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[Bomber]

Hi everyone,
Have been on Everol 50 patches for the last couple of years and doing ok on them. Doctor recently asked me to switch to Elleste 1mg tablets which I did and started to feel really awful again. She told me it is very hard to compare patch dosage with tablets, but even though she has now upped my Elleste to 2mg I'm still feeling v bad particularly with joint pains and the dreaded nausea again.
Is this all in my head or am I getting a lot less estrogen ? Any ideas ?
Thanks 

[Dana]

I think it's a bit strange she took you from a 50 patch to a 1mg tablet. That is actually going down in dose. A 2mg tablet would be equivalent to a 50 patch.

Now that you're on the 2mg hopefully things will stabilise. However, what was her reasoning for taking you off the patch? Patches are considered better than tablets, especially as you get older, and I found myself that I didn't do as well on the tablets as I do on the patch. My doctor put it down to my liver "working too well" and I wasn't getting the full absorption of the tablet dose.

[Bomber]

Thanks Dana,
She told me that she would like me to get off HRT by the time I'm 55 if possible because of the risks and that Everol have stopped making 25s so stepping down the dose would be easier to manage with tablets.
I'm still not back to where I was, but the extreme anxiety, nausea, dizziness and joint pains which returned with a vengeance seem to be reducing although I had night sweats again last night for the first time in ages. I have to say asking me to change meds just before the long summer holidays with a learning disabled young adult and another younger child to care for was not ideal timing and I was completely unprepared for this.
Have to say, I'm not convinced that the tablets are working as well for me as the patches were, but suppose I should persevere ??

[Hurdity]

Hi Bomber

Oh dear! Are you in UK? Whether you are or not - unless there are health reasons why you should not continue with HRT then you should be able to carry on with it as long as you want to!

Your doc is terribly out of date!! 55 is so young! The risks such that they are, do not even start to count when HRT is taken under the average age of menopause which is 51-52. That's the first thing.

Secondly there are other patches that do come in a low dose - Estradot for example which are much better than Evorel as they are much smaller.

Thirdly there is no need to reduce in  dose at all nor come off HRT!!!

If it isn't broken then why fix it? Unless there are reasons not to - then I would hot foot it back to the doc and go back onto your 50 mcg patch - and by all means change to Estradot. Transdermal oestrogen is much more effective than tablet oestrogen anyway as it is not subject to the vagaries of your digestive system!

I presume you either have a Mirena or have had a hysterectomy hence you don't mention progesterone?

If you want to have a look at the NICE Guidelines in menopause they are here https://www.nice.org.uk/guidance/ng23/chapter/Recommendations  - and if your GP won't play ball please go to a different doc in the practice who is up to date with HRT and the menopause and is prepared to prescribe HRT for longer periods, and understands the data on risk.

Hurdity x

[Mary G]

Why oh why is this still happening despite the new guidelines?  There is no way you need to stop using HRT just because you are 55, it is far too young to even think about stopping HRT and you don't actually need to stop taking it at all if you don't want to.

If you were happy with what you were using before then go back to it immediately.  If this doctor refuses to prescribe it for you, then find another doctor who will and if necessary, find someone privately. 

My first port of call would be be make a fuss and insist on her prescribing the HRT of your choice and if necessary, call in the practice manager.

Your out of date doctor has caused you undue stress and upset and has in fact prescribed an ineffectual form of HRT that has more side effects.  It's outrageous. 

[Tempest]

Just a wee note Hurdity - there are big supply problems with Estradot 50's at the moment. I've tried a host of pharmacies here in Scotland, and no dice. I understand another member in England can't get them either! As I recall, isn't this what you use? Are you still getting yours ok, or have you managed to stock up at all?

[Bomber]

Thanks all for your input. I'm 53, UK based and have a Mirena coil so only take oestrogen. Actually my Mirena needs to come out very soon and I'm not sure whether they'll give me another or whether they will suggest combined HRT - any thoughts on this would be much appreciated.
Interestingly my female GP is one of the youngest doctors at the surgery so shouldn't really be out of date !
It's really good to know about Estradot as even if go back on Everol 50 sounds like I could 'step down' to Estradot 25 if ever I'm feeling like I want to put myself through this turmoil again.
 

[Tinkerbell]

If you are happy with your
Mirena I would go for another one. I am the same age as you and had one fitted recently, doctor said she would be quite happy to fit another one in four years time if that was what I wanted.

[Tinkerbell]

Mind you I think I remember someone saying you shouldn't have a Mirena without added oestrogen once post meno.

[Mary G]

Tinkerbell, that was probably me!  I had a Mirena post menopause without enough oestrogen and it caused my all sorts of problems down below.  My gynae would never give a woman a Mirena without adequate oestrogen. 

[Hurdity]

That's right - it could have been me as well! A Mirena used into post-menopause without added oestrogen can cause over-thinning of the endometrium, and lead to ulceration and bleeding.

If you get on well with the Mirena I would definitely have another one - and it works well with any oestrogen only HRT. The only reason I didn't have one (recommended after a hysteroscopy and biopsy by the gynae when I was 60) is that I have almost never used any synthetic progestogen so didn't want to start then! The decision should be yours re the Mirena - if you want to continue with HRT

Hurdity x