Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Liz on October 06, 2015, 12:56:28 PM
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Went to GP yesterday and she was going to prescribe a 75mcg patch but decided to increase the gel instead to 3 pumps. Is this equivalent to a 75 patch, does anyone know?
Bit nervous today, as used an extra pump of gel this morning (3 instead of 2) so wondering how the effects will manifest?
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Hi Liz - I'm not sure what exact dose 3 pumps would be but it is a good idea to spread the applications when doing more that 2 pumps per day - so use 2 pumps at night and one in the morning - this will give better absorption and will spread the dose more evenly. My gynae suggested I do this if had wanted to increase my dose of Oestrogel. Also, you don't have to increase so much so quickly - perhaps try squeezing out a half dose extra for a few days so the increase in gradual? This is the beauty of using Oestogel - you have so much control and flexibility. DG x
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Thanks, I must admit it did seem a lot of gel to use in one go, took quite a while to dry and even later in the morning when I'd got dressed I'm sure I felt my trousers "sticking" a bit to it...... I did wonder afterwards if I should have increased it more gradually. I feel OK today, though, so will probably just try a little bit more tomorrow then.
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I am fretting today, though....... about the higher dose. I don't like the idea of being on 3 pumps if it's a high dose.
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Liz - don't worry. I can't remember how old you are or whether you have had a hyster - I assume you have - but 3 pumps is not that high. I'm sure that the increase from 2-3 will make a positive difference. dg x
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I was told by meno consultant 3 pumps was equivalent to Estradot 50. Maybe depends on patch.
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Thank you both of you.....I'm almost 48, not had a hysterectomy, still peri, so using Utrogestan for 12 days per month. Been all over the place though - having periods every 2 weeks or so, not bleeding at the right time after the Utro, so think it can safely be said that hormones are up the creek! x
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I was told by meno consultant 3 pumps was equivalent to Estradot 50. Maybe depends on patch.
It's not that high then really, is it? 3 pumps, I mean. I started out on Estradot 50 but had allergy to them.
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Just to say this equivalence thing is really tricky - and I'm sure I've found different answers in different places. The point is there is huge variability between women in how much is absorbed from the different formulations so the equivalence is only an average. For example some women absorb better from patches than gel or vice versa so equivalence would be higher (pumps to patches) in this case. I think it best just to look at broad categaories of low medium and high dose and just try it and see. Also different gels come in different concentrations ie Sandrena vs Oestrogel.
Cubagirl - all 50 mcg patches are designed to deliver the same dose ie 50 mcg per day. They are physically different sizes so may absorb differently depending on an individual woman's skin and also what she has put on it!
The main thing is that you are increasing the dose Liz - which is what you want? Can't remember why you are increasing and therefore what you are expecting in terms of your Q "how the effects will manifest?" . eg if you are still getting flushes and sweats and the 2 pump dose you would expect these to be eliminated. Most women also feel better on a higher dose of oestrogen - but of course replacing it exogenously (from outside the body) is a different matter than endogenous production ( from the ovaries etc) so doesn't feel quite the same.
Let us know how you feel anyway, and hopefully an improvement soon!
Hurdity x
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Hi Hurdity, GP suggested I increase as I was having low moods again. Mind you, this evening I feel absolutely shattered, as though I've been sedated. Had a headache all afternoon too, so think I may have used too much, or too quickly. Think I'll drop back to the 2 pumps tomorrow.
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Liz - Like you I am using Oestrogel and Utrogestan. I think the problem with Utrogestan is that it isn't as strong as the synthetic progesterones so not as good at controlling the bleeds. I am 59 so have been advised to try taking Utro continuously as I am post meno and this may get the spotting under control. You are peri meno and your own hormones may be still kicking in and out so causing your erratic bleeding a mood swings. I have to say that at this stage 2 pumps per day for you may be sufficient and the problems with the bleed is because your endometrium is building too much due your own hormones rising and falling.
You could possibly try Provera, a slightly stronger progesterone, which is often well tolerated and this might sort out the erratic bleeding.
Dealing with mood swings in the peri stage is very difficult because hormones won't be balanced - even with HRT.
I do find that I get more headaches with higher oestrogen. If your flushes and night sweats are under control then stick with 2-3 pumps and 12 days of Utro for a few months yet. Sadly we can't expect HRT fix everything.
Keep us posted. DG x
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Thank you, Dancing girl........ Just after I'd posted last night, I had to almost crawl up the stairs to bed. I felt absolutely sedated and barely managed to clean my teeth. Think I overdid the oestrogel yesterday by upping it to 3 pumps! Going back to basics today and using the 1 and a half pumps that I was originally using before I increased. I was getting some flushing on the lower dose, hence GP suggesting I try the higher dose, but I think it's too much for me.
