Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: CrispyChick on December 01, 2024, 03:10:02 PM
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Hi ladies.
If I'm only absorbing 72 pmol from a 50mcg patch. Instead of doubling to 100mcg patch would i be better trying oral. 1/5mg femoston??? For potential better absorption.
Any thoughts.
I'm desperate. This is the end of my chemical menopause trial if I can't get this right. And I know it's really stabilised all my hellish peri fluctuatuons. But right now I need to prove, or otherwise, if I feel so ill because of genuine low E.
P.s I know I'm only absorbing 72 pmol as my hormones are totally zero underneath (as shown in previous bloods).
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I wouldn't have anything but oral myself so I'm probably biased but I think it is definitely worth trying.
I don't know what you are doing progesterone wise at the moment but just in the short term I would suggest an estradiol alone rather than femoston.
If you immediately go on to a combined product you can't tease out what's what in terms of effects - good or bad.
Also be aware that blood levels can be more variable across 24 hours due to the peaks and troughs with oral. This is still less than with gels, and clinically makes no difference to most people (and those who do feel it can of course split their dose) but it can make blood tests harder to follow.
They can still give meaningful information though especially if tested at the same interval after taking the estradiol pill. Mine are pretty consistent.
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Thanks bomb
I should've said, I'm on combined products for P as I do not tolerate utro or cyclo. So I'm using conti patches so it'll have to be femoston or elleste duet.
I've doubled my patches. See what happens there first. I've ordered my own blood kit. Any idea of how soon I could test. I know officially it's 2/3 weeks for blood levels to stabilise, but Google tells me that's oral and that patches are pretty instant, given the continuous delivery system.
In terms of oral. If I try femoston conti (my preferred due to a kinder progestin). It's only 1mg E. Which seems to compare to 25mcg patch. But 50mcg patch was doing nothing. But then, that's clearly an absorption issue - so 1mg oral might be fine. 🤔
Also. I have 0.5mg/2.5mg femoston in my hands. It looks like 2 x 0.5mg/2.5mg equates totally to the 1mg/5mg femoston Which I'd want to try.
Can I just take 2??? Saves wasting a GPs time. Anyone know?
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Yes taking two 0.5/2.5mg tablets is exactly the same as one 1/5mg tablet. It just costs more.
If you don't mind bleeding there's also a 2/10mg, which is only available in sequential.
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crispy, I think it's probably jumping the gun a bit to move to oral if you've only tried a 50mcg patch. My levels would be about the same on that...
The thing about oral, is you can't reliably test estrogen at all once you start it. Because oral E is broken down by the liver into metabolites, so when you test you will get a falsely high result due to all those metabolites, which doesn't reflect the estradiol which is available to your body. (It's the same with oral P. We can test women accurately using regular P tests only if they use all their P vaginally or rectally. We can't reliably test women in the UK who take oral P. In the US they have a P test called LC MS P which avoids this, but no where in the UK offers it - to my knowledge, even privately.) So you really don't know what you are getting at all, if you switch to oral.
Plus, you increase the risk of clotting so will come under pressure to get off oral HRT as you get older. Plus if you need surgery, you'd need to stop oral HRT and not transdermal.
As you might know, I'm on 200mcg patches and (now) 3 pumps of gel at night. I will test on this in the new year but I have been on 200mcg patches and 6 pumps of gel - and my levels were 893pmol, so I reduced the gel to get me around 650pmol as that was a little high if I didn't need to be up there. But, before this, I couldn't get higher than 330pmol even on 12 pumps of gel (which was the same on 6 pumps of gel).
Which is all to say, you don't know yet if you can't get higher if you use a higher dose. The most common solution for poor absorbers seems to be a patch-and-gel combo because the two different routes seems to allow for more absorption than just using a high dose of only one.... (as me with the gel).
I get prescribed this from my Newson doctor but my NHS GP is happy to then give me the meds. Which is good as I couldn't afford this dose, privately.
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Hi
I didn’t absorb the patch (Estradot or Evorel) well at all. Tried everything from half a 25mcg up to 100mcg over a year. My Estradiol never moved more than 75 at any time (I tested 6 times in that year).
Then I switched to oestrogel and just 1 pump took me to 400. I’m peri, so it a bit different for me, but just to add to the counter that patches are pants for some people.
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I think with oral, the goal would be to just increase stepwise until hopefully you found a point where you felt well, and then think about a blood level, more from the point of having a reference level that you know works for you.
