Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: pepperminty on April 10, 2025, 05:05:20 PM
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Hi Ladies,
I am on currently on 1.5 mg to 2 mg of oral estrogen a day. I will be changing my HRT type. I have been advised to start on a 25mg patch. They suggested cutting a 50 in half and waiting at least 6 weeks before I increased. This dose seem to be a bit low? I was told that being late 50's I shouldn't need so much any way? I will be taking Utro for 14 days per cycle.
I wanted cyclical to ensure I got the right dose of estrogen before I even consider a conti regime, for obvious reasons.
My concern is that on 25 mg only I will be on the floor!
(I intend to get my estrogen levels tested regularly via medichecks to see where I am . I test now and my last level was 500 ish and I have always been consistent around the 300 mark before I increased my oral dose. )
Is 25mg too low?
PMxx
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Dose finding studies suggest 2mg oral estradiol produces similar blood levels to 100mcg patch.
Popular equivalence charts eg on the BMS website put 2mg oral as approximately similar to 50mcg.
I would start with at least a 50mcg patch (you could show them the BMS chart) and have a low threshold for increasing based on symptoms.
I would also ask them what evidence they have that older women need less estrogen. This belief is frequently stated but there are no published studies that I am aware of looking at outcomes in women who have their dose arbitrarily slashed at a given age.
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Dose finding studies suggest 2mg oral estradiol produces similar blood levels to 100mcg patch.
Popular equivalence charts eg on the BMS website put 2mg oral as approximately similar to 50mcg.
I would start with at least a 50mcg patch (you could show them the BMS chart) and have a low threshold for increasing based on symptoms.
I would also ask them what evidence they have that older women need less estrogen. This belief is frequently stated but there are no published studies that I am aware of looking at outcomes in women who have their dose arbitrarily slashed at a given age.
Thank you for confirming this. I have looked at charts and there dose as you say appear to be discrepancy about dose equivalents between charts . I thought 50 mcg patch was about right. The advice regarding a lower dose for older women was from the specialist and the reasoning was that older women don't have any estrogen anyway when they are menopausal. You can't argue with that :o
PMxx
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That's the most ridiculous and unscientific argument for undertreating a condition that I have ever heard!
I'm just glad he (and I am almost positive it was a he) isn't treating amputees "sorry that's your whole leg gone, but here's a prosthetic toe".
It sounds like that clinician is one of those types who really begrudges anything more that a sniff of estrogen and would rather we all just ****ed off and took antidepressants instead.