Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Daisy1 on December 18, 2025, 09:32:51 AM
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Hello!
My first question is has anyone successfully been prescribed testosterone while on the combined pill? I've been on a few different pills this year, trying to find the right one, but it's definitely negatively affected my libido. It wasn't particularly high anyway, due to small children and life in general - so I really can't afford it going down more! I'm hoping with the new pill I'm trying (Qlaira) it won't be as bad, but still curious if I could add in testosterone. Someone else suggested DHEA which I will also look in to.
Secondly - I had previously tried Evoral 25 mcg patches, but didn't notice any difference. Possibly just felt even more jittery and on edge. I've just started Qlaira - it's VERY early days because I've only been taking it for two days, but already I feel so much better! I really don't think it can be a placebo, as it's so significant. The first two pills in the packet are estrodiol only 3 mg and the big difference is my mood - much more positive, energised, friendly and I actually feel motivated to exercise, get stuff done and eat well. For the first time in months!!
I'm wondering what the equivalent dose of transdermal oestrogen would be vs the oral estrodiol 3 mcg? Maybe if I'd tried a higher dose patch I would have noticed a positive benefit. Do people find that one type absorbs better i.e. spray over patches? I felt like the patches peeled off around the edges after a couple of days, so maybe that also affected the dose. I've looked online and it seems it might be 75 mcg patch needed to reach a similar dose to the Qlaira first few pills.
Thanks so much in advance! This forum is incredibly helpful!
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In my experience and from what I have read, 2mg estradiol orally is equivalent to a 100mcg patch.
Some authorities will cite 50mcg patch as equivalent to 2mg oral however this is not what studies measuring plasma levels show.
A 25mcg patch is so low you may as well just buy a box of plasters from Tesco. It is so low that some of the old school menopause specialists were/are happy to prescribe it without endometrial protection and there wasn't any increase in endometrial cancer.
I do not know anyone who has prescribed testosterone to someone on the combined pill but it would be clinically reasonable under a suitably experienced specialist if you could find someone willing.
Unfortunately the most testosterone friendly specialists also tend to be transdermal, body identical evangelists as well.
This, as well as cost and existing safety studies is why I take DHEA, a pro drog of testosterone.
Actually if you are taking Qlaira, estradiol valerate is a pro drug of estradiol, which the body converts to estradiol.
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Haha box of plasters - yes I'm now realising this! My GP was very keen to start on lowest possible dose of oestrogen. But reading more, I think possibly because of my age being 39 I in fact did need a much higher dose.
So if I'm feeling good on 3mg oral estradiol then I could even need more than 100mcg patch? It's so odd how the GP really didn't want me on high patches, but was more than happy to prescribe combined pill which is sky high oestrogen! I don't need the pill for contraception as my husband has had the snip! But they're more than happy to dish it out for contraceptive purposes.
I tried 200 ultrogestan with the 25 mcg patch, but felt awful - but thinking maybe this was heightened because oestrogen was so low now...
Please could you explain what you mean regarding 'estradiol valerate is a pro drug of estradiol, which the body converts to estradiol'? Thank you so much, I really appreciate you taking the time to reply!
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Ok how do I explain that - it's not biologically active in the form that you ingest it.
Often what we eat, or medication we take, needs to be converted into something else inside our body in order to be useful.
Our ovaries don't make estradiol valerate, they make estradiol.
The molecule in Qlaira has a slight chemical modification, that our body processes to turn it into the identical estradiol that human ovaries produce. This is perfectly safe and effective.
Younger women especially if their own hormone production is waning, often need higher doses than older women, however this is very individual and for some they may only need a small top up initially, progressing to higher doses as their own ovaries fail.
Unfortunately the NHS doesn't really have the resources to provide this individualised level of care - a GP typically is allocated 8 minutes per patient and may not have had any menopause specific education.
There are two reasons the pill is more easily obtained in this setting - one is familiarity and experience, they are very used to prescribing birth control. Most women use some form of contraception during their life but only 14% of eligible women use HRT.
The second is because the primary objective of birth control is to sleep with men, whereas hormone therapy is purely about the woman's health and quality of life. One is valued culturally, politically and medically far more than the other, and you can probably guess which.
However I personally believe the pill, used continuously, is a better option for women under 50 for multiple reasons, including the very common and serious risk of undertreatment with menopause hormone therapy, particularly in younger women (e.g. being given a 25mcg patch) whereas the doses in birth control are fixed by default and known to protect against osteoporosis.