Still feeling very zonked this morning, hope it wears off soon! x
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Hi Liz sounds to me you are getting to much oestradiol. Especially as you're peri, not menopausal.
X 2 measures (pumps) = 2.5grams = 1.5mg of oestradiol
Depending on make of patch, but roughly 75mcgs = 1.17mg of oestradiol
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Liz...just to add, the probable reason for you having a bleed every two weeks will be 1. The withdrawal bleed from the utrogestan after taking it for 12 days. Then your own endogenous progesterone dip monthly bringing on your natural period. Unless they work concurrently you are going to have irregular bleeding. Same happened to me in Peri. It's difficult to get a balance until you actually stop menstruating unfortunately. I know how awful it is, take care.
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Thanks Orchid, that's very helpful. So....according to your calculations 3 pumps of gel is more than a 75 patch?? No wonder I was zonked then! I'm going back to basics today and just going to use 1 pump of gel and see how I go. If I feel I need more, I will gradually increase is very slowly over days.....
You're right - this Peri stage is a total nightmare! People keep telling me that things calm down when you get over this stage - I hope so!
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Hi - I was told 4 pumps of Oestrogel is equivalent to a 100mcg patch.......
Dancing girl - do you mind me asking how many pumps you use? Also it makes sense to me that a post menopause woman may need a higher dose to feel well. However I'm also told post meno woman require less?
Wx
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Liz...when ladies are given progesterone with oestrogen it's usually to protect the endometrium the lining of the womb from building up and allowing it to shed. As you are still having regular periods (you are aren't you...monthly?) then why were you put on Utrogestan? Quite often, like me, women don't fair very well with progesterone's. If you are a person that suffers bad PMT when progesterone is at its highest level within your cycle, it's likely that extra is going to make you feel unbalanced. It's when periods have ceased that it's important to have progesterone to oppose the oestrogen and protect the endometrium? On the other hand if your periods are getting few and far between, well that's a different matter. Just a thought. Keep strong! X
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I was put on Utrogestan because I was having periods but every two/three weeks so I couldn't have Oestrogen without the progesterone and this was the most "natural". Obviously that was a couple of years ago now, so I don't know what my own cycle is doing now naturally.
Anyway, I've used 1.5 pumps today and feel much better, so I reckon this is probably enough for me at the moment.
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Hi Liz - they have put you on the right regime - even if you are peri meno and still getting periods you must have some progesterone to counter the oestrogen and stop the endometrium from building up. I expect your bleeds will become more regular as you get deeper into meno and your own hormones stop having such an influence.
warwick01 - I think the amount of oestrogen one uses will vary very greatly from one women to another. My theory is that many women believe a higher dose to be better but in my experience I have found high doses give me headaches and actually don't make things any better. As long as my flushes and night sweats are under control and I get some sleep that is all I ask. I have used oestrogel on and off for 20 years now (due to early menopause). I started out in my late 30s with just one pump per day then even in my late 40s, when I had gone into post meno, I only increased to 2 pumps per day.
I tried going up to 2 pumps a day when I went back on HRT last year but didn't find I felt good so dropped it to one pump per day which seems to be perfect for me now at 59. I am also trying Utrogestan 100mg continuously to see if this sorts my erratic bleeding. I had a scan so know all is fine but I think that Utro does sometimes give some problematic bleeding as it is not as powerful as the synthetic progesterones. True progesterone intolerance I think is quite rare - many women do fine of synthetic progesterone - Norethisterone made me want to kill people - no good!!!!
It's all trial and error but I do think one should give a low dose plenty of time to work before increasing. DG x
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Liz...when ladies are given progesterone with oestrogen it's usually to protect the endometrium the lining of the womb from building up and allowing it to shed. As you are still having regular periods (you are aren't you...monthly?) then why were you put on Utrogestan? Quite often, like me, women don't fair very well with progesterone's. If you are a person that suffers bad PMT when progesterone is at its highest level within your cycle, it's likely that extra is going to make you feel unbalanced. It's when periods have ceased that it's important to have progesterone to oppose the oestrogen and protect the endometrium? On the other hand if your periods are getting few and far between, well that's a different matter. Just a thought. Keep strong! X
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Thanks Dg - I'm going to stick with the dose, not thinking of increasing again, I couldn't bear to feel like I did last night.
Thanks Orchid - Replied to your post above (think this is a double post??)
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No probs Liz, you'll get there....
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Hi Liz sounds to me you are getting to much oestradiol. Especially as you're peri, not menopausal.
