Switching from tablets to oestrogen gel and Provera tablets

[imstilljenny2]

Quick query for any meno knowledgeable MNetters. I've been on Femoston 2/10 tablets since I was 43. I'm now 47. I had a phone appt with my GP today and we were discussing my HRT. We discussed DVT risk and I asked about switching to transdermal HRT which my GP was happy to do so I'll be picking up my prescription for oestrogen gel and Provera (medroxyprogesterone) tablets in a few days. I also have sooooo much brain fog so wouldn't mind switching HRT to see if that helps.
Any tips or advice? I don't think the progesterone I am getting is micronised or body identical. I don't think the body identical progesterone is available for prescribing in Scotland.
Any advice on applying the gel etc? I'll obviously have a good read over the patient information leaflet when I get them but thought some practical advice from others on these meds would be good.

You get a lot of gel in one pump! Best place to apply it is your thighs. I tend to alternate each day. Best applied same sort of time each day.I’ve only been on it for a week and noticed huge improvement in my symptoms but no change in brain fog yet so will be interested to see if that improves in time.

The gel absorbs really well and feels nice, although quite cold

i alternate between inner thighs and upper arms, and really rub it in, since seeing a video demo from Louise Newsome that was shared on another post.

Otherwise it takes aaaaaaaages to dry/sink in and i end up hairdryering it and getting hot. Which kind of defeats the object.
No idea about the progesterone, I have mirena to deal with that.

Yes I rub mine in well too, same as I would for moisturiser.

I put mine on my upper arm

Thanks everyone. Exactly the kind of info I was looking for

How many pumps of oestrogel have they advised? Femoston 2/10 contains a high dose oestrogen, the equivalent would be around 4 pumps of the gel.

Utrogestan has become more popular in recent years as the oral progestogen component because it's most similar to natural progesterone. You may get on fine with provera, but it's an alternative option if not

@confusedlots I don't know how many pumps she has prescribed. I'll find out when I pick them up on Monday. Fingers crossed I'm ok with Provera. I did ask for Utrogestan but the GP I don't think knew what they were which makes sense as they are not accepted for use in NHS Scotland so it will be much more difficult to get these prescribed.
How do you remember when to take the tablets? Do I take them from the 14th to 28th of every month?

[quote imstilljenny2]**@confusedlots I don't know how many pumps she has prescribed. I'll find out when I pick them up on Monday. Fingers crossed I'm ok with Provera. I did ask for Utrogestan but the GP I don't think knew what they were which makes sense as they are not accepted for use in NHS Scotland so it will be much more difficult to get these prescribed.
How do you remember when to take the tablets? Do I take them from the 14th to 28th of every month?[/quote]
Most GPs don't say how many pumps to use.
The starting dose is on the leaflet- it's 2 pumps .
That is 0.75mgs estrogen x 2 = 1.5mgs.

@confusedlots Femoston 2/ 10 is 2 mgs estrogen. But less is absorbed through tablet types, so you won't actually get 2mgs.

There are some areas of Scotland where you can get Utrogestan.
It depends. If you want to pursue this you can ask Dr Currie (menopause specialist in Scotland) via an email on her website Menopause Matters. It costs £30 to email her. The details are on the Home page of the site.

@JinglingHellsBells I would certainly hope that the GP will prescribe an actual dose, it's still a prescribed medication, even if it's being delivered via the skin.

Yes the starting dose of oral oestrogen is 1mg and of oestrogel is 2 pumps. You can go up to 2mg orally or 4 pumps, and 2mg orally is roughly equivalent to 4 pumps when you take into account the different bioavailability of a tablet and the gel.

I only point this out because if the OP has been used to taking 2mg orally and then suddenly switches to a lower dose of 2 pumps she's likely to see a return of symptoms and then think that the new regime isn't effective.

@JinglingHellsBells and @confusedlots thanks so much. That's hugely helpful information.

