Why am I not absorbing my HRT patches?

[Lioney]

I've been on 150 Everol (or Estradot when possible) and 200 Utrogestan plus tostran and an Estring for 13 months, I'm under the care of an NHS menopause clinic.

Bloods showed my estrogen levels to be less then 100.
When I was on 6 pumps of Estrogel it was 180.

I'm very careful about using creams etc, patches generally stick very well so no idea why I'm not absorbing.

Any else experience this?
Suggestions to increase my absorption appreciated!

Bump

I think it's just "one of those things" that some women absorb better on patches, others on gel, others on spray. I am the opposite - patches are great, gel is awful. Is there any reason you can't just switch back to using the gel?

@Lioney I was told by a consultant gynae that blood tests are inaccurate and the only way to test estrogen is over 24 hours, with constant testing during that time. That' s not practical and shouldn't/can't be done.
They also pointed out that many private clinics offer blood tests as a kind of 'reassurance' or being seen to do something, when in fact it doesn't prove anything. (I appreciate you're NHS for this but even NHS meno clinics vary in who they employ as specialists.)

The main point is whether your symptoms are being relieved by the dose.

https://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/what-is-hormone-testing-#:~:text=Because%20hormone%20levels%20vary%20day,reflect%20the%20body's%20hormone%

Testing hormone levels is not required to determine whether a woman has the “right amount” of hormones. The optimal hormone levels in postmenopausal women have not been established. How symptoms respond to a particular dose of hormones or nonhormonal menopause medication is the only reliable guide.

Saliva testing is often a part of custom-compounded “bioidentical hormone therapy” with hormones. But saliva testing is not only unnecessary; it has also has also not been proven to be accurate or reliable. Because hormone levels vary day to day as well as throughout the day, even a blood test cannot accurately reflect the body’s hormone levels.

The common hormone test that may be appropriate is for the level of follicle-stimulating hormone (FSH) to help determine if a woman is in menopause, especially for women who do not have a uterus and thus cannot tell by their menstrual pattern that they are menopausal.

NAMS does not recommend saliva testing to determine hormone levels and does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.

I was on 6 pumps a day and still having many symptoms.

Sadly my symptoms aren't well managed.

I actually thought I was mentally unwell and imagining my symptoms.

I have severe Vaginal Atrophy, hot flushes, fatigue, feeling of ants on my skin, brain fog, fatigue and zero labido.
They only did the bloods as I was struggling do much but the dr insisted I couldn't still have symptoms on my dosage.

Thankyou for answering.

@Lioney Are you using more than 1 patch ? I didn't know Evorel came as a 150mcg patch.

Have you tried various regimes such as sequential, on a long cycle, so you only use estrogen for several weeks? Some specialists suggest this where you use estrogen only for 10-12 weeks to try to get the dose right.

I'm unsure if your 200mgs Utrogestan is daily to offset a high dose of estrogen, or if you're using it on a cycle.

Have you tried other progestogens other than Utrogestan?

eg a combined patch, or a Mirena coil?

Also I have found that Ovestin cream (which is estrogen) applied directly into the vagina is a game changer for atrophy. You can use it alongside other forms of HRT.

Yes 2 patches at a time, a 100 and a 50.
I have always struggled with Utrogestan so although I do try to take it continuously, I then need to change as my mood gets so low.
I have been using Utrogestan for about 5 years on and off.

I have tried Provera, Everol Conti and Femoston. All made me very depressed and terribly anxious.
I won't risk a Mirena as its incredibly difficult to access the Menopause Clinic and don't trust them to remove it if I was really struggling.

I had an issue this summer regarding needing a hysteroscopy and being on the 2 week pathway and couldn't get them to even answer my messages.

I do wonder if the Everol is the issue as I thought I felt better on Estradot but the doctor dismissed this.

I use an Estring and Ovestin externally.
It hasn't made a significant difference.
I have been using this regime for about 2 years.

I had the same issue, i ended up on multiple estradot patches and my estrogen levels were still under 100, plus I had loads of symptoms. I started using 'second skin' clear film to hold the patches in place, and I have been able to drop the patches right down to a low dose. My estrogen levels are now 2-300 because I am absorbing so much more.

