Oestrogen patch above 100mcg?

[Leftoversgalore]

Dear all,

I have an HRT review tomorrow. I'm currently on 100 patch (since April), ovestin (for a full 12 months), mirena (6 months) and testosterone (5 months).

Just recently my night sweats have started to come back, plus the 3am waking, my skin is painfully dry, my vulva and vagina is agony despite the ovestin (possibly a different conversation to have) and I am exhausted.

I am unsure about what to ask for - can a GP prescribe over 100mcg?

I am absorbing the T, my FAND level went from less than 0.4 to 0.8 in four months.

My GP surgery is very meno forward but I'd be grateful if anyone can advise.

Also I sleep like a log when I'm not sweating but I never ever wake up feeling refreshed. Even if I've had 7hrs sleep.

Yes they can prescribe 125 or 150, but I've only ever seen a 100 patch, plus a 25 or a 50 patch.

Thanks @Oblomov23 I wouldn't mind wearing more patch, I just wondered if 100 was the total ceiling for a GP and if meno clinic had to prescribe higher.

Could it be that you are not absorbing the oestrogen properly for some reason?

I recently saw my GP to ask about the return of symptoms, like you OP, it was night sweats and 3am waking. I was on the maximum dose of Oestrogel (4 pumps) and asked if I should increase it to 5 pumps. She said that it was only tested and licensed for up to 4 pumps and I would have to see the menopause clinic to get a prescription for a larger dose.

I have changed to patches and started on 100mcg, (supposedly the same dose as 4 pumps of oestrogel) but found I was getting nausea and sore breasts which are a sign of too much oestrogen. I am now quite happy on 75mcg.

@MagpiePi Possibly. I'm really happy on patches, there's no way I would consider gel, so I'd need to switch to tablets otherwise. I like only having to do the patches twice a week.

I do know that I started on 50, sweats disappeared and returned fairly soon. Same on 75. 100 has kept them at bay, but really I've had three sweats in the last week, no heating in bedroom (draughty old cottage with gaps around the windows!) and a summer weight duvet.

I woke up when the dog needed to go out at 5am this morning, I was sleeping in vest and pants and felt my chest and it was wet. And then of course I was freezing.

I keep having dizzy episodes bizarrely when I'm sitting down, my memory is bloody awful - nouns and people's names.

My iron is fine and all other blood tests have been OK this year.

Is there any way at all I can test absorption?

You could possibly add one pump of gel to your existing patch to get an increased dose, in the hope that gel absorbs better than an increased does through patch alone.
the gel is very easy to use, dries in under a minute on the thighs at night I find.

I had exactly the same and my GP was happy to prescribe 125mg patches but it would have been a 100 + 25. I was happy to try it but I figured I’d just be back in a few months asking for more.

In the end she switched me to 2mg tablets and it has changed my life. I am very happy on my tablets.

Interestingly my vagina is also a lot happier on the tablets, which was unexpected! My libido has increased and so I’m going to leave off the testosterone for a while as I was planning to start this in January.

So I think you have options with your GP and may be able to find a solution without going to a specialist clinic.

@LuckyCharmz that's a good idea I hadnt considered topping up with gel.

@RedChester wow that's a brilliant experience to hear about! I have had a years worth of issues with my vulva, sores, had to use hydrocortisone, never ending thrush because of using emollients etc. This week I went to wipe (well blot) after a wee and saw I'd managed to cut the skin through scratching on the vulva.

Maybe I will discuss tablets instead.

Is there a reason you're not keen on considering the gel? I was on 100mg patches and the hot flashes and night sweats came back with vengeance. Saw a new GP who said she swore by the gel so I sceptically tried it.
I'm using 3 pumps a day and it's been 4 weeks during which time I've only had 3 episodes of a night sweat, and even those were really minor by comparison.
I'm having a review in a fortnight but so far I'm amazed by the difference.

@Weatherwax13

It's just more faff. I haven't liked rubbing on the testosterone gel either and that's a tiny amount.

I just know I wouldn't bother with gel. It seems very time intensive for something I have to do for years and years. Also I have patches of excema that come and go on my arms and legs and wouldn't fancy exacerbating that.

I also sometimes shower at the pool before work and I haven't the time to stand around while gel dries.

I think it's the least good option for me. I'd rather wear two patches at a time.

But @Weatherwax13 I'm really glad it's working out for you so well 😊

If your vulva is that sore then it definitely sounds like you could do with some more oestrogen. Hope the appointment goes well tomorrow op, let us know how you get on

@RedChester thank you, I will.

@RedChester I've spoken to my GP today about absorption - I posted yesterday about restarting HRT as I had a surgically induced menopause a few years ago. I was and am under an NHS menopause clinic and they monitored my estradiol levels on patches and gel and on both, my levels were absolutely dismal even on 150mcg worth of patches and alternatively 6 pumps of gel. I have also been given oral estradiol (Elleste Solo) upon advice of my menopause consultant but chickened out of taking them after only 2 days over Christmas as I had a very upset tummy. Feel very silly now and will be restarting tomorrow as my DH has had similar symptoms and GP has confirmed that there is a real spike of a nasty tummy bug at the moment. 😳 I'm so glad that you've found that the tablet HRT is working so well for you!

@SebastianFlytesTrousers that sounds so tough for you. it’s really interesting that you had your levels checked. My GP prescribed on symptoms only but said she would check them in a couple of weeks just to make sure it’s not too high.

I’m only 41 though so it’s early meno, and the way she described it the Elleste Solo is body identical to what I should usually be having, and much less than the contraceptive pill.

I’ve only been on it two weeks and had a bit of nausea for a bit but it’s settled right down and I’m really happy with it.

@RedChester Your GP sounds like she's on the ball checking your level and hopefully this dose will be just right for you. In my experience the only time levels are checked are if someone has premature or early menopause like yourself to check that the level is adequate for bone and cardio. protection, or if someone is particularly symptomatic on an adequate dose after a reasonable trial period. I'm so glad the nausea has settled down so quickly for you too. It definitely sounds like you're on the right path!

I was on a 100 patch but felt the effect reducing after day one. I’m now on gel so I know I’m getting a dose every day.

Well, I've had my appointment. Dr is going to look into what to do next and do fresh bloods and another appointment in three weeks. My preference would be another patch but could consider tablets.

@MagpiePi Possibly. I'm really happy on patches, there's no way I would consider gel, so I'd need to switch to tablets otherwise. I like only having to do the patches twice a week.

One of the reasons I was happy to switch to patches was because of the faff of rubbing in gel. With 4 pumps it meant both arms and both legs, which is not so much fun on a cold morning!

There have been lots of reports of the ‘new’ Oestrogel not working properly which is what seemed to happen to me. There are other gels that you only need to apply over a much smaller area, but I think they can sometimes be difficult to get hold of and you end up ringing round dozens of chemists.

One GP I saw did offer a low dose antidepressant which apparently can help to control night sweats, but I didn’t fancy it.

I do hope you can get it sorted out.

Yes I've been offered anti Ds too but that's a no from me as well.

Dr didn't say no to prescribing over but wants to consult on best approach.

It's the time thing for me with gel too, a patch can be done anywhere any time. Gel has to be when I'm naked I guess!!