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[awake and nervous]

Hi!

I’m 61, post menopausal, and have been on HRT for ten years, primarily to treat debilitating hot flushes and night sweats. I’m in good health generally, am not overweight, and don’t smoke.

After being on Elleste Duet Conti Tablets for some time (initially 2mg, then 1mg with a view to gradually reducing the dose over time), I had to change to Kliovance 1mg/0.5mg in 2020 as it was impossible to get hold of Elleste Duet post Brexit and during lockdown.

Still with a view to eventually coming off HRT, towards the end of 2021 I started to reduce the dose by halving the Kliovance tablets - so essentially taking 0.5mg a day. At end of last year (2022), during my 6 monthly HRT check up, my GP prescribed Femoston-conti 0.5 mg/2.5 mg - to save me cutting Kliovance tablets in half!

I should say that up until this point, I had done very well on the various HRT tablet preparations, with no side effects. Although the reduced dosage (from 2mg to 1mg, and latterly to 0.5mg) has meant my hot flushes have returned, they are much less frequent, less severe and manageable.

At my most recent HRT check up, I spoke to another GP at the practice. Because I’ve been on HRT for so long, she suggested I might try moving to Bioidentical HRT - Estraderm MX50 patches and Utrogestan 100, or Evorel Conti 50. So I opted for the Estraderm and Utrogestan and have been on this for just over a month now.

For the first time ever, I am experiencing side effects from HRT. My breasts have increased significantly in size and are tender. This started to happen within days of starting the combo and has only become worse over time. I’m also noticeably fuller around my belly and thighs and feel heavier. I’ve had a low mood since the end of week one and have generally felt quite lethargic. I have a tortuous colon and slow transit (have had this all my life and generally manage it well); however, constipation has worsened slightly too. 😕

I’m just not myself at all! 😵‍💫

Could all this really be down to the Estraderm and/or Utrogestan?

And if so, I’m wondering which is more likely to be causing these issues - the micronised progesterone in Utrogestan, or the estradiol in the Estraderm patches?

If it’s more likely to be the micronised progesterone, I’m wondering if a move to Evorel Conti might be worth a try? Or would it make more sense to go back to tablet form and the Femoston Conti?

I know the general advice is to persevere with a change to HRT for another month or so, in case my body eventually gets used to it (!), but I’m really reluctant to continue. 🙄

I’d be grateful for any advice from my peers 😊

[meno-mel]

Hi, I had Evorel Conti last year and I didn't like the side effects of low mood, which was due to the progesterone part of it, northisterone, which is definitely not bioidentical, it is an older type of progesterone that isn't great for a lot of women.
My GP told me Evorel Conti was bioidentical, it's not, and I found the correct info here.

I thought femoston was a bioidentical hrt, but perhaps the oestrogen part isn't, I'm sure the progesterone part is bioidentical and that is the part which carries the risk, oestrogen on it's own hasn't had much risk attached to it, but more testing needs done of course before that statement means much.

Now I'm on Utrogestan and Estradot 50 patches, I tried Evorel 50 patches, but they weren't like Evorel Conti and didn't shift my symptoms at all (at least Evorel conti worked!). So I'm happy with Estradot, it's utrogestan I've been tweaking and I've been taking it vaginally to avoid the side effects. It seems better taken that way, lots of discussions on here if you search.

P.S. I'm only trying out all these HRTs because I want to take it long term, for the health benefits, especially heart disease and bone density are things that go wrong post meno for women in my family. It's no longer thought to be necessary for women to stop, but cheaper if we do.
If I were you I'd go back to what works, your body is telling you it's not happy with this new HRT and it doesn't usually complain!

[sheila99]

Sore boobs are usually too much oestrogen or too big an increase. I think (not certain) that you have doubled the dose? You can get a 25 patch or you could cut a piece off the ones you have. When you feel bad usually the culprit is progesterone. You could use it vaginally which avoids digestive problems or you could have a trial period for a couple of weeks without it. Obs not a long term solution but will show you which is the problem. If you change anything best to only change one thing at a time. Some people (I'm one of them) get sore boobs with progesterone but if you do you'll know from your menstruating years.

[meno-mel]

Just adding that taking utrogestan vaginally avoids the mood crash symptoms for me, taken orally I get very low indeed.
The gastro problems are reduced but not eliminated by taking it vaginally so I'd assume a systemic action causes the reflux and heartburn, progesterone relaxes muscles and some types set off fight or flight, either of those actions will affect digestion.

I got sore boobs with utrogestan & Estradot50 and on Evorel Conti, but not with utrogestan & Evorel50 and not on provera & Evorel50 either.
Someone pointed out the former two regimens contain Estradiol hemihydrate while the latter two contain Estradiol which isn't a hemihydrate so might not be absorbed so easily.

Your boobs might just be reacting to the sudden increase in dose, I think to Estraderm50 is equivalent 2mg femoston, so after your other doctor reducing you with a view to stopping, this doctor has put your dose back up to the average given to peri women, which might be too much for you and also seems to throw all your efforts to reduce back in your face.

[awake and nervous]

meno-mel and sheila99
Thank you both.

You’ve got me looking closer at dosage. But I’m going round in circles with mcg (micrograms) and mg (milligrams) 😵‍💫

1,000 mcg = 1 mg

According to both patient info leaflets, the estradiol contained in Evorel Conti 50 and Estraderm 50 corresponds to a release rate of around 50 micrograms (mcg) of estradiol in 24 hours. So 2 patches each week would release around 350 mcg in total over that week.
350 mcg = 0.35 mg.

The Femoston tablets I was on previously each contain 0.5 mg (milligrams) of estradiol. Dose one tablet each day. So I guess that means a release rate of 0.5 mg a day. Releasing a total of around 3.5 mg estradiol each week.
3.5 mg = 3500 mcg

Which I think would make the estradiol weekly dosage of both patches less than that of the Femoston tablet weekly dosage?

But I think much must depend on actual absorption of estradiol? Certainly you’re meant to absorb more through dermal patches.

I’m confused.
But nothing new there 🙄

I’m on holiday at the moment and have just run out of the Utrogestan (my pharmacist at home was unable to fulfil a complete prescription due to the recent nationwide shortages.)
So I’m taking a break over the weekend and will try to speak to my GP on Monday.

Wish me luck! And thank you again for your thoughts. Much appreciated 😊

[Madge79]

Awake and nervous this link shows equivalent doses, if you look at page 2 it shows the you have approximately doubled your estrogen dose which would explain you symptoms.

The equivalent patch of you were on 0.5mg would be a 25 mg.

Hope this helps 😀

https://balance-menopause.com/uploads/2021/10/Equivalent-doses.pdf

[Dotty]

https://thebms.org.uk/wp-content/uploads/2022/12/03-BMS-TfC-HRT-Practical-Prescribing-NOV2022-A.pdf

Hi page 2 of this document shows you the equivalent doses of different hrts.

If you were taking a 0.5mg tablet then the increase to a 50 patch is a lot.

Evorel Conti and Estraderm 50 contain the same amount of oestrogen. The equivalent in oral hrt would be a 2mg tablet ( Kliofem or Elleste Duet Conti ).

It could be that you have increased too quickly and your body needs time to adjust. If you were still getting hot flushes then your oestrogen dose wasn’t high enough.

Hope that makes sense .