On 1.5mg estradiol (Zoely) I am reliably around 390pmol/L. As others have said there will be some other metabolites such as estrone that are not being measured and this may not be as pure a result as I might have on patches.
But what it means is when the time comes to swap from a birth control pill to a licensed HRT product, if I choose an estradiol based pill I can aim to replicate the value that I know works for me.
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Thanks all.
I doubled my patches to 100mcg. Having a very low threshold as I need out of this hell. And I'm about to stop it all. So I'm testing later this week as I've read levels pleateu on patch immediately. Obviously that's not how we feel it.
Anything in my blood is pure patch, as I was at zero on cm.
Interesting comparison with zoley bomb. I always thought it was 2.5mg E. But I see that's the progestin.
I can't swap to gel or spray as I can't take bio progesterone. So it's progestin for me.
So if not much improvement in blood, I may try 1mg femoston. I mean I always used to absorb contraceptive pills. So assuming patch might be the issue here.
Thanks all. It really is my last chance. It still looks like I have extreme bodily reactions to hormones rather than levels themselves. But I need the damn E to get to a sufficient level to be sure. Sigh. >:(
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You do have the option of desogestrel 150mcg daily or slynd as your progestin, if this is what is keeping you from trying a gel.
Even provera if it allows you to take an estradiol product that works for you.
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Thanks. But I can't take Slynd or desogrstral any more either. :'(
Think it's quite obvious now that hormonal levels are not my main issue - more my body is overreacting to them all, especially external sources.
No idea why?! Been going on so long, but this year is the one cerazette turned on me when I tried it again, after taking it for years before.
Endocrinology is my next step. :(
But thanks for all the advice as I do need to finish this test with a decent add back E level. Sigh.
I do think my joints are feeling mildly better today, so hopefully I'm absorbing enough from the 100mcg patches to conclude.
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Crispy, I got so fed up with the very-slowly-slowly approach and never getting where I wanted to, that I decided to increase relatively speedily (like every week) until I really felt different....
You can always overshoot and then come back down if you test ridiculously high.
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Yip. That's my current plan. ;D
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I'll just add, in light of Dr Currie's latest post - I took advice from my BMS gynae (having to pay for) and I was told to up the patch.
The swapping to oral is my own idea, but I will go back through my gynae if I want to pursue this.
I appreciate blood tests are unreliable in peri. But I'm in chemical menopause with none of my own E. So I think it's highly valuable. I think if my joints are in agony on a high dose patch it's very much worth a blood test. What's the point in sitting it out in agony if I'm not absorbing. ???
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I think most providers would support a blood test if someone is still symptomatic on a 100mcg patch.
Where to go with that is less agreed upon eg wearing multiple patches vs changing methods vs combining methods.
Do you think your specialist, might support topping up the combi patch with gel, with endometrial monitoring?
This is off label but is being done by some private providers.
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I'm not sure to be honest.
So you mean, add a pump of gel, but not take any further prog?
I guess I need to see where this double patch takes me first. But it'd be something to ask.
I still believe in the blood test and will be doing my own tomorrow. ;D
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Do let us know what level you're at on 100mcg!
And yes, there are women topping up the combi patch with a small dose of gel.
But this is non standard treatment, and does change the E:P ratio.
So it should only be done under specialist supervision and if it is continued longer term you should have a scan periodically to monitor the endometrium.
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Crispy, sometimes I think all this hormone measuring is... Well, I know why we do it - because we just don't have anything else to go by or to do when trying to figure this out, but watch this YouTube clip (I've set it to start at the right place). This is one woman, post-menopause, having her stable HRT estrogen dose measured at multiple times through the day: https://www.youtube.com/watch?v=RZYX75Kesbk&t=1728s
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Oh. Thanks joziel.
That is very interesting...
And yet Newson go by blood tests, do they not???
Anyway, day 5 on my double patch and my joints are loads better already. So I will test (same time as my last test) to see. I think I've read levels are always higher in the aft. ;)
To be honest, I just needed to know my levels are decent enough to rule levels out. Unfortunately it's still not my answer. Something else is at play. :'(
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Crispy, sometimes I think all this hormone measuring is... Well, I know why we do it - because we just don't have anything else to go by or to do when trying to figure this out, but watch this YouTube clip (I've set it to start at the right place). This is one woman, post-menopause, having her stable HRT estrogen dose measured at multiple times through the day: https://www.youtube.com/watch?v=RZYX75Kesbk&t=1728s
I'm actually quite interested in the potential of FSH as a marker - this has never been used in mainstream clinical practice but there is evidence that high FSH correlates with multiple undesirable health outcomes such as osteoporosis, cardiovascular disease and Alzheimer's pathology, independent of estrogen.
