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[Jasmin20]

Hi,
Long story short. Age 55. LMP jan 2020. Started Evorel conti Patch Aug  2020. Fab within a week, symptoms resolved. Past few weeks feeling crap and emotional to the point I was behaving very differently to my norm. I increased to one and a half patches by myself and within a week felt so much better. However, not keen on the extra progesterone.
My Question: is it reasonable to request estradot 25 or oestrogen gel to supplement?
My confession: I’m a doctor but no experience with this, i am so grateful to have found this forum!

[PMDD]

Hi there, I was in the same boat (and i'm NHS Pharmacy)....I don't think the progesterone in the conti patch would be enough to oppose the additional supplemental oestrogen. I did this last year, and ended up with endometrial hyperplasia. Now, effectively treated with using utrogestan PV 100mg ON.

I would either change your patch to oestrogen only, with utrogestan or the coil for endo protection, or stay using 1.5 patches (if that seems to suit you). The doses are so low transdermal, that I wouldn't be concerned about how much is going in, as long as we feel well.

Hope that helps 

[Jasmin20]

Thanks so much for replying so quickly. I do have several fibroids so I guess best to keep with the patches then. My body is quite sensitive to these patches, I noticed a helluva difference in my menopausal symptoms within a week. It was like a miracle! I did have bleeding on and off for first four months and GP pal told me they don’t worry unless goes over six months so kept going and it stopped.The tailing off of the effectiveness has been disappointing. I’ll ask to continie the one and a half and see what they say.
Many thanks again!

[shrosphirelass]

I asked the same question at the drs and he was adamant I couldn't add more. The menopause clinic said I could increase with an extra half patch but it wasn't recommended due to likely side effects with the increased progesterone.

[sheila99]

I don't understand the logic. If you have utrogeston it's the same dose regardless of the amount of oestrogen so I'm not sure why evor conti is different.

[Jasmin20]

Hi. You don’t take ultrogesten with Evorel conti. The prog. is in the patch, so if you use an extra half, you effectively are increasing the dose of prog. too.

[CherryC]

I recently tried adding a 25mg Evorel oestorgen only patch to the Evorel Conti (with consultant approval to try it for 3 months but she did say it may cause bleeding).  Strangely it made me feel very irritable mood wise and I ended up ripping it off.  I haven't re-settled on the Evorel Conti patch and so am reverting to my previous hrt which was Estradot patch and 100mg utrogestan as it seems more flexible.

[sheila99]

Hi. You don’t take ultrogesten with Evorel conti. The prog. is in the patch, so if you use an extra half, you effectively are increasing the dose of prog. too.

Obviously you don't take utrogeston as well as evorel conti. The point I was trying to make is that you take the same amount of utrogeston if you have 25 or 200mg oestrogen. So if the conti patch has insufficient oestrogen why can't you just add a 25mg oestrogen only patch?

[Jasmin20]

Hi, yes that’s what I suggested to GP but he suggested just keeping on the patch and a half for a few months anthem try to reduce but then went on to stress higher risk of stroke. After the call, I ripped off the extra half patch in fear. Was down to one for two weeks and the insomnia, moods and hot flushes are back. Just slapped Ona extra half today in desperation.
I think I’ll ask for the gel or oestrogen  patch with  the oral ultogestan but I just wish that Evorel conte did patches with higher oestrogen in along with the prog at same dose. I am so crap at taking tabs even tho I seem to peddle them for a living!! Has anyone any experience of the evorel conti effect wearing off??
Side note- I did notice increased hair loss when I reduced to one patch as evidenced by the amount in my robot hoover and hairbrush. Many thanks for any further advice.

[Hurdity]

Hi Jasmin20

 

Theoretically it could be possible to add extra oestrogen to an Evorel conti patch but it is unlicensed and as stated could lead to endometrial hyperplasia. The reason I say this is because Evorel conti patches are used for  2 weeks of the month as part of Evorel sequi ( cyclical HRT), but used all the time when used on a continuous combined basis. Therefore for SOME women maybe on LOW doses of added oestrogen - the amount of progestogen may be sufficiently protective.

However being unlicensed it should only be done under medical supervision (your own?!) and regular scans etc. In addition it could be argued that most who are using Evorel sequi are peri-menopausal and will be ovulating naturally now and again ( depending where in menopause they are) - which means they will be producing their own progedsterone now and again (to deal with the extra  lining potentially building up) - which won't be happening when post-meno.

