Estrogel didn't work. Now highest level of patches not working. HELP!

[ChocolateTruffleCake]

I was up to 4 pumps Estrogel and still having hot flashes, night sweats etc etc.

Ob/gyne tried me on 75mcg Estradot. No change. Now I'm on 100mcg Estradot and still having night sweats, and all other symptoms.

Perhaps I just don't absorb transdermal estrogen very well?

Anyone have advice or ideas?

Just to answer tried it and gave up, only used 2 pumps. However, the flushes stopped for several weeks, and are sadly back. But not as badly.

Hope you find some ease soon.

Chinese medicine practitioners and acupuncture are very helpful for menopausal symptom management. Chinese herbs are very effective to help the body cope with the changes, you might want to consider this as a support. In the USA women are referred to TCM traditional chinese medicine commonly. Hth

Have you tried Oxybutynin?

Thanks all. Why would I used Oxybutynin?

It is very effective in stopping the night (and day) sweats. I was put on it to help with these symptoms after I was put very suddenly into a medical menopause as part of my breast cancer treatment. I can't take anything with oestrogen, as it would 'feed' my particular type of cancer.

Anyway, my point being is that it really works!

Oh ok thank you!! I will ask my OB about it!

@ChocolateTruffleCake Your dr needs to do a blood test to check your estrogen levels. Not usually done but in your case it's odd to use 3mcgs estrogen and still not have any improvement.

Oh @JinglingHellsBells - so glad you answered. I was hoping you would. My OB did check my blood level - my estrodiol is at "

I might be imaging this @ChocolateTruffleCake :) but ages back did it look as if you were using too much progesterone from what you posted then?

If Prometrium is the same as Utrogestan, the dose you use is wrong.

Daily dose is 100mgs. You only use 200mgs a day for 12 days each month. This is on the patient info leaflet and online.

No wonder you feel awful if you are using that amount.

You have a good memory @JinglingHellsBells! Yes, that's me.

I argued with my OB about it and showed her the pamphlet, and she said that amount of progesterone is for standard doses of estrogen, but because I am a high dose, I require a higher dose of progesterone. She is my second OB (I switched doctors due to the previous OB doing the same thing!).

This OB is a NAMS certified menopause specialist so I had hoped she would be better. But she also insists I use 200 mg per day progesterone.

To get rid of the progesterone debate altogether, I asked if I could instead use IUD as my progesterone. But she refused, saying it's off-label for HRT use.

Not sure what to do. There aren't a lot of NAMS menopause specialists in my city, most aren't taking new patients, and I had to wait 4 months to see this one.

Does progesterone level affect estrogen absorption/levels?

@ChocolateTruffleCake There is no guidance to increase progesterone to that level if you use 4 pumps of gel. This would be 'common knowledge' if it were and on patient leaflets and guidance for prescribing.

I know you aren't in the UK so all I can say is in the UK I've never come across anyone doubling up on progesterone like that, partly because Oestrogel dose is up to 4 pumps a day.

I know (of) a lot of women who see menopause experts who use a lot LESS progesterone than the guidance says,( 7 days per cycle instead of 12, longer cycles using it only every 2 months etc) because they can't tolerate a higher level. As long as they have no odd bleeding, in which case they would have a scan, it's considered safe.

I'm sorry but I don't think your dr knows what she's doing.

YES, that amount of progesterone negates the benefits you will feel from estrogen.

It's your choice 100% but I'd go by what the leaflet says and ignore her.

Thanks very much @JinglingHellsBells. I do very much appreciate and value your opinion. I am troubled by my OB's advice, as the research I have done say that you are correct.

But my husband (also a physician but not a menopause specialist!) points out that I have been given the 200 mg/daily advice by three different OB/gynes since they all consider 4 pumps estrogen as high dose.

I'm going to press my OB to consider IUD for progesterone and then I don't have to worry about dosage anymore.

Thank you for your advice! I REALLY appreciate it and your sharing your valuable knowledge.

