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[hereandthere]

Hi everyone
After one year on Evorel Sequi I'm changing to 2 pumps of Femigel (in SA, UK it's estrogel I see) and 100mg tablet utrogestan daily. I was really happy on the Evorel but asked for a change as I'm worried about hair loss.
My gynae says I have to wait a minimum of 7 days with no HRT before starting the new regime.
I only realized after my appointment that I'm surely going to get my bad flushes and insomnia back. I'm already awake again on the second day past midnight!
Why the seven days? I couldn't find this on a post.
Luckily and unluckily it's Christmas time.

[Hurdity]

I presume he said use up the whole packet and then wait 7 days? I imagine this is to allow for a bleed without building up the lining with oestrogen. However I would suggest that stopping for 3 days (after the last of the Evorel sequi combi patches) would be sufficient. Also even if you started the gel straight away you shouldn't get much build up (of womb lining) in 3 days so probably I would do this ie finish the packet. Start the gel and then after 3 days start the utrogestan. You should get your bleed as normal. This is my suggestion however go with stopping completely - but for 3 days - if your gynae gave a specific reason for this?

Also I presume you are over 54 and have been using HRT for a while or post-menopause? The regime you have been prescrobed is for post-menopause whereas Evorel sequi is for peri. If you are not yet at menopause ( but you won't know this probably if you started hRT before reaching menopause) then you could get sporadic bleeding as your natural cycle kicks in if you take progesterone every day.

Hurdity x

[CLKD]

I would be ringing for clarification.  Point out that you weren't clear about the necessity of a gap between products - this may trigger his bed-side manner and 'teach' him to be more clear.  Many times I had to explain to patients what the SHO had meant  : they know but that doesn't mean that they are able to be specific 

How's the weather there ?  [I'm so nosey]

[hereandthere]

CLKD the weather is very hot! I was sweating yesterday with my Xmas party zip lining. It's around 28 to 30 degrees lunch time, but we have high humidity so it feels hotter. Thanks for your advice guys- really appreciated!
Yes, my gynae provides explanation but he is a very quick talker, though I can be a bad listener-A.D.H.D. and no medication 😆 .
Hurdity, you're right that he wanted the king to shed, which he pointed out on the ultrasound. My period in fact started late yesterday (2nd day after my last conti patch). He said the recommendation is a minimum of seven days no HRT, but it can be more if I want, so he suggested to just stick with seven days. He is a pretty old gynae (older than me 😆),but runs a bone density clinic and his specialty is menopause.
I'm 49 and suffered hot flushes for ten years. When I started on the Sequi a year ago (at 48), I did blood tests and a vaginal ultra sound (in his rooms), and was apparently at the start of the menopause, hence the Sequi as you say Hurdity. I had only missed a few periods and having had tests 6 months before that too, my gynae said there was a very large decrease in hormones since that point, matching my periods going away.
Now a year later I haven't had further blood tests but my gynae did the ultrasound and showed me (not that I could actually see it myself 😂) how my poor ovaries have shriveled, so there's been a lot of change again since then he says. Which is why when I voiced concern about my hair he said he thought I was ready to go on to this regime, which he said the Alzheimers Society (SA/UK/US/global? Not sure), is the most recommended one there is currently.
I have to take the utrogestan every day but he said to just phone if I get unwanted spotting and he will change my prescription to being cyclical again.
So Hurdity and CLKD, I assume that if this prescription is not suitable my body will let me know with the spotting?
One thing I did mention was that I've noticed a tiny bit of flushing lately on my Sequi and did that mean I needed more hormones? He said no, that was interference of my own hormones over the Sequi. He said the Sequi was the highest level of hormones I was allowed, so it's not possible to up it to get rid of all flushing. I assume the estrogen? Find that a bit confusing.

[NorthArm]

Hi Hereandthere

I'm thinking he might have meant that 50mcg is the highest oestrogen level on the Evorel Sequi patch.

The good thing about the gel, is that 2 pumps is sort of equal (I believe) to 50mcg patch - so if it's not a high enough dose, you can always go up from there xx

[hereandthere]

Thanks NorthArm, that makes sense. Good to know I can increase the estrogen if necessary. I wonder if South Africa has a different guideline for maximum estrogen levels (for persons not at cancer risk). Do you know what it is in the UK?

