Michelle: Yeah, that's really not how it's supposed to work. I was using a *weekly* Mylan patch that started to run out near the end of the week; it was supposed to last 7 days, but even laboratory testing suggested that it tapered down from the full dose after day 4 or so.

Using one that was meant for biweekly only once a week would mean that was effective for, at most, 3.5 days out of 7. And that's if it's delivering the dosage it's intended to - it's entirely possible that another biweekly generic from Mylan actually works for only 1-2 days. It's just like taking antidepressants or some other daily drug only 4 days out of 7 and expecting it to work.

I have no idea why your endo suggested this, but I'd be dubious if I were in your shoes. I started on a super low dose (think half or less of what menopausal cis women get) and I still was told to simply use a patch that was the appropriate dose, not to use one half as often as recommended. You're suffering the "roller coaster" because she deliberately chose to give you medication for only half a week at a time, which really does defeat the purpose of the patches' offering regular and steady levels.

Michelle, what is unacceptable is that she (the endo) does not want (or is not able perhaps) to explain to you the reason for applying patches in such an odd way...

Actually, I sat there with the endocrinologist while she looked through the online pharmacopeia for the HMO, and what they had both listed as in-plan and in-stock in one of the regional pharmacies.  I could tell that she was getting annoyed as she kept picking things and getting "Discontinued" or "Out of stock; no estimate for arrival" messages.  What I'm on is the best we could find after about 30 minutes of searching and phone calls.

The pharmacist thought the instructions (one bi-weekly patch per week) were odd, and called up the endocrinologist to verify.  The instructions were what I had expected from talking with the doctor.  It was a sort of 'make-do' situation.

There's apparently some form of supply shortage for 17-beta-Estrodiol right now in injectable and patch form, at least with the suppliers the HMO contracts with.  We didn't want to do pills or synthetic non-bioidentical because of my age and family history.

I'm hoping to get a better result when we tinker with the numbers next month.

I guarantee the current roller-coaster ride lows are still vastly better than what I was seeing before HRT, and my body is definitely responding.

Quote from: Michelle_P on August 20, 2016, 04:01:37 PM
There's apparently some form of supply shortage for 17-beta-Estrodiol right now in injectable and patch form, at least with the suppliers the HMO contracts with.

That's true. It seems it's a world wide shortage. However in my country it's easier to get low dosage patches than high dosage ones (unfortunately for me ).

As far as I know, there's no shortage for patches, but obviously I can't speak to a specific HMO's choices. (Basically all patches use 17-beta-estradiol, which is one of the safest forms of estrogen, and so if there is a shortage, it's a localized one and/or limited to the higher-dose patches. Otherwise, menopausal women the world over would be frantic right now.) That does make sense of why the endo would choose the best of a bad set of options, though it's frustrating as heck that the HMO refuses adequate coverage. I wonder if it was actually that it was only possible to get them to cover half of a prescription for biweekly patches, and so she's having you use them twice as long? When I was on weekly patches, the endo had to specifically contact my insurance company with a request to "double the normal dose" [she wanted me doing the reverse of what you are, using 1 weekly patch at a time but changing it every 3.5 instead of 7 days, so I'd use up twice as many in a month as my HMO expected]. Before she called to yell at them, however, the HMO only issued me half as many as I needed. But *biweekly* patches are usually packaged specifically for that purpose - that is, 8 to a box - so it's still baffling why the HMO wouldn't cover a box a month as is typical.

Anyway I'm sorry you're having to deal with this hassle. It doesn't sound like going up to a transitioning dose is going to be covered by the HMO either, if you must do patches or injectables and they're claiming a shortage of both...

Quote from: Jenna Marie on August 20, 2016, 07:05:29 PM
Anyway I'm sorry you're having to deal with this hassle. It doesn't sound like going up to a transitioning dose is going to be covered by the HMO either, if you must do patches or injectables and they're claiming a shortage of both...

I'm not worried.  The HMO is the insurance company, Kaiser.  There's lots of gals in the group I'm in who are on full dosage. They just didn't have available the range of dosages the endocrinologist needs for starting, from what I could tell.  (She's a little conservative with us late bloomers, I think.)  Eight a month of what I'm on would be fine. 

The pharmacy is currently splitting boxes and giving me 4 in a little baggie with the prescription label tacked on.  I suspect they do this a lot.  When I went in to first pick these up the pharmacy said they only had 3 patches in stock (!), but another pharmacy in the medical complex had more, so they sent me over there.

Honest girls, it's not that big a deal.  I still feel better than I did a few months ago, by a ridiculous amount.  Heck, I feel like my senses are turned up to 11 now.  The wife and I were out at dinner at a Ruth's Chris steak house last night.  Now, I've been on a severely restricted sodium diet until I started spironolactone.  Now, I can eat anything.  I was happy and posted the other day about eating a spinach salad and bagels, which I though was wonderful.  Last night I had a strawberry salad, filet mignon, and their 'Thanksgiving pie" sweet potato with pecan crust side.  Oh... My... Goddess...  I thought that was so good, and kept tasting the steak and the sweet potatoes, while trying to explain to my wife why I felt so very good, and was enjoying the meal.  I'm pretty sure the patch was still delivering E.  My nipples got hard, my tiny breastlets were aching, and I thought I was going to explode, from a darn steak and side dish!

When I was done, I felt like maybe I should roll over and have a cigarette...   

I can't wait for my adjustment next month.   

Quote from: Jenna Marie on August 20, 2016, 07:05:29 PM
As far as I know, there's no shortage for patches, but obviously I can't speak to a specific HMO's choices. (Basically all patches use 17-beta-estradiol, which is one of the safest forms of estrogen, and so if there is a shortage, it's a localized one and/or limited to the higher-dose patches. Otherwise, menopausal women the world over would be frantic right now.)

AFAIK there is a shortage for transdermal estradiol, either patches or gels, at least in my country. Trans women are impacted, as are a lot more of cis women (either pre or post-menopausal) who also need HRT.

I'd heard that patches were pretty good and talked to the Endo but unfortunately am also allergic to adhesives and even get rashes from simple band aids    Also, sublingual tabs were the only thing my ins. would cover and that was a bit of a wrestling match to get done in itself