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[EllaAurora]

Hello,

Does anyone know, if the patch is always releasing the same amount of oestrogen (irrespective of the person), or if there are individual variation in how much oestrogen the patch gives per hour? I'm asking as I feel with 50mcg patch that at the beginning I may be getting too much from it, and towards the end at day 3, it feels the dose is wearing off.

I know there is small gradual decrease over the 3.5 days but my question is if its possible that the variation is greater for some people? I had to move away from gel to patch exactly for the reason that I was absorbing gel too quickly and getting huge fluctuations. So now I'm wondering if the same can happen with patch, or if its not possible due to patch design releasing only certain maximum amount in a given time.

Thanks for support and hope you are keeping well! xxx

[Postmeno3]

Yes, I'd be interested to know about this, too. At what stage of menopause, height/weight etc? I can't imagine how a one-size-fits-all method would work and whilst it's all very trial-and-error (and, hence, time-consuming!) it would be great to have a clearer idea. Let's hope we get some very useful information!

[EllaAurora]

Hi Postmeno3,

Yes, let's hope someone knowledgeable spots this message!
I'm still peri (I think) but assuming towards the end of this phase. Started HRT last year and during the past couple of months have had very strong feeling that my own hormones are fading in the background, which means I'm more dependent on stable estrogen supply from HRT. Currently on 50 mcg patch, but should try higher dose next as still symptomatic. I'm just wondering that if my issue is uneven absorption, rather than dose per se, higher dose might not fix it.

How are you doing and are you on patch at the moment?
Take care! xxx

[Postmeno3]

Hi.
Yes, am on Evorel 25 at the moment, but feeling it's not enough. Am very post-meno and have an Estring and Vagifem. I'm just starting out on returning to systemic hrt at the age of 69, so am looking forward to my first quarterly review soon.
There are some VERY knowledgeable people on here, so, 🤞!

[Jasmine20]

I don't know any science behind the release of hormones in patches but from personal experience, I feel a drop in estrogen levels by the end of day 3 because symptoms start to slowly return.

EllaAurora - I am also in peri (I think - 53 at the end of the year and I'm on sequi HRT) and I feel my endogenous estrogen has dropped again recently. I am moving up from Evorel 50 to 75 next week after my VA worsened and my thermostat has been going haywire.

I do wonder how absorption differs from one manufacturer to another - would I be ok with an Estradot 50 now for instance?

(I have also recently had an issue with a particular batch of Evorel 50 patches as I felt less well on them compared to some from a different batch. They were packaged differently too but Theramax say there should be no issues. It's added to the recent muddle I've been feeling.)

[Salad]

One of the questions I was asked at the Menopause Clinic was could I feel my patch wear off. I could.

It was recommended I change the patches three times a week (Monday, Wednesday& Friday), instead of twice a week, to ensure a more consistent absorption.

[Wrensong]

There is said to be variability over the life of each patch & even at different times of day.  Some of us try to compensate for the fading effect toward the end of patch life by changing every 3 days instead of 3.5 or 3+4, so similar to what Salad was recommended to do.  There are also other factors affecting levels, such as site of application, amount of subcutaneous fat, blood flow etc.  The extract below from the following link details some of the variables involved.

https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol

"Variability in pharmacokinetics
Transdermal estradiol patches are described as delivering a fixed amount of estradiol such as 50 µg/day or 100 µg/day.[10] However, there is large interindividual variability and intraindividual variability in the pharmacokinetic parameters of transdermal estradiol, and fluctuations in circulating estradiol levels with estradiol patches are almost as great as with oral estradiol.[10][93][12][17] As such, the actual delivery rate of estradiol and mean levels of estradiol achieved with transdermal estradiol patches may be different from what is described and from the mean levels observed in clinical studies, respectively.[10]

