Blo*dy Transdermals!

[SebastianFlytesTrousers]

Having been on the transdermal merry go round under both a private menopause consultant and an NHS menopause clinic after coming off implants, I've had bloody enough!

Honestly - this is 💩. I don't absorb the gels as proven by my blood work, I'm allergic to Evorel and now the new Estradot too and I have no desire to try the other patches which are the size of a crisp packet and just as crinkly. I've tried Lenzetto and that is rubbish - blood levels on that are so low even on 4 sprays and the NHS menopause consultant doesn't prescribe it anymore for that reason (her words: 'a great idea for a product, but very disappointing performance').

I need to be on SOMETHING as i've had a surgically induced menopause (TAH/BSO), so here I go with Elleste Solo again after abandoning them early after 2 weeks before due to all the pressure of 'transdermals are best' (mostly from social media and my GP practice preference - my consultants feel they are still perfectly fine to use).

Is anyone else totally cheesed off with this sticky/non sticky, itchy, gooey game? My GP has also said that she's recently had to put more women on oral HRT despite the practice preference for transdermals as women are increasingly not doing well on them (she said lots of complaints about Estrogel and the 'new' Estradot particularly).

If any of you are on oral (especially estrogen only) long term - how are you doing? Tips for getting started re: nausea, any fluctuations etc? (Sorry if I've asked this before somewhere. I can't remember).

Thank you!

The risk with oral estrogen is the small risk of blood clots.
It's very small and less than with the Pill.
If you are otherwise healthy, there's no reason not to use tablets.
Being ultra-cautious you could have your cholesterol tested and even your blood to see if you are a ' clotter' ( a genetic risk factor, so I understand.)

Other than that, it's not a big deal.

The only thing I'd say is that I've been told several times by my private gynae that blood tests for estrogen are not accurate. And it's not a cost issue, as if it was worth it, I'd be paying. So you need to go by your symptoms.
If whatever you've used so far isn't working, then yes, swap to tablets although in theory a lot is lost in digestion.

I use gel and there is a slight question mark in my mind over the new packaging simply because my current bottle seems to give out slightly less and the gel is slightly less firm. Which is very odd as it's the same batch number as the previous bottle which was fine. I've had so many changes of packaging over 16 years that I don't get worked up about it, and have checked it with my consultant for their opinion (which is it's okay and they have hundreds of patients.)

Thank you so much @JinglingSpringbells, that's very reassuring re: how small the clot risk is.

My GP said the practice and it's sister practice had a 'drive' to move everyone over to transdermals and that it hasn't gone quite as swimmingly as they had hoped, so they are 'being more flexible' now regarding oral hrt.

She also did say that she didn't think the Estrogel pump pack type made much difference until just recently where she's had a definite uptick in complaints and women wanting to swap to something else. This perhaps correlates with what you've experienced with the pump dispenser of late, and maybe some women are particularly sensitive to this variation. I'm so glad that Estrogel has worked so well for you over the years, though.

The 'insistence' on transdermal is really for women who start HRT over 60. That's a given. But for younger women it's not such an issue.

With gel, I'm currently using a bottle from a batch that was prescribed several months ago (shelf life is still a couple of years.) The bottles all have batch numbers and the 3 I got were all the same which is why I'm a bit sceptical that there's any difference.

I have withdrawal bleeds and obviously if the gel was 'weaker' that would be obvious by the amount of blood loss (and I've also had a recent scan.)

I'll do a comparison with the next bottle before this current one is empty.

Good luck with your tablets.

Thank you, @JinglingSpringbells that's really kind of you.

And yes - please do let us know what you find, it'll be interesting if you notice anything (your thoughts re: the amount of blood loss makes perfect sense, though).

Yes! As discussed on my thread :( I feel your pain.

Jingling what would the cholesterol issue be re the tablets?

When you say allergic to the patches do you mean you get a localised red patch on your arm?
If it otherwise suits you can just try a couple of sprays of a steroid inhaler on the skin before applying and that often stops the reaction.
I'm a GP and see loads of menopause (being female and nearly 40).
We use it for pain patches too.
Oral oestrogen really does increase clot risk so it's always my last choice.

@smileatyou My NHS hospital based Menopause Consultant who runs the complex menopause clinic (women with POI, surgical menopause, complex histories) doesn't have a problem with oral estradiol only in particular as the clotting risk is actually minimal when women cannot tolerate other methods.

I have also spoken to her regarding skin reactions to patches - she says these only usually get worse over time and using any preparation under the patch including Beconase (yes, my GP suggested this too) is not a good idea as it may well affect absorption plus your adding another drug (albeit a relatively low dose topical steroid) to counteract a problem that can often be solved simply by changing delivery method.

I'm thinking of this the other way round to the way you've asked the question.
High cholesterol is a risk for hardened arteries and blood clots/ CVD.

If a woman has high chol they should be using transdermal HRT not tablets which have a small clotting risk.

@smileatyou Do you think that GPs are more concerned about HRT and clots than they are about the Pill? It has a much higher risk of clots because the hormones are synthetic, and now, even for women up to age 50, it's acceptable if they are non-smokers.

Also, as @SebastianFlytesTrousers says using a spray of any kind under a patch is surely going to interfere with absorption.

Yes, that is what I was asking. My cholesterol has just gone up so yet anotehr reason why I ought to be on transdermals. I hate the tablets anyway - they really make me feel quite awful.

But, on the whole I am just baffled as to why they can't make hypoallergenic patches when they seem to manage it with blister plasters!

@thaneofglamour What is it about the pills that makes you feel awful? Is it the nausea at first, or (assuming you need a progestin/progesterone) that part of the pill that doesn't agree with you?

The usual HRT symptoms are worse on the pill - so very sore boobs throughout the cycle, nausea, very heavy bleeding (under investigation), ovary pain (cleared after scan), bedridden at times because of stomach issues..

I am frustrated because I can no longer get through a full cycle on anything transdermal to see if it's better. Definitely the first half of the cycle is better on patches. I have yet to see how Utrogestan/Gepretix does or does not work for me.

The one time I was not on HRT most of the symptoms above went - except for the pains , nausea and vomiting. Nice.

Essentially on the tablets I felt ill - very ill for about 18 days of 28.
On patches , I felt ill for more like 8 days - but then developed the allergy.
On gel, I could only use for a week because the allergic reaction was severe.
Without HRT, I am very ill for about 8 days of a cycle and have night sweats and nosebleeds. But no allergies , ovarian pain or sore boobs.

I have had stomach issues for the last 10 years or so but becoming worse over time.

Sorry to hijack your thread!

@thaneofglamour Oh, that does sound awful for you. At this point and with your complex history, I think a referral to an NHS menopause clinic would be in order. Have you discussed this possibility with your GP?