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[paulapo]

Hi all,I've never posted before as all the info i ever needed I alway found, this forum is amazing but I am now after some advice please , I've searched posts but not much luck as yet. I was prescribed evorel conti patches ( took them for 6 months)but had to stop as was getting very sore boobs and terrible PMT symptoms ( no period for 3 years btw ) doc took me off patches as she said the continuous progesterone does not agree with me. I asked to try bioidentical HRT which she was happy to do, ( I have tried about 4 different types of HRT (tablet form) and nothing has agreed with me, they were all pretty high does of estrogen also). Anyhow started utrogestan 100mg capsules 1 capsule for 15 days and 3 day break ( vaginally and my choice not docs)   and oestrogel gel( each dose is 0.75mg estradiol . My only concern is lower progesterone and higher estrogen. The patches   had a absorption rate of 50 micrograms of Estradiol  in  24 hrs and 170 micrograms of norethisterone Acetate in 24 hours. Doc said to give it 2 months as no sex drive either( that went years ago )and we could try Testosterone also. Anyway the last few days I have been starting to have brain fog, disturbed sleep ( early hours of morning and waking up warm) no hot flushes through the night though. my TSH is low so my Thyroid meds was decreased from 100 mg to 75 mg (1 week ago )as last 3, 6-8 week repeats bloods TSH  was .11 t3 and t4 ok. So my question is do I increase my gel pump  or decrease to 50mg so the same as the patch, I find it so hard to get my head around this especially when I'm having problem with my thyroid  atm as well. I so long to feel like the old me again as its been years of battling. I've just tapered down from venlafaxine 37mg which was prescribed for hot flushes 3.5 years ago but it stopped working, 2 years to taper as drug made me so ill with withdrawals side effects. I will get there lol

[CLKD]

That's technical   

Have you put the product names into the search box here - individually, make notes.

I'm sure someone will be along.  It took me 9 weeks to wean off an AD - it was the bounce back anxiety that upset me until I realised that those symptoms didn't last more than 36 hours and didn't get worse which was my biggest worry.

[Ladybt28]

Hi Paulapo and welcome 
How many pumps of gel are you using please?

[paulapo]

hi and thank you, currently 1 pump every morning, unsure if i can go higher as was only on a low dose before with the patch.

[Ladybt28]

It is Hurdity that is our expert on the conversions of doses between patches and gel and I'm no good at that and anyway the chemicals do not always convert the same inside the body.  There are posts on the forum about this if you want to try and find them by putting some searches in the search box.  Just because the patch has a certain supposed absorption rate does not mean that everybody's body (I you see what I mean!) absorbs at that rate.  Some women don't absorb well at all and just have to have the maximum dose of everything.  I'm not saying that is you mind..

My GP and my meno consultant goes on symptoms and not testing levels so if you are waking warm, and having some of the symptoms you had got rid of, back again, then I would say the dose of gel isn't high enough.  With oestrogel you can go up to 4 pumps a day so 1 is incredibly low.  The normal prescribing dose when first starting off is usually 2 pumps per day.

I would increase not decrease by half a pump at a time, leave for a week and see what happens, you can do no harm.

[paulapo]

hi and thank you for your reply, I have been searching posts but none similar to mine as yet, I will increase dose  though and see how this goes, I basically feel how I did when I needed HRT lol we know our bodies us girls

[Hurdity]

Not sure about the expert bit Ladybt...

However - paulapo - Ladybt is just right. We all vary in how much we absorb of the different types of HRT so don't go strictly by the amounts. Patches pills and gel are not comparable. As you say a patch dose is given by the average absorption from that patch over a 24 hour period whereas gel is applied as the total amount of oestrogen in that pump of gel, of which only a very small proportion will be absorbed. This can vary by a factor of 10 between women ie some women absorb 10 times as much from a given dose as others. All sorts of other factors come into play too eg re skin nad products applied, possible temperature (of body and outside), as well as temperature of the gel (canister) - it may well be runnier when it's hotter weather for example and so dry quicker before it has time to absorb maybe? Tablets are also variable - much is lost to digestion and metabolism through the liver.

To look at approx equivalents then best to go by low, medium and high dose – which can be found under Treatments on this website, and other menopause sites also give this info. This is a starting point and then if your own absorption varies – then try a higher or lower dose. So on average Evorel 50 is medium dose as is 2 pumps gel so an incrrase might be what you need. However a few days is not enough to adjust so ideally give it a while before deciding ie don't chop and change too much. If you increase eg by half a pump then stay at that for a few weeks and see how you go?

You also can't compare progestogens with oestrogens either and nor with each other. You are confusing yourself I think!

Sorry can't help with the thyroid issue - maybe start a separate thread as there are members who know more about this. I do know that it is important to get thyroid meds right before HRT, but also that some HRT can affect how much  thyroxine you need too (more the case with oral HRT).

Well done for weaning off the ADs - they should not have been prescribed for hot flushes in the first place, if HRT is possible for you!

