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[laszla]

laszla, what is the dosing like with implants? If you get the dose wrong you can't take it out....  How did they start you out? Do you get multiple pellets or just more stuff in one pellet if you need to increase? What happens to the pellet afterwards, does it break down in your body or stay there forever or what? And do you know if they are available privately? I can't now wait months and months for an NHS referral...

I'm fine with T. For some reason I have zero problem absorbing Testogel. In fact, I have to use LESS than the amount recommended for women or my levels go too high. Why the Oestrogel made by the same company I just can't really absorb, I've no idea.

Joziel the standard pellet dose for oestradiol is 50mg and while in theory this is, I believe, equivalent to 2 pumps of oestrogel (which worried me at first as it seemed too little), in fact they absorb so differently in my case that the two systems aren't really comparable. For the first two pellets (spaced 4-6 months apart) I had the 50mg dose and gradually my plasma levels went up but it was quite slow.

The doctor I work with, once I reached about 800 nmol (which was a tad high for me), suggested cutting the next implant in half to 25mg as my rate of absorption seemed to increase with time and this was a good strategy as when I was due for my next pellet my plasma E2 was 650 nmol, a good level for me.

I then had a mishap in that that very good and 'tailor-made' approach doctor was away at my next visit and I had a nurse who hurried me, wasn't interested in the numbers (as I and the previous doctor are because it works for me) and insisted that a whole 50mg pellet was a better idea. Stupidly I didn't stand my ground.

Result is that now I've gone too high (for me), nearly 1000, caused a little bleeding and cramps, now resolved but the gp's making a fuss, even though endometrium is fine at 5mm.

But I consider this just a blip, it gives me the advantage of having tested what higher serum levels are like for me and establishing that my sweet spot is probably about 650-700.

The pellet itself breaks down (it's very small) and insertion isn't painful. But clearly you don't have the same degree of control of absorption with pellets though for me they are incomparably more effective and convenient than slathering myself in gel and never getting above 400 max.

I believe they are available privately - I actually didn't have a very long NHS referral wait but that was a few years back and it might well be worse now.

[joziel]

That's interesting, how often do you need to have new pellets put in? Is it every 6 months?

And where do they go, in your arm? Does it hurt?

Before you tried pellets, what had you tried in terms of transdermal and what was happening? How high did you manage to get your levels and what symptoms did you still have?

I might be okay with slightly lower levels around 650, but at the moment - because I am getting my thyroid levels right - I don't want to be changing estrogen as well. So it is best to hold it steady until everything is good and then to slowly see if I can come down a bit. I have no high estrogen symptoms like sore boobs or bleeding at weird times, but I do have very heavy periods at this estrogen dose. They are very short - it is 2 days of armageddon. I can slightly control when it comes by extending the utrogestan use a bit to delay...

UPDATE: Newson have come through and prescribed me Estradot 100s. WHOOP WHOOP. Only 48 patches. Which will last me 2 months at 300mcg and 3 months at 200mcg. I am wondering if I can use 200 and stick fk knows how many Evorels on as well.... surely I have to be absorbing something from them...  I think they couldn't prescribe me 3 months at 300mcg because that wasn't my last valid prescription from them. Hopefully after my follow up in 2 weeks, they will change that.

[laszla]

That's interesting, how often do you need to have new pellets put in? Is it every 6 months?

And where do they go, in your arm? Does it hurt?

Before you tried pellets, what had you tried in terms of transdermal and what was happening? How high did you manage to get your levels and what symptoms did you still have?

I might be okay with slightly lower levels around 650, but at the moment - because I am getting my thyroid levels right - I don't want to be changing estrogen as well. So it is best to hold it steady until everything is good and then to slowly see if I can come down a bit. I have no high estrogen symptoms like sore boobs or bleeding at weird times, but I do have very heavy periods at this estrogen dose. They are very short - it is 2 days of armageddon. I can slightly control when it comes by extending the utrogestan use a bit to delay...

UPDATE: Newson have come through and prescribed me Estradot 100s. WHOOP WHOOP. Only 48 patches. Which will last me 2 months at 300mcg and 3 months at 200mcg. I am wondering if I can use 200 and stick fk knows how many Evorels on as well.... surely I have to be absorbing something from them...  I think they couldn't prescribe me 3 months at 300mcg because that wasn't my last valid prescription from them. Hopefully after my follow up in 2 weeks, they will change that.

About 6-8 months per their official guidelines https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/hormone-implants-in-hormone-replacement-therapy-hrt, I would say that as time goes on they need to be spaced out a little more as the fist couple of times they were inserted at between 4 and 6 months.
They're inserted in upper buttock, they switch side each time, if you get 2 pellets (E2 and T) they go in together. They give you a local anaesthetic shot before so it doesn't hurt.

Before pellets I tried estradot patches (pathetic absorption for me) and mostly oestrogel, got up to about 6 pumps and bloods never more than 300-400 tops after about three years and it just wasn't practical for me to increase the gel.

No vasomotor symptons (though I guess always being cold kind of is even if not in its more typical manifestation), awful fatigue, palpitations sleep and mood and bones getting thinner and thinner - went from osteopenia to osteoporosis in the femur but since the implant all three of my bone density values greatly improved, no more osteoporosis - obviously this is the area that's easiest to measure the benefits of HRT in the most, literally, concrete terms.

Sleep is still a problem but everything else has improved and to me the long term benefits have always been crucial, not just the here and now.
They are certainly worth considering for anyone with absorption issues.
Glad you got your patches resolved.