The fact that you have fibroids - depending on the size and how troublesome they have been - points to erring on the side of caution re the progestogen because you don't want to be troubled by random bleeding.

As for the risk of stroke - where is your GP getting that idea from? At 55 you are not much over the average age of natural menopause, transdermal HRT does not increase risk of stroke from what I recall, and unless you have other risk factors for stroke re BMI, blood pressure, cardiovascular problems, cholesterol etc, have a good diet and plenty of exercse then there is no need to worry about this. You are probably aware of the Qrisk score thing so you can plug your data into that and gives you an approximate guide to your stroke risk....

Just for balance - I am 67 and have been taking (Transdermal) HRT for 14 years, I take oestrogen patches and utrogestan vaginally on a long cycle ( approx 6 weeks). I am otherwise healthy.

Hope this helps and you manage to find a regime that suits you that you can stay on long term.

Hurdity x

[Jasmin20]

Many thanks for your reply Hurdity. I’m grateful to you for this. One thing I’m not clear on is how the utrogestan is taken with the oestrogen patch. You said on  a six week cycle. How does this work? When I was started on the HRT I hadn’t gone a year without periods. (7 months no period) I do wonder if I should have gone in to sequi first but understood because of my age the GP chose the continuous patch. First GP tried to get me to take oral HRT but I insisted on transdermal having read up on risk etc.
I seem to have a worry about too much progesterone really. So likely will follow with oes patch and either oral/vaginal utrogestan. I have no preexisting illnesses nor am on any other meds. Had three kids uneventfully. (All in three and a half years!j

There is definitely a huge gap in medical education surrounding menopause and my own experiences have made me reflect more on the effect of menopause in women and presenting symptomatology and I realise many have probably been started on medication they don’t need instead of HRT.

Thankyou so much again for your reply..

[Hurdity]

Hi Jasmin - I only lengthened my cycle when I knew I was post-menopausal. OI didn;t start HRT until I was almsot 54 and hadn't gone a year without periods. GP started me on cyclical HRT ( I used Cyclogest pessaries for the progestogen back then) and took it on a 28 day cycle. When I got to 57/58 she suggested continuous combined and gave me Evorel conti but  the first one I applied gave me a migraine so after various different regimes (I tried low dose oestrogen with intermittent Cyclogest) I settled on a longer cycle. This means I take 200mg progesterone ( 2 x 100 mg capsules) vaginally for 12 days every 6 weeks and then get a withdrawal bleed ( as I said even in my 60's ugh - not many of us left on here I don't think that do this).

I have always been nil-by-mouth when it comes to HRT.

It's up to you whether you want to go with continuous or cyclical. I agree I don't want to take too much progestogen - the jury's out I think on the breast cancer risk and also with progesterone itself, is the least likely to be associated with any increased risk if any. There is small increased rsik of endometrial cancer with cyclical HRT but this is more easily recognised at a much earlier stage and more easily treated and the causal relationship/link established.

If you think you are post-meno or very late peri and you don't mind having a bleed you could return  to cyclical HRT though best to start on a 28 sday cycle - see what your bleeds are like and gradually lengthen. My bleeds stopped on a 28 day cycle with 50 mcg oestrogen so I knew my uterus would behave itself if i went to a longer cycle.

I agree with you re the medication - far too may anti=depressants etc given out instead of hRT as first line of treatment for menopausal symptoms.

Hope this helps

Hurdity x

[KaraShannon]

Hope it's ok to jump in, is Evorel Conti the same as Evorel Sequi?  I guess not.

My fatigue is back so I was wondering about whether I needed a higher dose, I can't seem to get a gp appointment about this at the moment, I guess they don't think it's priority and I understand why.

[Jasmin20]

Thanks Hurdity. I think I should probably been started on cyclical at the beginning as had only been 7mnths no periods before starting. I tend to find despite my background, the GP didn’t really listen to me as it was a phone appt and he seemed rushed. The first GP I spoke to wanted me to take oral HRT and I asked me reasons why I would not take it (!!) I’m worried about the increased prog as my breasts have swelled up with the extra half patch. I’ll make another appt in a few weeks. I’m trialling two weeks 1.5 patches with two weeks of one patch.
(This has definitely changed my practice for the better and.I tell my Hosp colleagues this at every opportunity to make them realise this is actually ‘a thing’ and not fixed by antidepressants at first bat).
Kara, sequi is different. I wish I’d started on that on the beginning.