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[nissa11]

Hi everyone!
I was doing some research about the difference between Estradiol Hemihydrate and Estradiol Valerate as I noticed the difference between Climesse and Kliovance. It was interesting to read that these were just salts added which effect absorbtion rates. It appears that there is a peak of effectiveness of the oestrogen in HRT about 3-4 hours after taking. This interests me as I found taking half a dose in the morning and half 12 hours later really helped me to sleep. It is difficult to do if you have to break a small pill in half but it seems to help me. I bet our bodies naturally spread the oestrogen across the day, rather than pack it into one big dose so if any docs are reading this it might be a consideration? I appreciate some of you might not care to take HRT twice a day but if you're happy to it would be nice to have this sort of preparation. 

[peegeetip]

Hi Nissa

I had mentioned similar things in an earlier post.

There was another example of some ladies who went private and we given their est+prog tablet in the morning and an estrogen "top up" later in the day.

This saved them from having sweats overnight when the morning tablet had been exhausted.

Same applies for gels when some can be taken in the morning and some later to "top up" later in the day, rather than all at once.

Patches avoid this as they are constantly feeding levels of estrogen in

Your observations are very helpful for others who might find later in the day or overnight a challenge even on HRT.

[Hurdity]

Hi nissa11

The most important difference between estradiol valerate and estradiol ( as hemihdrate) is the mount of oestrogen you get from a given dose.

Estradiol hemihydrate is pretty much excatly the same as 17B-estradiol - the biological form. It just consists of two molecules of 17B-estradiol bound together. 2 mg of this gives 2 mg of estradiol.

Estradiol is a different structure - it has some extra atoms on the end which have to be broken down to give estradiol. The breakdown product is Valeric acid which is excreted. There is no mention as to whether this causes side effects or not. According to the summary of product characteristics for Climesse 2 mg of this ( ie estradiol valerate) is equivalent to approx 1.5 mg of estradiol so is 3/4 the dose of the equivalent 2 mg HRT consisting of estradiol (as hemihydrate) eg Elleste.

Therefore if you have changed from Kliovance to Climesse you have slightly reduced your estrogen dose and you may well notice this effect.

In terms of effectiveness and taking morning or night - from what I've read the biological effect of HRT is the result of the hormone building up to steady state where it will exert biological effects at cellular level. Even though there will be some daily fluctuation in blood levels of estrogen, there won't be the same fluctuation at cellular level and in the target tissues if you see what I mean. it's not like pain-killers where you need to take them every 4 hours just to maintain the pain-killing effect.

The other thing is with any tablet HRT is that it has to be digested and go through the liver and most of the estrogen gets metabolised to estrone and estriol and are excreted and it could also be the large concentrations of these compounds in the system could lead to some of the side efects experienced with large doses of tablet HRT?

Bit of a ramble again but hope it is helpful!

Hurdity x

[peegeetip]

Hi

I think there are some who have posted that they take HRT in the morning and are ok all day.
However there is a falloff in the evening and overnight where their symptoms come rushing back.

There are others that seem to be on edge when taking their HRT.

For those a top up / second half dose later in the day would prevent this happening.

This can either be done by taking your current dose and taking half in the morning and half in the evening.

You can do this by breaking the tablet or gel dose in two with no risk to yourself.

Or going for a more tailored approach with a morning tablet or gel then a followup estrogen tablet or gel for the evening from a private doc.

This has been mentioned in articles where people have gone to private doctors for HRT.

Not sure why a doc in the NHS could not try something this simple approach when some ladies can't handle a full dose of their HRT at one time or where it does not last till evening/night time.

One of the articles that first mentioned this approach.

http://www.dailymail.co.uk/femail/article-2442081/Could-designer-HRT-stop-menopausal-women-suffering-HRT-effects.html

Hope that helps.

 

[Dandelion]

I was on femoston tablets which were a really handy way of taking hrt, as they had phase 2 of tablets which incorporated the progestin, but, ssadly, for me, they didn't work.
Patches work better for me, but I had to go up a couple of doses to get any effectiveness, and I may have to go up in dose again, but will wait a while longer, and monitor myself as the weather gets a little warmer.

[Dandelion]

I was on femoston tablets which were a really handy way of taking hrt, as they had phase 2 of tablets which incorporated the progestin, but, ssadly, for me, they didn't work as I could not get the hormones to absorb into my system orally.
Patches work better for me, but I had to go up a couple of doses to get any effectiveness, and I may have to go up in dose again, but will wait a while longer, and monitor myself as the weather gets a little warmer.

[nissa11]

Apologies for not responding earlier but thank you all for your helpful comments on timing of HRT taking.
 

[jaycee]

Hi Nissa, just posted something similiar, didnt see yours until later
Hope i can get some answers from someone taking my type livial, dont know if all HRT acts the same or differently, if patches or tablets

[nissa11]

I think the trouble with patches as they can come off, meaning you get intermittent hormone issues. I would put a patch on one leg and in the bath it would come off and end up on the other!!!
I feel that it is stability of the hormone that is important. On patches I was all over the place...angry, moody, tearful, and I put this down to the fact that there wasn't a steady stream of hormones.

[Hurdity]

Apologies for not responding earlier but thank you all for your helpful comments on timing of HRT taking.
 

nissa11 - I love that you have apologised for not replying more than 2 1/2 years after your post!!

