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Author Topic: Estradot v Evorel  (Read 16459 times)

racjen

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Estradot v Evorel
« on: September 05, 2020, 10:59:41 AM »

Hello everyone,

has anyone else found that, despite in theory all estrogen products being essentially the same, they get on OK with one brand of estrogen and not another? I was doing OK on Evorel patches plus Provera, until around Christmas when it became impossible to get Evorel so the pharmacy substituted Estradot instead.

Since then I've gradually been feeling worse and worse - my main symptoms are depression and anxiety - and the only thing I can really see that's changed is the patches. It's not an absorption problem as a blood test showed that my estrogen level is OK, but I'm wondering if there's something else going on, maybe the availability of the estrogen is different? I guess the only thing I can do is ask to switch back to Evorel now that it's available again (hopefully), and see if that makes any difference.
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Mary G

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Re: Estradot v Evorel
« Reply #1 on: September 05, 2020, 04:31:02 PM »

It could be the delivery is less stable with the Estradot patch.  I've attached a graph which shows that the 50mcg and 100mcg Estradot patches are less stable than the 37.5mcg and the 75mcg Estradot patches.  So it would depend on which patch strength you are using.  The 100mcg patch in particular looks like it goes up and down quite a bit. 

Some women, myself included, are very sensitive to hormone fluctuations so it might explain the difference in mood.  In my case fluctuations trigger migraines.

I don't know about Evorel.

https://en.m.wikipedia.org/wiki/Estrogen_patch


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Joaniepat

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Re: Estradot v Evorel
« Reply #2 on: September 05, 2020, 04:51:33 PM »

Interesting! Is Estradot "Vivelle type" or "Climara type"?
JP x
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racjen

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Re: Estradot v Evorel
« Reply #3 on: September 05, 2020, 05:24:28 PM »

Estradot and Evorel are both twice a week so I guess that makes them the Vivelle type according to this?
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racjen

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Re: Estradot v Evorel
« Reply #4 on: September 05, 2020, 05:25:49 PM »

Mary G, I'm on the 100 so I guess this could be part of the problem, I certainly do seem to be very sensitive to small fluctuations.
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Joaniepat

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Re: Estradot v Evorel
« Reply #5 on: September 05, 2020, 06:36:26 PM »

Thanks, racjen.
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allie007

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Re: Estradot v Evorel
« Reply #6 on: September 05, 2020, 07:08:09 PM »

This could be why I feel so rotten lately, I'm on 100 Estradot. When my bloods were taken a year ago using them my estrogen level was over 350 pmol, had them done 2 weeks ago and its plummeted to 160. Reason I had them done was because I felt like my symptoms were coming back and I was so up and down. Maybe I just need to try a different patch?
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Mary G

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Re: Estradot v Evorel
« Reply #7 on: September 05, 2020, 07:27:20 PM »

Yes, it's definitely referring to the Vivelle patch. 

My (new) migraine specialist was talking about this at my last follow up appointment - she suffers with migraines herself like all the doctors at the clinic and uses Estradot.   Migraines, low mood and anxiety are closely linked and severe hormone fluctuations are bad news for anyone who suffers from any of these conditions.

racjen, perhaps you can change to the 75mcg Estradot patch because that looks like the most stable one.   I hope the dose is high enough for you but if not, you could top up with half a 75mcg patch which would take you to 112.5mcg, just a little higher than your current dose.

One more important point... make sure you change the patch after exactly 3.5 days to get maximum stability and to avoid any drop off as the patch loses strength at the end.   It's probably easier to change it on the same day at the same time twice weekly anyway. 

Stability seems to be very important for many of us.
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Wrensong

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Re: Estradot v Evorel
« Reply #8 on: September 05, 2020, 07:58:00 PM »

MaryG thanks for posting the link.  I knew there was variation in levels over the life of a patch but the fluctuations shown on these graphs are greater than I'd realised.  This could be significant for so many of us who are still struggling despite reasonable blood levels.
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Uptick

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Re: Estradot v Evorel
« Reply #9 on: September 05, 2020, 09:09:45 PM »

Although Vivelle-dot can be considered the equivalent of Estradot, they're from different manufacturers, not sure their pharmacokinetics can be compared.

Racjen, one thing to bear in mind is that Evorel Sequi and Conti are estradiol hemihydrate and Evorel Mono is estradiol, while Estradot is estradiol hemilydrate. Although they have little chemical difference (water molecule) their stability is different. I suppose estradiol hemihydrate is more stable when combined to norethisterone, hence the difference amongst Evorel patches. Maybe changing from Evorel to Estradot has influenced absorption or stability.