A wide range of estradiol levels are measured in women using the same estradiol patch or gel and dosage, with an up to about 10-fold difference in levels.[10][93][17] In a study of estradiol gel and patches, the maximal difference in peak levels between individuals was 11-fold for the gel and 7-fold for the patch, and the maximal difference in area-under-the-curve levels (total exposure) was 6-fold for the gel and 8-fold for the patch.[93] It has likewise been reported that the interindividual variability in bioavailability with Estraderm reservoir patches ranges from 25 to 225%.[17] In as many as 30% of women treated with a 50 µg/day estradiol patch, estradiol levels are low.[10] There are also significant short-term intraindividual differences in estradiol levels with estradiol patches; estradiol levels can fluctuate considerably from hour to hour.[10][181] In addition, estradiol levels with estradiol patches are higher in the evening than in the morning, which may be due to circadian variations in skin blood flow that may influence absorption.[10] In terms of area-under-the-curve levels of estradiol, the interindividual variability of transdermal estradiol has been found to be 20 to 44% using different transdermal formulations, and the intraindividual variability with transdermal estradiol has been found to be 20%.[12]"

There are graphs in the full article showing variation over time for anyone who finds them helpful. 

It does all seem complex & there's no replicating the way our own bodies fine tune hormonal regulation before ovarian production begins to decline, but there is at least the option of trying different brands & doses to see what suits us best.
Wx

[EllaAurora]

I don't know any science behind the release of hormones in patches but from personal experience, I feel a drop in estrogen levels by the end of day 3 because symptoms start to slowly return.

EllaAurora - I am also in peri (I think - 53 at the end of the year and I'm on sequi HRT) and I feel my endogenous estrogen has dropped again recently. I am moving up from Evorel 50 to 75 next week after my VA worsened and my thermostat has been going haywire.

I do wonder how absorption differs from one manufacturer to another - would I be ok with an Estradot 50 now for instance?

(I have also recently had an issue with a particular batch of Evorel 50 patches as I felt less well on them compared to some from a different batch. They were packaged differently too but Theramax say there should be no issues. It's added to the recent muddle I've been feeling.)

Hi Jasmine, thanks for sharing your experience! Do you also feel an oestrogen 'peak' or 'rush' during the first hours with new patch? I'm feeling this and it makes me worry that my body is in some way taking the oestrogen from the patch too fast.. not sure if this really is possible, though, so maybe its just that the patch is not the right strength for me.
Good luck for changing to 75 and do let us know how you get on! xx

[EllaAurora]

There is said to be variability over the life of each patch & even at different times of day.  Some of us try to compensate for the fading effect toward the end of patch life by changing every 3 days instead of 3.5 or 3+4, so similar to what Salad was recommended to do.  There are also other factors affecting levels, such as site of application, amount of subcutaneous fat, blood flow etc.  The extract below from the following link details some of the variables involved.

https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol

"Variability in pharmacokinetics
Transdermal estradiol patches are described as delivering a fixed amount of estradiol such as 50 µg/day or 100 µg/day.[10] However, there is large interindividual variability and intraindividual variability in the pharmacokinetic parameters of transdermal estradiol, and fluctuations in circulating estradiol levels with estradiol patches are almost as great as with oral estradiol.[10][93][12][17] As such, the actual delivery rate of estradiol and mean levels of estradiol achieved with transdermal estradiol patches may be different from what is described and from the mean levels observed in clinical studies, respectively.[10]

A wide range of estradiol levels are measured in women using the same estradiol patch or gel and dosage, with an up to about 10-fold difference in levels.[10][93][17] In a study of estradiol gel and patches, the maximal difference in peak levels between individuals was 11-fold for the gel and 7-fold for the patch, and the maximal difference in area-under-the-curve levels (total exposure) was 6-fold for the gel and 8-fold for the patch.[93] It has likewise been reported that the interindividual variability in bioavailability with Estraderm reservoir patches ranges from 25 to 225%.[17] In as many as 30% of women treated with a 50 µg/day estradiol patch, estradiol levels are low.[10] There are also significant short-term intraindividual differences in estradiol levels with estradiol patches; estradiol levels can fluctuate considerably from hour to hour.[10][181] In addition, estradiol levels with estradiol patches are higher in the evening than in the morning, which may be due to circadian variations in skin blood flow that may influence absorption.[10] In terms of area-under-the-curve levels of estradiol, the interindividual variability of transdermal estradiol has been found to be 20 to 44% using different transdermal formulations, and the intraindividual variability with transdermal estradiol has been found to be 20%.[12]"

There are graphs in the full article showing variation over time for anyone who finds them helpful. 

