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[jaydee]

Hi there,
I'm hoping that one of you ladies can advise me here. I'm 61 years old and have taken HRT since I was 43 yrs. Two years ago, my then gp reduced my dosage of femoston sequential from 2/10 to 1/10, which I agreed to as the only alternative they offered me was to come off it altogether. Ever since, I've felt lethargic and, at times I get mild flushes; I also feel as though I've lost my 'zest' for life.   What I'd like to know is, if I went on a patch, could I have a higher dosage and what patch dosage would be equal to femoston 1/10 and femoston 2/10?

Many thanks in anticipation.
Jaydee

[CLKD]

GPs have been given new guidelines recently so maybe a trip to your GP and ask to go back to the regime that eased symptoms?

[Mary G]

jaydee, why not try the gel instead of the patch?  It is more flexible because you can adjust the dose to suit your needs and I personally found the gel to be far more effective. 

There is no reason why your doctor can't prescribe the gel or patch and I would say that you would probably need to start with either 2 pumps of gel everyday or a 50mcg patch if you go that route.  They are roughly the equivalent of 1mg oral oestrogen but only on paper.  As always, I found it didn't quite work like that and I absorb the gel far more easily than the patches so if you are the same as me, you could probably use 1 pump of gel.  You can go higher than that if you need to and try 3-4 pumps of gel and a 75 or 100mcg patch.

You will have to take a separate progesterone and most of us on here use Utrogestan vaginally to avoid side effects. 

1mg of oral oestrogen is very low and certainly didn't do anything for me so I am not surprised that your symptoms have returned. 

[Hurdity]

Hi there jaydee

Just to add re the patches - it isn't really possible to give an exact equivalent because there is such variation in absorption -  but generally the doses are given as low medium and high.

Femoston 1/10 is classed as low dose, whereas the standard post-menopausal oestrogen dose of 50 mcg patch is classed as medium. I have been on this dose ever since late peri-menopause at just before age 54 and it has always suited me fine - eliminated all flushes and sweats.

Therefore if you want to switch to a patch then Evorel sequi or Femseven sequi are the only combi patches available. I am interested to know that you are still on a cycle and presumably have a withdrawal bleed - and wondered if this was through choice or because the doc never suggested going onto continuous combined HRT? If you do change then I would recommend maintaining a cycle - not least because it involves a change in progestogen and you will need to know whether you can tolerate it or not.

If you don't like the idea of these progestogens in the combi patches - as Mary G says you can take separate patch or gel with utrogestan - which is micronised progesterone - and if you tolerate the one in Femoston then you will likely tolerate this too - except larger doses (of utrogestan) are needed due to its instability as a compound in the body.

I think you may well be pleasantly surprised when you go onto a 50 mcg patch and I certainly would not go higher than this at your age if you can manage on this dose, because of the larger amounts of progestogen needed and the possibility of heavier bleeds - which I am sure you do not relish at your age - I certainly don't!

By the way I am almost 63 and have been on HRT for 9 years, on a long cycle of 50 mcg Estradot patch and 200 mg utrogestan vaginally for 12 days every two months.

Hope this helps

Hurdity x

[jaydee]

Thankyou all, for your advice.
Hurdity, I did try Femoston conti but put on 2 stone in four months,  so decided to come off it.   If I use the gel for twelve days in a two month period, does that mean I'll only have a bleed every two months?  I've no idea how the patches and gel work!
Many thanks
Jaydee

[Mary G]

Stellajane is right.  The best thing is to try the oestrogen gel and see how much of it you need.  Most women start on 2 pumps everyday and either reduce down to 1 pump or go up to 3 pumps depending on how well their symptoms are controlled.  You can also split the dose and use 1 pump in the morning and 1 pump in the evening if you need to.

Re the Utrogestan, there is much debate on here as to how much you need but I take 100mg vaginally for 7 days every 5 weeks and that is enough for me but I can't leave it any longer than that because of breakthrough bleeding.  A lot of women, myself included, are intolerant to synthetic progesterone and large doses of Utrogestan and have to limit their intake but hopefully this will not apply to you.  People vary as to how much Utrogestan they need for shedding the uterine lining and the only way to find out is to take it for a few months, see what kind of bleed you get and then have a scan. 

I had never heard of the oestrogen gel either until I had problems with the patches.  They were not sticking properly, left a horrid black mark and itchy rash and I wasn't getting enough oestrogen out of them.  I then went to Professor John Studd and he recommended I switch to the gel.  I have never looked back and find the gel far more effective and user friendly.  The only real challenge was the Utrogestan part of the regime but I have now found a formula that suits me. 

Hope that helps.

[Hurdity]

If you decide to use separate oestrogen patch or gel with progesterone rather than a combi patch, then I would initially start with the recommended amount of utrogestan on a monthly cycle (ie 12 days x 200mg) - until your body gets used either to the 50 mcg patch or the pumps of gel - and as Mary G says - see what sort of bleed you get. After all you are used to cyclical monthly HRT. Being of a similar age I would definitely want to move to a two monthly cycle if your womb could stand it, but I must stress only after you have trialled the "right" dosage for a few months.

Hurdity x

[jaydee]

Sorry to appear a bit dim but, do I ask for an oestrogen patch and separate utrogestan?   I would prefer to have a monthly bleed, although I know it's really tiresome at the time.   I feel I have to give the 'illusion' of knowing what I want and need, before I enter the doctors surgery.

Your help is gratefully appreciated.

Jaydee

[Hurdity]

Also I would suggest printing off the info from this site ie the oestrogens and progestogens - especially in case the doc has never prescribed it before - as that has happened before on here!
http://www.menopausematters.co.uk/treatafter.php
http://www.menopausematters.co.uk/to_progestogens.php

As Stellajane says - say you want transdermal oestrogen because you have heard that this is recommended once you are over 60. Re the utrogestan - this is bio-identical with our own progesterone - and the progestogen in Femoston is very close. If the doc tries to prescribe you Evorel conti/sequi or Femseven - both these have synthetic progestogens that are not like our own progesterone. There is info here about the progestogen types: http://www.menopausematters.co.uk/perimeno.php

Progestogens which can be used cyclically are of 3 main types:

Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
Less testosterone related - Medroxyprogesterone acetate(MPA).
Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

As you can see both the types in the combi patches are testosterone derived.

The doc will not prescribe it vaginally but you just have to use it this way if you prefer.

Hurdity x

[Mary G]

jaydee, you might want to try the oestrogen gel instead of the patches, it is more flexible because you can adjust the dose to suit your needs - I found it to be more effective that patches.   It comes in a container with a pump mechanism and most women start with 2 pumps of gel every day.  It's easy, you just rub it into your upper arms or thighs every day. 

The Utrogestan works better when taken vaginally and has fewer side effects when used in that way.

Good luck!