I buy it on amazon and cut a piece 0.5-1cm larger than the patch. It stays on perfectly. My consultant said they just don't stick well enough for me by themselves possibly because I am very active.

This method worked well for me, I didn't want to switch to gel.

The patches stick absolutely fine, never had an issue with them not sticking.

To be honest @Lioney if you can afford it, I'd suggest a private consultation with a menopause gynaecologist. They have the options to prescribe off-licence and you won't have the worry of waiting for treatment etc.

For instance, you say you have struggled with Utrogestan and used it off and on, but you don't seem to have used estrogen only to start with, then adding a progestogen to see how that affects your symptoms.

There is no need to use any type of progesterone continuously. You can use sequential on various cycle lengths (under medical supervision) long term.

I've had a couple of private consultations with a Newson clinic and a local independent Menopause service.
The Newson clinic recommended the coil and oral HRT & the other one recommended Kilovance.

I have used estrogen without Utrogestan at times i was only using Utrogestan every 6 weeks.
It was ok but my symptoms have never been totally resolved. Obviously because my estrogen levels are low.

I ended up sticking with the NHS menopause clinic as they were willing to prescribe off licence.

I wonder if I could get Estradot patches again if things would improve, unfortunately I haven't had them for months now.

I hoped there was a way to stay on transdermal HRT but realistically I think I need to try oral estrogen again.

I never felt like my patches weren't sticking, but the second skin holds them much tighter to the skin so you absorb more.

@everycowandagain I will get myself some. I've nothing to lose!
Thanks

It's worth a try! Just beware that if it does work you could end up with high estrogen levels which will also give you symptoms. I ended up over 850 (from 84!) because of the second skin but have been able to reduce the dose of the patches right down to get it back down into range again.

It was a game changer for me. Good luck!

A mirena doesn't have to be removed by the menopause clinic, your local GP should be able to do it, though getting an appointment can be tricky. Have you tried the spray as an alternative to gel and patches? I love it and it might be something that works better for you - a lot less hassle than the gel!

I guess the other important question to consider is whether there's something else going on as well that is contributing to your symptoms - some of the symptoms you describe do sound very much like peri but it's very possible to have more than one condition cropping up and causing confusion.

My GP doesn't offer any services to do with coils.
They refer to a sexual health clinic.
I just don't want one, no bleeding issues, no need for contraception and as I've reacted to every progesterone I've ever tried I'm not optimistic it would be any different.

I'm really not keen on the spray. I really disliked the gel but stuck with it as I kept being tolf it was the best HRT and safest option.
Patches are so much easier.

Where are you sticking the patches?

I was having trouble absorbing and my Dr put me on Estradot. Obviously can't get those at the moment but I read that it's better to put them where there is less fat so I've changed to putting it on the least fat part of my belly near my hip bone. Symptoms seem fine. Also much better when I change them religiously on same days twice a week. Brain fog gets worse if I don't

@Lioney It looks as if tablets are your best option.
The risk is a clotting risk and it's very low. Far lower than the Pill.

It's not so much of an issue for younger women because the advice on tablet V transdermal really kicks in for older women on HRT or starting it for the first time, over age 60.

The downside is that a lot of estrogen can be lost in digestion, so you may need to experiment with doses, such as 1mg or 2mg.

Everyone's skin is different and it may be that your skin just doesn't absorb transdermal products.

Big sis and I both don’t absorb patches. She tried gel, same issue. We’re now both on Lenzetto and to quote my sister “it’s a wonder drug”.
I am only about 3 week on it but feel so much better. Sis been on it for months and months and says it changed her life.

How are you now @Lioney?

I was interested to read your post as I've just had my estrogen level checked (privately as the NHS wouldn't do it) and it's 163. I've had a hysterectomy and now use a 100mcg Estrodot patch which I thought was the best for me (tried gel, Evorel and various other brands of patch ) and still feel terrible, I'm wondering if I'd be better using tablet form now although I am going to buy the film mentioned above.