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[Lizab]

No one answered this question buried in my other post, so I'm starting a new thread for it. Has anyone else experienced the patches seeming to run short by a day or so? What's your solution?

I've read that this is not really possible, because the patches are designed to deliver evenly throughout the prescribed days. On the other hand, I've read that if it's not a high enough dosage, your body will take all the estrogen out more quickly and you can come up short at the end. You can find anything on the internet, I wonder which is correct.

Has anyone else experienced this?  I am definitely having hot flashes on the last day, and I think my blue moods are following a pattern as well. Does a dosage increase help? Or do you still get fluctuations but with a higher level? Does the patch simply not work for me, and if so, what's a better option?

I'm only on .375 changing Tues nights and Sat mornings. I can ask for an increase, but if it's not going to help I'd prefer to not waste any more time with it and instead find another course.

[Mary G]

Lizab, my first thoughts are that you are on a very low dose which might not be enough to control your symptoms anyway.  You could try upping the dose or changing to the oestrogen gel which is more flexible because you can adjust the dose. 

When I was on the patches, I always stuck the next one on a day early while leaving the existing one on for a day as back up.  I now use the oestrogen gel which I find much better.  In order to keep the oestrogen levels up, I split the dose by 12 hours and that has really helped.

[Worrywart]

Lizab, how long have you been on the patches for? Mary is right, the dose does seem low, but it does take a while to build up a level of estrogen so it might be worth asking to increase the dose and trying it for longer.

On the other hand, many women get on really well with the gel and I'm tempted to switch over to it myself (I've been on patches for years). I'm not sure of the equivalent amounts though. Do you know that, Mary?

[Mary G]

That's a trickly one Worrywart!  Generally speaking, 1 pump of gel = 25mcg patch, 2 pumps = 50mcg and so on but that is only in theory.  The problem is, everyone absorbs each product very differently so it's trial and error, you have to try it out and see what works best.  Most people start on 2 pumps of gel and go on from there. 

[Lizab]

Thank you, ladies. I'm in my 5th week on the patch. It may be too soon to try an increase, but I think I'm seeing a pattern now. If things don't settle in the next week or two, I'm certainly going to ask for a bump in dose. My fear is that an increase in dose will give me an even more intense yo-yo effect, which is why I'm asking. So the ups and downs more  likely to be from inadequate dosage than from the patch method being a bad match for me?
While putting a new one on a day early may help, I would run short before my insurance would allow a refill.

[Hurdity]

Hi Lizab

As you say - they don't work like that. The patches do deliver a constant dose and cannot deliver it more quickly than designed - so if your oestrogen is low it doesn't use it up. The long paper I have downloaded about the pharmacology of all of this says that all patches are actually designed to last a week. The absorption of estradiol rises quickly over the first 12 hours and then declines slowly over the next 7 days. There is much more oestrogen in the patch than can ever be absorbed in the time. I won't go into the maths unless you want me too  . Most brands are designed to be changed twice a week to deliver the dose of estradiol stated. They do not run out after two days - unless of course they become stuck less well. Also even if you take a patch off completely it takes 12 hours for the systemic levels to drop to baseline. If you find they are not enough then as Mary G suggests maybe you need a higher dose.

Apart from a few short forays into lower doses I have only ever been on 50 mcg which has always been sufficient to eliminate my menopausal symptoms - whereas 37.5 mcg did not. (Actually I am now on 62.5 mcg but that's because I also take testosterone and didn't want to become relatively T dominant as happens in post-menopause).

An increase in dose will not give you a yo-yo effect as long as you change the patch on the required days and make sure it's well stuck - I periodically have a feel of mine and press them down again to ensure they make contact with the skin all over - especially after shower or bath.

Hurdity x

[Worrywart]

Lizab, you also don't say how long you've been on it - it really does take a while to get a constant level, but my gut feeling is that, as Hurdity says, 37.5 isn't enough. I started at 50, went up to 100, then down to 75 at one point. Maybe ask for a higher dose and see how you get on?

[Lizab]

I'm only in my 5th week on them. I'm planning to schedule a followup after 8 weeks. I hope by then I'll be able to say for certain if I need more estrogen. I would love to ask for an increase today.  At this point, other than my early morning hot flashes, I feel much better physically, but am an emotional disaster, very up and down.

[Worrywart]

I've honestly not heard of starting that low before and I wouldn't wait but would ask for 50s. It's great that you feel better physically but there should be a difference in 5 weeks. If you think you can hold out until 8 weeks though there's nothing wrong with that as a plan. X

[Lizab]

It's just that my doctor had said followup 8 weeks after. I'm afraid if I go in too early, he'll want me to wait it out. I think I will go ahead and schedule though. This has gone on too long. It may be closer to 8 weeks before he can see me anyway.

[Lizab]

All right. I'm on a fresh patch since last night, and I've been weepy all day, so my pattern theory is blown away. I scheduled an appointment for next week.

Another question, at the end of the progesterone course, my bleed wasn't super heavy, but it wasn't light either. There was one morning I woke up soaked. My last period had been in early November. I'm afraid increasing estrogen will bring back the floods. I guess it's silly to think that with my FSH over 100 that I have much estrogen of my own, so bumping to .5 should be ok? I would prefer a little reassurance. I'm terrified of swinging too far and developing high estrogen symptoms.

[Worrywart]

I do remember my bleeds getting heavier when I started HRT. Being perimeno they had decreased massively. But it really is unlikely that you will get symptoms of too much estrogen from a 50 Mcg patch. It's a normal starting dose. The problem is partly that the very emotional symptoms you're experiencing make it terribly hard to think clearly about what's happening and you need a sympathetic gp to guide you. It's so hard to ask for what you want when you feel all at sea. Have confidence in knowing that you don't feel like you should and you need some help with that. When you find the right thing, at the right dose, you will feel so much better (although not completely perfect, because none of us is)! X

[Briony]

Can't remember how old you are, but as the others have said, your dose sounds very low. I am 43 and found 50 mcg did nothing. I am now on 100 mcg as I need to suppress ovulation to avoid fluctuations. Have you considered gel so you can play with the dose?