Obviously the immediate symptom and quality of life concerns guide treatment for many, but I believe FSH could have utility in the future for those interested in long term health outcomes.
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...in light of Dr Currie's latest post...
https://www.menopausematters.co.uk/forum/index.php/topic,71486.0.html
"...any decision about changing your HRT should be with a discussion with your healthcare professional, taking into account your medical history, other medications and types of symptoms and/or side effects."
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bomb, my FSH is low....
Crispy, it can take a while at the right dose before you know. I tend to see an improvement of some kind within 48hrs but it can take up to 2 weeks for my neurological symptoms at night to improve.
I also don't know at what level we can 'rule levels' out. I forwarded my blood results onto my Newson Health doctor. My estrogen was 893pmol and I'd already halved my gel dose after getting that result (from 6 pumps divided 3 AM and 3PM to just the 3 pumps at night), along with 2x 100mcg patches which stayed the same. My Newson doctor just said these were within the range they aim for (250-1000pmol) ::) and didn't advise any adjustments based on levels alone there. Whereas the doctor at the private blood test clinic had given feedback suggesting I reduce 'according to the Chelsea and Westminster NHS guidance' blah blah. But he doesn't know the severe neurological night time symptoms I'm dealing with. So I may well go back up again if needed.
I have just started to use 100mg utrogestan vaginally this cycle, along with 200mg orally still. So far I haven't noticed any huge differences at all. But we'll see if I still get my period around day 20. If I make it longer, perhaps I am absorbing more of the utrogestan. If it makes zero difference I will go back to all oral because it's an extra faff.... So much trial and error and nebulous variations and way too many variables. And I am still getting back onto levo as well - this Saturday is 2 weeks since I restarted so levels will be 75% of final levels by then, so it's going to increase some more...
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I'm not convinced that hormone blood tests are worthless.
I have just had my annual health checks and as always, my oestrogen blood level is 270 and it has reliably been at between 270 and 300 (in pmol) for years. I am 63 and over 15 years post menopause and use one pump of Oestrogel. If blood tests were as unreliable as the NHS like to suggest, there is no way on earth they would be so consistent year after year.
Blood tests might be unreliable in peri menopause but they are not unreliable post menopause.
I also had a DEXA scan this year and it came out better than 5 years ago (0.4 as opposed to 0.3 on hip and spine) so this level of oestrogen is working well for bone density in my case at least.
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I believe that at the bottom end blood tests are helpful for sure.
Even the NHS accept that a threshold of 250pmol/L is where bone protection can be reasonably assumed for the majority.
Personally I favour prof Studd's threshold of 300pmol/L, but the point is acceptance that there is a minimum threshold for health benefits, regardless of where you believe that lies.
Not everyone has symptoms, my mum had none, and when I was in chemical menopause prior to IVF, nor did I. But I absolutely don't want osteoporosis, which both my parents have.
Also if someone is taking a reasonable dose by whatever route, if they are getting no benefit from it, then a test is very worthwhile, rather than than telling them they must be imagining their ongoing symptoms or suggesting antidepressants instead, when they may simply not be absorbing it very well, or at all.
But I don't think that someone who feels well and is really stable on their treatment should have their dose arbitrarily reduced based on a single "high" reading, as this may have been significantly different had they tested at a different time of day.
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Ok. Just to conclude this thread...
Within days of doubling my patch dose my severe joint pain is abating.
So. Let's not forget I measured at 72pmol on 50mcg patch only last week (with zero of my own E). And my joints were scraping on the floor.
So yesterday, day 5 of 100mcg patch I did a fingerprint test. Results (super speedy!) 629pmol
I'm not sure what to conclude with that:
A) finger prick tests are unreliable?
B) my finger is contaminated by touching the patch on changes?
C) I really have super absorbed 100mcg in 5 days??? I mean, my joints say I have. :o
Unfortunately, for me, I've proven what I needed to. There is unfortunately something a lot more at play for me than hormone levels. As I still feel hideous. So I'm stopping the whole lot.
But thought you'd all liked to see these results.
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Crispy, that's very disappointing after all the effort you have put into it. What is your next move? Have you thought about getting some specialist help like an endocrinologist or a different type of specialist?
There must be someone who can help you.
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Thanks Mary.
Yes, I have an endocrinologist referral.
