Anyone else on 150mcg patch

[Furryfeet]

I’m 45 and on wk 5 of HRT, Evorel + utrogestan. The private consultant I saw advised 1 week on 50mcg patch, 2-4 weeks on 100mcg and then 150mcg ‘as required’. Since the last instruction is pretty vague and I was feeling low last week (my 3rd week on 100mcg) and I really can’t afford to go back to the consultant just yet for more advice, I asked my GP, who advised me to go up to 150mcg. I am struck by the fact it seems like a higher dose than most people get. So I wondered if anyone else out there is on 150mcg and does anyone have an understanding of the rationale behind dosing? I notice that the Newson Health school of thought re dosing seems to be ‘if in doubt go large’.

I would be very careful about what you are doing with those increases.
The rule of thumb is to give a each increase at least 3 months, to take full effect.

150 as required?? That's a huge dose of Oestrogen to be trialing now and then.

I'm afraid the whole ' if in doubt go large', doesn't sit well with me at all.
Whilst I appreciate that some women need more Oestrogen than others,you really do need to give each dose increase the time it needs to work properly.

Hormones are powerful. Be careful.

i am indeed wary of upping the dose in this way, hence the post. It’s tricky when both consultant & GP advise as much. I wish I understood how they arrive at this dosage advice. My only guess is that it’s because I was on Elleste Duet 1mg for 8 weeks with no benefit.

mpoweredwomen.net/real-life/hot-bothered-hrt/

As you can see from one of the Q&R’s linked Louise Newson’s team seem pretty blasé about high doses.

What is odd is that so far I haven’t had a single symptom of too much estriadol. If anything in the last 3 weeks my physical symptoms are indicative of further oestrogen depletion.

Mmm.. I have read that Newson is a fan of large doses.
I guess you are young and maybe you need the additional hormones.

If you feel well on the high dose, it probably means that it's suiting you.

Sometimes to much Oestrogen can mimic too little also.

At the end of the day, every woman's menopause is different.
Some need a little or no Oestrogen ,whilst others feel terrible and need more.

It's so individual.

It’s been good reflecting on this with you. It’s the too much oestrogen/too little issue that does worry me. I think I’ll stay on this dose for a little while but I’ll make a note of all the symptoms of high and low and stay vigilant. Things that make me think I might be low include my breasts sadly losing all their volume almost overnight, which just seems unlikely if I was brimming with oestrogen 😅

GPs know very little.

I am also very sceptical of a consultant suggesting that kind of increase so soon. (Are they well respected in the menopause world? Be interested to know who they are, by PM of course, only.)

At 45 you may need more than a woman of 60, for certain, but upping to what is around 4gms, compared to 1mgs, is a lot.

And you are supposed to give a dose 12 weeks. Granted, that's not set in stone and some consultants would say allow 4-6 weeks, then increase gradually, but rarely start messing around after a week.

And, I hate to say this, but there are other specialists around apart from Dr Newson! Some of what is on her website is not what other drs do, so I'd not set too much store by all of it.

A diary is an excellent idea.
That way you can track symptoms etc.

Jingling is correct however, in that few consultants would advocate changing doses so quickly. Mine says 8 weeks minimum.

What were your key reasons for wanting Hrt? Have those symptoms resolved in the main? Anxiety for example, can be a stubborn one to go and could take a few weeks longer to shift.

@JinglingHellsBells My GP's don't seem to know much but I always go for a particular practitioner who is in her late 40's and has hinted that she's going through the same. Hopefully she's done I little homework even if it's out of hours😅

It's just so challenging knowing where to get reliable advice, when the only certainty is that everyone responds differently.

Anxiety has been a big issue for me, as well as insomnia (which may be improving gradually) and general emotional 'flatness'. As you say, Newson seems to be into large doses, I am learning, but with this in mind I'm surprised I haven't seen more people on here having been prescribed this dose. It's not as if I went along to my consultation pushing for a high dose. Tbh when I got the consultation my main concern was establishing if it was even hormonal at all as all I knew was that I didn't feel 'myself' so didn't even know if I'd be getting any hrt

Yes anxiety was the main reason I went on HRT, that along with hot flushes, crying and lack of sleep.

As long as try to give each dose a good shot, that's the main thing.

All specialists operate differently. Newson is of the opinion that even the highest doses of HRT, don't come anywhere near what our own hormones would produce naturally. Therefore high doses are okay.

My own specialist, is of the opinion that the lowest dose is best, to control symptoms and that other things come into play, such as diet, lifestyle, exercise etc etc, which is true to a degree.