[NorthArm]

I'm not sure - I'm in Australia myself and the only gel equivalent allowed (lucky us!) is Sandrena gel. I myself am on a 100mcg patch, which is marvellous...we're about 20 years behind the eight ball - Utrogestan was only approved for use here in August last year 😂😂

As for maximum dose in the UK, many ladies on here are on as many as four pumps, and a handful are on as many as six...

Isn't it strange how the ‘rules' for ‘women's troubles' are so different in each country - strangely there's no such difference in Viagara or testosterone for men 🙄🙄.....I find it frustrating in the extreme...! Surely we all have the same biology?? Hopefully ours will be the generation that changes this....

When you start the new regime, will you be doing a sequi or a conti regime? If you find the Utrogestan hard going (I do) and you're on a conti regime, you can always ask to go on a sequi...it will give you a bleed, but the reduced amount on the sequi may mean you'll feel a bit better on it. Just remember to take it in the evening as it can be very sedating.

Good luck with it all xx

[hereandthere]

Thanks NorthArm. The variation between countries is interesting. Obviously still so much everybody is not 100% sure of. So many South African friends and family have emigrated to Australia. Sounds like there is one reason not to though😉
I'm going on the conti after the Sequi for evorel so a bit daunting I must say.  My gynae said to change to Sequi if I get spotting. But what do you mean by being hard going? Thanks for the tip about when to take it. I'm also worried about feeling nauseous on the tablet as I'm sensitive to that.
The Evorel Sequi was so perfect for me, I must say I'm wondering if crazy to switch. This is all on account of me trying to avoid the norethisterone in the evorel conti part, due to my hair thinning.

[NorthArm]

Oh lol, hereandthere, we also have awful biting things..yuck! But our marsupials are rather sweet...

The Utrogestan makes me feel a bit down and anxious, I get flushing (but nowhere near as bad as it was pre hrt!) and find it a bit tough to stay asleep. Apart from that, the sedative effect means I literally crash when my head hits the pillow. I was having a bit of breakthrough bleeding on it, but that seems to be settled now...basically I feel very pms whilst taking it. I have been taking it orally, but next time I'm going to try it vaginally and see how I go - it's a capsule and is also quite effective when used this way apparently.....loads of ladies on here find it better tolerated.

Best thing about it - I haven't lost any hair lol...

Keep us updated, and I hope it all goes well, sounds like your gynae knows his stuff xx

[hereandthere]

Thanks for the support 🤗

[CLKD]

I don't do heat  - it was 7 weeks straight with no rain in our garden this year, fortunately we face East/West so could escape the intensity.

How R U today?

[hereandthere]

I just stuck to the recommendation as I was ok. However five days probably would have been better than seven as it was the last couple of days I noticed sleep trouble.
I had a few night sweats starting with this gel and concerned I've no idea how much not to overly rub into my legs and how much to pump out- a total depression? How should I know how much gel is 1.25g per pump?!!
I'm also wondering if this tingling in my arms coinciding with the gel and the utrogestan can have nothing to do with the HRT. I hope not! Going to see a GP about it after my holiday and will mention the HRT.

[Hurdity]

I haven't used pump packs of gel but from what I understand one full ( ?metered) pump gives a standard amount of gel ie 1.25 g containing 0.75 mg estradiol - so yes that would be a total depression - bloop!

The general advice is to apply rather than rub as it (estradiol) needs to soak in before it dries (alcohol evaporates) and also not to spread on too large an area - however rubbing won't do any harm if the formulation enables you to rub it in ( if it's like Testogel - and is a similar formulation - then it's very slippy so spreading out may be the best way), provided you apply it consistently and to the same body part (!) each day - as this will give you the most stable and consistent dose.

Hurdity x

[hereandthere]

Thanks Hurdity, I'm trying to spread less. Mine has no way of measuring except a full pump, but my gynae did say to just swipe and not rub in. Just because I'm having flushes again, wondering if I'm doing it right.

[hereandthere]

Hi Hurdity
I'm not sure if I'm supposed to start another thread here, but after 7 weeks I had a blood test- oestrogen only, as my flushing has got pretty bad again. I'm in summer, which hasn't helped.
So my gynae said my oestrogen level is low at 113 (photos/ml I'm not sure in SA?),
so I'm not absorbing well. I asked what was good and he said should have been 170. Since my hair fell on the  Evorel patch, he suggested a pill, although that has an increase of 12% for blood clots. (which he said is not bad).
I asked about trying one more pump (so three in total) and he said I could try first.