Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Jane50 on December 03, 2020, 10:51:57 AM
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Hi all,
I'm currently on 5 pumps oestrogel and 200mg utro on a sequi regime.
I'm still having hot flushes, night sweats and night time cortisol surges.
Possibly not absorbing gel very well? Dr Currie advised trying a switch to Estradot with the utro to see if different delivery method would help.
Requested this from GP today and they said they're not licensed to prescribe Estradot and utrogestan together.
:o
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That can't be right :o
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It doesn't sound right. What did they suggest instead?
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She suggested the Mirena and Estradot or a continuous HRT. I've asked to be referred back to gynae. I don't want either of those. I'm happy (ish!) on utro and just need the oestrogen sorting. Honestly, you'd think menopause was a new phenomenon the lack of expertise there is!
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Hi Jane50, are you peri or postmenopausal?
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Hi uptick, I'm peri. Been on oestrogel for about a year, slowly creeping up from 2 pumps to 5.
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Thanks Jane50, I thought that maybe you GP had refused Estradot based on the new PIL that states Estradot is only for postmenopausal women :o
1. What Estradot is and what it is used for
Estradot is a Hormone Replacement Therapy (HRT). It contains the female hormone oestrogen. Estradot is used in postmenopausal women with at least 12 months since their last natural period. Estradot comes as a patch that is applied to the skin.
Estradot is used for:
Relief of symptoms occurring after menopause
During the menopause, the amount of oestrogen produced by a woman’s body drops. This can cause symptoms such as hot face, neck and chest ("hot flushes"). Estradot alleviates these symptoms after menopause. You will only be prescribed Estradot if your symptoms seriously hinder your daily life.
Prevention of osteoporosis (for Estradot 50, 75 and 100 only)
After the menopause some women may develop fragile bones (osteoporosis). You should discuss all available options with your doctor.
If you are at an increased risk of fractures due to osteoporosis and other medicines are not suitable for you, you can use Estradot to prevent osteoporosis after menopause.
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Hhmm, thanks uptick. Perhaps, but her issue seemed to be it's combo with utro 🤷
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Well, if that's the case, it's absolutely ridiculous.
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I'm pretty sure hurdity was an estradot and utrogeston before the estradot shortage.
Any idea why it should be for post meno only? Surely oestrogen is oestrogen.
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Tbh I don't know exactly what has changed regarding that section of Estradot's leaflet. All the emc website says it's that it has been changed today. I don't have the older leaflets any more.
I think they say it's for postmenopausal women because it's supposed to replace oestrogen levels and during perimenopause they are usually oscillating and not necessarily low. But of course it can be used by perimenopausal women, it just won't be necessarily effective if oestrogen levels are peaking at extremely high levels.
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Must have been written a man! So in peri you get symptoms because you're deficient in oestrogen but you can't have oestrogen because for 3 days in the 5 years you suffer you might have too much oestrogen instead of too little. >:(
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I suppose it's because high levels of oestrogen would be necessary to control symptoms in perimenopause and the highest dose available in patches (100mcg) wouldn't be enough.
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Wouldn't it? I may have the doses wrong but I thought 50mg evorel patch, 2 pumps oestrogel and 50 estradot patch were all roughly equivalent? So estradot comes in more or less the same dose as other brands?
I was going to ask for estradot as it will be easier to apply than gel. Late peri now.
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I thought the Estradot 100 patch was equivalent to 4 pumps oestrogel? It's what it has to do with the utrogestan that's befuddling.. as if I'm not doolally enough already!
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What progesterone are you on Sheila 99? If it's utro it will be interesting to see what you're told .
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I think your gp is the one who's befuddled! I'm on utrogeston. There's another post from someone who can't get hold of it so I might wait until the shortages are over.
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Hello? Is somebody talking about me? I'm definitely Befuddled, in more ways than one. I'm also on Estradot and Utrogestan, just picked up a new prescription yesterday.
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Wouldn't it? I may have the doses wrong but I thought 50mg evorel patch, 2 pumps oestrogel and 50 estradot patch were all roughly equivalent? So estradot comes in more or less the same dose as other brands?
I was going to ask for estradot as it will be easier to apply than gel. Late peri now.
Yes, you're right. What I meant to say is that for many perimenopausal women this average dose is not enough. Jane50 is already on 5 pumps of the gel... some members of the forum are using more than one 100mcg patch... That's probably because the fluctuations in oestrogen levels are not being overridden by the 'maximum' HRT doses of gel (4 pumps) and patches (100mcg).
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I thought the Estradot 100 patch was equivalent to 4 pumps oestrogel? It's what it has to do with the utrogestan that's befuddling.. as if I'm not doolally enough already!
