Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Cookie25 on March 30, 2021, 01:33:12 PM
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Hi Lovely Ladies
I am going to start my patches tomorrow!
Can you tell me the best method if cutting a patch in half? Before I open the pack or after? In half diagonally or straight? Also is bedtime best or after my shower in the morning?
Thanks for all your advice xxxxx
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Despite what some people say it really doesn't matter how you cut the patch provided you cut it so that you can peel it off properly with each half. Just open the sealed pouch thingy and snip,. Then pop the unused half back into the pack, fold over the opening, put it back in the box or wherever you keep them and use the other half later.
There could be a tiny amount of deterioration along the cut edges but this would be negligible. I would prefer to cut so the patch is rectangular rather than triangular only because I feel the pointed edges may come unstuck more easily. Also this makes it easier to gradually increase the size/dose of the patch in a more controlled way. Just my view though. There will be others happily cutting theirs diagonally. Whatever works for you.
I always apply mine in the morning every third day but if after a shower then make sure you don't use oily/very moisturising shower cream etc so it sticks well. I think some women clean the area of application, again ie after showering to remove traces of product though I never do.
Good luck and let us know how you get on :)
Hurdity x
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Thank you Hurdity!
I've gone for it tonight and stuck my first half patch on my bottom! Let's see if it makes it through my restless night without becoming detached!
I'm nervous yet excited about the promise of a better quality of life! I'll keep you posted xxxxx
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Hi
I’ve still not started my patches they’re sitting in the box, I was planning to start on half patches to see how I get on, why did yiu decide on half patches? Mine are evorel conti, would love to hear how you get on xxx good luck
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Hi Neviebell
It was my menopause specialist who decided I should try half a patch to begin with along with vagifem.
I'm only a couple of days into it and my first patch came unstuck today! So I've pit a new half on in a different place to see if that sticks better.
Too early to say if I feel any different yet.
Let me know how you get on too xxxxx
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Hi Neviebell
Have you started your patches yet?Xxxxx
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I’m really interested in this thread. I am having a GP consultation this morning and plan to ask for Evorel sequi patches instead of tablets. I find my current tablets (Femeston 1:10) give me awful bloating and I’d like to try something else. Would someone explain the cutting in half thing for me and why you might do this. Thanks in advance
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Hi NicolaJ
My menopause specialist was keen for me to start on a low dose to start with and advised that I use half a patch and then we will review in 3 months time. I'm only a week in, so not much to report yet. Let us know how you get on xxxxx
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Hi Cookie25
So I have my box here!! A bit frustrated I’ve only been given two months supply when tablets were three months supply. £18 prescription later!!! GP didn’t say anything about the building up. I’ve been on Femeston so probably why. I’m going to stick first patch on now and see what happens. Found GP great though and he talked about using Mireya coil for the progesterone next if the Norethisterone causes mood swings. Catch up soon and let me know how you are too x
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Hi NicolaJ
How are you getting on?
I'm not feeling much difference yet and on tuesday I go onto the second type of patches in the box which I'm more nervous about.
I'm also not quite as comfortable down below now that I'm not using vagifem every night like I did in loading. I'm keeping a note of when I use it though and I hope I don't have problems getting a repeat prescription.
I'm in Scotland so am fortunate to not have the prescription costs that you do.
Xxxxx
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Hi Cookie25, I don’t feel any different but know they’re definitely working as the hot flushes are far less. I’m managing to keep them stuck, have gone for the upper part of bum as suggested many times on here. So far so good 🤞
I’m also slightly worried about the second part of the box as I previously didn’t like Norethisterone when I took it in tablet form a few years ago. I did find though that this was very gradual and took six months before I realised my anxiety was slightly worse. In hoping patch might be better! Again 🤞
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Can I ask has the doctor suggested halting the patch? I only ask as I was put on to patches for peri menopause and when in a matter of days I was getting terrible headaches and feeling really low. I’ve spoken to the doctor who said to stop taking them and now I need to just manage the symptoms myself or go into antidepressants.