At the end of the day there is no one size fits all.

I have just been prescribed Evorel 100 plus Utrogestan 100 x 2 on days 14-28 of my cycle. I was originally on Evorel Sequi 50 combined patches which stopped working for me. I’m worried this is a high dose I’ve been prescribed. I’m 51 and still have periods. Has snyone had experience of this dose

I'm 43 and I'm on the exact same. I still feel dreadful and wonder if it's the progesterone

I saw Menopause Consultant NHS again today. She was originally cross I was only on 25 then 50, and put me on 100. She said today she had no problem of women if necessary, if it was good for them, going up to at least 200. She would do it in 25 increments. I'm on 125 now, to go to 150 if I choose before seeing her again, ultimately to go to 200 if I choose/need.

@JinglingHellsBells

Jingling is fab and I've seen her on lots of HRT threads.

I do agree with OP though. GP lack of knowledge is shocking. The recent Davina programme shows that. It's got a little bit better recently but not much.

Across the UK and across MN there are hundreds and hundreds of women being fobbed off by GPs, who don't know what they're talking about, it's absolutely shocking.

I corrected one GP when she clearly didn't know which tablet to give me and I referred her to the 2015 nice guidelines. she admitted to not knowing this and that 100's of Her ladies were on a lower dosage tablets then they needed to be. Why am I telling a GP her job?

I've had a shocker of experience over the last 10 years with early onset of menopause and I was denied everything for years and then everything I do now I seem to have to fight.

I was denied anything for years, and then only put on 25 patch.

And why am I fighting all the time?

1)nice consultant Insisted bone scan. When I got the letter about the osteopenia and I rang the GP and she said well I can offer you a calcium tablet there's no need to rush into anything let's put it on hold for the moment and I said no I'd like to have it now please.

2. and then another GP when I got the last letter from the consultant raising patch from 50 to 100 (she said today I should probably on 200, not the 25 I was on for over a year, which is bare minimum ) said .... well is that really necessary maybe we should hold fire on that as well. I said no I'd like it now please. I asked GP are you actually overriding the consultant? Audacity of GP was shocking.

3)Now this most recent one where I wanted to change from patch to pill the GP has put me on pill half dosage, it's just the final straw for me. I mean that's a dosage error. how is that ok?

4. worse still because I was put down from 100 to 50 by been given the wrong dosage of pill I started to feel ill - told the GP in February and she said there was nothing that she could do until I see the consultant in June. 5 months? the GPs are too frightened to do anything, without consultant agreement, about that left me with five months of being unwell.

I realise this is a really tricky situation because for GPs, they don't know what to do. but if you only get to see the consultant once a year you can't then just leave people and not do anything. and as it turned out it was because of a dosage error made by the GP.

if this was any other medication something more serious like cancer or diabetes and the GP had given a half dosage there would be absolute uproar.

Consultant said today the GPs should be doing more and doing it on a patient case by case basis, but I genuinely believe there either GP's not trained enough on HRT and / or too frightened to make decisions in case they get sued.

I'm just giving an example of my struggles I've had Years & Years,but even recently, it's not being that much better and I know that my problems I am not alone there are loads of MN'ers and many other people all over the UK who who just having terrible trouble and this is not really getting any better.

I'm on Evorel 150 patch, actually reduced from 200, also daily utrogestan 100 mg and testosterone gel, all from Newson Clinic.
I'm 58.

Just got my hormone test results back from the GP and while I'm still on 150 patch my estradiol level is only 154pmol/l so I'm thinking that maybe I'm not absorbing very well

Interesting.. I have been on 100 for some time and all has been good. I have started to have some night sweats etc again and Newson have advised going to 150 immediately. I am a bit reluctant, firstly not sure my GP will prescribe the increase and also, not sure about that large a jump..
They justified it as I still have low oestrogen readings and they say possible low absorption and I also had a one off bleed which they suggested could be due to low oestrogen.. Kind of torn at the moment as to whether to increase or not if I'm honest...

I have just turned 44 I started going through menopause at 37 didn’t want to take anything but time went in I am on Everol 50 patch to give it 3- 6 months but I have lot of symptoms had to give up work.. not sleeping aches fro head to toe bad hot flushes brain fog etc then my go put me to 100 I felt worse really bad anxiety so back on everol50 now I’m getting cold flashes still aching tingling extremities and bad stiffness am going out of my mind with it had to also change wat I eat and drink to go back to see gp