Switching to transdermal patches

[Alana Ashleigh]

I had my appointment with my new hrt doctor. The appointment went very well. I asked to be moved from oral estradiol to a patch. The doctor didn't object, and sent it the pharmacy. Will I notice a difference being on a patch vs taking it orally?

[Lori Dee ✅]

Will I notice a difference being on a patch vs taking it orally?

I believe you will. Oral tablets must first pass through the liver, so the doses are typically higher to achieve the same effects. The patches bypass the liver and slowly absorb into your bloodstream. This means that you dose can be lower and still do the same job. It may take a week or two before you notice, but you should feel much better.

With tablets, my hormone levels would rise and fall every day. It was miserable. The patch lasts for 3 - 5 days, so the rollercoaster effect evens out. I only had the hot flashes, night sweats, and moodiness when it was time to change patches. Then my endo changed to twice-a-week patches. That smoothed things out a bit more.

The only problems I had were keeping the patches on. The generic (Mylan brand) would come loose from sweating. My doctor added Tegaderm to put over the patches to hold them on. The problem was that the Tegaderm wasn't big enough to cover the patches. The pharmacist changed it from Tegaerm to an IV cover. The film is very thin, covered the patch, and was ventilated so the skin could breathe beneath it. That was a HUGE improvement!

Then the problem was that the generic patches did not raise my hormone levels enough. We switched from the Mylan brand to the Grove brand. The patches (mini-dot) were so much better. But we later figured out that my metabolism is too fast for patches, and I got switched to injections.

Everyone's metabolism is different, so hopefully, the patches will work well for you. If you have problems with them staying stuck on, ask about covering them with IV film. The brand is Smith & Nephew IV3000. They are just under 3 inches by 3 inches square.

Let us know how the patches are working for you. Good luck!

[Jessica_Rose ✅]

Most patches adhere to skin much better than pills, even with duct tape.

Lori covered it pretty well. Some people develop rashes related to the patch adhesive, switching brands may help. The only issue I had with patches was around the edges of the patch, where the adhesive seems to attract debris. After only a day or two, you may notice a debris ring around the patch. When you replace the patch, use some baby oil on the old adhesive. After a few minutes, the old adhesive will become much easier to remove. Try to place the patch on an area that doesn't typically have a lot of friction with clothing. I typically placed patches a few inches below my belly button, slightly off-center, so I could alternate sides.

The parches did work very well for me, but after a few years I switched to injections. It took me a month or two to get used to doing it, but I find it more convenient now.

Love always -- Jessica Rose

[ChrissyRyan]

I do sublingual and avoid the liver issues of swallowing the tablets.
At $4 a month or 30 pills this is also inexpensive for me.

[KathyLauren]

I have been on patches from day one, due to being old.  My doctor wanted to take it easy on my liver.  Fine by me.

There is a huge variation among brands, especially between generic and name-brand patches.  I have used generic (Sandoz) and Estradot brand (also Sandoz), and there was no comparison.  The generic patches were enormous, limiting the available sites on my body, and requiring me to re-use the same patch of skin too frequently.  The adhesive was an irritant, causing nasty rashes.  And the adhesive was water-soluble, so they would come off in the shower.  The Estradot patches are much smaller, so I can go a full month without re-using the same bit of skin.  They are less irritating to my skin.  And the adhesive is oil-soluble, meaning that they stick in the shower.  It means that I need a bit of bath oil to remove the remaining adhesive when I remove them, but that only takes a minute.

I had to plead with our drug plan to let me use the more expensive name brand patches, but they agreed that the skin rashes from the generic were sufficient justification to do so.

[Lori Dee ✅]

The generic patches were enormous, limiting the available sites on my body, and requiring me to re-use the same patch of skin too frequently. 

I had the same issue with the large generic (Mylan brand) and the small Grove minidot brand. 

[Alana Ashleigh]

@Lori Dee I started the patches last night. I definitely feel more stable, and balanced. Interestingly, my boobs are more sore than usual.

[Lori Dee ✅]

@Lori Dee I started the patches last night. I definitely feel more stable, and balanced. Interestingly, my boobs are more sore than usual.

Good deal! Pay attention to your mood. If you start feeling down, notice if it is right before the day to change patches. I usually noticed it on Mondays (I changed on Tuesdays), and it bothered me at first. Then I realized that it only meant the patch was worn out, and it was time to start a new one. If you notice that is what is happening, don't panic. Just stick to your schedule and you'll be fine.

Congrats on starting the next step!

[Devlyn ✅]

I started with the Sandoz patches, I really liked them. Then I switched to sublingual tablets, then compounded capsules.

The patches were trouble free, I changed it out on Sunday evenings and Thursday mornings.

When I switched to pills, I got one of those old person pill boxes with the days on the little doors. Well... colour me shocked at how many times I went to get my pills only to discover I hadn't taken them the day before. 

[Courtney G]

My peak seems higher than it should be and my trough lower. I think I have a similar issue to Lori: I "burn" through the patch medication quickly. But I've had excellent development so I'm staying where I'm at.

I'd been dealing with the dark rings from leftover adhesive until recently. I figured out that putting a Tegaderm HP over the adhesive and leaving it on for a couple of hours is all that's needed to remove most of the adhesive.

[CosmicJoke]

This thread is a little older but I am also being switched from pills to patches. My hematologist is looking at lowering my Eliquis dose so my PA-C tells me I will have to start patches in that case.

I had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

[Lori Dee ✅]

This thread is a little older but I am also being switched from pills to patches. My hematologist is looking at lowering my Eliquis dose so my PA-C tells me I will have to start patches in that case.

I had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

This is true. Patches bypass the liver's "first pass," which can affect coagulation. Hopefully, the adjustment will be smooth and effective.

