Lenzetto - cure worse than the ailment?

[PeriMoan]

My gp has recently prescribed lenzetto - it's a spray you use daily. Reason being we still have shortages with patches around here, and she claims nobody has had any issues with the spray. It also dries a lot quicker than the gel. Seemed like a no brainer.

Anyway, I'm only a few days in and feeling like death. I'm exhausted. Like extremely exhausted. Having hot flushes, which I never had before. Sleeping a lot but it's very disrupted. I wake up several times during the night and am catching up during the day. I have terrible dreams.

Then I also feel nauseous, feel like I'm verging on getting sick most of the time I'm awake. My head is killing me, and my muscles ache.

I could get over all those things except the exhaustion. It's like nothing I've ever experienced. Closest I've come is when I was sick with flu or covid. Just really fatigued and weak.

So I guess my question is, should I stick with it? Has anyone experienced this type of exhaustion and recovered reasonably quickly. I have a job and family. I can't just ignore my responsibilities for long. Currently treating it like I would when I'm sick - I'll rest up now and be back to normal in a week. But then I read about side effects taking 3, 4 and even 6 months to clear up. Why would you live like this for that long? Is it really worth it?

I take this and it's really improved things for me. Hot flushes are gone and I sleep properly. I do need to make sure I drink enough water or I can get a headache, but I had that before. Are you taking progesterone too?

Yes, but not yet. I will be taking utrogestan for 14 days I think it is.

Try reducing the dose.
Too many GPs tell women to start with the 'average dose needed' and it's often not the best advice.

I've used gel for over 15 years. My consultant started me on 1/4 of the 'average dose' (1/2 a pump instead of 2) and I worked upwards over several weeks.

You could try this. I don't know how many sprays you use- is it 3? If so, start with 1 and see how that goes.

On the other hand, it could be that all the symptoms you're having are peri symptoms that have suddenly escalated and it's coincidence they are happening at the same time as using estrogen.
Hot flushes, poor sleep etc are classic ones.

Feeling nauseous can be too much estrogen though so try halving your dose for a couple of weeks?

Sorry you feel like that. Been on Lenzetto a few years with no issues, best speak to GP don’t suffer in silence! X

I've been started on the lowest dose. 1 spray. Google seems to bring up results saying too much estrogen could explain the symptoms but I don't know how I would reduce to half a spray. Maybe covering part of the nozzle so only half the spray hits my skin?!!

I wonder if I even need it yet if I only need so little. I've been prescribed it because I'm 49 with thinning hair and bad sleep. I don't really have any other symptoms.

I was started on one spray too, then had most of the horrendous symptoms you described but then realized that I should have been advised to take 3 sprays. I was previously on a high dose of estrogen with the patches, so it should have been like for like.

That's interesting @flatsevenup . I wasn't on any hrt before this though so I'm not taking a drop in estrogen. I "halved" my dose this morning by placing the spray nozzle half on a piece of card and half on skin, removing the card and just letting the bit on my skin dry. I will do this for a couple of days and see if any easing of the side effects. If not, I will have to come off it. I have never felt so rough in my life.

From your update I'd still consider that your increase in symptoms is not related to the spray as it's a low dose. The only one that's a bit odd is the nausea.

You'll only know by stopping it.

With gel, it's reasonably easy to press the plunger half way on the pump so less than a whole pump is dispensed.
Can you do this with the spray?

The other option is to change to Oestrogel which is probably a lot easier to manage the dosing. Gel dries in no time at all- less than a minute if you put half a pump on each arm or leg (Put a whole pump into your palm and then put half onto each arm/leg.)

As far as I can see it's one spray or nothing. No inbetween. It's a bit like an inhaler. If you don't press enough, nothing will come out.

Nothing else has changed in the past week to explain the symptoms unless I have an actual bug of some sort. Everyone else in the house is fine and I work from home, so only place I could have caught anything was at the gp or chemist. But the exhaustion literally kicked in about 6 hours after my first spray of lenzetto.

I'm not totally against trying another type of hrt, but I would hate to have to go through something like this every time I changed, especially if it's something that would have settled in a week or two.

I'm not totally against trying another type of hrt, but I would hate to have to go through something like this every time I changed, especially if it's something that would have settled in a week or two.

Or you may find something else is perfect. You won't know without trying.

Absolutely. I'm just wondering what's normal and how long to allow things to settle down before I give up. So if I stopped taking this today and went back to gp next week (chance would be a fine thing!) and started something else, but that also has horrible side effects, just what is the point where I go, OK, I've given this a good shot.

