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[Anastasia]

Hi Ladies,
I'm posting for the first time! How fabulous to share with you guys. Just when I think I'm sorted and done research I hit another stumbling block. Sure is a mine field this Peri and menopause event of our lives.
Anyway, hope to help some of you amazing ladies a long the way to.   

So my dilemma. I'm 47 peri menopausal  and started HRT at the end of November  as in Everol 50 patches and separate   (progesterone)Utrogestan  100 mg on days 15-26.  I'm finding the patches a bit inconvenient, not always sticky, a bit itchy and placement issues because I like swimming. Anyway I spoke to the GP about replacing the patches for equivalent dosage of estrogen tablet form but me continuing the same progesterone  but wanted a good recommended equivalent. GP said he'd get advice and speak to his colleague. Long story short I ended up speaking with him today  the GP pharmacist  who said the patches although 3.4 mg of oestrogen only release 50mcg of eostrogen over 24 hours but the tablet lowest dosage is 1mg every 24 hours so he said the dosage in tablets is far higher. I am confused as 1mg is the lowest dose in tablet form but appears much much higher in dose  than any of the patches. Have I got this completely confused?   Ps feel like I do need a higher dosage of oestrogen as some symptoms not gone away like moods and my bleeds are not in sync with when I stop the progesterone and I had 3 periods within a month.
 

[Anastasia]

Hi Stellajane,
Thanks for your reply. I already ruled out gel for various reasons.

[Tc]

Anastasia. Welcome to the forum. .

I would much rather just take a pill but my gynae was reluctant. she said that it can get broken down/metabolised by the liver first.

Unlike you  am post meno tho so don't know if that might've also been a factor
 
There are other patches. Maybe some stick better than others. Hopefully someone will be along who has experience of different ones  I only tried femseven and I had issues with them sticking.

Good to have you on board.

[Anastasia]

Hi Tc,
Thank you for welcoming me.
Yes I chose the patches for similar reasons you state and after careful thought and listening to Dr Louise Newson's advice re transdermal ie patches or gels  being the safest way to take HRT i. e.  straight into the blood stream and not being broken down through liver etc. but I understand the risk is very minimal re blood clots etc.  If I'm completely honest I've found everol patches to stick quite well now I'm used to them and when applying I smooth the patch with my hands rubbing and holding  a little while  and the heat of my hands helps.
I've got in my mind that a tablet  would be  more convenient. (Discreet)

However, it's the dosage thing I'm completely confused about as the pharmacist gave the impression there is far more eostrogen in the tablet I.e 1mg as opposed to 5mcg (0.05 of a mg) released over 24 hours. I'm aware you can increase patch dosage but it doesn't appear correct to me the comparison of amounts. Can anyone help re the dosage thing and how that works! Very confused 🤷🏻‍♀️ xxx

[Dotty]

https://www.menopausematters.co.uk/perimeno.php 

Hi have a look at the above link which tells you which treatments are low, medium and high dose.

You cannot directly compare the amounts in tablets, patches and gels as they are absorbed differently.

The pharmacist is wrong to say that the pills are a much higher dose !

If you are on a an Evorel 50 patch then the equivalent in tablet form would be 2mg or 2 pumps of gel. The general opinion is that transdermal is much safer but it's fien to personal preference . A lot of ladies do very well on the tablet form.

There is a table from the BMS which shows equivalences between the different types. I'll see if I can find it.

Hope that helps. I seem to have written an essay 😄 x

[Dotty]

https://www.menopausematters.co.uk/treatafter.php 

This link might be more useful as it's just the oestrogen tablets that you need with the Utrogestan x

[Dotty]

https://thebms.org.uk/wp-content/uploads/2018/08/HRT-Practical-Prescribing-AUG2018.pdf

Hi this document shows the equivalent prescriptions x

[Anastasia]

Good morning Dotty, oh my goodness yes it does help!
Thanks so much for this and essays are perfect  👌  (bring it on).
 
As I was like a dog with a bone last night I did find the first link you sent and some info from BMS but I didn't find the ‘equivalent prescription info' which is absolutely perfect and just what I needed to make sense of all of this. I did wonder if it was about absorption rate as that makes perfect sense to me now.

In fairness the GP's pharmacist wanted to check it out with the GP first (which is reassuring)as I don't think he understood the dosages. I can share this BMS info with him now.
At least I know I'm on a medium dose oestrogen now.
 
Maybe I should stay with the patches  a little longer as I think I got in my head the patches may not be getting into my system as well, whereas it's probably the opposite from what research I've read. (I seem to have mastered the place to stick them firmly now  lol 😂) so less worried.

I've just about  hit the 12 week
Mark of being on HRT and I feel there is some improvement in moods and no hot sweats now, but this last few months  brought some personal family events which have been emotionally draining, so some irritability may be as a result of that. I'm eating well and exercising again so all helps.
GP suggested reviewing again in 3 months if changing to tablet. Even if I decide to stick with the patchess should I give this dosage more chance to work and review again in another 3 months? I'm thinking the periods may become more regular eventually? Got that impression from GP and what time be read? (Now that's an essay... sorry for long rant)
Thanks Dotty and all you wonderful ladies.
X

[Anastasia]

Correction, I meant from what I've read xxx

[Tc]

.Do you mind me asking how you get them to stick better where do you put them?
Please don't feel you have to answer but I had to switch from patch to gel because they wouldn't stick, although the one I was on has now been removed from the market while they sort out issues with the adhesive!!

I'm not getting on great with the gel. Plus it's a real faff.

Glad you sorted out the dose issue.

[Anastasia]

Hi Tc, thanks!
No I don't mind at all. So to explain... I put them on my hip bone, right at the top of my leg, if you're sitting down you're not sitting on them and if you stand straight in front off the mirror you don't see the patch, if that makes sense. If I rub my hand over it patting gently for about 10 seconds they seem to stay well for the 3 or 4 days which includes going swimming and steam room or sauna. I alternate hips when I change patch.
Think I'm convincing myself then patch is good. This everol brand seems to stick well and from what I've read maybe better than most. Hope that helps!
Gel did seem a faf when I read about having to wait before dressing and no body contact for a while etc.. we need things to keep life simple, life is complicated enough at times  lol 😂

[Tc]

Thank you. X