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Hi mchaplin
Did you mean to say Halfing?
My GP suggested I start on a half patch to see how that goes for three-month first x
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cutting in half?
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Hello ladies.
I just wanted to say that halving a patch is something many of us have done without problems. My GP explained that the matrix design meant that this was an easy and effective way to reduce the dose. I used to peel off one half and keep the remainder under its plastic cover until I needed it.
I hope this helps ladies and take care.
K.
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thank you. I am only asking as I started on the patch and had to stop due to head aches that were really bad and feeling low and my doctor has said that I was on the lowest dosage so I would just need to manage my symptoms or the other option was antidepressants so I may now go back and ask about cutting the patches in half.
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I’ve been told by my menopause specialist to reduce to quarter of a patch because I’m suffering from very low mood and constant nausea since I started hrt about 3 weeks ago. The Utrogestan made things worse.
Hoping my body will cope better if things are done gradually.
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It’s now been a few months and I really feel I need to start trying the Patch again. So thinking start with quarter of a patch. When it comes to change day do I need to use a whole new patch or is it ok to use another quarter of one that I’ve cut?
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Hi mchaplin
I use half a patch and I just store the second part in the foil packet until I'm ready to use it so I'm sure this would be okay for quarters too x
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Thank you
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Sorry for resurrecting an old thread but I can’t find one I previously posted about halving patches. The nurse told me to try half a patch as I had started bleeding and had sore boobs. I got my prescription late and so had no patches left for a few days and have now been on half for a week. I feel ok so far. My questions are:
Is there a way of knowing what dose I need and can’t I just have a lower dose patch?
I’m worried about halving the patch as I have read conflicting evidence about doing this. The pharmacist in this link say don’t do it.
https://www.theindependentpharmacy.co.uk/menopause-hrt/guides/evorel-sequi-how-to-use
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Hi. Many of us (me included by leading meno specialist) have been told to cut patches in half. X
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The way the pharmacist explained it is that a matrix patch is designed to release a set amount of product per day into you. So by halving a patch it will still release exactly the same set amount from the half patch but will run out quicker therefore leaving you without any until you put your next half on. I’m so unsure about this now. 🤦♀️
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Sorry for resurrecting an old thread but I can’t find one I previously posted about halving patches. The nurse told me to try half a patch as I had started bleeding and had sore boobs. I got my prescription late and so had no patches left for a few days and have now been on half for a week. I feel ok so far. My questions are:
Is there a way of knowing what dose I need and can’t I just have a lower dose patch?
I’m worried about halving the patch as I have read conflicting evidence about doing this. The pharmacist in this link say don’t do it.
https://www.theindependentpharmacy.co.uk/menopause-hrt/guides/evorel-sequi-how-to-use
That can't be the case otherwise small patches with less hormone on them will run out quicker. Also half a patch is stuck to half the area of skin so is not likely to run out quicker. That doesn't make sense at all!! I imagine for example that a 50 mcg oestrogen patch and a 25 mcg oestrogen patch have the estradiol distributed over the patch at exactly the same concentration. Halving a patch won't run out quicker, it will just release less oestrogen ( and progestogen) into your body over the same period of time.
What the pharmacist says in the article at that link is wrong. Look here at an academic paper on the subject:
https://academic.oup.com/bjaed/article/7/5/171/535087
Although not talking about HRT specifically the paper describes the charatceristics and properties of matrix and reservoir patches:
"In a matrix patch, the active ingredient is distributed evenly throughout the patch. One-half of a patch will have half the original surface area and deliver half the original dose per hour. "
Even so, halving the patch would be off-licence as strictly speaking, the trials have not looked at the efficacy of that particular dose but I know halving patches is commonly prescribed by specialist judging by what I've read on here, and Dr Currie herself (founder and manager of MM) also endorsed cutting Evorel conti patches off licence ( in post-menopause). What would NOT be advisable (without medical supervision) is to only cut the sequi part of the cycle when you are on Evorel sequi as you would then be maintaining the oestrogen dose suring the first 2 weeks of the cycle but halving the amount of progestogen. (However confusingly because the same Evorel conti patches are used for both Evorel sequi and Evorel conti - this means that the same progestogen dose is given in both regimes, so implying it's not quite so rigid!).