Maybe I'm expecting miracles. Maybe I will have to leave things at least a month before any of the side effects subside, whichever type I take. I just don't know at the moment.

As I said earlier, I took a half dose today. I still feel a bit crap, but possibly slightly better than yesterday. I'll keep doing the half doses for now and see how I get on, I guess.

Hi, it's not just you, I also feel like I've been heavily drugged on Lenzetto one spray. Extreme fatigue within two hours of using it. I have only used it for two days, today I haven't used any yet and feel a lot better. I was also going to try "half sprays". Please let us know if you feel better taking half the dose.

Hi @HormoneHell1234 . I have been dithering all morning about taking my next half dose, and I just can't do it. I haven't taken any today. I've still woken up with a headache but hoping that lifts. But I can't spend however long unable to function. I ended up in bed at 3 yesterday. Realised it was really bad when I didn't have the strength to drink a cup of tea my husband had made me. At this point in time, I can't justify making myself feel absolutely awful, when prior to this I actually felt reasonably OK.

I honestly think that if patches are in short supply you should ask for gel.

It's easier to titrate the dose.

Lenzetto is relatively new compared to gel. one spray is the same as 2 pumps of gel.

Each spray delivers 90 microliter of transdermal spray, solution containing 1.53 mg of estradiol

One pump of gel is 0.75mgs estrogen. (2 pumps = 1.50 mgs)

You shouldn't be feeling as ill as you are. It certainly shouldn't make you feel you can't lift a cup of tea.

Thanks @JinglingSpringbells . Any idea how they compare to the patches? I don't really know much about the dosage. Think it's the 50mg is in short supply. I presume that's not the lowest.

Sorry, I've just googled. It says 50mg estradot gives 0.78 mgs estrogen. So this spray is the equivalent of me starting on 100mg patches?!? That sounds very high to me.

What you've posted here doesn't make complete sense, because 2 pumps of gel is definitely the same as a 50mgs.

There is a BMS table comparing types and doses. I'll see if I can link to it for you.

https://thebms.org.uk/wp-content/uploads/2024/02/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-JAN2024-B.pdf

PAGE 4

TABLE SHOWS THE EQUIVALENTS FOR TRANSDERMAL ESTROGEN

3 SPRAYS OF LENZETTO IS THE SAME AS 2 PUMPS OF GEL OR A 50MCG PATCH.

Thanks. I'm even more confused now. 50mg seems to be the norm here. It's what everyone I've spoken with started on. But due to the shortages, many are halving the 100mg patches or "making do" with 37.5mg patches. But 1 spray of lenzetto is less than a 25mg patch. I'm not sure how it would explain my symptoms which sound a lot like the dose is too high.

I'll have a good read of that link.

You may not agree but could you have a bug or something at the moment and none of this is due to the HRT?

50mgs isn't the norm.
It's what most GPs suggest but that's because the 'default' for gel is 2 pumps.
The ideal dose is one that controls your symptoms.
That could be 1 pump (25mcg patch) or 1.5 (37mcg patch) or more.

I have the same reaction to estradiol, and I have tried different doses with a break of several weeks between without any HRT. My doctor started me on two sprays of Lenzetto. I was so sedated I couldn't stand, then I had excrutiating gut pain and diarrhea for 3 days. A few weeks later I tried starting with half of one spray. I was extremely fatigued again but no stomach upset. I also couldn't stay on that for more than 2 days to see if my body would get used to it. So I'm off everything again. There are several women on Reddit who have reported the same sensitivity to estradiol, the same crushing fatigue. I am also progesterone intolerant and cannot take oral progesterone.

@HormoneHell1234 the crushing fatigue, as you put it, is unbearable. I haven't had any since Saturday morning. I'm still battling a headache and still feel slightly groggy, but it's definitely improving.

Given that it's taking a while to clear up, however, I'm not 100% sure if I can rule out a bug. But it did start within hours of taking the lenzetto, long before the utrogestan.

I did struggle with the contraceptive pills in my younger days. Tried 4 or 5 types. It worked as a contraceptive alright - I turned into a monster with a continuous headache so no sex! But maybe I'm just not able for hormonal treatments of any type.

I'd do a covid test- there's a lot around still.

I've done a test today and it's negative. I'm about a week in though since it all started so not sure how accurate they are at this point.

I've not been anywhere all week, though obviously DH or DC could be spreading it around, but none of them have any symptoms.

I couldn’t get on with lenzetto at all

switched to patches and been fine so maybe worth trying a different type of hrt

Im having the exact same effects ad you and struggled to find others who have the same. Its been a few months for you now. Do you mind me asking if things improved or if the doctor changed anything?