Considering swapping from oestrogen gel / patches back to tablets

[OrdinaryGirl]

I’m nearly 49, started HRT on private prescription at 44 with oestrogen tablets and Mirena coil.

The tablets really helped with symptoms but then when I switched to NHS GP, I was moved to patches quite early on, because the data suggests they are safer.

My issue is that I am not sure the patches are that effective. I’ve tried gel too and gone back to patches, but I’m considering getting another private prescription for oestrogen tablets to see if they really are more effective for me. I’m possibly willing to wear the increased risk, on the basis that I’m a healthy weight, active, no underlying health conditions, barely drink etc.

So as not to dripfeed, I got the Mirena for the progesterone component, and to help with iron deficiency (now corrected through supplements and not bleeding at all!) and because progesterone tablets give me very low mood.

I’d be grateful for your experiences if you have found oestrogen tablets to be noticeably more effective than gel / patches, or vice versa. Thanks in advance. 💐

Is your patch dose high enough, though? Big difference for me between the 50 and the 75 microgram patches. NHS make you start on the lower dose.

I’m on 75mg. Went up to 100 and didn’t feel any different so went back down again. Fully accept it might just be life!

Bumpety-bump
Hoping for more MN wisdom 🐝

I could be completely wrong, but I thought pills were meant to be a general no-go in terms of efficacy and also not protecting certain areas of the body/organs (apologies, I'm sleep deprived and my brain has stopped functioning)?

I found switching from patches to gel (at the same dose) really sorted me out.

Yeah doctors don’t like to prescribe tablets now because of the clot risk. My GP wouldn’t switch me back to tablets. I’ve tried gel and didn’t notice any difference to the patches.

Following
Op. I’ve noticed a panicky feeling in the morning, on waking, after starting progesterone tablets.
Did you find the mirena stopped this anxiety?

There is a spray you could try as well? Sandrena. Some women find this much better. Jo Whiley was raving about it on her podcast. Worth asking

The spray is called Lenzetto. I’ve tried patches (oestrogen test showed very low absorption), gel and the spray but didn’t feel any better. Now been on tablets for a month. Don’t think I’m feeling any better either really but seeing how I go.

My symptoms are more mental than physical - brain fog and anxiety. Apparently it’s easier to tell whether HRT is working if your symptoms are more physical - hot sweats etc but I don’t get those.

For me, oral progesterone just creates a sense of flatness and sadness rather than panic. And switching to Mirena was the right thing on that basis.
I would say panicky feelings in the mornings were my first symptom of perimenopause when I turned 44, so it could simply be that, Lizzbear. Sorry you’re experiencing this, it is wretched isn’t it?

Yes exactly this. I don’t get hot flushes. My main problem is brain fog and feeling anxious / panicky (defo hormones as had never been like this - it started at 44) as well as waking up between 4 and 5:30am and not being able to get back to sleep.
I had another thread about sleep and have discovered that just half a Phenergan taken at 8:30pm will mean I can sleep through until 6:30 or 7am, with no grogginess at all the next day. I only do that about once a week when desperate as don’t want to rely on it.

Thank you @lizzyb - I’ll research this and talk to my GP. 💐

Love to hear how you get on! Hope things pick up for you @LattePatty ☕️ 🍰

There are plenty of women at 49 still on the combined oral contraceptive pill FFS.

In three years I'll be one of them.

The estrogen in HRT pills is body identical just like the patch or gel.

There is a very small increased clot risk with tablets, of the magnitude of around one extra blood clot per 4000 or 5000 women.

And don't forget most clots are easily treatable with prompt medical attention.

Frankly this is not worth using a less effective and convenient delivery method for me personally.

I don't know why your GP won't prescribe them unless you have any personal risk factors.

There are absorption issues with transdermal, not everyone absorbs a beneficial amount through the skin, and I would say the risk of poor absorption with these methods outweighs the minuscule clot risk with tablets.

Many of these women turn up with osteoporosis, believing themselves to have been treated for years, and a hip fracture carries a MUCH higher thrombotic risk than any tablet!

You can also get a blood test whilst on your patch which have some mileage in confirmation absorption however there are limitations to the accuracy especially if still perimenopause.

Thank you @Charliede1182 this is really helpful. I am usually fairly up on these things but had not realised until seeing your post about the oestrogen dosage in the combined pill vs the amount in typical HRT.

I’ve done some researching and learnt that the pill contains a much more potent form of oestrogen, so it does seem a bit weird that GPs are so unwilling to prescribe oestrogen tablets as part of HRT to a slim, fit 49 year old with no health issues!

Not sure what to do for best.

I had to stop HRT because of this. The progesterone made me stressed, anxious, completely wired and increased my blood pressure.

sorry you had to stop all HRT because of this. I’m hoping to find a way to manage my symptoms without having to stop altogether. But if I can’t, I might have to .

Thank you. Yes, it’s getting to the point that I’m thinking of paying to see a menopause specialist 😌

It sounds like you would still benefit from HRT, but with a progesterone component that didn’t go in your bloodstream. You do need progesterone if you have a womb, because it prevents the womb lining thickening up too much with the oestrogen component of HRT.

But it doesn’t have to be tablets. A Mirena provides the necessary bit of progesterone direct to your womb so if you’re sensitive to progesterone you don’t get the side effects of it. That’s why I had a Mirena fitted.
I would definitely suggest going back to your GP - you do have options that mean you could avoid the progesterone problems but benefit from the oestrogen.

@Charliede1182 Am now eyeing an old (but within date) pack of Ovranette (combined pill) and wondering whether to switch back to that to see if it helps matters. 🤔
It seems (from my googling) that it’s ok to do that with a Mirena as they don’t interact.

Thanks. Should have said I have ADHD and progesterone lowers dopamine levels which is why I had that anxious feeling. I would chance having the mirena and it having same effect and me have to have it removed again. Luckily I dont have any menopause symptoms really but wanted it for the protective bone and heart health

This is not harmful - when women are spotting persistently on the IUS they are often given a short course of the combined pill to stabilise their endometrium (provided they have no medical contraindications to the pill).

It would certainly help establish whether oral estrogen helps your symptoms or not, and you can take it from there.

My private meno doc says I don’t absorb well with the patch so I have to have max dose.
i know it is working ok because I don’t have hot flushes anymore?

This is interesting. I also have ADHD and I didn’t know that progesterone lowered dopamine.
It’s a minefield not knowing what to take and whether it’s making my anxiety worse!!

Mirena is the answer. Get an NHS prescription for the device, collect it from boots or wherever then pay a private GP or gynae to put it in.

You get twice the amount of time on the bed and a much more sympathetic insertion experience!

Progesterone nearly ruined my life. I could not stop crying or thinking about motorway bridges.

Mirena had zero side effects like this. One month of bloating and exhaustion and then totally normal again.