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[applejack]

Hi there

I'm 54.

After a year of no periods in 2016 at age 51, was put on femoston .5/2.5.  Spotting kept going so the doc raised it to 1/5 which caused really heavy periods so we gave it a break for a bit, then I went on sequi 1/10 which worked fine.

I got a bit fed up having periods, so came off this earlier this year and went HRT free.  The symptoms came back big time so tried estradot patches and utrogestan 100.  This worked fine, no spotting, reduction in symptoms, but like a lot of people the sketchy availability of the patches has caused so much disruption and stress I can't be doing with it.

So, am about to go back on femoston.  The doc has recommended 1/5, not the lower dose as she thinks the meno symptoms will return if I drop down that low (I was on estradot 75).

Thing is, I'm worried the same thing will happen as before - that is, I'll start bleeding heavily, although she assures me this is less likely to happen on 1/5 than .5/2.5.

Also, I'm 54 now, i was three years younger when I was on 1/5 before.  I'm well into menopause whereas the last time I'd only just hit a year when I first took HRT.

She does know what she's talking about.  i guess I'm just looking for reassurance, really.  I don't want all the fuss I had before when I bled like billy-o and needed scans and wotnot.  So complicated.  And those damned patch shortages...I was perfectly happy on estradot+utrogestan.  GAH!

[KiltedCupid]

Applejack - very roughly, 1mg oral = 50 patch, so that's a lower dose than you're currently on with patches. You'd need to take a 0.5/2.5 and 1/5 tablet to be around the same dose. Of course, some women absorb more readily from oral than transdermals and vice versa so perhaps this is why your doc is starting on a lower dose?

The other more obvious option, is to use a different patch. If you're happy on the Utro and patch combo, don't change it. There's oestrogen only patches available, but not readily and you may have to get them online with your prescription. If your side effect and bleed free on your current combo, you're doing well, in your position, I wouldn't swap to another entirely different product.

[Hurdity]

Hi applejack - I would try to stay on the combo that suited you rather than trying to work out equivalence.  On average 1 mg oestrogen is classed as low dose wheareas 75 mcg patch is medium to high so not at all comparable - but of course absorption of each type will be different for everyone.

There is no higher Femoston conti oestrogen dose than 1 mg unfortunately.

I have recently had to swap from Estradot 75 mcg ( which I cut down to 62.5) and have been given Estraderm and I am fine with this despite their huge size. I would press for continuing on the patches an Utro if this suits you personally. I wouldn't want to go onto pills (or back to them) after transdermal HRT - but I've never used pills myself!

Good luck and keep us updated

Hurdity x

[applejack]

Hi

thanks for the advice - especially for the explanation of how the doses compare.

I might try reordering the patches again - my pharmacist phoned the doctor to get them to recommend an alternative and they told him to prescribe super low dose femoston (would be nice if they'd spoken to me about it).  So now I guess I've lost that prescription. 

I might wander down to the surgery now and ask them what to do - they might be able to reissue a prescription again.

If I do have a gap in between using patches, would I also stop taking utrogestan?  I take patch+utro together, so if I stop one, even temporarily, I guess I'd have to stop the other?  And then I guess I could just go back on again after a few days/week when the stock comes back in?

I don't know if a) stopping and starting as a result of unavailability is a good idea and b) what to do about the utro whilst I have no patches.

[KiltedCupid]

applejack - I'm a tiny bit confused. Your pharmacist called your doc and your doc said dispense low dose Femoston? Was this after prescribing 1/5 for you?

In terms of patches, if you get your gp to give you a prescription for patches you can search around for online pharmacies who fill prescriptions, they usually deliver within 2/3 days and there are oestrogen patches available this way.

If you decide to stay on your patch/utro regime but run out of patches, you'd stop the utro too and when you have your patches you can start the utro again. If it's only a couple of days to wait for patches you could continue with Utro alone if you don't have any problems with it. Stopping utro for a few days, then starting again, might cause some minimal spotting which is triggered by a drop in progesterone levels, perfectly normal and may not happen to you as women differ in levels dropping and bleeds starting.

[Hurdity]

It won' t do you any harm to keep going with just one of the products for a wee while depending on how long the gap is - even just the utrogestan. In fact if you are on an even keel with that one (Utro) maybe keep going with it even if there is a short break between patches - only because progesterone withdrawal comes with its own set of symptoms so perhaps better be a few days without oestrogen than the prog withdrawal which can take several days of pms for some women ( eg me!). You might experience a bit of a slump in mood with the decrease in oestrogen but if only for a few days or  so or up to a week - probably not as bad as the prog withdrawal?

How did you get on at the surgery?

Hurdity x

[applejack]

Ah, the confusion was that I called a private doctor who prescribed femoston 1/5, THEN the pharmacist, who was supposed to be dispensing estradot but had run out (hence I'd called a private doctor in desperation) then called my NHS doctor who told him to dispense femoston .5/2.5 instead.  Neither of this was discussed with me first.  I simply called the pharmacy, asked if the estradot was available yet and he said "no, doc said to give you femoston .5/2.5".  Well, thanks for telling me :-(

I went down to the surgery to see if they could write another script for estradot but the receptionist said no, sorry, can't do that now as it's been taken off your repeat prescription list "the doctor has now prescribed you femoston .5/2.5". 

However, when I got home i logged on to my online prescription ordering to double check what was on there, lo and behold, estradot  still showed up so I put in a request just to see what would happen.  Checked this morning and it's showing "approved".  So someone has written me a prescription.

To be honest, though, getting hold of estradot is proving such a stressful thing I wonder if I should just go back onto femoston and see what happens.  Although it does sound from the advice I've got here that  private doctor is correct and .5/2.5 is too low and I need 1/5.

The doctor who spoke to the pharmacist has never met me.  But she went ahead and changed my medication anyway - without telling me. 

[KiltedCupid]

applejack - take the prescription if you can get it. You may well be able to use it for a different type of patch, same dose, different manufacturer. Im pretty sure pharmacists will accept it as an oestrogen patch and dispense what they have. As I said previously, if that combo, patch/Utro  is working well for you, I'd be loathe to swap it for a completely different product and run the risk of side effects.

[applejack]

Yeah, I think I'm going to follow that advice.

Just to be clear - estradot is oestrogen only continuous (just in case I need to ask for an alternative).  Have I got that right?

[applejack]

OMG I've found a pharmacy which has them in stock...woo hoo!

[KiltedCupid]

Fantastic! Hot foot it down there pronto!

Yes, all the patches are oestrogen only unless they say sequi or conti.

Good luck.

[Hurdity]

applejack - you're lucky you have got a prescription. I never get one - just a repeat form because the dispensary is attached to the practice for rural rather than town patients. I then order my patches through my online account with the practice.  If I had known about this I could have asked for the prescription to send off myself too - especially as being over 60 they are free. Not sure if anyone can do this - I know there was discussion a while back on one thread about nominated pharmacies etc?

I thought you said you had been on Estradot already  ie oestrogen only rather than it being new to you (re your Q). I hope you have been using the patches all the time - continuously (when you had regular supplies anyway!)?  Anyway hopefully it's all good and you get them and are happy with them. We like success stories we do.

Hurdity x