Anyone that had experience this patches vs. oral (pills) and can relate the difference?

I'm not sure whether my Tinnitus is related to pills, but I actually think it is.

I had various feed back from ggs on HRT, menopause or hysterectomy, that did not tolerate oral very well - for various reasons. One was high BP.

Thanks,
Axélle

I was on oral HRT from October 1992 through October 2010. My dosage was lowered after SRS in March 1994. Towards the end of 2000 I developed a serious metabolic problem (which is under control thanks to mostly food supplements and a homeopathic doctor who really understands his business). I can't say whether or not the oral HRT caused this or not. In October 2010 my endocrinologist switched me to patches. It hasn't made much difference with respect to my metabolic problem, but what it certainly has helped is my interest in sex. I recently read that women who are on oral HRT for an extended period can become androgen deficient. I suspect that must have happened to me (without me realizing it; long story) because when I switched to the patches, my interest in such things returned.

I use a patch. The brand I have is Climara. My main issue with the patch is I'm very active. I run, bike, and swim 1-2 hours a day. The patch is supposed to last 7 days. But for me it falls off in 3-5 days. I think 5 days was the longest I was able to keep one on. Patches cost more than oral. I also experience some mild skin irritation underneath the patch. I apply it in a new spot each time to minimize the skin irritation. I have taken premarin in the past and never had an issue.

The medical research recommends patches over oral estrogens especially in women over 40.

"Transdermal oestradiol administration is recommended in male-to-female transsexuals, particularly in the population over 40 years in whom a high incidence of venous thromboembolism was observed with oral oestrogens."

van Kesteren, P. J., Asscheman, H., Megens, J. A., & Gooren, L. J. (1997). Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf), 47(3), 337-342.

I use gel

I'm using a creme. At our age I would avoid oral if you can for a variety of reasons.

Thanks for interesting feedback.
Patches are 50% more cost then cheapest E 17ß oral, but same price as e.g. EstroFem...

Interesting also the comment about libido... yeah, WHAT libido?!

My total T now is 0.5 nmol/l post-op - that's the lowest it ever has been.
(0.7 nmol/l one year ago and pre-op)

So I guess I must give patches a try.

Thanks again,
Axélle

Quote from: Axélle-Michélle on February 01, 2012, 10:55:42 PM
So I guess I must give patches a try.

I found creme estrogen wasn't much more than generic pills. The patch I tried was crazy expensive. Both are transdermal just the creme is a 2X a day thing where a patch you leave on for 3 and forget about it.

Interesting the prices Stephe...

Patch is R150-00 per month, transdermal cream from compound pharmacy R250-00 i.e
US$ 20.00 to 32.00/month for cream - so it be patches... :-)

Axelle

The prescription plan I have with my health insurance has 3 levels of coverage.  Generics cost US$10 per month; name brands cost $20; super brands cost $35.  The price does not change with the dosage level.

I have used a name brand transdermal patch that can be worn for a week.  After about 5 days, it becomes itchy, so I will move its location (I wear them on my butt) and rotate sides each week.  Even though I am taking Plavix and 81 mg aspirin each day, to lessen potential blood clots, I was advised against using pill-form hrt.

The patches have one advantage over other forms of hrt, in that they provide a constant, even level of medication.   

I have to replace the patches I use twice a week, and I switch sides when I do. So from Sunday to Wednesday it is on the left and from Wednesday to Sunday it is on the right. As for it falling off, I sometimes have to make an effort to peel it off, so no problem there. I love the patches and wouldn't want to go back to oral.

Thanks ladies,
it's my first day using a patch today. Had put it on last night - already a little itchy, maybe because I just now was reading about it? :-)

So far it has made no difference to my tinnitus, so we'll have to see how it goes.

I also might have to change from ESTRADERM® to some other stuff.
I just read it is being/is already discontinued for '-something-Dot' or other.

Axélle

The Dot is the most expensive of patches. I am taking Sandrena daily and if I was taking the equivalent iin the Dot costs would rise 50%. Climara patches are too large

Well, to be sure my patches are also 50% more expensive than taking ESTROPAUSE® (oral).

But then... ESTRADERM®  costs just the same as does ESTROFEM® (oral).

JoanneL, you aught not mention doses here, I'm sure it will be edited my the next moderator.
I don't think patches' daily delivery can be straight converted to oral. Patches avoid liver first-pass, oral does not. This reduces relative efficacy compared to patches (and also cream for that matter).

Axélle

Quote from: Axélle-Michélle on February 03, 2012, 11:19:09 PM
I don't think patches' daily delivery can be straight converted to oral. Patches avoid liver first-pass, oral does not. This reduces relative efficacy compared to patches (and also cream for that matter).

Not sure on estradiol but I was told estriol requires 10X the dosage if taken orally vs transdermally for that reason.

OK, maybe some clarification...

Estriol and estrone are both metabolites of estradiol i.e. produced by the liver when metabolizing estradiol.
It is ALWAYS metabolised by the liver, whether by patch, taken oral or sublingual...

Both estriol and estrone therefore are not as such part of any HRT intake, but rather a result of estradiol (HRT).
I may speak under some correction. I've never heard yet of taking oral estriol or estrone...

