena is not your best option. Your skin will suffer in the long run. And what if you need to increase the dose? It's a lot of alcohol being put on the skin, not to mention a waste of time and money if you're not absorbing it properly. Do you know that only 10% of the gel, as estradiol, enters the blood?
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Thank you for that! I did wonder what happens next as the specialist said I need to get numbers near 400 and am only on 356! She said to wait for the Mirena to settle first then she said about introducing something else into the mix so no idea what that may be? I have given most things a real good go but couldn’t cope with the Everol patch it was so extreme and took me right back to the beginning where I couldn’t function day to day! I really do appreciate the advice given and if this doesn’t settle will look into the different patches! To be honest I thought they would al be the same and she said Sandrena is the best choice for me so we will see
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Patches are definitely not all the same. There are some recent threads on here about that, women feeling rough after having to change brands due to shortages. I'm glad you can afford this specialist but as Brit66 says, you could be on the NHS and have the same treatment, because the tough part is often to find a suitable progestogen and it seems you're okay with the coil. You really don't need to pay for it.
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Thank you Uptick! Will keep you posted on how things go but with all your info it does make sense to try a different patch! I do hate the thought of changing again but do not want to go in like this! Constantly tired from not sleeping, anxious tummy and palpitations just rubbish really! Suppose I should give it another few weeks( more wasted weeks probably!)
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Anything is possible when it comes to this menopause malarkey. Keep us posted and good luck ;)
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Patches are definitely not all the same. There are some recent threads on here about that, women feeling rough after having to change brands due to shortages. I'm glad you can afford this specialist but as Brit66 says, you could be on the NHS and have the same treatment, because the tough part is often to find a suitable progestogen and it seems you're okay with the coil. You really don't need to pay for it.
Agree 100%
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Ok will continue emailing specialist until she asks for more money then if things haven’t settled will book appt at local well woman clinic
Your advice has been amazing Brit66 and Uptick so thank you ! Here’s to a good weekend !
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:drunk:
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Ok will continue emailing specialist until she asks for more money then if things haven’t settled will book appt at local well woman clinic
Your advice has been amazing Brit66 and Uptick so thank you ! Here’s to a good weekend !
You do what's best for you-your menopause-your way! You're so welcome, thanks for your support too, have a great weekend! :D
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I am not a good absorber hence the 4 sachets! I gave patches a trial of about 2 weeks which unknown wasn’t long enough but they made me very depressed, anxiety was through the roof and just felt awful!
This was the reply from my specialist:
absolutely not on arm -it drains to breast lymph and that is not advised
I wouldnt put it all on in one go as it needs an hour to absorb so you wait an hour and reapply the second lot but not all together
too much for body to absorb
This is why it’s confusing for me and I do read into things 10 times over which doesn’t help my decision easier!
well i don't know where to put it then as I get no result from putting it on the in
side of my thighs, none at all
I am really appreciating your replies Britt66 and Uptick so thank you
Thanks for sharing the info from your specialist about the dangers of putting it on your arms, that's really important to know!
Did you say that you are paying a lot of money to see your specialist? Do you live in the UK? If so, I'm just wondering if there's any way you can see your own GP or be referred to a gynaecologist? Take the pressure off you a little? :)
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This is what I've found about lymphatic drainage of the upper limbs.
https://teachmeanatomy.info/upper-limb/vessels/lymphatics/
Practically all superficial and deep lymphatic vessels drain to the lymph nodes in the axilla (armpit) .
If you think that lymph fluid flows in one single direction towards the nodes and from there to the bigger lymphatic ducts, which have valves to prevent back flow of fluid, that would mean estradiol coming from the arms couldn't reach the breasts via axillary nodes, BUT that's not the case, because 'Valves are found in larger lymph vessels and collecting vessels and are absent in the lymphatic capillaries.' https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/19%3A_Lymphatic_System/19.2%3A_Lymphatic_Vessels/19.2A%3A_Lymphatic_Vessel_Structure
So, in theory, estradiol inside upper limb lymphatic capillaries could reach the breasts via back flow from axillary nodes, BUT lymph nodes afferent vessels (that directs lymph into the node) have a valve to prevent back flow, so, in practice, estradiol couldn't reach the breasts, unless there's infection or inflammation going on which could cause swelling of the nodes and disturb the dynamics of lymph flow.