Gel vs Patches

[Dirtystreetpie]

Started on one pump of gel and tablets days 14-26 about 5 months ago. Initially helped but I am more anxious, insomniac and night sweaty than ever again. Also struggle with forgetting the gel/tablets/not liking the wet sticky thighs and waiting for it to dry.

I heard the gel/tablets is now seen as so called “gold standard” of HRT, but was wondering if I may get on better with patches and wanted to hear of anyone else’s experiences. Do you need to take pills as well with the patches if you still have your period?

I use combined patches (Evorel Sequi) so 2 weeks oestrogen only then 2 weeks oestrogen and progesterone. I do sometimes get a period/withdrawal bleed but not always.

upsides are you get 3-4 days out of each one, so don’t have to remember every day. And the patch itself is a reminder to change it. They suggest picking 2 specific days, especially if they coincide with eg work patterns or an evening activity so you remember for example Tuesday is swimming so change your patch.

downside for me is visibility as I’m currently dating and seem to go for younger men, so I end up taking it off if I think I’m going to have sex! Whereas gel wouldn’t be an issue.

Also the patches don’t stick too well for the full 3 or 4 days so I use a tattoo wound dressing strip on top to keep them on, which is even more visible!

Pills I thought were not recommended any more, unless it’s just the progesterone in a pill form. But again, when I tried oestrogen patch and progesterone pill I just forgot to take the pill on the right days.

it’s all a bit of a balance but hopefully you'll get it sorted and start to feel better.

the biggest win for me has been increased sexual feelings again (especially as I’m on ADs which can diminish that) and generally physical improvement down there, from urinary continence to the reversal of my shrivelled clitoris, which was one horrendous aspect of menopause I had no idea about!

All patches contain oestrogen, like the gel. Some also contain progestagen, which is the synthetic form of progesterone, which is the hormone that will be in your pills. Everyone who still has their uterus needs to take some sort of progesterone if they are taking oestrogen, to stop the womb lining getting too thick. So you could change to patches alone, if they included progestagen as well, or to patches instead of gel but still take progesterone separately. If you still have periods it would usually be recommended to take progestagen or progesterone intermittently so you still have a withdrawal bleed. Patches are made with and without progestagen for this reason.

I’ve always used patches plus progesterone capsules and am very happy with this combination. Some people don’t like the glue marks from patches, but they clean off easily with baby oil. Some people prefer gel because you can adjust the dose more easily. I’ve never used gel, partly because I have animals and there have been cases of them absorbing the gel by licking their owner’s skin; mostly because I’m happy with patches, which work very well for me.

My friend uses gel which comes in handy sachets so all premeasured. She’s really happy with that and doesn’t have the glue issue that I do. I wondered about asking for some sachets for the odd day when I don’t want to wear a patch.

Have you not tried increasing your gel to 2 pumps?

That's the standard dose. 1 pump is very low- the same as a 25mcg patch, and less than a 1mg tablet.

If you don't like applying the gel, maybe ask for a patch like Estrodot, and you can carry on using Utrogestan.

There is no 'gold standard' really when you're comparing gel and patches.

It's personal choice.

The 'gold standard ' (which has actually been around for over 10 years, it's not new) is about using a transdermal type of estrogen (gel or patch) and micronised progesterone (as it's possibly safer re. breast cancer.)

I use the gel but two pumps here. I do one in each arm first thing if I’m not having shower in morning or after shower if I am. Rub it in quite thoroughly and then by the time I’ve cleaned my teeth, faffed about getting clothes out and starting to get dressed it’s dried in less than 5 mins. I found when I did it on my thighs I couldn’t then get on with other stuff for the time it needed to dry.

Have you asked about upping the number of pumps and really tried rubbing it in? I didn’t know you could do that until I saw a video of someone explaining using the gel on the balance app and it definitely helped!

I use évitez continue which is oestrogen and progesterone. They don’t come off despite hot baths though you have to scratch off the glue. I love it, change it twice a week then forget about it.

Evorel conti (bloody Duolingo)

It's not quite that simple because the gel is in two strengths so you'd need to use the right amount to be the same as you patch.

I didn;t get on with the gel at all. I have had a hysterectomy so only use oestrogen. Started on Evorel patches which were OK but they are massive and I am allergic to the adhesive, GP suggested I switch to the gel but it just didn;t agree with me at all, I was an anxious mess and I just don't think I was absorbing the oestrogen in the same way as I do through a patch.

I am now on Estradot patches and they suit me very well. Small size, not allergic to glue, no faffing around with gels and smearing it on and stickiness, also easier for upcoming holidays, swimming and sunscreen.

Gold standard implies that one is better or worse than the other - I can't use the gel as it doesn't absorb properly. Am I not getting the best treatment then?

the gold standard is whatever works for YOU

@MrsHerculePoirot You're not really supposed to rub it in! (I've seen the balance video and it goes against the manufacturer's instructions.)

You are supposed to apply it enough to spread it but not actually rub it in (the old leaflet used to have a template saying spread across the same area, roughly, as an A4 sheet of paper.)

If you rub too much, a lot of the gel will just be absorbed by your hands.

