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[KaraShannon]

Hi everyone

I don't want to scour google because I'm bound to find information that will make me anxious 

I've felt so much better on Evorel Sequi since I started it last year, but I'm trying to understand a couple of things:

1)  I feel fine on both the estradiol and the combined patch - BUT I feel really well on the combined patch, lots of energy.  I know while I'm on that I'm going to be buzzing, I'm productive and happy.    I'm ok on the estradiol part, but there's not major feeling of well being and if anything I think my body struggles just a bit on it.  I've started noticing palpitations again, only slight, but I was getting them before starting the HRT, usually when my body was trying to ovulate    it's making me wonder if I need a 'stronger' HRT now?  this leads me to.....

2)  Is there a stronger HRT than Evorel Sequi.  i was kind of under the impression that this one was a gentle 'start' to HRT and now I can't see my doctor, I've tried, my request keeps being missed, so can't ask or have the review.  Or maybe people have different doses of it?

Thanks for any info or advice 

[Hurdity]

Hi Karashannon

It's difficult to say what's going on once you start HRT and especially if you are still peri-menopausal. Can you remind us what your periods were doing before you started hRT to determine where you are in menopause? ie early peri or late?

The other thing is, many women will experience normal pms when they change back from the combi patch to the oestrogen only one - just like when you were fertile. This is due to the progesterone withdrawal. You should feel better after a few days so for example especially during the second week of the oestrogen only patch.

If you are generally begining to experience menopausal symptoms (that you experienced before starting HRT) then it could be that you need more oestrogen yes.

There is no higher dose of Evorel sequi nor any combi transdermal HRT. The options are either tablet combi HRT, or separate oestrogen and progestogen. With the latter, options are limited to: the Mirena coil, Provera, or utrogestan. They are all listed here:

https://www.menopausematters.co.uk/to_progestogens.php

You will see also that the oestrogen only patches come in 75 mcg doses:
https://www.menopausematters.co.uk/treatafter.php

Your should be persistent with your doctor - normal services are now supposed to be continuiing concurrently with Covid treatments, vaccines etc.

Hope this helps and let us know how you get on

Hurdity x

[KaraShannon]

Hi Hurdity

thanks for the reply.  My periods were a bit erratic, sometimes I'd go for 2 months without, its possible even 3 months, but not longer I don't think.  Then I'd get a period and it wouldn't stop for 6 weeks.

I started to feel like everything was changing too quickly with me, less about the periods, but overnight I saw a lot of changes, I felt like my muscles were weaker, I was exhausted, just lots of vague things.  When I told the doctor that I felt like I was sinking into the chair, as if I wasn't 'firm' anymore in the legs, etc, as if I was turning to liquid, she said that can be lack of oestrogen.  The feeling improved a lot with evorel sequi.  I'd say it's coming back a bit and I'm feeling a bit 'harassed' again, lol, like my body isn't coping.  it's a lot milder than it was and the patches are clearly still helping, I just wondered if I could improve on it as it's better but not how I was before.  I know it's the change, but things like muscle weakness etc, if that can be resolved I imagine it's better than leaving it.

I didn't realise you couldn't just increase the patches though. 

I have numerous things to discuss with a doctor, it's all a bit overwhelming and I'm not ready to do it all at the moment.  I'd say I've got some pelvic floor issues happening, not sure what, a mild rectocele possibly, or mild prolapse.  I did have the peeing while coughing thing for a few months then it disappeared, around starting vagifem, but I think even a bit before that with just the evorel patches.

Thanks for your ear on this 

[KaraShannon]

I also noticed I was staying awake all night and not getting tired (although I'd be physically exhausted, just not sleepy).  I've always been a bit like that, but never to the extent of being up all night.

On Evorel I could fall asleep if I put myself to bed (though I'd be fine awake if I stayed up and wouldn't get sleepy).

Once vagifem was introduced, while it shouldn't do a lot, for me it really did.  I got migraine and hair falling out, but that's settled down now and isn't happening and I take it every other day.  But the other really noticeable thing with it was that I'd sleep a lot more deeply, like I slept as a teenager.  Still up late, lol, but once asleep there was no waking me (not due to urinary improvement as I never woke at night anyway).

I feel like that effect with vagifem is wearing off a little, only slightly, but also the pelvic issues are a bit more noticeable, so maybe I need to up the dose to daily.