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[Dana]

I just thought I would tell you all about an interesting experiment I've just conducted.

Because Estradot patches can be a little hard to get at the moment (although I've mananged to aquire a supply of 4 boxes) I decided to see how long I could get a patch to last before symptoms returned. I used to change every four days with no problem, but I assumed I could get a bit more.

I'm now up to a full week. I could possibly go a bit longer, but a week is good because it will be easy to remember when to change. I haven't had any return of symptoms and the patch is still firmly attached. I wonder just how long you could get a patch to last?

I realise this might not work for everyone, but it's an interesting experiment to conduct, saves money and it could even be better for the environment because discarded patches will has less estrogen on them.

[Rhiner]

Hi Dana, That is very interesting, just need to be a little careful, as the timings given by the manufacturer will have been fully validated (to enable the product to get approval by the Regulatory Authorities, who review the results).  The time stated 3.5/4 days will be well within the actual time that the patch starts to loose its efficacy. The actual time period may well be a week. The conservative time stated  is required due to patch to patch variability and also absorption between individuals, i.e. some folks will not absorb as well as others esp when it is coming to the end of its life.

A very interesting experiment though!
Rhiner

PS I am certainly finding some variability with adhesion, certainly on the 75ug patch.

[cubagirl]

GP told me to try that as I was trying to reduce further.  Sadly after a few weeks I had to give up.

[Dana]

I don't think it would be a good idea if you were actually trying to reduce your dose though. I think you would be better off to cut small amounts off over a period of time.

[Dana]

Hi Rhiner

Yes it wouldn't be a good idea for anyone who doesn't absorb it well, but apparently I must absorb it quite well. I'm curious to see just how long I could get a patch to last, but a week will do for the time being.

[Hurdity]

Here is some info from the paper I usually go to re the pharmacokinetics of oestrogen absorption ( how the oestrogen is absorbed into the body over time and what happens to it):

Patches are available, which are labelled to deliver a daily dose between 25 mg and 100 mg estradiol, even though the actual delivery rate may be different. In contrast to the general belief that is based on the graphic presentation of mean values, a wide range of estrogen serum levels are measured in women treated with the same patch1,34. Using patch or gel, there are large interindividual variations in the estradiol levels, which may differ by up to a factor of 10, and, in as much as 30% of the patients treated with a 50 mg patch, the estradiol concentrations are low. There are also considerable short-term intraindividual changes in the estradiol levels.

Within 24 h after removal of the patch, the estradiol levels decrease to baseline. Using a matrix patch, it was observed that the serum concentrations of estradiol are higher in the evening and lower in the morning. This might be due to circadian variations in the dermal blood flow, which is highest in the evening and may enhance absorption.

The adhesive layer of the matrix patch consists of polymeric acrylate or vinylacetate in which the estradiol molecules are distributed. Therefore, as the dose delivered daily depends on the size of the patch, it can be individually adjusted by cutting the patch. The diffusion of the estrogen from the patch matrix into the skin is facilitated by the so-called penetration enhancers (fatty acid esters, oleic acid, lecithin, ethanol). In contrast to the reservoir patch, the diffusion rate remains relatively constant over 7 days, with an only gradual decline38. Therefore, the patch is effective for 7 days, even though some producers recommend a change twice a week. After application of the matrix patch, the estradiol levels rise to a maximum within 12 h

The main thing is it seems that actually there is sufficient for some patches to be effective for 7 days - as Rhiner says it is not going to run out in 3 or 4 days - but needs to be changed due to the gradual decrease in levels and also as Rhiner says ( and this paper confirms) that there is enormous variability (up to 10 times difference!) in the amount women absorb from a given patch.

Also if you look at the product info - Estradot 50 contains 3.2 mg oestrogen which is 3200 mcg - whereas 7 days at 50 mcg only gives 350 mcg - clearly a lot is wasted as with gel (and tablet because of digestion). However Femseven (50) which is kept on for a week only contains less than half this amount - 1.5 mg.

Interesting experiment in your case though Dana - great that you are able to make more use of your patch. Perhaps more of us post-meno women on medium doses should try the same! The only issue though is it gradually coming unstuck at the edges which will reduce levels further.

Hurdity x

[Dana]

Thanks for that info Hurdity. It's definitely not for everyone, but I think it's worth experimenting. There was a very slight lifting around the edges, but that didn't seem to affect the dosage for me. Possibly 50mcg is a bit more than I need anyway.

Also interesting what you said about the weekly patch.  I didn't like it at all. I didn't have any problems with it sticking, but it was definitely lower in dose than the estradot.

[Hurdity]

Yes I was amazed to discover that about Femseven - that the total estradiol dose is so much lower - so if you add in the differential absorption - some women may not be getting very much at all! Another reason to choose Estradot - haven't looked into Evorel etc to see how this compares though....

Hurdity x

[Dana]

I've got 1½ boxes of the 7 day patch (we call it Climara here) and I was going to try using them up by putting on an extra half patch, but maybe I might need to put on two patches. One box isn't opened, so I'm not sure if the chemist will take them back. I should ask I suppose. On the other hand, maybe it's just easier to bin them.....

[Hurdity]

I'm not sure about putting on two patches.....They are designed both to deliver 50 mcg per day so the difference must be in the adhesive and how it releases the estradiol. Although we are all different I would have thought you could end up getting almost twice as much if you did put two patches on - notwithstanding the fact that the total dose is lower - not much of this total dose actually gets into the system before the patch is removed. I presume also perhaps the adhesive becomes less active or perhaps the release rate declines over time and maybe changed by the skin/exposure to air etc? You can tell I'm thinking aloud here as I've no idea really!!

Hurdity x

[Dana]

I think it will just be easier to see if the chemist will take back the unopened box or to bin them although I hate waste like that. I've got a really good stash of estrodot now, especially now that I can use a patch for a week. So I don't need to keep the climara "in case".

[matildamouse]

Interesting posts and info thanks ladies!

Just to make sure I understand correctly...With the Estradot supply issues, if I try to keep my patch on eg. 5 days and change on day 5, 10, 15 etc (instead of the current 3.5days) and I get no return symptoms, I should be OK?

[Dana]

I built up to the 7 days over a few weeks, because I was a bit nervous about doing it. I had always changed at 4 days (instead of 3.5 days) and that's never been a problem. So I initially changed it on the 5th day, then I tried the 6th day, and finally settled on changing on the 7th day. So that means that I now my patch every Wednesday afternoon, which makes it really simple to remember. So far there haven't been any problems. Provided you aren't getting any symptoms I can't see any harm in doing it, because as has been noted above, these patches are probably designed to last longer than the 3.5 days anyway.

Good luck. I hope it works for you, but even if you can't get the full 7 days, getting a few extra days out of a patch will still help, considering the current supply problems. I will continue to do this even when supply is more reliable because it just makes sense to get more out of a patch if you can.

[matildamouse]

Thanks Dana. I am going to give it a go!

[Night_Owl]

This is an interesting thread as I too have thought about leaving the patch (Estraderm 25) on longer than 3.5 days as a way of slightly decreasing estrogen - 4 days would be good.

What bothers me is having to remember the different days to change the patch (currently I'm set on Monday and Wednesday lunchtime and to lose the routine would be a little unsettling) - has anybody found an efficient reminder - wondering if there is an app.