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[PollyH]

Hi everyone
Can anybody help re patches and dosage. I was originally on femoston 2/10 and have been on hrt for eight years. Recently the 2/10 didn't seem to be working - so thought I would try estradot patches as I thought the same dose transdermal would be more effective (and safer) as I have been on it for a long time and would therefore not need to go any higher in dosage. So started on 50mcg but didnt feel right, then took 75mcg for a month and my estrodial levels were 103 - endocrologist says on the low side. So confused - am I absorbing the patches - should I use gel as well. I also took utrogestan (200mg) with this patch for days 12 to 26 and really struggled with this dose of progestogen.

So confused about post menapause as my fsh was 60 - when will I ever feel right - and if post meno - why do i need more and more estrogen - feels as if his is gonna go on forever. Also why is it that some women don't need estrogen post meno - where do they get theirs from. I'm so confused right now and I am off work again and have a gp appointment tomorrow.

Thanks for listening
PollyH
Xxxx

[Hurdity]

Hi PollyH

Sorry to hear you are having problems.

Blood tests are unreliable but if you have several close together it can build up a better picture I understand. I presume you are in UK and that this was a standard NHS blood test?

There are two different units of measurement for oestradiol - in UK it's usually pmol/l but best to check which yours were. This would be a low reading if so, but if measured in pg/ml then that reading is fine. Here are the references ranges (scroll down to the table)
http://en.wikipedia.org/wiki/Estradiol

Best to go on symptoms anyway. I would continue with the 75 mcg for a while - if you have only been on them for a month. Hopefully your levels will stabilise. It's difficult to predict how each woman will react to changing from tablets to patches. Generally patches give a more consistent dose if applied correctly. How often do you change them? Try every 3 1/2 days, and are they stuck down well? I have never had a problem with them and have only ever been on 50 mcg (now age 61 and probably about 7 years post-menopausal).

It's not a question of some women not needing oestrogen - all women become deficient in oestrogen (primarily (o)estradiol) following menopause. However some women do not experience obvious troublesome symptoms,or they are fewer than others. Nevertheless the deficiency affects everyone - because oestrogen has so many roles in our bodies. Fatter women have more estrone (stored in fat cells) - but this isn't a reason to be overweight!

If you used utrogestan vaginally then you could probably get away with a lower dose or slightly shorter course (unofficially) - but your  GP probably won't be happy with this, due to risk of endometrial thickening.

Hope this helps!

Hurdity x

[PollyH]

Hi Hurdity

Thank you for your detailed reply. My eostradiol level was measured in pmol/l - so I guess I have just gone further postmenapause or I am not making sure they are stuck down properly - but I'm sure that they are or I just need to give 75 patch a good go and if that doesn't work - I may need  the 100 patch. I change them twice weekly (Sunday evening and Thursday evening).

Do U think I would be better having the estrogel as a top up or will that just complicate things - either way I can't go back to tablets as the highest dose is 2mg equivalent to 50mcg patch. I feel like I am running out of options after this ax I struggle with the progestogen phase. Maybe a hysterectomy is the final answer as I would then only need oestrogen - bit drastic but so fed up with this. Sorry to moan.

Thanks again.

PollyH
xxxx

[PollyH]

Hi Hurdity

Forgot to ask - what should your eostrodial levels be when taking hrt and postmenause ? Also my reading was taken on day 15 of my cycle.

Thanks
PollyH
Xxx

[Suzyq]

75 patches is not a particularly high dose and you may end up needing more, but don't rush it. It took 3 months for my levels to fully build up and it's all obviously complicated by your own hormones joining in the party. I have found that too much can be as bad as not enough! I would suggest that you change patches every 3.5 days I.e. Sunday night and Thursday morning just to keep everything stable. My own levels on a 75 patch are low but when my own estrogen joins in go up to 600-700! I've tried the 100 but after a couple of weeks I can feel it's too high and I have panic and palpitations. I also have estrogel and can top up if I need to, but feel that faffing about too much with too many methods won't do me any good in the long run. I am hoping that I will acclimatize to slightly lower levels and that my own hormones will just give up the ghost soon! I have been peri for just over 5 years and have had some pretty hellish symptoms over the years, so now I just try to enjoy the semi-normal life I now have!!

Good luck and hope you start feeling better soon