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[maxi835]

Hi all!

There is no more Evorel Sequi to be had so I could only get Evorel 50s. My GP has prescribed 10mg Provera based on the British Menopause Society guidance for alternatives (which I pointed him to):

https://thebms.org.uk/wp-content/uploads/2019/11/HRT-alternatives-04.11.2019.pdf

I had a look at the peak serum levels and saw that the patch was delivering norethisterone levels at about 140-250pg/mL. With the Provera I'm going to be having 13-46.89 mg/ml of MPA. I know these are different so maybe by the time it's doing its thing in my body the effect won't be as huge as this sounds but I'm quite worried about this.

That said, I may actually benefit from more progestin because my periods are very random and very brown and clotty. They were increasingly like this anyway before I started on HRT last summer so I wasn't worried but after reading this forum, now I am. Is my endometrial lining getting too thick so it will benefit from this progestin boost?

I also feel great on my Evorel 50s but as soon as the progestin kicks in on the second half of the month I feel moody and sad. The last thing I want is to feel that x10! I see many women on here are only taking 5mg of Provera so perhaps I should suggest this instead? There must be a reason why the BMS recommended the 10mg as a replacement for Evorel Sequi though?? Would be grateful for any reassurance. Thanks!

[Hurdity]

Hi maxi835

 

A little knowledge can be misleading!

There is no way you can compare and oral tablet with a patch as they are complerely different delivery mechanisms and the progestogen gets into the body in a different way. Not only that they are different progestogens and have different affinities for the uterus receptors so different doses are needed to have the same effect in protecting the uterus. The effects on other areas of the body are also different (ie the side effects) and different from progesterone itself.

Also especially the Provera data are unhelpful. The data give this "MPA is rapidly absorbed from the G-I tract with a single oral dose of 10-250 mg. The time taken to reach the peak serum concentration (Tmax) was 2-6 hours and the average peak are far more detailed."

For example if you look at the data for Indivina which contains the same progestogen it says this:
https://www.medicines.org.uk/emc/product/4068/smpc

"The absorption of medroxyprogesterone acetate after oral administration is low due to low solubility and there is large individual variation. Medroxyprogesterone acetate undergoes virtually no first-pass metabolism. After multiple dosing of 2.5 mg or 5 mg medroxyprogesterone acetate to women aged 50-65 years, maximum concentration in serum was reached in less than 2 hours. After 2.5 mg dose Cmax was about 0.37 ng/ml, Cmin about 0.05 ng/ml and Caverage about 0.11 ng/ml. After 5 mg dose Cmax was about 0.64 ng/ml, Cmin about 0.12 ng/ml and Caverage about 0.21 ng/ml. Comparable medroxyprogesterone acetate concentrations were observed in women over 65 years.

Medroxyprogesterone acetate is over 90% bound to plasma proteins, mainly to albumin. The elimination half-life of oral medroxyprogesterone acetate is approximately 24 hours. Medroxyprogesterone acetate is extensively metabolised by hepatic hydroxylation and conjugation and excreted in the urine and the bile. Metabolism is poorly documented and the pharmacological activity of the metabolites is not known."

The point is the dose given and licensed (as part of HRT) is that dose determined by trials to be sufficient to protect the uterus and should only be varied under medical supervision, so really if you want to take Provera, then you should take 10 mg if using cyclically.

Incidentally I have just posted to another member than the progestogen component of Evorel sequi  (norethisterone) is available separately, and is licenced as part of combi HRT, although for some reason not listed as one of the progestogens. Like I said in clio's post the Chelsea and Westminster Clinic do prescribe it. I don't think it's available at the lower doses used in  combi HRT although  C and W recommend 5 mg daily.

https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf

However if this makes you feel rough then why not give Provera a try? There are several on here who get on very well with it!

Hope this helps

Hurdity  x

[Fusseh]

Check out my other post - I got Evorel Sequi today. Try your doctor/pharmacist again.
Good luck

[maxi835]

Thank you Hurdity and Fusseh!

Fusseh - If this Provera doesn't settle in I'll phone around some more and see if I can get Sequi.

Hurdity - You're absolutely right about a bit of knowledge being dangerous - at least in causing anxiety! I work in healthcare for pharma companies so I know a little about pharmacokinetics but obviously not enough to really understand any of this very well. I do appreciate the robust response though - it certainly makes me feel more reassured that I'm going to be on the right dose and I do understand about the clinical trials. I was actually on Femoston 1/10 last summer for 3 months and did OK on that, felt really 'back to myself'. When I went to get my follow-on prescription a locum GP told me she wouldn't give it to me as I get migraine with aura. I informed myself via the BMS (thank you BMS!) and I realised then (prompted by what she said) that I had been having quite a few headaches, though not migraines, so I went back to my normal GP armed with the information and we put me on the Evorel Sequi. I'm not particularly keen to stay on norethisterone as I find I actually struggle at work with feeling overly vulnerable during that part of the month, so I'm going to give Provera a go.

I've had Covid-19 (I think) and am one of those who have a lasting viral inflammation fatigue thing so am more concerned than usual with any changes as I'm just about hanging in there. My GP knows this, but it's all so unknown that we are just going to see how it goes!

Thanks again for the lovely response. This site is a godsend.

Maxi