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Author Topic: Flushes are back on HRT  (Read 416 times)

Bo

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Flushes are back on HRT
« on: October 07, 2018, 08:42:56 AM »

Hi Everyone
I posted about this earlier in the week asking about bad batches of patches. I have been on 75mcg Evorel patches since the end of June - just changed to Estradot this week. I use the 100mg Utrogestan vaginally. I was doing this every other day but decreased to twice weekly towards the end of August as it seems to cause me lethargy and depression and very bad breast pain...I say 'seems to cause' because i can't be certain but i always feel better within about 48 hours of reducing it (i have previously taken it once a day orally when first on HRT, changed to once a day vaginally, then every other day, and now every third day, and felt better each time).

Until the last two weeks, i have sometimes been able to sleep through the night, sometimes got a too warm feeling once in the night, and no flushes during the day at all. In the last two weeks, the flushes / night sweats have been returning, and i am getting a few during the day now too. I feel tired and lacking energy. It's almost like it was before i was on HRT. I am feeling tearful & down too. This is partly because it seems the HRT is 'failing' and i don't like the idea of increasing the oestrogen again, if that's what's needed. What is the maximum recommended Estradiol daily dose? Or maybe i need to increase the Utro back up to every other day.   :-\ On the plus side, my boobs are almost without soreness for the first time in months.

I am due a follow up appt in Dr Panay's meno clinic in November but any advice on what may be going on before then will be appreciated. Thank you  :)
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NorthArm

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Re: Flushes are back on HRT
« Reply #1 on: October 07, 2018, 09:17:44 AM »

Hi Bo

This happened to me on the 50 patch, Iíve recently gone up to 75 about 10 days ago, and Iím feeling better for it.

Give the 100 a little more time, and try to make your patch change day on a different day and/or time to when you use Utrogestan- Iíve done this, and I feel it gives the patch a little more time to Ďbed iní before I dampen it with the Utrogestan.

Your appointment is not far away, so hopefully things improve the longer youíre using the stronger patch. At least the specialist youíre seeing knows about these things and wonít give you the run around lol. Do keep a diary, and make sure you write down all your questions for him.

Good luck with it all xx
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Bo

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Re: Flushes are back on HRT
« Reply #2 on: October 07, 2018, 03:16:28 PM »

Thank you.  :)
Just to clarify, I'm not on 100mcg of estradiol at the moment, still on 75 mcg. I am wondering if i need to increase it though. And/or if I need to increase the Utro back up to every other day. Maybe i'm out of balance between the two  :-\

If i increase, does anyone know the maximum recommended amount of estradiol in a day? And i have also heard that our body can get used to the estradiol and that could be why it appears not to be working now  :-\ It's a bit of a problem if it is  :-X 

BTW, i had last period age 51 and i am now 56. I started on 2 pumps Estrogel daily and 100mg Utro (orally) daily for 25 days out of a month in July 2017. This regime did not produce a period, or control my flushes, or do my moods any good. So i gradually reduced and stopped the oestrogen for a few months, although kept the Utro going every other day (because i had read the progesterone only can control flushes - this dose didn't) until i got an appt in Dr Panay's clinic this February. Then i started on 25mcg patches plus Utro 100mg every day, which i had to change to vaginally because i got very depressed (not had this before in my life), and then gradually decreased until where i am now, on one (vaginally) every 3 days. I increased the patch dose by 12.5mcg every 6 weeks or so. I had a follow up appt in May which showed my blood/serum oestrogen levels were still too low to prevent osteoporosis, and i was still having some flushes. So i gradually increased the patch dose up to 75mcg this June. I also apply Ovestin cream twice a week as the patches have not fully helped my VA. And when i was on a higher dose of Utro, the VA was worse.
I am also on thyroid treatment (since 2015) - i have been stable for a while now on 62.5mcg of Levo + one NDT per day  :)
« Last Edit: October 07, 2018, 05:52:33 PM by Bo »
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NorthArm

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Re: Flushes are back on HRT
« Reply #3 on: October 08, 2018, 07:33:15 AM »

Why no try going up to the 100 - youíve been going up gradually anyway.

I know Studd/Panay like blood levels of oestrogen of about 300 to control symptoms. Weíre you thinking of having a blood test to check your levels?
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Bo

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Re: Flushes are back on HRT
« Reply #4 on: October 08, 2018, 12:37:02 PM »

I am considering increasing but concerned about risks etc. Do you know of the maximum recommended oestrogen dose per day? The Evorel leaflet says not to exceed 100 mcg per day but I can't find anything in the Estradot leaflet or anywhere else on the internet on this question.

The menopause clinic at Chelsea & Westminster have asked for the bloods to be done prior to my next appt in November, same as they did before my first 2 appts with them  :)
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Joaniepat

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Re: Flushes are back on HRT
« Reply #5 on: October 08, 2018, 01:12:30 PM »

The main thing is how well you absorb the oestrogen from the particular product you are using, rather than the actual dose as such. For example, I didn't absorb much from three pumps of Oestrogel, a medium high dose, so switched to Sandrena gel. Like you I go to the Chelsea & Westminster, and will have to get bloods done two weeks before my next appointment so that they can see if the Sandrena is more effective.

JP x
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Bo

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Re: Flushes are back on HRT
« Reply #6 on: October 08, 2018, 02:49:39 PM »

The main thing is how well you absorb the oestrogen from the particular product you are using, rather than the actual dose as such. For example, I didn't absorb much from three pumps of Oestrogel, a medium high dose, so switched to Sandrena gel. Like you I go to the Chelsea & Westminster, and will have to get bloods done two weeks before my next appointment so that they can see if the Sandrena is more effective.