@confusedlots This forum is absolutely full of posters being given gel etc with no dose from their GP!

The dose in 1 pump is 0.75 mgs.
The starting or normal dose is 2 pumps. That's 1.5mgs.

That is the equivalent of 2mgs in tablet form, because in tablet types of HRT, a lot is lost in digestion.

If the OP was to use 4 pumps that's 4 x 0.75mgs = 3mgs

That's at least 1mgs higher than Femoston 2/10 and bearing in mind that gel is absorbed better than tablets, it could be as much as twice what 's absorbed from a tablet.

The way to use it is start with 2 pumps and give it a few weeks to see if it controls symptoms.

If not, increase by 1 pump and continue for a few more weeks, and so on.

My prescribed dose is 2-4 pumps with the advice to use as lower dose as possible and to increase according to symptoms

@WhoNeedsaManOfTheWorld good to know. I've got a feeling I won't have any symptoms though as I started HRT age 43 only because I skipped some periods and blood tests showed I was peri. Maybe now I'm 47 my symptoms might be worse. Who knows?

www.menopausedoctor.co.uk/menopause/hrt-the-different-ingredients-brands-and-strengths-available

@JinglingHellsBells I don't think the experts would agree with your calculations, but hopefully OP's GP will be more knowledgeable.

@confusedlots

https://www.menopausedoctor.co.uk/menopause/hrt-the-different-ingredients-brands-and-strengths-available

@JinglingHellsBells I don't think the experts would agree with your calculations, but hopefully OP's GP will be more knowledgeable.

I've used estrogen gel for almost 14 years. Two pumps is 1.5 mcgs.

@JinglingHellsBells you are absolutely correct and 1.5mg oestrogen given across the skin is roughly the same as 1mg in tablet form. Anyway, I didn't come on here to argue, just thought it might be useful to share some information which might help the OP seeing as i specialise in this area. Won't bother next time!

OP, I hope you get sorted with your new HRT preparations and they work well for you.

I occasionally have three pumps ...if I have a run of restless nights, start to feel edgy, or wake in the night roasting providing it's not the cat doing his hot water bottle impersonation I suppose maybe I sill have some helpful hormones wafting about and the 2 pumps usually makes up the deficit!

Usually will do an extra squoosh for alternate days and everything seems to settle within a week and I am back to the usual 2 pumps.

You may have to nudge your GP, mine seemed to think that one bottle was enough for eight weeks and was not pleased when I pointed out the maths ( 1 bottle =64 pumps, equivalent to 1 month) so do keep a track of that.

@LaurieSchafferIsAllBitterNow brilliant thanks. I'm on testosterone gel too and do the same re applying a bit more when I'm feeling foggy 😂

I've picked up my new meds and have a couple of queries. Help!
My oestrogen gel is prescribed as one pump twice daily. I'm presuming I'll just apply two pumps once daily.
Also I've to take Provera 10mg tablets from day 14 to day 28 of cycle. I think the only way I'll remember to do this is to take them from 14th to 28th each month. As it's 16th August today that means I won't start Provera until 14th Sept. so I either apply oestrogen gel daily for a month on its own before I start Provera alongside it or have a two week gap then start. Sorry I'm probably not making myself clear!

i think it's pretty much personal choice to when you apply your gel.... so yes, 2 at once or 1 twice a day, no idea about the provera though

I do my gel in one go after my morning shower....I cba with remembering two things instead of one!

@LaurieSchafferIsAllBitterNow fab thanks.

hi
can I ask what dose of Provera you are taking with your estrogel
i have been give no guidance
Thankyou

I'm the OP but have changed username. I'm now on Utrogestan instead of Provera and getting on great with it. Why have you not been given instructions with your Provera? Your GP should have prescribed a dose and your pharmacy should have labelled the box with this dose.

I know is seems bizarre that I have had no instructions either verbally or written .
I am going back to the Gp next week but was wondering what dose most people take

Thx