I know what you mean about patches - they are actually supposed to deliver a very consistent dose of hormones - but this does assume they are well stuck! I have always stuck them to butt cheeks where nix help to keep them attached (but not if Brazilian or thong!). What HRT have you been using since then?

Hurdity x

[nissa11]

Hi Hurdity - I know, I  have been away a while because I suppose I have been feeling mostly ok, although the depression has been a contant problem (probably more to do with my life than hormones I suspect)..

I have been on Kliovance tabls which is a continuous tablet, before that I was on Elleste Conti. Once I reached 54 the doc agreed that continuous combined HRT was best and I was quite stable on this, whereas the progesterone tablets over 10 days was making me a mad woman for some of the time.

Kliovance is quite a low dose and has been fine but in the last few months there has been a return of my symptoms, which is really frustrating. I am loathed to go to the GP to get Kliofem, which is the higher dose as I am now coming towards 59 and think they will probably tell me to sod off! I have my doubts that my symptoms will ever go away as information from others suggests that as soon as HRT is stopped all your symptoms return with a vengeance and I don't think I could stand that.

As I have said in a previous post, I would like to try Livial but have been told this would not be as effective as what I am already on. I don't believe this, I think it's because it costs more than my cheap Kliovance. The reason I want to try it is because it makes breasts less dense. I hate that I am at the whim of what a GP says is ok as I don't think you know without experience of the HRT and how it suits your body.

I will think about it.

[Hurdity]

If you want to try Livial then you should be able to! It is especially indicated for libido so if you want to try it then go back to doc saying you've done some research and this is what is recommended. If necessary go to different doc in the same practice - this is supposed to be a choice so don't be fobbed off - it's your body  !

The other alternative is to try a patch HRT which you may absorb better than the 1 mg tablet? There is Femseven and Evorel. Really the HRT you are taking should eliminate flushes and sweats as a minimum and if it doesn't then you need a higher dose oestrogen (as general rule of thumb - there are exceptions). With combi HRT you can't increase the oestrogen separate from the progestogen and some women find that the conti prog either increases anxiety or doesn't work so well on flushes, so if this happens with you - if you change to patch, then separate oestrogen and prog is the answer (or Mirena coil with the oestrogen).

If you feel you want to be taking HRT long term and no medical reason why not it might be worth looking into your different option - especially before you reach 60 when some docs are trying to apply the old rule about stop at 60 so you could have more of a battle on your hands. Depends how much you feel up to experimenting at this point?

Hurdity x

[nissa11]

Thanks Hurdity - you really seem to know your stuff. 
Yes, Libido is very low also at the moment  so another reason to try Livial but I am concerned about putting on weight as this seems to be one of the side effects - (call me vain if you like but I was always a size 8-10 before and very fit and healthy).

It's taken me years to get back to a normal weight after GP's diagnosing me as 'depressed' and putting me on anti-depressants when I was 50. I now know the anti-depressants made me fat and why. Same thing happened to my husband when he was on Prozac last year.

It's interesting that when I read that piece about testosterone, the doctor talked about testosterone helping with libido, depression and exhaustion, which have continued to be a problem even whilst I've been on Kliovance. I'm SO sick of feeling low, especially in the winter time and would try anything to get rid of the GLOOOOOOOOOOOOOOM!!! 

I just wish that I could talk to a medical practicioner who was able to give good advice.  I have no high blood pressure and my weight is stable (no history of breast cancer in the family)  so I can't think of any reason why they wouldn't let me try Livial (Tibolone) but the low mood means I have lost confidence in myself and I find GP surgeries very uncomfortable places these days with all the stuff in the media about the struggling NHS.

Sorry to go on..............

[Hurdity]

Hi there - you're welcome. There are several of us on here who have been around for a long time reading about all of this, as well as trying some of it  ,  so like to help others by passing on what little knowledge we have gleaned to those starting out....

I can sympathise about the weight - mine keeps on creeping up and I try to knock it back - but I seem to get hungry and I am active - so need to eat! I never let myself go up a size though so only fluctuate by about half a stone. I think sometimes one has to make a bit of a sacrifice in order to feel well - and you can still look good even with a few extra pounds - as long as you keep within healthy BMI as you can tone yourself with lots of exercise - Fitness Pilates, and the various body-conditioning programmes - and there are many new ones around! Also good haircut (and colour?), flattering clothes etc

Re confidence to  get the prescription you want - give yourself a crash course on all of this - yes read about testosterone, libido, menopause etc. Also how about an e-mail consultation with Dr Currie - giving your brief background, age, symptoms and HRT you are one and what you would like to try - then you ask her a question and she will reply. Costs £25 - facility on home page. This might make it easier to take to your GP.

Hurdity x

[nissa11]

Thanks again Hurdity.
Yes, like you I am very active (I was a dancer) I do step and pilates and I look after appearance...I think I'm just being a perfectionist. My husband is also gorgeous, which doesn't help because it makes me feel insecure about myself. He's lovely though, and very supportive but when you feel low it's easy to beat yourself up.
I don't feel like I used to and I think I've found this hard to come to terms with. 
Yes, I may try the email question as you suggest (once I've got a spare £25!) as it would be nice to get a second opinion.
I am going to step up my exercise regime and my husband and I started the 5:2 diet on monday. I think maybe extra adrenaline isn't helping my symptoms and the only way to work that off is with exercise I guess.
Hows your stuff going?
Thanks again for your support. x