Natal females do produce of course all 3 of them naturally, and yes, those 2 metabolites are a LOT weaker then estradiol, but have their own 'job' in the scheme of things. This is now getting into endocrinology...

My comparison was for estradiol 17b batches mg/d transdermally absorbed vs estradiol 17b oral mg/d taken.

Something in addition I just found by:

http://www.project-aware.org/Managing/Hrt/estrogen.shtml

Quote
Transdermal estrogen and oral estrogen have differing effects on androgens in the body. Oral estrogen lowers free testosterone and can lead to androgen deficiency (affecting libido among other things), while transdermal estrogen has little effect on testosterone levels. Transdermal estrogen may offer other advantages over oral estrogens, although more research is needed.

Axélle

Quote from: Axélle-Michélle on February 04, 2012, 02:18:50 AM
OK, maybe some clarification...

Estriol and estrone are both metabolites of estradiol i.e. produced by the liver when metabolizing estradiol.
It is ALWAYS metabolised by the liver, whether by patch, taken oral or sublingual...

Both estriol and estrone therefore are not as such part of any HRT intake, but rather a result of estradiol (HRT).
I may speak under some correction. I've never heard yet of taking oral estriol or estrone...

Natal females do produce of course all 3 of them naturally, and yes, those 2 metabolites are a LOT weaker then estradiol, but have their own 'job' in the scheme of things. This is now getting into endocrinology...

My comparison was for estradiol 17b batches mg/d transdermally absorbed vs estradiol 17b oral mg/d taken.

Something in addition I just found by:

http://www.project-aware.org/Managing/Hrt/estrogen.shtml

Axélle

My understanding is that synthetic estrogens, or what big pharma calls conjugated estrogens (one brand is Premarin), are an ill defined cocktail of estriol, estrone and various other estrogens (see this search on Premarin: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm169045.htm). So, yes, Premarin is basically oral estriol and estrone, which to be effective, need to be taken in such high doses (estradiol is something like 80 times more potent than estrone) that they pose a significant health risk.

In terms of dosage vs efficacy, oral delivery requires the highest doses, sublingual is a bit lower, with transdermal (patches) and intramuscular (injections) having the lowest dosage to achieve equivalent effects.

For those having trouble with Climara patches coming off before seven days, you could try covering the Climara patch with large adhesive pads (basically very large bandaids 2 7/8" X 4" or 7.3 cm X 10.1 cm) that completely covers the patch and helps hold it in place for the balance of the week.

Hope this helps.

Quote from: chrishoney on February 07, 2012, 05:43:57 AM
1. My understanding is that synthetic estrogens, or what big pharma calls conjugated estrogens (one brand is Premarin), are an ill defined cocktail of estriol, estrone and various other estrogens (see this search on Premarin: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm169045.htm). 2. So, yes, Premarin is basically oral estriol and estrone, which to be effective, need to be taken in such high doses (estradiol is something like 80 times more potent than estrone) that they pose a significant health risk.

In terms of dosage vs efficacy, oral delivery requires the highest doses, sublingual is a bit lower, with transdermal (patches) and intramuscular (injections) having the lowest dosage to achieve equivalent effects.

For those having trouble with Climara patches coming off before seven days, you could try covering the Climara patch with large adhesive pads (basically very large bandaids 2 7/8" X 4" or 7.3 cm X 10.1 cm) that completely covers the patch and helps hold it in place for the balance of the week.

Hope this helps.

1. Noooooo, not so.
Synthetic estradiol is 'Ethinyl Estradiol' as is used in BC pills (EE) and about 10x stronger then plant based Estradiol 17beta (E2).

2. Not so either... in fact Premarin is somewhat STRONGER then plain Estardiol17b - BECAUSE - it already contains estriol and estrone in addition to estradiol, which is it's MAIN component.
Because it contain these, it is called conjugated = a mix, a cocktail. It contains a lot more than just those 3 items also.

3. Therefore -conjugated estrogen- is something else, as mentioned above in Premarin, but it is NOT synthetic at all! Not Premarin.
It's the least synthetic of the lot as it is made from horse pee, and yes, it contains the whole cocktail of Estrogens, yet also some only 'horse relevant' combinations which are simply dumped by the liver. Premarin is still known for it's high efficacy.

4. To compare, as you say, 80x stronger estradiol to estrone makes not much sense at all, as you will only get estrone and/or estriol in combination with estradiol i.e. conjugated.
The stuff (estrone & estriol) is far too week on it's own to be used for HRT --- all I know. It is used for some specific issues with natal-females like endometrial problems e.g. infertility and such.

You could then also say Ethinyl Estradiol is 800x stronger then estriol or estrone... now what will that mean?
Using no BC pills for birth control? ...
Note: That's why the stuff (EE) is always measured in micrograms (mcg) and not in milligrams (mg) as is estradiol (E2).

The highest dose with any patch known to me and my doctor will give 0.1mg (100 micrograms) estradiol17b!

Now compare that to 2mg HRT oral estradiol17b pills...
~ 90% of the oral stuff is dumped by the liver during first-pass - before ANYTHING is metabolized into estrone, estriol, glucuronides and sulphates...

Just to clear up some confusion - I hope... :-)

Axélle