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Original poster

When to increase HRT dose?

11 replies

UsernameNotAvailableNow · 22/04/2023 21:47

I am 40 years old and believe I've been in peri for around 2 years. Strong family history and aaaallllll of the symptoms. I started on Evorel 25 + coil 2 months ago and felt immediate improvement, especially joint pain. Moved up to 50 a month ago due to persistent insomnia which had helped.

GP said she would like me at thos dose for 3mo before considering moving me up to 75.

This seems reasonable, however I still have fluctuating anxiety and irritability issues that I'm really struggling with. Plus awful palpitations. I've had to quit caffeine and alcohol. My diet is exemplary and I already do weight training.

What else can I do?

OP posts:
not4profit · 22/04/2023 22:01

I was prescribed 50 on top of Mirena coil, but also had terrible palpitations. The cardiologist I was referred to recommended increasing to 100 and I've rarely had palpitations since.

ImAvingOops · 22/04/2023 22:20

I'm on Evorel 50 and top up with one pump of oestrogel. I was told the time to top up is when you get symptoms come back.

Original poster
UsernameNotAvailableNow · 23/04/2023 08:01

@ImAvingOops I didn't realise that was possible, thank you. Will discuss that with my GP. do you just do it as and when you need it?

OP posts:
JinglingSpringbells · 23/04/2023 09:45

@UsernameNotAvailableNow You can increase now. The guidance on HRT is try it for 3 months before switching to another type. This is usually because women can have side effects and after 3 months they often settle.

This is not the same at all as saying try a dose for 3 months, especially when all you are doing is changing to a higher dose patch. So your GP isn't understanding prescribing guidance.

There are no higher risks with transdermal estrogen, so no logic in making you stay with a lower dose.

Please question this with her and quote the 3 months for a type of HRT, not a dose.

I started off on gel (top meno gynae who trains others) and was advised to start on half a pump and work upwards until my symptoms were controlled, which I did, ever couple of weeks over around 6 weeks in total.

JinglingSpringbells · 23/04/2023 09:47

UsernameNotAvailableNow · 23/04/2023 08:01

@ImAvingOops I didn't realise that was possible, thank you. Will discuss that with my GP. do you just do it as and when you need it?

No, you can't just dip in and out of a dose as your symptoms will also fluctuate.

There is no point adding gel to patch- this is sometimes an option where some women are on the highest patch but it's not likely that anyone would do 100mcgs+ gel.

Just ask for a higher patch!

ImAvingOops · 23/04/2023 11:28

I add the gel every day. There does come a point where if you increase the oestrogen then you have to increase the progesterone too, but if using Evorel 50, you could (iirc) add 2 pumps of oestrogel before needing to up the progesterone.

JinglingSpringbells · 23/04/2023 12:24

ImAvingOops · 23/04/2023 11:28

I add the gel every day. There does come a point where if you increase the oestrogen then you have to increase the progesterone too, but if using Evorel 50, you could (iirc) add 2 pumps of oestrogel before needing to up the progesterone.

Is there a reason why you can't use a higher dose patch?

ImAvingOops · 23/04/2023 13:25

I've never really thought about it @JinglingSpringbells. I assumed that what I'm doing now is less of a dose than the 75 patches.
I did have a bad reaction to the progesterone tablets which is how I came to be on patches - is the progesterone higher in the 75? Maybe that's why the dr is happy for me to increase the oestrogen but not the progesterone.
Tbh I'm still guessing if I'm on the right dosage - it hasn't cured all the symptoms. Am on referrals list to see a specialist re testosterone too

JinglingSpringbells · 23/04/2023 14:29

ImAvingOops · 23/04/2023 13:25

I've never really thought about it @JinglingSpringbells. I assumed that what I'm doing now is less of a dose than the 75 patches.
I did have a bad reaction to the progesterone tablets which is how I came to be on patches - is the progesterone higher in the 75? Maybe that's why the dr is happy for me to increase the oestrogen but not the progesterone.
Tbh I'm still guessing if I'm on the right dosage - it hasn't cured all the symptoms. Am on referrals list to see a specialist re testosterone too

@ImAvingOops There is a table either on the BMS or Women's Health Concern of comparing types and doses. ( google!) I'll have a quick look for you. :)

Off the top of my head (which may be wrong) I think 2 pumps of gel= a 50mcg patch.

75mcg patch= 3 pumps of gel.

1 pump of gel is 0.75mgs of estrogen BUT patches are in mcgs not mgs so you can't compare directly.

So you are probably using the equivalent of 3 pumps of gel.

ImAvingOops · 23/04/2023 14:32

Thanks@JinglingSpringbells
I'm due a review soonish so I'll talk to the dr. Would be nice to just have patches and stop faffing with the gel

JinglingSpringbells · 23/04/2023 14:39

@ImAvingOops I think there is some confusion going on here.

Evorel comes as an estrogen only patch ( dose up to 100mcgs) BUT also a combined patch where the highest dose is 50mcgs.

The OP @UsernameNotAvailableNow is using estrogen only because she has the Mirena.

You must be using the combined patch where you get progesterone for half the month as part of the patch.

For the OP, she can ask to increase the estrogen patch to 75 or 100mcgs.

Doses and types here https://www.womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT-Doses-NOV2022-A.pdf

https://www.womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT-Doses-NOV2022-A.pdf

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