Let us know how you get on and hope it all works out

Hurdity x

[paulapo]

Hi  and thanks for your reply, at the moment i am suffering with an over anxious brain that will not switch off at bedtime, not too sure if its venlafaxine withdrawal side effects suddenly hit me 4 weeks after my last taper and that final chapter in my life of antidepressants to help hot flushes. The doc didn't want me on HRT due to my mothers breast cancer , but decide now i can, anyway this is my last hope and unable to find anything that agrees with me. I suffered severe PMT for many years so know i am progesterone sensitive (think thats right). I'm struggling to use the utrogestan vaginally as its making me sore using the applicator i bought off ebay , so will have to try orally and see how its goes, seriously dont think i can do 25 days vaginally again  not in less anyone has any other solutions   in reducing the days I can take it for, doc says that its not good to go back having periods after 3 years of not having any??. I feel like I am turning in to a madwoman again, don't know if its the progesterone, or the estrogen or venlafaxine withdrawal  side effects.I will look on other posts to see what else i can find to help also.

[Hurdity]

Hi again paulapo

Just to say - firstly you don't need to use an applicator in order to take utrogestan vaginally - most of us on here do not. You just push them up with your finger as far as you can so that might help. It is definitely better (ie they are more effective) if taken vaginally as more progesterone gets to the uterus. Secondly although most women do not relish the thought of having a bleed once they have reached menopause, for those of us who are progesterone intolerant or who feel worse when on it, then returning to a cyclical regime with a bleed can be the lesser of evils. I still have a cycle in my mid 60's (much as I hate it!) but when I am on the oestrogen only part of HRT I feel great!

Therefore there is no reason not to take it for 12 days per 28 or even 12 days per calendar month which gives you a little longer on oestrogen only. I see you are on 100 mg and although that is less than the licensed dose vaginally - it may be fine to protect your uterus ( because of more getting to where it is needed) provided your oestrogen dose is not too high. Do try this regime but talk to your doc too. Remember it is your choice. It can do you no harm to go back to a cycle. There is a greater risk of endometrial hyperplasia (abnormal thickening of uterus lining) when taken cyclically but provided your withdrawal bleed is normal and predictable and your oestrogen dose is medium, and you report any abnormal or unusual bleeding - then your risk will be minimised.

Although the jury is out on causes of breast cancer from what I understand there is some evidence that progesterone may increase the risk, although if you are using Utrogestan, again this is thought to involve the least risk. Did you find out what type of breast cancer your mother had? Your familial risk also depends to some extent on her age when she developed it.

If you have vaginal soreness then maybe you also need some local oestrogen such as Vagifem or estriol cream - many of us need both systemic HRT and topical oestrogen to keep comfortable.

If you adopt a healthy weght, diet and lifestyle and reduce alcohol,/smoking, you can also reduce your risk of all cancers.

Hope this helps and you get sorted!

Hurdity x

[paulapo]

Hi Hurdity
My mum developed Breast cancer In her 30's and died at 48 she got cancer back 3 times before it took her. This was about 25 years ago now and I'm I sure what time she had but know she had tamoxifen or something like that, all breast removal, radio therapy and chemo.
When I asked my doc about periods as I don't mind having them monthly she siad it damages the uterus so not a good idea but I'm
Happy to go back to periods if It makes me feel better. My docs don't do blood tests as they say it's not a reliable way to check hormone levels! They've never suggested scans for womb etc either. So if I do the 12 days Of a 28 day cycle would this be enough to protect my womb as I find this all so completed. Saying that I do get funny feeling like I'm going to have a period but nothing comes of it .

[paulapo]

Hi Hurdity I'm going to try the 12 days progesterone , tomorrow will be my 12 day so after that I stop until 28th day is that  correct ?Then start again 1-12 days

[paulapo]

Hi, just a update on trying the 12 days Progesterone, this has definitely helped with the PMT symptoms, as do feel a lot better and know i have problems with continuous progesterone.  I didn't have a bleed though so unsure of this is good or bad. My main concern is and I know that Oestrogel and Oestrodose are the same ( read the posts)but my pharmacy issued my repeat for Oestrogel rather than oestrodose and my hot flushes have returned, everything has been going along great and felt i had got to that stage where hormones were at last settled , I've only been on oestrodose since June increased dose from 1 pump to 2 and all good. I've increased the Oestrogel to 3 pumps last week but still waking up at night with hot flushes. I really don't know what to do ? If I increase oestrogel pumps will this effect my progesterone and womb lining ?

[Hurdity]

Hi paulapo

Oestrodose is not listed as one of our medications precisely because it is the same product. If you have been issued with a repeat for Oestrogel you will get the same product but it will be packaged as either on or the other. Oestrodose is the same stuff made by Besins but just packaged ( outer carton and leaflet) for different European countries or repakacged by a parallel import company. It is NOT a generic (which would have different constituents even if the active ingredient wads the same concentration). The difference you experience is likely to be coincidence but if you feel that you would prefer Oestrodose then see if you can ask for it - not sure if the pharmacist would be able to supply this packaging necessarily though ( I haven't used that gel myself - only Sandrena).

Yes the amount of stimulation of the womb is dependent on the oestrogen dose so more oestrogen may mean thicker lining and consequently more progesterone may be needed to thin it. Play this one by ear and monitor your bleeds but be sure to speak to your doc.

Hurdity x

[paulapo]

Hi Hurdity and thanks for your reply, I have not had a bleed yet since Ive been on the 12 days prog out of 28, is this normal?