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[Turkish delight]

Hia Gals!

So I've got fluctuating hormones again. Tell signs of odd flush, insomnia, dry mouth, headaches and UTIs.

I've been on Oestrogel and Utrogestan for 5 years and had good symptom-free years.
But the last 2 have been very up and down. I've increased the dosage of estrogel even up to 6 pumps and still having issues as above.
I won't go on about whether my issues are to do with Oestrogel production inconsistencies for fear of driving those not on it to distraction.
But whatever the reason is, I'm here again. 

My OH keeps asking me to consider switching to patches, he thinks they would give me more stability with the metered dose. Is he right is it better at keeping a baseline? Should I switch?

P.S I'm 56

Thanks in advance
TD

[sheila99]

They might be worth trying. Someone has reported a surge when it first goes on and others find they have to change it every 3 or even 2 days. I've found them better than gel because of the diminishing dose as the bottle gets emptier. I change every 3.5 dayscand don't notice fluctuations. And there's so much less plastic waste  .

[Songbird]

I'm the same as Sheila. I change my patch every 3.5 days (evorel 50) and don't notice any surge/fluctuations at all 

[Hollyboll]

The short, annoying and as so often for meno, answer is: it depends. 

It's certainly no guarantee, and if you are having fluctuations on something you change every day, extending that time perhaps intuitively unlikely to help - you might in fact want to make the intervals shorter and try splitting your many pumps between morning and evening - I've never been on gel but think I've read here others do this?? 
If you had an absorption problem, it would not fluctuate, it would just never go up - I think it's with absorption problems that people are often told to try a different method.  If you are right and you are sometimes getting high levels from the HRT (as opposed to from your own fluctuations ... might be hard to know if you are still peri if you've been on HRT for 5 years?), you at least know you can absorb gel so I'm not sure why changing to something you don't know you can absorb would help ... (I'm just thinking aloud, no need to answer!).

I've never done gel but think that's a high dose?  If you are still getting symptoms your GP should refer you to a specialist meno clinic - long wait but worth getting in the queue.  And if you are able to afford it you could see a private specialist in the meantime?

The only way to know if you're getting fluctuations (as opposed to your level is stable but that level is causing problems, be it too high or too low) is by repeated blood tests ...

It's common for symptoms to return after a while doing well on HRT, as our bodies/endogenous hormones change. 

I started on patches, partly because a well-known meno 'specialist' told me they gave the best, steadiest, release over the 4 days the patches are designed to last.  Long story short, I ended up with an actual leading meno consultant.  He said at my first appointment that it was common to have a drop on day 4 and I should change every 3 days - that is not uncommon, although plenty of people are fine over 3.5 or 4 days.
Even longer story short, that didn't fix my fluctuations, and he then recommended the best step was to go to something I changed every day, to avoid the risk of surge followed by dropoff over longer (even longer story short, turns out I have a very unusual uptake pattern so even changing patches daily, which as you can imagine was a total pain, gave me massive fluctuations - at that point he said no point in trying gel or spray).  But to stress again: my uptake issue is so unusual that it was only belatedly worked out by a top meno consultant after a LOT of blood tests - and therefore very 'challenging'. 

I'm not a doctor though and I've learned the hard way - this stuff is complicated, high doses of oestr from HRT can cause problems, and it's worth seeing a specialist.

VA mimics UTIs brilliantly and so worth trying local oestr. (If only my GP had known that before putting me through 3 years of antibiotics!)

There are others with a lot more knowledge here so hopefully someone will be along to help!

HTH and good luck xx

[Banjo1973]

Hi,

My understanding from my meno specialist was that gels had less fluctuations than patches, but I guess there is a lot of conflicting advice as how products work in theory can be very different in practice. I switched from Oestrogel to Sandrena. I have found I have to apply it twice a day to avoid fluctuations.

Good luck xx
 

[joziel]

With your 6 pumps, are you applying 3 in the AM and 3 in the PM? That will help reduce fluctuations and you can try that right away.

I am currently on 9 pumps of gel with advice to increase to TEN PUMPS of gel in a week or so to see if it further helps. If I need to go higher than 10 pumps, I will definitely need to switch to another type of product - only because I will run out of skin. But since there is no hard and fast 'this equals that' (just approximations) and since we all absorb different products differently, if I switch there will be time taken to adjust dosages and I just can't go back to how bad things were or risk that, right now. It could just prolong this and see my worst symptoms come back or involve costly Newson appointments to get prescribed more of whatever I switch to.

I echo the advice above to get your estrogen levels tested. Mine are only around 430pmol on 9 pumps, so I feel fine increasing to 10 pumps. Some people have 800+pmol on 4 pumps...

The thing is, hot flushes, insomnia, UTIs, are all symptoms of low estrogen. I would bet my money that you are not suffering from 'fluctuations' due to the gel at all, but you just are not on a high enough dose at 6 pumps as you've progressed further into peri/meno and need more estrogen.