X 2 measures (pumps) = 2.5grams = 1.5mg of oestradiol
Depending on make of patch, but roughly 75mcgs = 1.17mg of oestradiol
Just to clarify that you cannot compare the TOTAL amount of oestrogen in a dose of gel and a patch - it is the delivery and ultimate systemic concentration that is the crucial factor ie the daily average amount in your blood-stream after absorption. Also the patch is usually changed twice weekly and the gel applied daily so there is no comparison whatsoever!
So the fact that a 75 mcg patch contains 1.17 mg oestradiol has no relation to the total amount in a gel dose. The 75 mcg patch is so called because it is designed on average to deliver 75 mcg estradiol per day into the system and according to the product info for estradot each patch size leads to on average the same value in pg/ml. so 75 mcg patch would lead to 75 pg/ml.
According to the product leaflet 2 pumps of estrogel containing 1.5 mg oestradiol gave average estradiol level of 76.8 pg/ml - but there will be great variability as some women will get much less, others more, from the same dose applied.
However I'm not sure if the information/figures given for both of these is even comparable as it is not clear exactly what they are based on - at least I am not a pharmacist/biochemist and can't interpret them properly.
Liz - as i said before, below, the thing is not to get hung up on an exact comparison - but an approximation of low, medium and high and if it's not working for you - then with docs agreement, to try to increase.
One thing is certain - high oestrogen should not make you feel either "zonked" or sedated" - this is not a property of oestrogen - more likely the opposite. It is progestogen that has a sedative effect, but low oestrogen can also lead to dip in mood and energy. Not sure what a sudden spike in externally applied oestrogen would do though?
Are you still peri-menopausal? Your own hormones could be coming into play. I wouldn't have thought you would need to reduce from 2 pumps - this dose is not going to lead to low mood ie it's not too much!
Anyway hope you feel better soon!
Hurdity x
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Thanks Hurdity.....yes, I am still perimenopausal (I think!). Before I started HRT I was having periods every 2-3 weeks (having gone from a regular 28 day cycle) along with many other symptoms, in fact practically every one of the 34 symptoms of perimenopause!
I am going to continue with the 2 pumps of gel and see how I go, if I feel I need to increase, as per the GP's recommendation, I think I will do it gradually over a couple of weeks rather than one big hit.
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If your periods were close together before you started HRT (and you hadn't skipped any) then officially you weren't even in peri-menopause but in what is known as the late reproductive phase (according to the official stages of reproductive ageing). I can post the link if you're interested - have done recently elsewhere. There are hormonal changes which occur then, but if you went onto HRT then, as you say you won't know what is happening to your underlying cycle.
If it was two years ago then likely you will be somewhere on the peri journey by now, but what is certain is that your own cycle will be coming through and I would suggest that this is what is leading to your change in moods as I said in my earlier post below. Sometimes your oestrogen will be very high and sometimes will dip - althouigh because you are taking estrogel it won't dip as low as it would without HRT. Because you will still be ovulating even if irregularly - until you reach menopause your progesterone levels will also be going up and down - and the prog you are taking will add to it. If your own cycle goes out of sync then no wonder you will be feeling like you do from time to time.
I'm not sure actually if there is anything you can do at this point although when your cycle becomes very weak a consistent increase in gel might make you feel better for most of the time.
Sorry that probably doesn't help but it will get better!!
Hurdity x
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Thanks Hurdity! It was recommended by my GP that I start the HRT then though - are you saying that I may not have been in peri when I started, I'm concerned that I may have started the HRT too early then? Hope I wasn't advised to start HRT before I should have been!
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Liz, tagging on to what Hurdity has said, I found that I reacted very differently to the gel. I had been on the 75mg patch and, looking back, it was not strong enough and I was not getting enough oestrogen. I am now taking 3 pumps of oestrogel every day and not only do I feel much better (completely back to normal in fact), my blood tests prove that much more oestrogen is entering my blood stream. I was told that 75mg patch is roughly equivalent to 3 pumps of gel but as Hurdity says, it depends how well you absorb it and I obviously absorb the gel much better.
It's all about trial and error and finding out what works best for you.
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Im a bit worried that I started the HRT too early now, after what Hurdity said about me not being in peri when I started.
Used 2 pumps today and been feeling fine, so perhaps 3 was too much for me.
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Im a bit worried that I started the HRT too early now, after what Hurdity said about me not being in peri when I started.
Used 2 pumps today and been feeling fine, so perhaps 3 was too much for me.
I wouldn't worry too much, Liz. If you had been on the pill, you'd have been taking more hormones than you have been,regardless of where in peri menopause you are- or are not.
It sounds like your own fluctuations could be impacting on the HRT. If that's the case, have you thought about trying something more controlling like Qlaira or the pill? It is a personal choice, and I can understand why many prefer HRT, but if you search on here, you'll spot a number of ladies in their late 30s/early 40s finding that having the pill - which prevents ovulation - stops the fluctuations. I switched from Evorel 50 to Qlaira and feel better for doing so. I do still have blips, but they are far less severe / frequent.
