More Evorel Sequii or Oestrogen + patch & gel?

[54isanopendoor]

I'm 54 &, although still menstruating, was getting a lot of peri symptoms last 3yr.
GP loathe to give HRT but eventually caved in.

I've been on Evorel Sequi 50 patches now for about 10m. To start with they helped, but then the effect tailed off a bit (esp hot flushes). I stopped them 2m ago on GP advice as Mother just died ovarian cancer (& hist of breast & ov in family so have been ref for screening). GP says I can carry on HRT meantime as screening waiting list will be 'more than a year, probably'. I think I will as the peri symptoms are worse with no HRT - esp insomnia & hot flushes...

I've been told I can either - incr the patch dose by 25mcg

OR

'have an oestrogen only patch at 75mcg or 100mcg & use utrogestan vaginally at 100mcg ON CC or 200 mg 2/4 weeks if sequential'.

GP unable to elaborate 'as not an HRT expert but colleague is member of a website who advised this'.

Any advice please, from those who know about Menopause (I appreciate ususal disclaimer re medical advice online)

Bump.

Bumpety bump...

Presumably you are already taking Utrogestan though? As you are still menstruating?

Sorry I realise I misread the patches you are currently on - let me go & re-read your OP properly!

Sorry I'm no great expert (on HRT myself - Evorel + Duphaston] but it sounds like either option will help really?

I am on Evorel 50 & think I will discuss going to 75 when I'm back for a review in 2 months or so. My sleep which has improved so much is not anything like as good.

@54isanopendoor A question for you!

If you are using Evorel Sequi, it gives a monthly withdrawal bleed.
So- how do you know or think you are still having periods?
Is this the monthly withdrawal bleed?

The use of patch + continuous Utrogestan is only for women who are 12 months post meno (so no natural period for 12 months.) The Utrogestan dose is 100mgs daily, and you can use that orally or vaginally if taken daily.

The dose for women still having natural cycles is 12 days x 200mgs per calendar month (usually 1st of each month.)

I'd expect your GP to have explained why they were offering two different types of progesterone- the Norethisterone in your patch, or Utrogestan.

FWIW the research appears to show less risk of breast cancer with Utrogestan.

Links between HRT and ovarian cancer are very weak so I'd not base a decision on that (inconclusive evidence of links.)

You mentioned screening...what exactly? Are you being sent for an ovarian/ pelvic scan and a mammogram? And not for a year? (You can, by the way, have both done privately at around £200 each if that's something you wanted to do.)

How does your GP intend to manage these longer term?

Hi @JinglingHellsBells

Answers: it's Evorel Sequi 50 patches I am on (2 wks 50 then 2 wks conti)
I was still menstruating when I started on them.
I had a nightmare 'period' in 1st month (felt like an early miscarriage - v grim)
but since it has settled down to a 'withdrawal bleed' yes.
But that seems to have happened in the 3 months I've stopped using HRT too (enough to use tampons for 2/3 days sorry if tmi) so wondered if still 'period'?

I have been ref for screening as Mother just died of ovarian cancer & am aware of other female relatives who have died of breast & ovarian cancer pre aged 60.
GP says very slow so take HRT in meantime.
I have had stomach surgery in past so vaginal meds better than oral probably as I dont' digest supplments through my stomach well now.

GP 'knows nothing about menopause so googled it & this is what it said'

Which option would you advise?

@EarringsandLipstick
thanks for your reply too.
I am keen to continue some form of HRT as the hot flushes & insomnia are back.
Plus I am very low iron (so have infusions plus 8 weekly B12 injections) so I am keen to keep on an even keel ...

Hi @54isanopendoor I just wanted to comment on the cancer risk. I have a family history too.

After research (my own and discussion
with a friend who is an nhs menopause specialist,then with GP) I chose to have transdermal oestrogen (Evorel patch) and Utrogestan which is the most ‘breast friendly’ progesterone.

I’m a bit younger than you and am still menstruating so I’m taking 200 mg 12 days per month (with the oestrogen patch worn continuously). Sounds like utrogestan
vaginally would be appropriate for you, given the issues you have with absorption if you took them orally.

In terms of screening, annual mammograms are sensible. Have you not been invited for screening already? Usually starts from age 50. There is a backlog in some parts of the country as screening stopped at the start of the pandemic. It’s more important to be breast aware and report any changes to your GP who would refer to breast clinic under two week wait.
There isn’t any routine screening for ovarian cancer unless you've been referred via a family history or genetics clinic. You could ask GP about a referral to a family history clinic.

@54isanopendoor I didn’t tag you in that last message properly

Hi @Jedstre
thanks for your reply.

I have had 1 x breast screen since age 50 (helpful as my breasts are naturally very 'lumpy' so very hard to check myself). The GP has referred me on basis of family history for genetic screening (in a year or so, if they accept me).

I have been off Evorel for approaching 3m now so I thought i'd wait a couple of weeks to see if a period does show up & then ask the GP for the correct amount of Evorel & utrogestan gel (hoping it's not too fiddly to use / keep 'in' sorry if tmi)

Utrogestan isn’t a gel. They are oral capsules but can be inserted vaginally.

Usually you will be seen by a genetic counsellor who then goes on to recommend a screening regime for you, based on risk. I’d be surprised if you were waiting a year for that consultation.

@Jedstre oh sorry didn't realise (capsules sounds easier to manage)
Yes I hope it will be less than a year (I know waiting lists are bad though)
I waited a lot longer for my GP to agree to HRT to start with though (3 years)