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[Teresa]

Hi,
I hope someone can help -
I am low on eostregen, very low ( after a recent blood test) and have been  on HRT for 2-3 months. I’m about to up from Evorel 50 to Evorel 75 patch.
(I’m  also taking utrogestan 100mg orally every day).

They are a big patch…the biggest I’ve used so far.

I have been placing the Estradot and Evorel 50 patches up to now  either side of my belly button, towards my hip, on the sides of my tummy at the front, alternating with just at the top of my bottom at the back, again level roughly with my hip. Not too far round on my bottom, if you see what I mean as I can’t turn round too much as it gets awkward 
I don’t seem to have absorbed these patches ( especially the Evorel) very well in these areas, hence my low reading. Where would I be best to place them for optimum absorption?

I am planning to go to Estradot next time for Estradot 75, but my GP has prescribed me this 1 month supply of Evorel at my request. 

I am due to put my new ones on today just after lunchtime 

Thankyou in anticipation,

Teresa
X

[Hurdity]

Hi there Teresa

I always put them on my butt cheeks - always have done.

There has been some work done on absorption but I can't remember (sorry!). However the important thing for consistency is to keep to approx the same area of the body I would say due to differences in skin thickness for example. This way it shouldn't matter if there are differences if you see what I mean - so if you are not absorbing as a result of how or where you apply the patch then increase the dose - which you are doing.

How often do you change your patch and when in the change cycle did you have the blood test done? One blood test may not tell you anything very much and in any case most doctors do not go by blood tests, rather, by symptoms, though there is a minimum average level for optimal protection against osteoporosis.

Are you still experiencing the symptoms you wanted to alleviate with HRT, and if so what are they? Also how old are you and how far into menopause?

Hopefully you will be able to tweak your dose to get to the optimal level so you feel better - if you are not currently!

I've used many of the patches and at present on Evorel - not sure which I prefer since it's so long since I was on Estradot but I do find Evorel sticks really well even though larger than Estradot. I change mine every 3 days.

Hope this helps

Hurdity x

[Teresa]

Hi Hurdity,

Thankyou for coming back to me. I’m post menopausal and on continuous HRT, so no bleed. My blood test results after 3 months showed 105pml/L and my GP then said he shouldn’t have sent me for the test on the NHS and was supposed to go by ‘how I feel’. He also said that the E2 results the lab did for estradiol weren’t anything to go by, as the estradiol in the everel and Estradot were not the same. I wrote a post on here earlier about that, as I wasn’t quite sure he was right and I was advised that he was incorrect. He was confused I think and I am finding that my GPs do not know a lot about HRT.

My symptoms which led the to the blood test are increased facial hair ( more than I seem to ever get and growing quicker) greasier skin especially round nose and I was always drier, my pores have increased too  Also thinning hair and an itch down below ( not thrush) which is getting worse and I’m very dry. Also severe anxiety, not alleviated at all by HRT. I’ve had that for 4 months now.
I’m nearly 56 and about two years into post menopause. I had a mirena coil taken out about 2 years ago and haven’t had a period since. I had the mirena coil after a history of unbalanced hormones and heavy periods. I also have fibroids added to the mix, but they don’t give me any trouble.

I change the patch on Wednesdays and Saturdays. I try to time it so I’m about 3 1/2 days each side, so twice a week. I do place it on different sides of my body and didn’t realise I could keep it on same side, perhaps that’s where I’m going wrong? I have a lot of moles around my tummy area, so I try and avoid them….as this is a bigger patch it might be better that I do put it on my bottom. Should I keep to the same side of bottom then? But in a different part of my bottom each time so I don’t apply it in sane spot more than once a week? Does it matter that there’s ‘more flesh’ there?  Or is it better when there is?

Thankyou so much,

Teresa
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[Hurdity]

Hi there

May I suggest firstly that you change your patch every 3 days which may result in your using them up slightly quicker but this could easily be expected eg if they sometimes fall off, if you think your doc might be resistant to this idea ( every 3 days). For some women, the levels will drop away quicker - depending on absorption.

Also goes without saying your skin must be clean and dry and free from any sort of lotions or oils even moisturising shower gel - which could potentially limit absorption? Also hold the patch in place with a warm hand for 30 secs or so so that it sticks well.

You didn't say when in the patch cycle you had your blood test ie which day of the week? This could also impact the results.

Symptom wise - those symptoms tend to suggest an androgenic effect - but utrogestan is not an androgenic progestogen. Also though, it could be that because your oestrogen levels are falling and are not being sufficiently topped up by the hRT, you may have an imbalance and could be somewhat testosterone dominant - which tends to happen around menopause ( because oestrogen declines quicker than testosterone) - which partly explains our change in body shape at this time - as I understand. Anxiety could be due to insufficient oestrogen....