Hurdity x
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I have been halving my patches since finally getting the dose right. I am on one 37.5 patch plus a half of 37.5. I cut mine in half as a triangle and have not had a problem with it becoming unstuck at all (Estradot patches) but its entirely up to you however you want to do it. I apply mine first think in the morning but I have to change mine every 2 days as unfortunately they don't last for me for 3/4 days. Its such a personal thing dose etc whatever suits you the best and whatever you are advised by your Dr. Hope so much all goes well xx
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I saw a specialist recently who said you can’t cut Evorel Conti patches. I thought you could. She said estrogen ones are ok. But not the conti as you don’t know where the progestin is in the patch.
Is this just nervousness re womb protection do you think?
I have heard many instances of women cutting up patches. But this doctor used to work at newson and is very reputable so I’m really confused now.
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Hi Scampi - yes probably nervousness. From what I just read the progestogen is evenly distributed throughout the patch at is a matrix patch. Most modern HRT patches are matrix patches these days.
Also there's a difference between what the licensed dose is and what some specialists will prescribe off licence. Like I said - Dr Currie herself endorsed this but for Evorel conti when used continuously, but if a GP or specialist OKs it and is prepared to supervise (ie arrange scans etc) then that's fine.
Having said that maybe thinking has changed more recently due to instances of womb thickening on unlicensed regimes - but it's nothing to do with how the progestogen is distributed, as I understand, anyway.
There is nothing in the description of the patch to indicate that the hormones are unequally distributed throughout:
"The EVOREL CONTI Transdermal Delivery System (TDS), or transdermal patch, is a flat two-layer laminate which is 0.1 mm in thickness. The first layer is a flexible, translucent, and nearly colourless backing film. The second layer is a monolayer adhesive film (matrix) composed of acrylic adhesive and guar gum and contains the hormones. "
https://www.medicines.org.uk/emc/product/10929/smpc#gref
Hurdity x
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Thanks that’s really helpful. I did think, why would all the progestin be in one corner, for example!
As you say it’s a matrix design.
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It is mega confusing and it does seem to be the pharmacists that don’t want to endorse it as my own chemist said no the same as the link. I’m halving evorel conti 50 patches so maybe I should ask for 25mg patches to be on the safe side. I’m not 100% sure the dose is right yet because I’ve been back to feeling really tearful this weekend.
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Hi PearlJ - there seems to be a lot of ignorance out there!
Evorel conti does not come in 25 mcg doses - it is only the Evorel oestrogen only patches that come in different doses. If you feel it is the wrong dose anyway then maybe just cut a quarter off it (both the Evorel 50 and the Eovrel conti part of the cycle) to give 37.5 mcg?
Hurdity x
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Hi PearlJ - there seems to be a lot of ignorance out there!
Evorel conti does not come in 25 mcg doses - it is only the Evorel oestrogen only patches that come in different doses. If you feel it is the wrong dose anyway then maybe just cut a quarter off it (both the Evorel 50 and the Eovrel conti part of the cycle) to give 37.5 mcg?
Hurdity x
You are dead right about that! When you rely on experts and they don’t have a clue, what chance do you have! I had a nurse appt last week and she’s supposed to be a menopause nurse. She was googling to find out which way I should cut my patch!
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It is mega confusing and it does seem to be the pharmacists that don’t want to endorse it as my own chemist said no the same as the link. I’m halving evorel conti 50 patches so maybe I should ask for 25mg patches to be on the safe side. I’m not 100% sure the dose is right yet because I’ve been back to feeling really tearful this weekend.
A cynic might think the pharmacists are incentivised by the drug companies!