This has been the most brutal thing I've ever put my body through, but it has proved the hormonal levels themselves are not my problem. Well, not most of it. I can see in this cm what my real peri symptoms are. So I'm going back to them. They are horrible, but they're not the same as the hideous ill feelings I get.
Right now my plan is to stabilise on nothing. Because I've messed so much I do wonder if I'm dealing with a highly oversensitised nervous system.
I'm broken to be honest. Absolutely broken. But I'll keep going for the sake of my children. :'(
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Thanks Mary.
Yes, I have an endocrinologist referral.
This has been the most brutal thing I've ever put my body through, but it has proved the hormonal levels themselves are not my problem. Well, not most of it. I can see in this cm what my real peri symptoms are. So I'm going back to them. They are horrible, but they're not the same as the hideous ill feelings I get.
Right now my plan is to stabilise on nothing. Because I've messed so much I do wonder if I'm dealing with a highly oversensitised nervous system.
I'm broken to be honest. Absolutely broken. But I'll keep going for the sake of my children. :'(
Hey Crispy
Your poor body and mind have been through so much. Personally I found a good therapist helped me make sense of the sh@tstorm that hit me 5 years ago (hysterectomy + breast cancer + autoimmune arthritis all in 5 months). It’s not for everyone and finding the right match is so important, but it really helped me. I finally feel emotionally robust enough to tackle whatever my body throws at me. It’s a long, slow, sometimes painful process, but has been a key element of survival for me. Most therapists offer online sessions so
You aren’t limited to the options close to home. I chose a woman in her mid-50s who uses an integrated approach.
I hope you find balance soon—you deserve it.
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Thank you Dramy. Very kind words x
My GP mentioned phsychiatrist referral. Is that the right thing? I declined, but I'm thinking of asking for it now. I do feel like the last 3 months have traumatised me even further.
I want to do antidepressants too. I need to get out of this awful overthinking cycle. I just find the start up really really hard.
I'm glad you have now found stability. I know it takes time and I'm now ready to stop.messing with my hormones as they are clearly not my overall problem. ???
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Crispy, I'm glad you have a plan and you are not just left with nowhere to go.
In your situation, I would research all options and probably consult two or even three different specialists. I think with something as complex as this, you need several opinions. It might end up costing money but it will be worth it, particularly if you get your life back and you can work again.
Hopefully other members will have some recommendations and luckily, most specialists are happy to have telephone or video consultations now.
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I'm sorry this hasn't gone the way you had hoped, however it can take up to 3 months to stabilise on hormone therapy and you have only been on the 100mg patch for a few days.
Unless you feel the HRT is worsening things for you, I would be inclined to persevere for a while longer to give yourself chance to acclimate and stabilise.
This doesn't mean you can't pursue psychological intervention alongside.
Given the physical stresses that you have been through, some form of talking therapy if you can afford it is probably way preferable to introducing psychiatric drugs into the mix as well, which don't help nearly as many people as we would like to think they do, have some really toxic side effects and can be difficult to come off.
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Thanks for all the advice.
Bomb the reason I wanted to ensure my E level was high enough was to now prove my horrific symptoms are not hormonal levels.
I was just getting iller and iller and iller on the HRT and cm. Just as I did last year on the various pills i tried. No way could I continue for another 3 months. I now want it all out of my body. This is not a case of stabilising at a hormonal level. Unfortunately.
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Woah, Crispy... I was like 'hmm, interesting' reading your post... until you came to the conclusion to stop it all :o
I mean, surely if you have noticed a huge improvement in your joint pain and then you've tested your E and found you're in the 600s, that actually proves (or at the very least suggests) that getting your E up will help your symptoms? (At least some of them!!?)
It's very true that the increase may not be due to the patch, it might be that your own body has produced some - but wherever it has come from, a high level has correlated with an improvement in your symptoms?
I would really just focus on increasing according to your symptoms and not even thinking about bloods except checking very occasionally to be sure you are not going stratospheric with levels. (Like above 1000pmol.) You are not anywhere near that at 600...
Really the goal is to even out the lows so they are not too low. Because most people reckon that's what causes the symptoms. Which is why there might sometimes be higher results. For example, I asked ChatGPT if a woman can spike high with estradiol even during her period if she is peri-menopausal. Chat GPT said:
"Yes, it is possible for estradiol levels to spike during a menstrual period in a peri-menopausal woman. Perimenopause is a transitional phase where ovarian function becomes irregular but is not yet completely shut down, leading to fluctuating hormone levels. Here’s why this can happen:
1. Irregular Ovulation
• During perimenopause, the ovaries may occasionally release eggs sporadically, even outside the typical ovulation window.
