Switching from Sandrena to patches??

[GlomOfNit]

Sandrena gel takes forever to dry! I mean, over an hour and it's still tacky. I've resorted to patting talcum powder on top after about 40 mins so I can get tights on without it sticking, but not sure that's a great idea. I have no idea how long the active ingredient takes to go through the skin - when I mentioned this to a medic friend of mine who's now taking a personal interest in perimenopause and treatment she just said 'I think you should really just let it dry off naturally' - but this doesn't happen. It is ALWAYS sticky even after an hour, but who has that long to wait in the mornings?

While a lot of my peri symptoms have abated (breast pain at certain times of the cycle, some of the pelvic pain issues, irregular periods, night sweats) I do still have low mood, low energy, joint aches (could just be arthritis!), palpitations (maybe they're improved a bit). I don't know how much change is reasonable to want from HRT and I know it's not a game-changer for everyone.

If I want to switch to patches, how do I phrase this to my (reluctant to prescribe in the first place) GP? I don't want him to drag his heels. Do I need an in-person appointment to request this? And I know the doseage will be a bit different - I'm on 2mg Sandrena a day.

Advice, please!

Are you rubbing the gel in and over a wide enough surface area? It takes about 5-10 mins for mine to stop being tacky on my thigh.

In any case, I think you should go back to your GP. You are on a dose that is higher than the licensed maximum of 1.5 mg. And also not sure it’s working for you. Also do you have any progesterone?

in terms of switching from gel to patch to tell them you’d prefer a patch. No drama.

Why don't you try Oestrogel which is the same but evidently not to sticky?
It's perfectly reasonable to ask to change.

@CaptainCaveMum Wondering where you are getting your 1.5mgs is the maximum from?

Sandrena comes in 0.5 and 1mgs sachets.

Many tablet forms of estrogen are 2mgs.

It's perfectly fine to use 2mgs or even 3mgs.

Oestrogel is 0.75mgs per pump. The daily starting dose is 2 pumps= 1,5mgs.
The dose can be increased to 4 pumps = 3mgs (this in on the patient leaflet.)

If you want patches, there are equivalent doses online but you'd need to consider if you want estrogen only + Utrogestan, or a combined patch with Norethisterone for the progesterone.

@JinglingXmasbells maximum licensed dose listed on the product information on the electronic medicines compendium. See photo.

Different medicines will have different safe doses.

And to add, doctors can choose to prescribe medications outside of licensed doses if their clinical judgment suggests this is advisable… but it needs to be explained and considered against alternative licensed approaches because it does carry additional risk. Doesn’t sound like op’s GP is an expert on menopause so I’d be nervous they have made an error rather than a considered prescribing descision.

The active ingredient in Sandrena is estradiol
This is the same whether it's in a patch of gel, and even different gels.
The whole bonus of gel is you can titrate the dose to relieve symptoms.

Oestrogel can be used as anything from half a pump to 4 pumps per day.
4 pumps is 3mgs estradiol.

(I've used it for a long time from a meno consultant.)

The estradiol is the same as in Sandrena and both have been prescribed regularly during the shortages. Many women find Sandrena harder to absorb.

The side effects with increasing the dose do not include anything 'worrying' if that is what you mean. Not sure what you think are added risks?

If so, all women would be advised of this when they increased their dose of gel, patch or tablets, and it doesn't happen.

@JinglingXmasbells not helpful to op to suggest you know more about dosage of hrt than the licensing authorities and manufacturers.

“The two commercially available transdermal gel formulations differ in composition and application recommendations. Sandrena Gel contains 0.1% (w/w) and Oestrogel 0.06% (w/w) estradiol and recommended dosages are 0.5-1.5 g over 200-400 cm2 (Sandrena Gel) and 2.5 g gel over 720 cm2 (Oestrogel).” source:
pubmed.ncbi.nlm.nih.gov/9651909/

@GlomOfNit please go back to your gp

I think you should ask for patches @GlomOfNit. Each surgery is different but I did the same thing recently by completing an online e-consultation form and explaining that I wasn't getting on with the gel and would like to switch to patches. The GP just sent the prescription through to the pharmacy, no questions asked.
I had several problems with the gel, including some changes in symptoms, but one of the reasons why I decided to switch back to patches was I found it never dried properly and stayed tacky throughout the day.
I know lots of women love the gel but the patches work better for me.

Maybe there are some crossed wires here?

The dose is presumably what her GP has prescribed.

The OP has to go back to her GP to get patches. She's asking how common it is to change from gel to something else.