[Penguin]

With your 6 pumps, are you applying 3 in the AM and 3 in the PM? That will help reduce fluctuations and you can try that right away.

I am currently on 9 pumps of gel with advice to increase to TEN PUMPS of gel in a week or so to see if it further helps. If I need to go higher than 10 pumps, I will definitely need to switch to another type of product - only because I will run out of skin. But since there is no hard and fast 'this equals that' (just approximations) and since we all absorb different products differently, if I switch there will be time taken to adjust dosages and I just can't go back to how bad things were or risk that, right now. It could just prolong this and see my worst symptoms come back or involve costly Newson appointments to get prescribed more of whatever I switch to.

I echo the advice above to get your estrogen levels tested. Mine are only around 430pmol on 9 pumps, so I feel fine increasing to 10 pumps. Some people have 800+pmol on 4 pumps...

The thing is, hot flushes, insomnia, UTIs, are all symptoms of low estrogen. I would bet my money that you are not suffering from 'fluctuations' due to the gel at all, but you just are not on a high enough dose at 6 pumps as you've progressed further into peri/meno and need more estrogen.

Where do you use aside from inside arms and inside thighs if you don't mind me asking, please? Looking for alternative skin!

[Hollyboll]

The thing is, hot flushes, insomnia, UTIs, are all symptoms of low estrogen. I would bet my money that you are not suffering from 'fluctuations' due to the gel at all, but you just are not on a high enough dose at 6 pumps as you've progressed further into peri/meno and need more estrogen.

Could be low. Or could be high. I had my first hot flushes (years into a very awful and missed/untreated peri) only after I was put on so high a dose that the peaks of my fluctuations meant tachyphylaxis. That’s one of the reasons to get bloods done, especially on an already high dose (I’ve not done gels but I think 6 is ?)

Xx

[Turkish delight]

Wow so many great replies, thank you so much to all.

To answer some questions,

I do always split the dose to AM and PM.
I've spread and rubbed in the usual areas, like arms and thighs and had good results for a bit.
Then last summer I took a massive dive as didn't realise until 3 months later that my new fake tan was stopping me from absorbing it as well.

I've not put on tan on since last summer and things improved but never got back to how it was before then. even though putting it on the thighs and arms as before. I'm now putting it on my butt lol, and have been for some time and seen no difference to arm and thigh results, with symptoms still going on in the background worse sometimes more than others. Putting it on the butt has one benefit, and that's cz it's where the sun doesn't shine hehe! I don't fake tan my butt, so I have to hold my hands up and admit I'm vain and do this now cz I will want to fake tan my legs and arm this summer...is that bad?! I've not heard of anyone else do this??

TD x

[Tulip256]

Have you had your testosterone levels checked? I was suffering the same on evorel 75 patches and tried to increase to 100 but it made things worse. My oestrogen level on 75 was 400. I introduced testosterone and although it is early days (2 weeks in) it seems to have helped.

[Turkish delight]

Hia,

Yes I have been on T gel for years.

I did drop the ball with it as I realised I was using an oldish bottle near the end date.
Catching up again now so hopefully that will help.

I think after reading all the comments about the UTI side of things, I reckon I might have VA. I have vagifem here and haven't used it like a fool.
I've been having non-stop UTI's. Sometimes 2 in the space of a month. Had scan which showed I wasn't completely emptying my bladder so DRs thought that was the sole cause, but maybe not.

Which antibiotic do you all think works best on your UTI? I Have had Monoril mostly.

TD
X

[joziel]

Penguin, I put 3-4 pumps on each thigh (inner, outer, back of thigh) and 1 pump on my butt cheek AM and PM (left side AM and right side PM).

[Turkish delight]

Oh good, someone else who applies gel to butt!

Thanks Joziel

[Hurdity]

I've mostly only ever used patches and have never had any problems with them, Breifly tried Sandrena gel a few years ago but flushes came back, so rather than spend time tweaking the dose I went back to patches which I knew worked.

I change every 3 days after a blood test on day 4 patch change day showed around 90 something pmol/l whereas on a retest mid change it was nearer 200 which was fine by me. I also increased to 62.5 from 50 mcg patch. So no fluctuation as such, but dtoo much decline by Day 4. Initially I changed to 3.5 days and then decided 3 would be better.

Unless you have an unusual absorption pattern patches should give you a very stable dose with only a very gradual decline. There may be some variation with body (and therefore skin) temperature though as with all transdermal HRT. Higher temp will increase blood flow to the skin and increase absorption.

Hurdity x

[Turkish delight]

Hi Hurdity,

Thanks for your help. I'm interested in why you changed briefly to try the gel if you were happy with the patches.

Was it because of the fade in estrogen as you near change day 4, so doing a 3-day change fixed the issue for you?

Also interested if you know off the top of your head what the equivalent of the dose you take is in oestrgel pumps because I have no clue lol!

Thanks
TD