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[Mintea]

I have been on Evorel Conti since August starting off on half a patch and a full patch since November. Over the last few days I've been feeling really bloated and tender in the abdomen. It's really unusual for me to have these type of problems. I've taken buscopan and peppermint tea but it doesnt seem to be helping. My joint aches and pains seem much better since being on EC and anxiety is better but I still feel a bit sedated and have periods of bad irritability. I've also put on a lot of weight which is definitely the EC as it  was noticeable after starting the patches. I'm taking hrt as a preventative for osteoporosis and also general health but am not happy with my current symptoms. I also feel slightly nauseous and my blood pressure seems to have gone up. Anyone experienced similar things on EC or have any suggestions? I've tried utrogestan and estrogel but had very heavy bleeding and felt awful on the utrogestan.

[Uptick]

Hi Mintea, I'm not an HRT 'expert' but I have read a lot about cutting HRT patches and there's some inconsistency of opinions about this. I have found a link to a hospital website advising how to cut them correctly and it's completely different from what it's usually done so maybe you had variable amounts of estradiol and norethisterone and now that you have a full patch your body might need some time to adjust to the new levels.

[Mintea]

That's interesting Uptick. Do you have any links you could share about this as I was never sure if I was cutting the patches properly?
 

[Uptick]

https://alderhey.nhs.uk/application/files/6415/8142/1323/Estradiol_Patch_Leaflet_PIAG_M14.pdf

[Mintea]

Thanks for that,  Uptick. It's really useful. I was given no instructions about how to halve the patches and just cut straight across,  not diagonally!

[Uptick]

You're welcome, Mintea. And this lady Pharmacist explains why diagonal cuts are more precise.
https://www.jensmith.me.uk/transdermal-patches-useful-things-to-know/

[Hurdity]

Hi mintea

Sorry to hear about your ongoing symptoms.

However it is very unlikely to be anything to do with how you cut the patch and in fact those references do not suggest you need to cut your Evorel conti patch diagonally at all. With a patch the size of Evorel conti it would be very unlikely that you would be giving yourself significantly variable amounts of estradiol etc but cutting the patch in half by eye - whichever way it's cut, and in fact personally I think it might be more likely to come unstuck by cutting diagonally as there would be sharper points on the patch (being a traingle) - if you see what I mean? Also a longer cut edge to come unstuck and for any damage to the matrix ( although actually i think this is not likely to be relevant when cutting a 50 mcg patch in half).

One of those refs refer to cutting a patch into tiny pieces (ie into 16) in children where precision may well be an important issue and where diagonal cuts enable such precision - but not for an Evorel conti patch I would say.

Unfortunately your symptoms may well be due to ongoing low-grade progestogenic side effects ( from the norethisterone). Nausea from increased oestrogen would have settled by now as the dose (50 mcg) is not very high. Do you experience intermittent nausea regularly or maybe soon after patch change?

If you can detect a pattern ( relating to patch change) in your symptoms then possibly a change of application site might affect your absorption?

Ideally you want to feel better on HRT for more of the time then when off it - so sometimes we do have to settle for less than the best just to feel better overall? (eg I hate taking Utrogestan but choose to remain on a long cycle and enduire a bleed in my 60's so that I can have several weeks on oestrogen alone and not feel I have to give up HRT yet).

High BP obviously needs to be controlled and maybe there are some lifestyle factors you could change that would help with this?

Sorry I can't be of more help and hope your symptoms resolve soon.

Hurdity x

[Uptick]

Hi Hurdity, this is the original article quoted in the Hospital document and that picture is actually of an Evorel Conti patch.

https://europepmc.org/article/PMC/6454296

I have no idea if the way you cut the patches will affect symptoms. I can't find any other studies about this and the manufacturers say you can't do it anyway, so this is just a thought. It's worth a try though, don't you think?

[Hurdity]

I started to cut my patches diagonally and it seems to work better for me.
I had done a bit of research and had found the same info as Uptick.
It might be all in my mind but I have better symptom control than I had with just cutting my patch across.
My night sweats have stopped. I still get overly warm but I’m not sweating buckets which I had done before, it’s a win for me.

I'm pleased you're feeling better Rattymaid but it is highly unlikely that you will achieve better symptom control from cutting an Evorel patch diagonally as opposed to straight across. For the reasons I gave I think if anything I would have thought it is likely to be the reverse.

I  haven't read anything to suggest otherwise and any difference compared to the size of patch is likely to be miniscule - common sense tells me that!

No-one need worry about this, I am certain!

Hurdity x

[Hurdity]

Hi Hurdity, this is the original article quoted in the Hospital document and that picture is actually of an Evorel Conti patch.

https://europepmc.org/article/PMC/6454296

I have no idea if the way you cut the patches will affect symptoms. I can't find any other studies about this and the manufacturers say you can't do it anyway, so this is just a thought. It's worth a try though, don't you think?

I think it's a red herring, so no!

Hurdity x