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[Anjia]

I started estrogen pill four years ago after having a full hysterectomy and did well for two years but started having stomach problemsI was on 2mg then I went on to the patch 75mcg then down to 50mcg but to be honest I just cant get on with it I have really tried even though most ladies say estrodot stays on fine it never has with me so fluctations all the time.I now have estrogel and am hoping this works Ive been told to use 2 pumps a day but keep getting flushes Im 56 so should I be using 3 pumps would love some advice.

[Tinkerbell]

I had trouble with Estradot too and changed to estrogel which I prefer and seem to be absorbing better...fingers crossed!
I was on Estradot 75 but started off on 2 pumps of the Estrogel but found that was not sufficient...went to 3 pumps and that suits me better.

[Mary G]

Anjia, pills and patches didn't worth for me either, I could never get anything like enough oestrogen out of either of them and I also hated wearing patches. 

I am 55 and on 2 pumps of Oestrogel everyday which works well and I feel great but if you are still having symptoms after a month or so on 2 pumps then firstly, I would try splitting the dose to 1 pump every 12 hours (try splitting the location too i.e. 1 pump on arms, 1 on legs) and then if that doesn't work, I would increase to 3 pumps. 

How I envy you for not having to ruin the wonderful effects of the gel with progesterone. 

I hope it works out for you. 

[cubagirl]

Doctor told me 2 pumps was equivalent to 37.5 patch, so going on that, I reckon 3 pumps would certainly be nearer 50 patch.

[Anjia]

Thankyou its so good to have answers from you lovely ladies theres no help at my gp just dont have a clue !!

[Hurdity]

I don't think it is possible to give an equivalence like that - all the serum estradiol levels are averages from a populations of women being studied and actual readings are hugely variable. With gel particularly I think there is a huge variation between different women in levels and I read in a paper about pharmacokinetics of HRT (roughly - what happens to the hormones from the external source, how much of it gets into your body and is transported/metabolised, as time progresses) that one of methods - can't remember if patch or gel - had a ten-fold difference between the highest level ( of serum estradiol) and the lowest in the women studied.  Also some women absorb the oestrogen better via one mode of delivery than another as we have seen on here. The best way is just to look at the approximate strength of the dose ie low medium or high. The standard starting dose for patches and gel or at least for post-menopausal women - ie a medium dose, is two pumps of gel and 50 mcg patch.

From reports on here some women achieve far higher levels of oestrogen on 1 pump of oestrogel than a 50 mcg patch but others barely absorb it at all. It's probably partly to do with application method ( for gel) as this can make a huge difference in how much is absorbed, or skin type or what you put on the skin. Body weight will have a bearing as well - all other things being equal, small thin women will achieve a higher concentration of estradiol from a given dose than tall fat women!

You oestrogen level should not fluctuate with a patch - as long as it stays on of course - and even if it comes completely unstuck levels only decline over 24 hours so you do have a bit of leeway.

According to the Australian Menopause Society in fact 50 mcg patch or  1 mg gel is medium dose (1 sachet of Sandrena) which is between 1 pump estrogel (0.75 mg) and the standard dose of 2 pumps (1.5 mg), so it sounds from this as though 1 pump is more like 37.5 mcg ?

How long have you been using two pumps of gel and why did you reduce from 75 mcg to 50 mcg? Were your symptoms controlled with 75 mcg?

Hurdity x

[Anjia]

Hurdity I reduced to a 50mcg patch on the advice of my gp I have high blood pressure but its controlled with tablets so thats fine with me but she thinks that as I am over the age of 55 I am 56 I shuold be lowering my estrogen,as for the gel I dont think its working yesterday I used 3 pumps 2 in the morning and 1 last night but had the worst bout of flushes and sweats Ive had for years I am tall and slim and also very active maybe I just dont absorb it well, I read somewhere yesterday that if your active it can use up your oestrogen that cant be true ?Anyway Ive just put a patch back on so fed up today.

[Anjia]

Sorry Hurdity you asked how long I switched to gel just a week.

[Hurdity]

Well my view would be if the 75 mcg was working for you then why reduce it? Some women are unfortunately especially susceptible to changes in oestrogen level even when on a high-ish dose. Some women manage to ride it out but it can take 6 months, but for others the symptoms of any lowering of oestrogen can persist. As you are only 56 the risks of HRT are still less than the benefits - as long as you are generally healthy, and you also don't have to worry about the progestogen element and the risks of that. You did mention you had problems with the patch staying on though - so that is quite important. Perhaps stick it on in a different place? I have always used my butt cheek away from knicker line.

What dose patch have you put back on? If you've gone for the 50 mcg - maybe give it a month if you can, and see where you are?

I haven't heard anything about using up oestrogen if you are more active - it doesn't sound likely to me ie the exogenous oestrogen being used metabolically during exercise - but I am not familiar with all the details.

Are you also doing anything to control your blood pressure naturally as well as with tablets eg reducing salt, alcohol, taking more exercise etc which would mean being less worried about higher doses of oestrogen? According to this website blood pressure is not a real issue on transdermal HRT anyway. http://www.menopausematters.co.uk/atoz.php#GlossH

Hope you feel better soon

Hurdity  x