It does all seem complex & there's no replicating the way our own bodies fine tune hormonal regulation before ovarian production begins to decline, but there is at least the option of trying different brands & doses to see what suits us best.
Wx

Hi Wrensong,
thanks so much for sharing this. Very interesting, though I must say, also confusing. I was under the impression that with patch one would get  more stable levels (that was the reason I was moved from gel to patch in the first place). For me personally patch has been so far better than gel, which didn't work at all in the end, but still not finding good balance. Reading this, it does seem that there's probably no way to get fully stable levels and it's more about getting used to the fluctuations than aiming for perfect balance.

My worry at the moment is less the fading levels towards the end, as its always possible to change the patch more frequently, but I'm concerned about the possibility that I'm absorbing too much at the beginning and then again big fluctuations created which lead to worsening of symptoms. I'm thinking now that maybe I'd need a smaller dose, and change more frequently. Would be interesting to hear if anyone else has had this type of experience of getting too much from the patch at the beginning?

Hope you are feeling well Wrensong and thanks again for support! xxx

[EllaAurora]

One of the questions I was asked at the Menopause Clinic was could I feel my patch wear off. I could.

It was recommended I change the patches three times a week (Monday, Wednesday& Friday), instead of twice a week, to ensure a more consistent absorption.

Hi Salad, thanks for sharing your experience, appreciate it!
Do you feel more stable now when you are changing 3x week? When you change to a new patch, do you feel any 'rush' from it, to just normal stable feeling?
Hope you're feeling well & take care! xxx

[Postmeno3]

I thought I was getting a very brief "rush" on application in the form of heat in the patch location only. I'll monitor this more closely. Interesting stuff about patch location in the article. Thanks! 💚

[Wrensong]

Hi Ella, the article is mindboggling, I agree.  I wonder if what you are finding is that as your levels from the old patch have declined by the end of 3.5 days, the influx of oestradiol from the next new patch is a bit of a shock to your system, rather than that the dose as it averages out over time is too much, if that makes sense?  Maybe if you try changing every 3 days there will not be such a dip at the end so that when you start a new patch there won't be such a difference from end to start levels?  As you say though, perhaps the dose is too high & you might feel better on less.

Sorry, OH is wanting us to get out the door so no time to say more this morning!  I hope you manage to find a way to feel better though.  It can certainly take some tweaking & perseverance.
Wx

[EllaAurora]

Hi Ella, the article is mindboggling, I agree.  I wonder if what you are finding is that as your levels from the old patch have declined by the end of 3.5 days, the influx of oestradiol from the next new patch is a bit of a shock to your system, rather than that the dose as it averages out over time is too much, if that makes sense?  Maybe if you try changing every 3 days there will not be such a dip at the end so that when you start a new patch there won't be such a difference from end to start levels?  As you say though, perhaps the dose is too high & you might feel better on less.

Sorry, OH is wanting us to get out the door so no time to say more this morning!  I hope you manage to find a way to feel better though.  It can certainly take some tweaking & perseverance.
Wx

Hi again Wrensong,
thanks for your thoughts again and yes, it can be either of these things. I may do some tweaking in the coming days and reduce the dose slightly to see what happens. Usually if the dose is clearly too low, it's quite easy to feel it quickly as flushes start to return.
Have a great Sunday & thanks for support! xxx

[Salad]

One of the questions I was asked at the Menopause Clinic was could I feel my patch wear off. I could.

It was recommended I change the patches three times a week (Monday, Wednesday& Friday), instead of twice a week, to ensure a more consistent absorption.

Hi Salad, thanks for sharing your experience, appreciate it!
Do you feel more stable now when you are changing 3x week? When you change to a new patch, do you feel any 'rush' from it, to just normal stable feeling?
Hope you're feeling well & take care! xxx

Hi 
I only felt a rush whilst using gel and more recently with the spray. My problem was feeling the treatment wear off and that’s been with gel, patches and spray. Things did settle for a longtime changing three times a week though.

Ive recently had a review of my HRT as I felt unwell for a few months.
I’m now back to twice weekly changes of my patches, but I also use Lenzetto Spray daily and Testosterone gel twice a week.

My hormone levels have improved dramatically and I do feel better 

[Wrensong]

Sounds entirely sensible Ella.  Hope it helps you know for sure & that you will soon feel better.
Wx