JP x

O ok. I didn't realise that we can have different absorption rates, although I do know I didn't get on with the Estrogel which is a shame as it's BHRT and I believe the patches aren't  :-\
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NorthArm

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Re: Flushes are back on HRT
« Reply #7 on: October 08, 2018, 08:53:49 PM »

Patches are also considered BHRT - Estradot is produced from soy 😁

And they make a 100 patch, and Iím going on it if the 75 stops working as well as it has for the last 10 days xx
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Bo

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Re: Flushes are back on HRT
« Reply #8 on: October 09, 2018, 09:52:16 AM »

Patches are also considered BHRT - Estradot is produced from soy 😁

And they make a 100 patch, and Iím going on it if the 75 stops working as well as it has for the last 10 days xx

Sorry to hear that, i hope you do better on 100. I have just increased to around 87.5mcg today, cutting an old Evorel patch up, so I've got both types of patch on currently. And then there's the debate on whether the soy-based patches are no good for those with thyroid troubles, like myself, or whether it doesn't matter because the lab has 'modified' the natural ingredients so much  :-\
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Hurdity

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Re: Flushes are back on HRT
« Reply #9 on: October 09, 2018, 07:45:28 PM »

There's no debate about that (ie soy etc) except maybe on wacky forums I imagine  ::). Estradiol is pure wherever it comes from so bears no relation to and contains no impurities from the plant from which it was extracted and refined.  Estradiol used in the manufacture of HRT will be pharmaceutical grade just like any other drug or product. It is just nice to know that it is of plant origin in contrast to Premarin and similar which are from horse urine!

The main thing is that you need to have an dose which controls your symptoms so if you are still getting flushes weeks after changing your dose then maybe too low. However if you do have an underactive thyroid then an imbalance here can cause flushes too and I know (from reading on here) that some women find it tricky getting them both right.

SueLW has posted quite a lot about this as she uses both (thyroid meds and body-identical HRT) and is knowledgeable so maybe search for her posts?

It is unlikely that reducing progesterone will cause an increase in flushes - often the reverse - many women need an increase in oestrogen dose when they start the prog phase of their cycle or if their prog dose is high. If you are increasing your oestrogen dose to 75 or 100 mcg - depending how well you are absorbing it - you may find that 100 mg of progesterone twice a week (even vaginally) is insufficent to protect your uterus lining so when you go to the clinic hopefully you can talk about his and get this checked out - vaginal use is better absorbed but it is dose dependent (ie more prog needed the greater the oestrogen dose absorbed) so best to keep an eye on it?

The other alternative is cyclical use eg on longer cycle although maybe this doesn't work for high oestrogen doses? Maybe a 6 week cycle to minimise the times you need to take prog? Great that you are with the Chelsea and Westminster so you are being well looked after!

Hope this helps and you see an improvement soon :)

Hurdity x
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Bo

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Re: Flushes are back on HRT
« Reply #10 on: October 10, 2018, 11:24:05 AM »

Thank you.
Yes, I am aware that I may have to increase the Utro back up to every other day. I will just see how I get on with the increase to 87.5mcg and then decide: i really don't like the depressive symptoms it gives me though  :-\. The doc said back in May that if I continue with Utro vaginally every other day, i would be a 'guinea pig' for them. I tried following her instructions of daily use of Utro back then (because i was gradually increasing my patches then too) but felt awful  :( They are going to order my first scan in November so we will see what's happening then in terms of my uterine lining. :)
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Hurdity

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Re: Flushes are back on HRT
« Reply #11 on: October 10, 2018, 05:15:15 PM »

There has been research on the efficacy of intermittent use of vaginal progesterone and one study looked at twice a week - but probably not for higher doses of oestrogen. Usually the studies of vag  prog are with lower or medium oestrogen doses, otherwise reports are anecdotal.  There was also a summary/review paper which gives all the info to date. I posted links and abstracts of all the papers which I can link to if you want?

Good luck with your scan and do post up here the outcome as we are all interested in off-licence individualised regimes and how they work for different women! Do hope you can cope until then....not long to wait.

Hurdity x
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Bo

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Re: Flushes are back on HRT
« Reply #12 on: October 11, 2018, 09:33:09 AM »

There has been research on the efficacy of intermittent use of vaginal progesterone and one study looked at twice a week - but probably not for higher doses of oestrogen. Usually the studies of vag  prog are with lower or medium oestrogen doses, otherwise reports are anecdotal.  There was also a summary/review paper which gives all the info to date. I posted links and abstracts of all the papers which I can link to if you want?

Good luck with your scan and do post up here the outcome as we are all interested in off-licence individualised regimes and how they work for different women! Do hope you can cope until then....not long to wait.

Hurdity x

Thank you. A link would be good thank you. I looked up some research/info on the French regime (prog twice weekly) but i think the HRT they were using were different brands/types to what i am using, so not easy to make a direct comparison. I think Australians use a similar regime. What is considered a low, medium, or high dose of oestrogen, if you know?  :)
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NorthArm

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Re: Flushes are back on HRT
« Reply #13 on: October 11, 2018, 10:09:01 AM »

Hi Bo

25mcg patch is low, 50 is medium and 75 & 100 are considered high x
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Bo

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Re: Flushes are back on HRT
« Reply #14 on: October 11, 2018, 12:45:35 PM »

Thank you...of course i would need a high dose!  ::)

I have seen in some posts that people can be on 4 pumps a day of Estrogel, which i thought was equivalent to 150mcg.  :-\
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