HRT. Oestrogen-only form of HRT its source and cost

[fellwalker]

We currently use Progynova 2 mg (Estradiol valerate) for HRT, it seems to be less effective than it used to be.
Does anyone have a similar product Viz, oestrogen-only form of HRT its source and cost?

Regards

[Puccini]

You write "we", which indicates that you are talking about yourself plus one or more other persons, presumably all female.

 

Do all of you feel that the estrogen product you are currently taking is now less effective than it used to be?

 

For what purose are you taking estrogen, ie what is the specific effect that you feel has diminished?

[Sheryl]

Dermal preparation is preferred to oral (no liver pass) and also easier to titrate.

 

I and many others use Oestrogel. As the name implies, it is a gel. One tube I think costs around 300 baht or a bit less and lasts me at least 3 months but your needs may vary. It comes with an applicator to measure out dose but I find less than that works for me.

[fellwalker]

Hi Sheryl

If it’s good enough for you then my better half will be in good company.

Can you say where it might be sourced, perhaps on line? Not sure pharmacies will have it out here in the sticks.

Regards

[Sheryl]

13 hours ago, fellwalker said:

Hi Sheryl

If it’s good enough for you then my better half will be in good company.

Can you say where it might be sourced, perhaps on line? Not sure pharmacies will have it out here in the sticks.

Regards

https://bangkokdrugstore.com/product/oestrogel-80-g-2/

 

While estrogen alone will deal with hot flashes, stabilizing mood swings often requires both estrogen and progesterone. The common idea that progesterone replacement is unnecessary in women without a uterus is incorrect, progesterone has multiple effects and is just as important as estrogen in HRT. 

 

Unfortunately while the same company that makes Oestrogel makes a natural progesterone gel (Progestogel) it is off market in Thailand. There is a micronized oral form called Utrogestan which is the next best thing.  While it is not currently listed on the Bangkokdrugstore website I got it from them in the past so could inquire.   Or, it is definitley available from https://medtide.com

You have to first create an account to do a search

 

Also likely you can get both from  https://medisafepharma.com/

Have to use the Messenger function to ask.

 

Medisafe also can provide Femiest, a vaginal estrodial, which is often needed to deal with vaginal dryness, the systemic estrogens are often not enough for that.

 

 

 

 

[fellwalker]

Sheryl

I much appreciate you ongoing involvement.

New data is coming to light.

Language differences have been identified as a problem and have been reconciled.

 

My wife used to have the “night sweats”, she described as being “hot”. These were resolved with Progynova.

 

Recently she has experienced what she calls “inside hot” which we have expanded to mean “agitated, tense, or nervous”.

I now appreciate the problems Doctors must have when dealing with language differences.

So it looks like it’s the side effects of the currently administered Progynova are at issue.

 

Your observation that post hysterectomy, her situation, progesterone may be taken as well as oestrogen suggest that this might alleviate the ”inside hot” symptoms.

 

There is no necessity for such an alternative drug to be “natural” a standard pharmacological product is acceptable to be taken by mouth.

Can you suggest one?

[Sheryl]

On 3/30/2024 at 3:04 AM, fellwalker said:

Sheryl

I much appreciate you ongoing involvement.

New data is coming to light.

Language differences have been identified as a problem and have been reconciled.

 

My wife used to have the “night sweats”, she described as being “hot”. These were resolved with Progynova.

 

Recently she has experienced what she calls “inside hot” which we have expanded to mean “agitated, tense, or nervous”.

I now appreciate the problems Doctors must have when dealing with language differences.

So it looks like it’s the side effects of the currently administered Progynova are at issue.

 

Your observation that post hysterectomy, her situation, progesterone may be taken as well as oestrogen suggest that this might alleviate the ”inside hot” symptoms.

 

There is no necessity for such an alternative drug to be “natural” a standard pharmacological product is acceptable to be taken by mouth.

Can you suggest one?

As mentioned in my prior post, Utrogestan. It comes in both 100 and 200 mg doses, 100 mg is enough for most women. As it can induce slight sleepiness best taken at night.  If you ever travel to Phnom Penh can get Progestogel there which is better as easier to titrate and slower acting.

 

Do not take a synthetic progestin. These are entirely different drugs than progesterone and except for shedding of the uterine lining (not relevant in your case anyhow) do not have the same action as progesterone. 

 

 I would still recommend switching from Progynva to Oestrogel as it allows better dose titration. Basically one wants the very  lowest estrogen dose that controls the hot flashes/night sweats. Often this will be  much less than standard dose.  

 

 

[fellwalker]

Hi

I am up to speed, just need to source and that's not beyond me.

Thanks for all the advice.

I hope it helped other folk.

Regards 👍👩‍⚕️

Took a while to find a lady health worker Emoji

[fellwalker]

Hi
One last consultation. The text below is from a new Zealand data sheet.
Which of the regimes do you suggest?

The usual dose is 100 mg/day at bedtime at least 12 to 14 days per month, i.e. on days 15 to 26 of each cycle or in the last 2 weeks of each treatment sequence of oestrogen therapy followed by approximately one week without any replacement therapy and during which withdrawal bleeding may occur.
Alternatively 100 mg can be given at bedtime, from days 1 to 25 of each cycle, withdrawal bleeding being less with this treatment schedule.

Regards

[Sheryl]

On 4/1/2024 at 3:38 AM, fellwalker said:

Hi
One last consultation. The text below is from a new Zealand data sheet.
Which of the regimes do you suggest?

The usual dose is 100 mg/day at bedtime at least 12 to 14 days per month, i.e. on days 15 to 26 of each cycle or in the last 2 weeks of each treatment sequence of oestrogen therapy followed by approximately one week without any replacement therapy and during which withdrawal bleeding may occur.
Alternatively 100 mg can be given at bedtime, from days 1 to 25 of each cycle, withdrawal bleeding being less with this treatment schedule.

Regards

If I understand correctly your wife has had a hystetectomy so withdrawsl bleeding neither necessary nor possible.

 

Her choices are:

 

1. Concurrent therapy - estrogen and progesterone every day.

 

2. Estrogen daily and progesterone only from around the 12th of each month.

 

3. #1 but increase the progesterone dose (200 instead of 100) for the latter half of each month.

 

4. #1 but increase progesterone when and as needed 

 

Was her hystetectomy total (i.e. ovaries also removed)? If so she has no naturally produced progesterone so I  would rule out #2. 

 

Otherwise it is really trial and error. 

[fellwalker]

You are correct, complete hysterectomy due to Intramural fibroids at 49 years, no bits left in.

We will go for the simplest regime.

1.   Concurrent therapy - oestrogen and progesterone every day.

If there no improvement will do a bit of system 4.
Utrogestan 100 is in the cabinet and treatment started, she did notice the sleepiness.

Regards

[fellwalker]

Just a few lines to update on the efficacy of your recommended treatment.

Concurrent therapy - oestrogen and progesterone every day.

After 16 days.

I notice more smiles, body and face more relaxed, less reaction to stressful situations. She’s back to normal. Very surprised on the speed of response.

She say’s, feels different, less anxious and generally happier. The sun shines more!

Thanks from us both.