I was referring to the BMS chart, below and what the equivalent would be in patches.

This is from the British Menopause Society / WHC and shows the equivalent doses for each product (transdermal.)

On the list below, 2 pumps of gel (1.5mgs)are exactly the same as 3 x 0.5mgs =1.5mgs Sandrena.

www.womens-health-concern.org/help-and-advice/factsheets/hrt-types-doses-and-regimens/

@GlomOfNit If you want the equivalent dose of estrogen, a patch of 50mcg is what is usually used.

below your referenced table is the following health warning -
“Not all suggested doses are within Summary of Product Characteristics, so if used, are used off licence”
it’s a crude table that doesn’t identify the specific doses for individual brands.
Medicine dosing is an exact science that is specific to active ingredient and method of delivery.

so to repeat
op’s gp has prescribed a dose of sandrena that is not recommended and it appears there is no clinical rationale in this situation
in addition op needs to check she’s using the product correctly and whether she also needs progesterone
op’s symptoms have not resolved so clearly this treatment is not working for her - but a switch to patches may not be the right/only solution.
if op’s gp can’t or won’t engage in those concerns, op needs to get a new gp who will.

Thanks for the information about the correct dose of patch to request, Jingling. And also thank you for your concerns, CaptainCaveMum - I can confirm for you that my GP prescribed the Sandrena starting at 5mg a day and working up to 2mg a day if I needed to, and to titrate the dose according to need. I see no reason to mistrust this prescription. I am of course on progesterone as well! I didn't mention it because my issue isn't with that part of my HRT so I'm not sure why it needed to be brought up here.

I've also spoken at length to a very qualified friend (she's consultant level though not in this area, admittedly) who has taken a personal interest in perimenopause management since it hit her, and now runs seminars to share and discuss information with fellow medics. She thought 2mg was absolutely fine (she said a lot more but I'm not putting it 'out there' because I'm not her).

WhereAreWeNow I'll see if an econsult works to get me changed, though perhaps now the Oestrogel shortage is better and I could try that instead first. I'm sure patches have their drawbacks too!

@GlomOfNit I genuinely hope you get yourself sorted out. If you are open to any advice, I suggest you allow your doctor to select the appropriate dosage of HRT for you, rather than demanding a particular one based on the advice of an internet random. (You will note that I have not at any point told you to change dose, just suggested you query it.)

Despite your pithy dismissal of my advice, I’m posting again for the benefit of any lurkers or future searchers.

None of this constitutes individual medical advice and has been necessarily simplified. You should always consult with your prescribing physician before starting/stopping/altering prescription medicines.

All medicines have licensed doses. If you are interested you can see these at medicines.org.uk under section 4.2

Doses are specific to the actual medicine, method of delivery and sometimes excipients so you can’t necessarily compare even if it’s the same active ingredient (drug).

Licensed doses are based on a balance of benefit versus risk eg side effects. Higher (or lower) doses may cause additional side effects with no additional medical benefit.

Doctors are allowed to prescribe whatever doses of medicines they choose including outside of licences.But they must be able to clinically justify their prescription due to the additional risk. And they should explain this to their patient.

If your HRT (or indeed any other treatment) does not resolve your symptoms, you should always ask for more advice and support. Perhaps it will take longer, perhaps you need a higher dose, perhaps you have a more complex or different diagnosis, perhaps you have another additional untreated condition, etc. Or maybe a different medication would work better for you.

Other medications that you take and other medical conditions you have may affect how medications work and the dose you need. That’s why it’s important to check if you are taking other treatments eg you are taking progesterone replacement as well as oestrogen replacement.

You can also get good advice on medicines from a pharmacist.

CaptainCaveMum I'm not sure if I've strayed into the crossfire in some sort of online feud between you and JinglingHellsBells - it feels like it. We are ALL 'internet randoms' here, of course. You included.

However, I'm not sure my comment was 'pithy'. I do genuinely thank you for your concern, and please be sure I'll be discussing this with my GP - who prescribed me what I'm on, precisely as I'm taking it and I have also had long talks about this regime with my consultant medic friend who knows a bloody sight more than the average GP about HRT and menopause therapies, and I trust her too.

Sandrena is more sticky than oestrogel so maybe try the equivalent dose of that but i find i absorb sandrena better and subsequently feel better overall on that. During shortages, I've had the pharmacist swap me to patches but i definitely experienced more ups and downs as the patches wore off, so i won't be using those again. I echo a pp who said try rubbing your sandrena in over a larger area.

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