Upping Evorel

[Turtlerunner]

I've been on evorel 25mg patch twice weekly for 3mnth with daily 200mg oral utrogestan. This v quickly helped me to sleep after months of insomnia & my mood lifted (also on antidepressants). Recently I've noticed my mood is much lower overall & I'm wondering if I need to ask to increase the evorel dose? Anyone else done this? I feel I'm working blind really ...I was put on a v low dose initially as I get hormonal migraines. Any experiences or suggestions welcome!

I have no idea if this is accepatble or not but I was put on 25mcg patches as well and after a year or so found the symptoms coming back a bit so now I leave the old patch on when I add the new one.

Why are you on daily 200mg Utrogestan? Thats what I take for 12 days a month. I thought it was only 100mg if daily? (but could be wrong).

Anyone know how I can get an endo scan to check all is well?

Did you find keeping the old patch improved symptoms? I'm on 200mg as that's what the doc recommended for my symptoms & history. No idea if that's standard or not.

After a year on Evorel 25 my mood lowered and I asked to go up to Evorel 50. It has really helped. You can put two patches on while you're waiting. The 50s are double the size.

It's usually 100mg continuous Utrogestan if you are on a 50 patch or under but if you have endometriosis or something you could be on higher.

There is a 37.5 Estradot patch if you felt 50 was a bit high. I cant absorb estradot though.

Over the past 18mo I’ve gone from 25mg Evorel to 200 (2x100 patches) so yes I think you’ve lots of scope to move up if your symptoms have come back, it’s very normal to have to review things unfortunately.

Yes this is working well for me now. Im only on the 25mcg patches though.

@Turtlerunner That's an odd prescription.

You don't explain if you're using Utrogestan every day or an a cycle (using it for 12 days a month.)

If it's daily, that's not the correct dose.

I wouldn't just accept what your dr has said (unless you have specific problems and need double the dose.)

There are too many examples on this forum of GPs who don't know what they're doing with HRT!

On such a low dose patch (and it IS low) the Urogestan dose is 100mgs a day. Or 200mgs x 12 days a month.

The only need for 200mgs a day is for women on higher dose patches of 75 or 100mcgs (and even then it's not always necessary.)

It's no wonder your mood is flat on the combination you're using.

Query your GP- the correct doses are on the patient leaflet or online- your GP can access them easily.

I wanted to edit my post above as I can see you've clearly said it's 200mgs Utrogestan a day.

This is incorrect. (unless you have some specific condition where the 200mgs is being prescribed to treat that.)

What is your 'history' that you mentioned that may make 200mgs relevant?

Also- are you post menopausal or were you having periods when you started HRT?

The reason you feel flat is that Utrogestan is a sedative and can cause low mood. The ratio of estrogen/progesterone you're on is causing how you feel.

Unless there is a good reason for using 25mcgs, most women start on a higher dose. It's usually tablets of 1mgs, gel of 2 pumps (1.5mgs) or patches 50mcgs.
25mcgs is very low and would usually only be used with older women (60+) who were starting out on HRT as new users.

My advice is you challenge your GP on all of this for an explanation - or see a different one.

Thanks Jingling, my prescriber is the Louise Newson menopause clinic. I was sleeping 2hrs a night so the high utrogestan was to help me regain a normal sleep pattern (it did), with the low Estorel due to horrific PMDD before my periods stopped to ensure I could tolerate hrt. I also had anxiety which was a feature of menopause, not something I'd had previously. I don't have periods anymore & yes, the utrogestan is daily.

I was also put back on antidepressants at the same time for low mood & anxiety_ which I firmly believe is hormonal & not reactive or clinical depression. I hate the side effects of them.

I'm now totally confused about whether the ADs are to counteract the high utrogestan. .so potentially could I manage with less utrogestan (& still sleep), no ADs (I'm not depressed), & increase my patch safely?

It feels like such a minefield!

I'm going to stick my neck out here, @Turtlerunner - I don't think you've properly been taken care of by Newson Health. A 25mcg patch is a very small dose with a whacking dose of Utrogestan just used to knock you out at nights - that is not good prescribing. Also PMDD is caused by either fluctuations in estrogen or progesterone withdrawal or both - the PMDD brain is extra sensitive. With careful handling, you can become stable on HRT and this is very well explained on the IAPMD website who cover the use of HRT for women who suffer as you do. Please do check it out - it's a wealth of information. You definitely deserve better care.

Hi @Apileofballyhoo - how do you know you can’t absorb Estradot. The reason I’m asking as I was on 25 of evorel which was helping a bit but moved up to 50 of Estradot and now I feel worse (particularly my anxiety). I did wonder if Evorel just works better for me but everything I read seemed to suggest Estradot was superior.