That being the case an increase in oestrogen may help.

Placement of patch - sorry I wasn't clear on this. By "approx same area of body" I meant the same anatomical location ie stomach, or butt or torso or thigh wherever you decide. Then you alternate sides every time you change the patch so gives a 3 day rest. I never worry about the exact spot on my butt cheek - I just slap it on - so it is more or less the same but it doesn't matter as it is still the butt cheek. You can choose whichever part of the body you feel gives best results though this might be difficult to say! I can't remember the ins and outs of flesh vs no flesh, location of patch and absorption of oestrogen though there have been some studies carried out....

Good luck with the 75 mcg - I would suggest cutting a bit off it to start with eg to give approx 62.5 mcg which is what I do.

You might want to think about using Utrogestan vaginally though taking it daily this way is not ideal....Oral Utrogestan can give rise to more side effects than vaginal use because there are ore metabolic by-products which some women are sensitive to.


Hope this helps

Hurdity x

[Postmeno3]

Wow! Really interesting! So, as I don't know that anything is improving noticeably on current regime, Evorel25 + topical treatments, and have been using thigh, butt, lower belly as was just told "anywhere from belly button down" by specialist, it would be great to understand absorption better and whether any one region tends to have the best conditions for absorption as none of these areas on me are without a wee bit of "padding"? Great tip, the every three days thing, too!

[sheila99]

If youve had anxiety all the time you've been on continuous utrogeston I would try a sequi regime for a couple of months and see if you're different on oestrogen only. My anxiety was from low oestrogen but someone posted about utro causing it.

[Wrensong]

I can't find the article that originally made me change application site from tummy to buttock  though I've posted it somewhere on here before.  It referred to a study that had found better absorption from patches applied to the butt.  The following link may be referring to the same study, but I'm not sure.

https://journals.lww.com/menopausejournal/Abstract/2000/07050/The_effect_of_site_of_application_on_the.10.aspx

"the extent of absorption was significantly more for buttock than for abdomen application, this application site may provide an advantage in women who experience menopausal symptoms at the end of the week."

I get good absorption from Estradot this way.  I have very little fat elsewhere & imagine this may be what makes the difference for me.

I second what Hurdity says about changing twice weekly patches every 3 days.  Quite a few of us on here do that to try to keep absorption up & avoid the tailing off towards the end of a patch's life.
Wx

[Postmeno3]

Gosh, I wish these things were explained more clearly at the time of prescribing! I feel I've wasted six months faffing about "anywhere below the belly button" randomly. Butt it is. Plenty fat, sorry, absorption scope there! Every three days from now on. Thanks everyone! 🙏

[Wrensong]

Postmeno3, many prescribers may be unaware of any potential for difference in absorption according to site of application.  It doesn't give study size in the article - it may have been very small, so perhaps not that meaningful a finding (& they were using a once weekly change patch) but I posted it as turning up a similar article is what made me try a different site & that does seem to work well for me.  For anyone who's struggling with absorption, any clues as to what may be hindering progress seem worth mentioning so that we can experiment & find out what works best for us.
I thought you & I had chatted on one of your earlier threads about shifting to a 3-day change, but it may be a bad case of menobrain on my part    Butt too far from head perhaps 
Wx

[Hurdity]

Wrensong - thanks for posting that link. I can't for the life of me find the study I remember reading about. All I remember is that the site of the body with slightly higher absorption wss opposite from that for the Intrinsa (Testosterone) patch - discontinued many years ago!

Here is what it says in the product mongraph for Estradot:

"The physician should discuss the most appropriate placement of the patch with the patient. Immediately after removal of a patch from the pouch and removal of the protective liner, the adhesive side of the ESTRADOT® patch should be placed on a clean, dry area of intact skin. The area selected should not be oily, damaged or irritated, and not exposed to the sun. The site selected should also be one at which little wrinkling of the skin occurs during movement of the body, preferably the buttocks, lower abdomen or hip. The patch may also be placed on the side or lower back. The patch should be placed consistently on the same area of the body with each application (i.e., either the buttocks, lower abdomen, hip, side or lower back). Experience to date has shown that less irritation of the skin occurs on the buttocks than on other sites of application. Therefore, it is advisable to apply ESTRADOT® to the buttocks. The waistline should be avoided, since tight clothing may dislodge the patch."

The bottom line ( ) is that for most women it is not crucial as long as you are consistent wtih respect to the area of the body as I said before and as advised in the Estradot instructions - since if you feel (or results show) that you are not absorbing it well then the option is to increase patch dose - which I realise can sometimes be met with resistance from medical profession if they are too blinkered in their approach and do not recognise how women will vary in the amount of absorption...

The difficulty comes when one is already on a high dose.....

...and there is always the possibility of gel or spray....

Hurdity x