Sequential HRT patches increase?

[RosieSun]

Hi. I started on Evorel 50 combined sequential patches 3 months ago (estradiol only patch 14 days, then estradiol/progesterone replacement hormone the next 14). I have a GP appointment tomorrow evening for review/new prescription.
The patches have helped my symptoms somewhat, but inconsistently. Some weeks I feel good overall. Some weeks (More so in recent weeks), I feel the HRT is just not enough to counter what I assume is big dips in my own oestrogen levels. The worst is psychological - anxiety, low mood and getting very easily upset.
I would like more estrogen but I’m on the sequi patches which only come in 50mg. I am wondering if these could be supplemented with some 25mg Evorel estrogen-only patches. Or adding another half patch of the sequi ones I’m on. I’ve done a tonne of internet research before posting here. Nobody agrees/gives clear advice on whether the progesterone in the Evorel 50 is enough to support an increase in estrogen, or whether it needs increased too. Lots of people think it must need increased, but I keep reading stories of women on gels upping their gel when needed, but they are staying on a constant dose progesterone pill.
I’m be really grateful if anyone on Evorel 50 (or similar) who’s asked for more estrogen has had a successful outcome they could share with me?

The GP I saw first time is on long term leave now, so I need to be fully prepared myself.

Ideally I would love estrogen gel and micronised progesteron so I have control over the dose, (and the patches are a pain) but I live in Scotland and they don’t prescribe it. (I’m not prepared to go private or spend months waiting to take a space at a menopause clinic I don’t need). Thanks in advance.
Ps. No one need suggest Mirena 😊 , I had an awful experience with it before and don’t want to try ever again. I’m on the mini-pill for contraception as I’m peri, not post.

Hi @RosieSun

I'm on the other thread and posted last week that my Gp had prescribed double Sequi patches.

I got a call back today to say she had since spoken to a colleague and was going to prescribe a top up of Evorel 50 instead of doubling- so 2 x Evorel 50 for 2 weeks then 1x Evorel Conti and 1x Evorel 50 for the other 2 weeks.

I have to say I'm happier about that as I queried it at the time and was apprehensive about doubling up on progesterone.

I'd say best to ask for what you want then if they won't prescribe that, ask we hat they will do.

I was also conscious that there are issues with gel shortages still so to have patches seemed a good option.

Hi @putthehamsterbackinitscage..lol! I got to your other post first! This one is very good news. I’m going to ask for the same as you. Do you mind me asking if you are in Scotland or England? They have different prescribing rules and I’m in Scotland.

I'm in England. I tried checking the local formulary back before my 1st appointment and it didn't seem to include utrogestan so I didn't expect to be offered that and gel but generally patches seem to be ok for me.

The local GPs seem to have some knowledge but are by no means fully clued up on what the latest recommendations are - I have already had comments about the risks are more for "long term" and it's fine if less than 5 years so I am anticipating having to push if I want to stay on hrt long term.

Fingers crossed you get a GP who is knowledgeable and listens to you.

Thanks @putthehamsterbackinitscage. I hope you get on well too with your new dose!