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Hurdity

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Re: Estradot v Evorel
« Reply #10 on: September 06, 2020, 07:18:37 AM »

Firstly - sorry to  hear about your ups and downs racjen. In terms of absorption I'm sure you know that a single blood test won't really tell you very much and especially about how you are feeling day to day which can be affected by all sorts of other factors.

Re differences in the patches. There is no difference in the estradiol between the patches that i can see - they are all estradiol hemihydrate but the online info on eMC isn't always precise enough and hasn;t always been updated ( I have found this before!).  For those interested - Evorel sequi consists of Evorel 50 for two weeks followed by Evorel conti ( for two weeks) and the estradiol is "as hemihydrate" which to all intents and purposes is estradiol.

Re variation between different patch doses. This is an interesting idea but you can't really draw any conclusions from that Wikpedia diagram as there are no data about numbers of women etc. Better to look at scientific papers if you want to look at absorption of estradiol over time (pharmacokinetics). Even the graphs in these vary -  because women vary and unless you measure levels in a very large number of women - will not come to a consensus. In any case the spot points on the graph are an average of (who knows how many) women and the scientific papers will show the variation on the graph and/or in tabular form.

Therefore I do not think it is possible to say that any one patch is more stable than any other and in fact there is no scientific reasons why this would be so - so personally I wouldn't worry on that score.

What is different between the two patches though is the size of the patch and the delivery system. As already mentioned Estradot and Vivelle dot have a very particular dot matrix delivery system which enable a particular dose to be provided on a very small patch. All of the other patches are much larger and have a different (standard?) delivery system so that alone could account for the differences you are noticing, especially if you are very sensitive to slight chnages. Maybe your actual steady state estradiol levels are not varying (or maybe they are but this is not reflected in the single blood test you had?) but the way the levels are changing over time might be ( because these can be very variable) eg with changes in temperature of your body, outside etc?

So in your case - given that there are differences in delivery mechanism and size between the two makes of patch, and your sensitivity - yes I would try to stay with the same one if possible (at the dose that you were previously happy with and stable) and then at least you will know whether that is to blame.

For info I change my patch every 3 days although many of them are actually designed to provide a good dose of estradiol of about a week.

Hope this helps and all the best :)

Hurdity x
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Traceyjd

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Re: Estradot v Evorel
« Reply #11 on: September 06, 2020, 07:29:45 AM »

Hi Racjen

I change my patch every 3 days now too, after having some advice on here.  It seems to of evened things out a little 🤞.  Maybe worth a try.
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Uptick

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Re: Estradot v Evorel
« Reply #12 on: September 06, 2020, 10:04:09 AM »

There is a difference in the estradiol between patches, the leaflets are brand new and you can check the info with the respective manufacturers. The combined patches (Evorel Conti and half of Evorel Sequi pack) are in the hemihydrate form, and the mono patches (Evorel and half of Evorel Sequi pack) are in the estradiol (anhydrous) form and they're not the same, as far as I know, apart from pharmacodynamics, but they can differ in solubility and bioavailability.

You can check some info on here https://pubs.rsc.org/en/content/articlelanding/2019/ce/c8ce01874j#!divAbstract
and here https://www.ijpsonline.com/articles/a-new-polymorph-of-estradiol-and-its-stability-studies-3763.html?view=mobile

I have extreme sensibility to hormonal fluctuations as well as extreme allergic reactions to skin products and I have been talking to the manufacturers (gel and patches) to decide which HRT would be the best choice, I'm not interested in oral HRT. I'm afraid trial and error is not possible in my case as I have nearly died after an anaphylactic reaction.

Sorry to digress, racjen. Hope you can switch back to Evorel and feel better soon.
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Winterose

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Re: Estradot v Evorel
« Reply #13 on: September 06, 2020, 12:16:32 PM »

For years I was on Estradot and as it became difficult to get hold of 2 years ago I was switched to Evorel
. So glad as felt so much better on it . Was a bit headachey etc with Estradot but just accepted it as part of
hrt and so much better than not being on it. Had to switch back to Estradot at beginning of year due to supply difficulties and within a week had original symptoms. Now back on Evorel - 100 patch and feel great again so you aren’t imagining this .

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Winterose

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Re: Estradot v Evorel
« Reply #14 on: September 06, 2020, 12:17:10 PM »

I also change patches after 3 days
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