• These sporadic ovulations can cause temporary surges in estradiol production, even during what might seem like the menstrual period.
2. Erratic Hormonal Feedback Loops
• The hormonal feedback system between the hypothalamus, pituitary gland, and ovaries becomes dysregulated in perimenopause.
• This can result in unexpected rises in follicle-stimulating hormone (FSH) or luteinizing hormone (LH), stimulating the ovaries to produce estradiol unpredictably.
3. Residual Follicular Activity
• Even if ovulation does not occur, small follicles in the ovaries may still produce estradiol. During perimenopause, these follicles can function erratically, leading to occasional surges in estradiol."
So I really wouldn't think too much about serum levels or adjusting dosages unless and until you are consistently and always getting too high results....
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" I mean, surely if you have noticed a huge improvement in your joint pain and then you've tested your E and found you're in the 600s, that actually proves (or at the very least suggests) that getting your E up will help your symptoms? (At least some of them!!?)"
I'm afraid not joziel. I'm probably not being very clear on here.
To cut a very long story short I've been in hell for 7 years. So many tests. Nothing found. I have always believed it is hormonal. I have messed soooo much in this last few years - paid out £££ for help. All fruitless.
The chem menopause is extreme but I was convinced it would work. Alas no. As I hurtled into menopause all my awful ill symptoms came on full force.
I developed new symptoms of classic meno - hot flushes and severe joint pain. It is important to note I had no low E symptoms before. Never had joint pain.
Then I realised I needed to get to sufficient E to ensure I was simply battling low E. Hence the shifting up the patches and this post.
But that conclusion was reached in a matter of days. Defo absorbing. Joints 70% better.
But me...I feel iller and iller. Very very ill. It's not tolerable. Now when I add/remove hormones I get worse and worse - I now know for sure these 'reactive' symptoms are nothing to do with hormone levels. Incredibly hard to explain, but takes me to a point where I feel so vile and ill.
I have been worse on this process than on nothing (and I do now get some wild peri symptoms - obvs they have gone in cm). The same thing now happens when I start or stop a pill. I get very very ill. When I stop it's like a steroid withdrawl. It's not normal. It's not low D or high E. It's taken this awful experience to prove that.
It's not normal and it is most definitely not something I can sit on for another 3 months.
If it was 'just' about hormonal levels I'd have cracked it this week and been sailing. Gutted doesn't come close. I'm broken and traumatised by the whole thing.
Hope that explains. X
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It sounds incredibly complex Crispy. I hope you find some answers. Have you had a full thyroid panel run, including T3 and rT3? Those symptoms can be v similar to sex hormone stuff and can also intersect with the sex hormone stuff. I am trying to navigate it all as well with a lot of guesswork...
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I have indeed. Yes.
But I'm off to endocrinology next. 8)
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Good luck with that. Is that privately or via NHS?
Because I've been told I should also see an endo but for various reasons it would probably need to be privately and so I am umming and ahhing because I really don't think it's going to go anywhere ultimately but will just be very expensive...
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NHS joziel.
I'm not overly optimistic either.
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Crispychick, Tibolone, have you tried it?
It's one dose fits all, one pill a day, on the NHS.
It is a progestin which is given to women who are intolerant to other progestins because the form of it is very different and you just feel better.
None of this nonsense of feeling better for two weeks then awful for two weeks.
I've been on it ages and I don't understand why posts suggesting it are shall we say, discouraged? :clapping: Only on this forum/business platform, I don't know the reason.
I think it is the best thing since sliced bread.
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I agree tibolone is a great option for some, and very underutilised.
I have certainly seen people thrive on tibolone and am interested in it for myself once I no longer need menstrual suppression.
There has been a lot of social media evangelism around bioidentical and transdermal options in recent years, which are great but will never meet everyone's needs as we are all different.
I don't know if tibolone is particularly disapproved of on this forum but I feel the disparaging of oral and/or synthetic options more generally has led to people feeling like they have to struggle on with treatment that is messy, inconvenient, expensive, doesn't stick, poorly absorbed and causing unpleasant side effects.
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Right now I need to stop everything.
I asked my consultant about tibolone, as I noticed the majority in a chem meno FB group seem to be given it. Sometimes if doesn't seem strong enough for many though. But that's those in cm, not natural meno.
I was told there's a higher incidence of migraine, which is why I was started on patches.