I apply half a pump to each upper arm or inner thighs in the morning and the same at night.

I don't know where this 'gold standard' thing comes from! It's not a term used by consultants.

The reason it's become popular is because of the apparent safety of micronised progesterone, compared to Norethisterone (in combined patches) or MPA ( in tablets.)

Gel and estrogen only patches are the same.

Likewise, it's well known that tablets have an increased risk of blood clots, so again that is a safety reason to try to avoid them.

I use estradot 50 for preference, but can't get them ATM so using evorel.
I very rarely get bleeds - maybe twice a year?
But am not great at remembering the utrogestan consistently. I don't worry about it too much as have always had very light periods which trailed off to almost nothing by my late 40s. The patches help with lubrication and sex drive, though I do hate the glue residue.

I have no idea if it's ok, but if it's a special occasion - anniversary or night away - I put a second patch on a few hours before for a libido boost, then remove the original patch the next morning. I hope that's ok!

@JinglingSpringbells perhaps ‘rub it in’ isn’t the right phrase, rub it to spread it more though then just sort of plonk it on a small area. It’s been amazingly effective for me so it’s obviously working for me. Completely changed my life within 5 days of starting!

Ok I get you!

I think sometimes women think you need to rub and rub, like body lotion until none is visible or sticky.

@ImpromptuGathering What are you doing with Utrogestan? Are your periods over and you're post meno? You should either be using it 12 days per month if you are in peri, or daily if your periods have stopped.

You can, with medical consent, use it every 3rd month but this is for women who are intolerant to Utrogestan.

you are getting erratic bleeds - not monthly, and now ever. They could be the lining shedding spontaneously if it's got too thick. But it depends how you are using utrogestan.

I'm also 5 months in and needing a review as it wasn't a magic cure-all I'd hoped plus some symptoms are back to near-intolerable levels (low mood, energy levels, lack of motivation/interest in life, sleep) but I'm on 2 pumps of gel already so not sure if that means changing to the patch but I actually don't mind the gel. One pump into each thigh at night and by the time I've done my teeth and taken off makeup/moisturised it's all dry and now just very much part of everyday routine.

I'd definitely increase to 2 pumps as I thought that was standard dose anyway. I also have zero libido so hoping my very good GP can prescribe testosterone as I can to go private.

so is the safest progesterone only available in the gel then?

I was hoping to get combined patches as I don't like the sound of gel at all; or if I couldn't get combined, then estrogen only patches, plus tablets progesterone. But if that's not as safe as other forms, then I would reconsider!

I went on HRT literally as we went into lockdown - appointment was 9th March 2020. So I have had very sporadic follow up. At that time I was 49 and having periods irregularly - from 20 to 70 odd days apart.
I started with daily patches and utro for day 14-28, but never got regular bleeds, and those I had weren't predictable (ie coming during the progesterone phase). I did speak to the doctor but got a very young woman who said no bleeding is what we want and clearly had no idea.

I still intend to take utro for 14 days starting on 1st of month, but am not great at remembering it every day. I forgot it completely in April. Last bleed was March this year, the one before was October last year, both very light.

I am obese (BMI 35) so I kind of wondered if my hormone levels are on the low side even with the patches.

So the issue is that the safest progesterone (mivronised) is only available as Utrogestan tablets right? So the least risk approach is gel plus Utrogestan or patches plus Utrogestan. I find taking the utrogestan a pain and would much rather just use patches all month.

Why isn't it possible to get a patch/gel that also has the micromised progesterone in for 12 days (or continuous of you're on that)

Good question Smart home. Yes I am on utrogestan tablets with the gel. I was hoping if I did switch to patches to get a combined one so would just be as simple as getting all I need from 1 patch and then changing the patches as required. But sounds like would also need to be a combination of patch and utrogestan.

Thanks for all the responses it’s very helpful & now understand what is actually meant by gold standard in terms of the less risk involved form of pill.

I am also thinking now I am not applying the gel correctly and I should up the dose. I have been rubbing it in as I get paranoid of the residue being transferred to things and my children coming into contact with it somehow so perhaps I have been absorbing a very minimal amount.

Might try the half pump on each shoulder in morning & half pump on each inner thigh at bed suggestion and see if that improves. I feel like I am having anxiety attacks every evening now and the insomnia from it all is starting to affect life

Yes sadly you still need to take the utrogestan tablets with the patches. There are some patches that contain both estrogen and progesterone but, my understanding, is that this is non the same micromised progesterone that is in Utrogestan tablets, it's a synthetic form (and so doesn't have the decreased progesterone risk that Utrogestan has).

You just know that if this was a treatment for men this would have been done by now right? Having the safest form of everything in one handy patch.

Why isn't it possible to get a patch/gel that also has the micromised progesterone in for 12 days (or continuous of you're on that)

Because the product doesn't exist. @SmartHome

Micronised progesterone is a powder that's held together with oil in a capsule.

It can't be absorbed through the skin, except either vaginally or orally.

It's nothing to do with it being for men or women!
It's physically not possible for the micronised progesterone to be absorbed by the skin (as other drugs can be.) In order for that to happen, we'd have to apply bucket loads of it as a cream, which isn't physically possible 😂