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[mchaplin]

thank you. I am only asking as I started on the patch and had to stop due to head aches that were really bad and feeling low and my doctor has said that I was on the lowest dosage so I would just need to manage my symptoms or the other option was antidepressants so I may now go back and ask about cutting the patches in half.

[Angel65]

I’ve been told by my menopause specialist to reduce to quarter of a patch because I’m suffering from very low mood and constant nausea since I started hrt about 3 weeks ago. The Utrogestan made things worse.

Hoping my body will cope better if things are done gradually.

[mchaplin]

It’s now been a few months and I really feel I need to start trying the Patch again. So thinking start with quarter of a patch. When it comes to change day do I need to use a whole new patch or is it ok to use another quarter of one that I’ve cut?

[Cookie25]

Hi mchaplin

I use half a patch and I just store the second part in the foil packet until I'm ready to use it so I'm sure this would be okay for quarters too x

[mchaplin]

Thank you

[PearlJ]

Sorry for resurrecting an old thread but I can’t find one I previously posted about halving patches. The nurse told me to try half a patch as I had started bleeding and had sore boobs. I got my prescription late and so had no patches left for a few days and have now been on half for a week. I feel ok so far. My questions are:
Is there a way of knowing what dose I need and can’t I just have a lower dose patch?
I’m worried about halving the patch as I have read conflicting evidence about doing this.  The pharmacist in this link say don’t do it.
https://www.theindependentpharmacy.co.uk/menopause-hrt/guides/evorel-sequi-how-to-use

[Hollyboll]

Hi. Many of us (me included by leading meno specialist) have been told to cut patches in half. X

[PearlJ]

The way the pharmacist explained it is that a matrix patch is designed to release a set amount of product per day into you. So by halving a patch it will still release exactly the same set amount from the half patch  but will run out quicker therefore leaving you without any until you put your next half on. I’m so unsure about this now. 🤦‍♀️

[Hurdity]

Sorry for resurrecting an old thread but I can’t find one I previously posted about halving patches. The nurse told me to try half a patch as I had started bleeding and had sore boobs. I got my prescription late and so had no patches left for a few days and have now been on half for a week. I feel ok so far. My questions are:
Is there a way of knowing what dose I need and can’t I just have a lower dose patch?
I’m worried about halving the patch as I have read conflicting evidence about doing this.  The pharmacist in this link say don’t do it.
https://www.theindependentpharmacy.co.uk/menopause-hrt/guides/evorel-sequi-how-to-use

That can't be the case otherwise small patches with less hormone on them will run out quicker.  Also half a patch is stuck to half the area of skin so is not likely to run out quicker. That doesn't make sense at all!! I imagine for example that a 50 mcg oestrogen patch and a 25 mcg oestrogen patch have the estradiol distributed over the patch at exactly the same concentration. Halving a patch won't run out quicker, it will just release less oestrogen ( and progestogen) into your body over the same period of time.

What the pharmacist says in the article at that link is wrong. Look here at an academic paper on the subject:
https://academic.oup.com/bjaed/article/7/5/171/535087

Although not talking about HRT specifically the paper describes the charatceristics and properties of matrix and reservoir patches:

"In a matrix patch, the active ingredient is distributed evenly throughout the patch. One-half of a patch will have half the original surface area and deliver half the original dose per hour. "

Even so, halving the patch would be off-licence as strictly speaking, the trials have not looked at the efficacy of that particular dose but I know halving patches is commonly prescribed by specialist judging by what I've read on here, and Dr Currie herself (founder and manager of MM) also endorsed cutting Evorel conti patches off licence ( in post-menopause). What would NOT  be advisable (without medical supervision) is to only cut the sequi part of the cycle when you are on Evorel sequi as you would then be maintaining the oestrogen dose suring the first 2 weeks of the cycle but halving the amount of progestogen. (However confusingly because the same Evorel conti patches are used for both Evorel sequi and Evorel conti - this means that the same progestogen dose is given in both regimes, so implying it's not quite so rigid!).

Hurdity x

[Pippa52]

I have been halving my patches since finally getting the dose right. I am on one 37.5 patch plus a half of 37.5.  I cut mine in half as a triangle and have not had a problem with it becoming unstuck at all (Estradot patches) but its entirely up to you however you want to do it.  I apply mine first think in the morning but I have to change mine every 2 days as unfortunately they don't last for me for 3/4 days.  Its such a personal thing dose etc whatever suits you the best and whatever you are advised by your Dr. Hope so much all goes well xx

[Scampidoodle]

I saw a specialist recently who said you can’t cut Evorel Conti patches. I thought you could. She said estrogen ones are ok. But not the conti as you don’t know where the progestin is in the patch.

Is this just nervousness re womb protection do you think?

I have heard many instances of women cutting up patches. But this doctor used to work at newson and is very reputable so I’m really confused now.

[Hurdity]

Hi Scampi - yes probably nervousness.  From what I just read the progestogen is evenly distributed throughout the patch at is a matrix patch. Most modern HRT patches are matrix patches these days.

Also there's a difference between  what the licensed dose is and what some specialists will prescribe off licence. Like I said - Dr Currie herself endorsed this but for Evorel conti when used continuously, but if a GP or specialist OKs it and is prepared to supervise (ie arrange scans etc) then that's fine.

Having said that maybe thinking has changed more recently due to instances of womb thickening on unlicensed regimes - but it's nothing to do with how the progestogen is distributed, as I understand, anyway.

There is nothing in the description of the patch to indicate that the hormones are unequally distributed throughout:

"The EVOREL CONTI Transdermal Delivery System (TDS), or transdermal patch, is a flat two-layer laminate which is 0.1 mm in thickness. The first layer is a flexible, translucent, and nearly colourless backing film. The second layer is a monolayer adhesive film (matrix) composed of acrylic adhesive and guar gum and contains the hormones. "

https://www.medicines.org.uk/emc/product/10929/smpc#gref

Hurdity x

[Scampidoodle]

Thanks that’s really helpful. I did think, why would all the progestin be in one corner, for example!

As you say it’s a matrix design.

[PearlJ]

It is mega confusing and it does seem to be the pharmacists that don’t want to endorse it as my own chemist said no the same as the link. I’m halving evorel conti 50 patches so maybe I should ask for 25mg patches to be on the safe side. I’m not 100% sure the dose is right yet because I’ve been back to feeling really tearful this weekend.

[Hurdity]

Hi PearlJ - there seems to be a lot of ignorance out there!

Evorel conti does not come in 25 mcg doses - it is only the Evorel oestrogen only patches that come in different doses. If you feel it is the wrong dose anyway then maybe just cut a quarter off it (both the Evorel 50 and the Eovrel conti part of the cycle) to give 37.5 mcg?

Hurdity x