Should I up my Evorel dose from 50mcg to 75 without GP ‘support’?

[Fordian]

I’ve been on HRT for 10 years, same dose, but Estradot when it’s available. It’s been reasonably effective but I am finding now I’m getting ‘breakthrough’ hot sweats, over the past few weeks. I attended a funeral a day or 2 ago and it was embarrassing, sweat literally beading on my forehead, a rivulet down between my boobs and spine, constantly mopping my face. I noticed none of the other 61-2 year old women there looked sweaty and disheveled! Happens 1-2 times a day, now, even in the forensic cold of the office I work in now and then. I haven’t been this sweaty for 3 odd years, when I had a patch of it which sort of went away.

My script says ‘Estradot’ but 2 weeks ago when I renewed, once again, Estradot 50 wasn’t available, so the pharmacist offered me Estradot 75, or Evolrel 50 (which I chose as I’ve been on that for a while).

I thought nothing of it but it occurs to me that the pharmacist had no issue in giving me a higher dose substitute, so, might I increase my dose myself, 1 1/2 patches twice a week?

Obviously I’m on Progesterone 100 tabs as well.

What do you think?

Sorry no advice but following with interest

It’s probably fine but no I wouldn’t. The pharmacist would have been expecting you to the larger patches

What progesterone do you use @Fordian ?

There is usually no issue with increasing the estrogen as such, BUT there was a directive from the BMS not long ago which said women on higher doses ( 75 or 100mcgs) may need to double the progesterone (to avoid hyperplasia/ breakthrough bleeds/ spotting.)

All this is online in the BMS report on progesterone use with HRT (google.)
It's a long doc but you can access and read it.

The pharmacist can't and shouldn't increase a dose without checking with your GP first.

The other issue is that at your age, it's often less estrogen that's needed, but that varies a lot, obviously.

I'm surprised the pharmacist offered a different strength as I thought they could only offer equivalents and not sure, as @JinglingSpringbells said, it is ok to increase dose without the approval of the prescriber.
Also, cutting patches is something that should only really be done as a last resort and you will, of course, run out and need another prescription sooner which the surgery may not be happy about. If you do decide to try it though you should cut the patch from corner to corner rather than straight across

Why might less estrogen be needed? I genuinely don’t know! What’s the science behind that?

I do know that if I forget to apply a patch for 24 hours or so, a hot flush reminds me!

I'm on Progesterone100 oral tabs.

Right now I’m about to go to bed. It’s 20 degrees in my living room. I’m in light cotton PJs. The bit between my shoulder blades is wet with sweat, my fringe is sticking to my forehead, and I can taste the salty sweat from my upper lip.

100mg progesterone on a continuous regime is still within guidelines with a 75 patch. Using 1 ½ patches will mean you’ll run out before your next prescription is due. Given the Estradot shortage (slowly coming back into stock but only 100 and 75 so far) I wonder if it’s the switch to Evorel that’s cause some of your symptoms to return. If so you wouldn’t be the only one to have experienced this.

Personally, I have found Evorel to be utterly shite compared to Estradot. The patches don’t stick properly and so I am sure I don’t absorb from them as effectively.

You could also get the Estradot 100 patches and cut them in half.

100mg progesterone on a continuous regime is still within guidelines with a 75 patch.

The BMS does suggest considering 200mgs a day if there is bleeding at any time.

It's not mandatory to go to 200mgs but it depends on the response to a higher dose.

Women in peri ( so usually from mid-40s to early 50s) tend to need more to replace the levels they have had to that point (when they were still ovulating.)
As we get older, we sometimes need less but it's individual.

I can 'cope' on the equivalent of a 25mcg patch (no daytime flushes or other symptoms etc) but was starting to get some night sweats back so I've upped to more or less 50mcg (I use gel, so 2 pumps.)

I'm older than you and been on it for around 17 years.

Thank you for the input, everyone! I think I may agree to 100mcg Estradot, halved, next time. First time I was put on Evorel patches, 8-ish years ago, I recall getting boob ache. I haven’t had it since but I’m sure there’s a reason people recommend Estradot over Evorel.

Estradot is a tiny patch which is why some women prefer it.

And it sticks better!

@Fordian
My symptoms all came back within 4 days switching from Estradot to Evorel.
It sounds unlikely that after 10 years you’ve had a sudden increase in symptoms, it sounds more like you’ve had a sudden decrease in HRT efficacy.

If it helps, I’ve had better symptom control with FemSeven patches than with Evorel. I asked my meno specialist if there was a difference between Estradiol Hemihydrate (Estradot & FemSeven) and Estradiol (Evorel). She wasn’t sure! But I do know that Evorel made me feel like crap.

My symptoms also came back when I switched to Evorel so my doctor was fine with me going up from 37 - 50.

I think the absorption isn’t as good with Evorel for many. I am now finally getting some Estradot as it’s back in stock so I’ll be cutting the 75 in half. So back down to 37.

I had a consultation recently and was told that 50 doesn’t touch the sides and at my age 49 it would’ve been expected. I would’ve been up to 75 already.

Next time you could always get the Estradot 75 and cut a third off to make it 50.. I was doing that with Evorel 75. That way you’d have a smaller more effective patch. Rather than a huge patch and a half of the inferior Evorel!

Thanks again, everyone!