(PS Cheers from Canada!)

It is a high dose BUT there is nothing in the dosage information to say that progesterone has to be increased accordingly.

There are also women in the UK (under medical advice) using 100mgs progesterone every OTHER day (rather than daily) and a research trial in Switzerland showed it was enough.

In the UK, a specialist would work with you on a more individual basis.
You'd be allowed to use 100mgs (the licensed dose) and then if you had spontaneous bleeding, showing the lining was not being controlled, you'd have a scan and discuss increasing the progesterone.

Would you consider dropping down to 100mcgs a day for one month to see if you felt better?

You are so sweet @JinglingHellsBells. I will try that: 100mg a day to see if I feel less groggy and lethargic. I am sure that you are right; I just hate that I am going against my doctor's advice and concerned that if I do get a bleed, then will have to confess that I didn't do as instructed. She's a colleague of my husband's at hospital and agreed to take me on as a patient as a favour to him.

But I don't like taking more than the prescribed dose either and unnecessarily if it's not required.

Thank you again so very much @Jingling! Again, your support and advice are incredibly appreciated.

I am off to take a short nap because I am so tired right now. (Fortunately I work from home!)

How long have you been on it? I ask because I'm on it and it took nearly three months for me to feel any better. I tried doubling my dose about six weeks in and it actually made me feel worse so I reduced it again.

Hello @yearinyearout!

I was on 4 pumps Estrogel since October 2019 but still having night sweats, etc. etc. Was switched to 75mcg Estradot in mid January but now hair is falling out!

I am going to ask to switch back to the Estrogel. At least with that, my hair wasn't thinning!

The other issue is my doctor keeps increasing my dose of progesterone with estrogen increases. In chats with @JinglingHellsBells and from my own research, I don't think the progesterone needs to be increased.

What doses are you on? (Currently, mine is 100mcg Estradot with 200mg progesterone daily)

I'm only on two pumps of estrogel daily, I also have the mirena coil. My main issue was anxiety/massive mood swings and touch wood I've felt much better the last six weeks or so.

I am very glad to hear that @yearinyearout! I am hopeful that I will get there too.

Hi @JinglingHellsBells
Just wanted to let you know: I happened to have a phone consult with my GP this morning, so I thought I'd ask HER about progesterone dosage. She said that it's 100mg continuous or 200mg cyclic. When I asked her if I change that with estrogen increase, she said no - it's a standard dose. So I am going to follow your suggestion and see how 100mg daily with current estrogen dosage is effective.

BTW, do you know if too high a dose of progesterone causes hair loss? Just curious if that's the cause as opposed to too low estrogen. I just recall some friends who had hair thinning due to pregnancy.

Thanks again for your help! I am so appreciative. Wish I could give you a hug!

Pleased you have had that chat with your GP.
I noticed earlier today there was a post on Menopause Matters forum from someone using progesterone and using 4 pumps of gel PLUS testosterone. I don't know them or their story but in the UK testosterone for women is only available from a consultant (usually privately) so if the needed to double the progesterone I am sure they would be and would have said in their post.

The hair loss is probably down to low estrogen because if you use too much progesterone it cancels out the good stuff E does.

Th thinning hair after pregnancy is due to the 'shock' of having huge levels of both hormones disappear after the birth.

Ah thanks so much @JinglingHellsBells. So need to up my estrogen for hair loss. I'm going to give the 100mcg patch another month to see how it works before giving up on it, and hope to see some benefit after reducing to 100mg progesterone.

Honestly - if it weren't for you and your advice, I'd be trucking along, miserable on 200mg. So you've changed my life with your wonderful advice. You are a godsend.

Ok, got it re: hair loss in pregnancy. Now that I think about it, women's hair and skin get that glow during pregnancy likely due to increased estrogen/progesterone!

It's the same issue here in Canada: testosterone gel only available through prescription. My OB wants to balance estrogen/progesterone first before attempting testosterone. I'm on the fence. What are your thoughts/advice?