Yes, that's the equivalent dose, but of course absorption rates vary. Are you thinking of starting with 50, 75 or 100mcg Estradot?
It's completely ridiculous, you can use any oestrogen with Utrogestan, unless there's an unofficial agreement between the NHS and Besins Healthcare to prescribe an Oestrogel-Utrogestan combo, but that doesn't seem to be the case, as far as I know.
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I'm not really sure what to start on Uptick. Maybe the 75?? Dr Currie had recommended a blood test to check if oestrogen levels were high or low so I could adjust HRT accordingly instead of groping around in the dark. My GP does not do tests for oestrogen levels ...Seems I've got a while to think about it though as will now have to wait to be re-referred to gynae. I also asked GP if I could instead be referred to a menopause clinic and apparently she can't do that either and it has to be done via gynae. I'm sure she doesn't mean to be obstructive but it certainly feels that way at the mo :-\
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What does one need to have to be referred to a Menopause Clinic apart from peri or menopause symptoms? 🤔
Some Canadian researchers advocate high doses of progesterone in highly symptomatic women in perimenopause, but I don't know anyone who has tried this approach.
https://bcmj.org/sites/default/files/public/BCMJ%20_47_Vol10_Clearing_Confusion_Perimenopause.pdf
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It's up to you but if it was me I would complain to the practice manager. You've been given duff advice about utrogeston and you've been referred to someone who isn't appropriate. Perhaps do some research and see where they run a meno clinic near you. You could start a thread asking for suggestions near you if you're unable to find anything useful yourself.
It's normal not to do oestrogen blood tests on the nhs but there's nothing to stop you getting a private one done (I've used medichecks before but not for oestrogen).
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Thanks both. I'll ring some Meno clinics on Monday and see if they take self referrals. It just seems so difficult to get the help you need. I feel like MM is the only reliable thing I've got. It can get very lonely and wearing trying to find ways to feel better. I feel like I'm being awkward with my requests! I certainly didn't ask to feel like this during meno. Thanks for your replies, I really appreciate it.
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Hi Jane50
Can you remind us of where you are in menopause - ie early or late peri or even post, if you know?
Yes I was on Estradot and utrogestan for many years. I think you're being fobbed off and what the doc may be saying is what the local formulary is recommending. Are you in Scotland by any chance? Even if not, your doc is able to override any such listings on the formulary. They just need to make a note of why they are prescribing what they are. None of my HRT is on the list in my area I don't think.
As for it being post-meno on the leaflet - any doctor should know that any oestrogen preparation can be used as part of HRT in combination with a suitable progestogen (for women with uterus) at all stages of menopause. You should not need to go to a menopause clinic. You would have to pay if you self-referred and you absolutely should not have to do this. Also your doc should be able to refer you for a blood test - can you show him/her the advice from Dr Currie? After all if you are not absorbing the gel and changed to a patch which does work, it would be saving the practice money I would have thought - eg one patch vs all that gel?
I hope you're feeling better and are able to get what you need.
Hurdity x
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Thanks for your reply Hurdity. I really don't understand why they can't prescribe me Estradot to try when clearly so many women use that combo. I'll ask again and see what they say...
I'm peri as far as I know . I started HRT about 2 years ago and I'm 51 now. Was still having fairly regular periods when I started but very heavy.
I'm not in Scotland, I'm in the Manchester area. It just seems that every time I ask my GP for help, they have a reason not to.
I've also recently been prescribed Omeprazole, as I know you have, for reflux, burping, nausea,bloating etc. I've been on it about 2-3 weeks and no improvement so I'm going to have to go back to GP. Great, can't wait to see what they say this time! I've also read high levels of oestrogen can cause bloating and indigestion so now wondering if they're connected as I'm on 5 pumps oestrogel...
It's like wandering around a maze trying to find your way out!
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Stepping Hill has a meno clinic, there are others in the Manchester area too. Can you see a different gp on case they're more helpful?
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Jane50, you might be able to self refer to either Dr Kasliwal at the Withington clinic or Dr Navani at Stepping Hill. Ring them and good luck. 🤞🏻
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Thanks so much uptick and Sheila. I was given advice by a gynae at Stepping Hill regarding heavy, painful bleeds but once they'd investigated and made recommendations they then discharged me. Nooo! I have lots of other problems too! So back to square one with who to contact. I will definitely try the Withington Meno clinic thanks uptick. I had no idea there was one there. Again, why doesn't my GP surgery know these things??
Thank you everyone for your replies. What the heck would we do without the help and support of each other on here :o
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Hi Jane50, it's actually a Sexual Health clinic but Dr Asha Kasliwal has a special interest in Menopause Care.
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Fab, I'll give them a go :)
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Fingers crossed for you :)