Switching gel to patches - advice?

[MeridaBrave]

I’m 51, I work out (lifting and some cardio) eat healthy, heathy weight and I have been taking HRT for a couple of years. I have a Mirena coil, and I have utrogen capsules (don’t take every day have them as I had symptoms low progesterone despite the coil). I also have testosterone gel (total loss of libido) and vaginal oestrogen. I was using 3 pumps of oestegen gel but I started having night sweats so I wondered if it was an absorption issue so I asked the GP to switch me to patches. The issue is that she gave me 25mcg patches which is I think very low. And it’s made everything worse. Was switching to patches a mistake? She said she will increase the dose to 50mcg but thought beyond that was “too high”. Any words of wisdom.

That’s weird. 3 pumps of Oestrogel is equivalent to 75mcg patches so I would have thought you could be switched to 75mcg and if you were still having symptoms you could be increased to the max dose of 100mcg patches.

Yes - saw that and i was very worried about such a low dose - I asked her for 50mcg. She said to see how it goes for 3 weeks 😓I think she is hoping it’s a gel absorption issue and hence a lower dose might work.

@MeridaBrave my hot sweats didn't resolve until I got to 100mcg patches.

I didn't try gel. Too much faff.

I'd go back ASAP. And absolutely don't wait for the 'see if it settles after 3 months' bollocks.

I went from 50mcg to 100mcg in 4 months, my GP just kept letting me go up when I went back.

Fuck me that's awful! Slap 3 on while you wait for your review

Actually I agree with this.

I switched from gel to patches, started with a lower dose just to see if it worked, I got symptoms so switched to a higher dose. I think its reasonable to try the lower dose but also reasonable to insist on a higher one as soon as it's clear it's not working for you

I agree in this case of waiting 3 months might be too long but the typical waiting 3 months isn’t ‘bollocks’. Your body needs time to adjust to exogenous hormones.

@hedgheog ok in this sense it is, if the op has been on higher dose oestrogen and then it's drastically dropped because the GP doesn't seem to know what they are doing.

Generally maybe not, I'll concede that. Even though in my experience I went up three doses in 4 months 50-75-100 between January and April.

I needed the max oestrogen to offset the revolting utrogestan impact (this was several years ago now and I'm happily on the coil and same dose oestrogen with T).

I said it was 3 weeks! Not months. i can see that I will neeed a higher dose than 25mcg but I am hoping 50mcg will be enough. 3 weeks seems reasonable in the doctors office but less so in the middle of the night having a night sweat.

I have a mirena but was taking utrogestan as well as I had low progesterone levels and splitting headaches as a result. I can safely cut back on it though. Interesting idea to see if it helps to not take it.

The GPs at my practice were useless - the nurse practitioner though is a genius! I've just upped my own dose for 50mg to 75mg by adding half a patch and she said brilliant at least you know it works. Try and find out who is the specialist at your practice and see them!

Sadly it’s probably the GP I saw. I can supplement with extra gel and nag them for an increased dose. I have 4 weeks supply so if I use 2 patches I won’t be able to get more when I use them all in 2 weeks.

I did pretty much the same but didn’t bother asking permission from the GP every time and am happy on 100mcg patches. I tried going down to 75s on the suggestion of the menopause specialist GP at my practice, but was back with night sweats and feeling crap within about a week, so ditched that idea.

This narrative that anything over 50mcg is too much is bollox IMO. It’s like saying you shouldn’t wear size 9 shoes because they are quite big. If you’ve got size 9 feet you need size 9 shoes, and if you need 75mcg of oestrogen, you need 75mcg of oestrogen!

ETA: I ordered prescriptions through an app and put a note on explaining I would need more (I was on gel at the time) and they prescribed more without any problems.

I supplemented with gel while waiting for an appointment with the menopause clinic. I did an econsult with the GP and he said that was fine while I was waiting. When I spoke to the menopause clinic a few months later she did tell me off, but that was only because I wasn't taking enough progesterone to go alongside it.

My case was a bit different to yours in that I was taking progesterone via patch too and it doesn't come in a high enough dose to counteract 100mcg of oestrogen. When I finally spoke to the menopause specialist she prescribed double patches, which is off book but often prescribed.

I have a mirena and haven’t had a period since DS2 was born in 2010! I have supplemented with gel since Monday although I don’t work on Friday so more inclined to see over weekend what implications are without supplementation.

This is GP rather than menopause clinic - I’d probably just pay privately to see the BUPA doctor again but for a 2-3 week trial prob only worth of it GP won’t increase to 75 or higher. Hard to tell 50 could be enough…

I get better absorption off my stomach than my bum! The skin on my bum is dry and I've got Keratosis pilaris so it just doesn't seem to work as well. But that could just be me.

For gel or patchs?

For the patches, 50mh