B
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Thanks Briony - I'm almost 48 now, so my GP ruled out the Pill for me, unfortunately.
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Sorry Liz I didn't mean to worry you! Starting HRT early (when having periods closer together but not having missed any yet) would have meant that you would not experience the big dips (in oestrogen) that other women experience as your oestrogen levels would be more evened out. It also means that what you are feeling now you are definitely into peri-menopause - are the fluctuations in your own cycle - a pain yes, but understandable. At least you should be feeling better than you would do without HRT.
I would just keep on with the dose you were using but accept that you may feel rough from time to time if your cycle is doing its own thing - most likely this will be due to the progesterone if you are ovulating at a different time than at the end of the two week oestrogen only part of HRT.
Interesting that you experienced all the menopausal symtpoms at that early stage anyway - which just shows it's all a bit of a mystery and it's not an all or nothing stage - there will be a gradual move towards lack of ovulation from the frantic burst of activity when periods come thick and fast. Have you read this article about peri-menopause - I'm sure I will have posted it at some stage? http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php
I'm not sure whether Qlaira counts as a Pill in terms of risk factors because as I understood it, the risks of the COC (stroke, clots etc) are due to the high doses of synthetic oestrogens which Qlaira does not have. Briony will know more about this!
It might mean your cycle stabilises a bit more for the few years while you are peri-menopausal -until you are late peri (you'd have to guess at when this might be!), if you can tolerate the progestogen dose. Might be worth thinking about? Your doc may not have been aware of Qlaira?
Hope you feel better soon!
Hurdity x
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Hi
Really interesting post.
I have tried patches several times the last one was Everal 75 with separate prog. For 6 weeks I felt horrid esp the weird head feeling I had 24/7.
I have gone back to the gel (again) starting on 3 pumps. My next experiment will be to try adding Utrogeteron 1-25 days.
Mary G - may I ask what your blood tests were and how hold you are?? I am 56 and was doing well on the gel for 3 years up until 12 months ago (think I must be post meno) when the anxiety esp agitation and panic set in along with the vertigo. I wonder if trying progesterone will calm me down??
Wx
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The risks with Qlaira are likely to be lower as the estrogen dose is lower than nearly all other BCPs (only 2 days of 3mg) and it's not synthetic, so again, less potent. It is for this reason that I am allowed it, despite my dad having had a stroke at a young age and me getting migraines (occasionally with aura). To be honest, the estrogen I take is similar to say, Femeston, so it worries me no more than when I took HRT.
Given that many pills have the same estrogen but different progesterones - with different risk levels associated with each generation's - makes me think the progesterone plays a role in the risk factor too? (Either alone, or in the way it interacts with the estrogen). Qlaira has a 4th generation progesterone called Dienogest. Research on it is sparse, mainly because it's so new (and expensive, so therefore less popular - though as a BCP, you get it for free!) but from what I can tell, it's very much an 'average or lower' risk - hence reason I was prescribed it, but the doctor would not let me have a conventional pill. It's not a brand new product, just new to the UK . It's far more common place in France and the US.
As I have said before, it is not the perfect product. I suspect such as thing does not exist. Spotting was an issue for several months and I do have the occasional blip when I am convinced my own hormones are still playing silly buggers, but overall, it's massively better than anything else I have tried.
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Liz, I'm 54 and about 9 years post menopause. When I have my check ups, I ask for hormone blood tests every time, I always tick the sheet that comes with the slip the doctor gives me and add on as many extras as I can! Nothing ever really worked before the gel (patches, Angeliq), I always felt a bit tinny and creaky and seemed to sweat too much but once I started on the gel, it all disappeared overnight and I suddenly felt completely normal again. I noted that the blood test results for the oestrogen went from 75 pg/mL when I was on both the Angeliq and patch (too low for me) to 190 pg/mL when I started the gel which is about right. I had them done in Spain so the readings might be different.
You may find the progesterone has a calming effect, many people react very well to it. I am severely intolerant to artificial progesterone (which are in fact progestins and not to be confused with the stuff you produce yourself) so I have to limit the use of it. Strangely, I have periods every month without taking any progesterone, I just get a natural bleed but over a longer period. If I do heavy manual work like building, lifting, heavy carrying etc. it causes a heavier bleed and speeds it up. No doctor has ever understood why I have periods without taking the progesterone and all my ultrasounds are normal. I'm just odd, but there is no reason why you should experience anything like this and you may find the progesterone helps in your case. You might want to try either Utrogestan (perferably taken vaginally for fewer side effects) or one of the natural creams like Serenity.
Hope that helps!