[Tills]

Hi ladies,

I'm seeing my Dr on Friday as I'm getting lots of light-headedness at the moment. Had my hormones tested 10 days ago and the results are still not through.

I'm thinking of asking the Dr and my Endo if I could be switched from gels to either patches or injections. I tried injections twice before: once in the bad days of self-medication (huge no-no if anyone is reading this thread) and then once properly supervised. I found towards the end of the allotted timeframe for the injection that the comedown was horrendous.

So I don't know. Maybe patches? I too have a fast metabolism. And I'm also prone to eczema which I'll need to monitor.

xx

p.s. a thread without the phrase 'YMMV' appearing. Yay!!! xx

[ChrissyRyan]

I never tried patches.  I continue with my tablets.
My nipples were very sensitive yesterday and this morning.
But I doubt my breasts will get any bigger.

Chrissy

[Lori Dee ✅]

I found towards the end of the allotted timeframe for the injection that the comedown was horrendous.

That was the problem I had with patches. With sub-Q injections, my levels stay high enough.

What I found (with me) is that when my levels drop to a certain point, I get the symptoms (hot flashes, night sweats, etc.). With pills, my levels were rollercoastering up and down wildly every day. With patches that smoothed it out over time, but I was still hitting those lows twice a week. With injections, my lows do not drop low enough to trigger the symptoms.

For a while, my doctors were relieved that we resolved the "lows" problem, but were concerned that my highs were too high. I am still training them so that they will listen to me. I have read the studies, and they haven't. We compromised and instead of injecting weekly, we extended it to every ten days. That smoothes out the highs over time, and the lows do not drop into my discomfort zone. It seems to be working out.

I'm just providing you with information so that if you have issues with patches or injectables, you will have an idea of what to try to get your levels to hit that sweet spot.

I know the misery of those horrendous crashes. I was PMSing for four years before we figured it out. Not fun.

[ChrissyRyan]

The tablets seem to work for me throughout the month.

I heard that less estrogen the better to avoid cancer for at least some people.
Doctors who manage your meds I trust to make the right recommendations for me.

[Tills]

That was the problem I had with patches. With sub-Q injections, my levels stay high enough.

What I found (with me) is that when my levels drop to a certain point, I get the symptoms (hot flashes, night sweats, etc.). With pills, my levels were rollercoastering up and down wildly every day. With patches that smoothed it out over time, but I was still hitting those lows twice a week. With injections, my lows do not drop low enough to trigger the symptoms.

For a while, my doctors were relieved that we resolved the "lows" problem, but were concerned that my highs were too high. I am still training them so that they will listen to me. I have read the studies, and they haven't. We compromised and instead of injecting weekly, we extended it to every ten days. That smoothes out the highs over time, and the lows do not drop into my discomfort zone. It seems to be working out.

I'm just providing you with information so that if you have issues with patches or injectables, you will have an idea of what to try to get your levels to hit that sweet spot.

I know the misery of those horrendous crashes. I was PMSing for four years before we figured it out. Not fun.

This has been such a helpful post Lori, and the thread in general, so thank you.

Rather than derail it I'll start something specific about menopause.

xx

@ChrissyRyan if you have found a doctor you trust to know what they're doing with hormone regimes then you've done well. In my experience they are gold dust.

[Courtney G]

My saga continues. I got blood drawn at absolute trough and the numbers were upsetting:
T: 196 ng/dL
E: 39 pg/mL

I guess the E number isn't too bad for trough but the T number was a real disappointment. I hadn't realized it, either, but I put two and two together and figure this may have something to do with the feeling of unease/sadness I've been struggling with for a while.

My doc and I decided to:
Add spiro (50 mg) back into my regimen
Double progesterone (from 100 mg to 200 mg)
Stay at 4 patches 2x/week

This should help me keep my T down.

So I don't know. Maybe patches? I too have a fast metabolism. And I'm also prone to eczema which I'll need to monitor.

I think I'm burning up the medication but I'm sure there's also some loss, as the patches can lift a little during showers, perspiration, etc. I use 3M Tegaderm patches to remove adhesive (as I mentioned in another post, put them on for about an hour and they pull the adhesive off when you remove them) and I have used them over the patches on occasions when I knew I'd be swimming. I think the delivery and absorption of medication is a bit better with a Tegaderm and I wonder if longevity is affected.

So I'm using a Tegaderm twice a week, which covers all four of my patches. We'll see how I feel and also what the test results show. I'm pretty sure the Tegaderms will be covered by insurance.

I do wish we could wear a monitor for a couple of months that would allow us constant data about our levels. It would be so much easier to get dialed in that way!

I had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

Yup. I had a blood clot in my leg while taking phytoestrogens, so patches are the safest delivery method for me.

[Tills]

I have my annual Gender clinic appointment a week today and I think I've reached the point of wanting to ask if I can switch from gels to patches.

Previously I was going along with the idea that 'if it ain't broke don't fix it' but since my microdose of testosterone was adjusted back up slightly my estradiol level dropped. So this seems like a good time to get things set up for the longer term.

The gels are a bit of a faff and have had quite an impact on my life. Applying them twice daily is less than ideal. So I reckon patches will be less hassle. I do have sensitive skin though so I'm going to need to watch for site reaction.

In the UK I think it seems to be Evorel or Estradot.

xx

[Lori Dee ✅]

In the UK I think it seems to be Evorel or Estradot.

I had problems with the generic patches I got from the VA Pharmacy. The brand was Mylan, and they had problems staying stuck on, and the formulation seemed to be inconsistent. I found some online reviews that showed that Mylan had changed its adhesive formulation a few years earlier, and the reviews were all bad after that.

After numerous complaints to my endocrinologist, she consulted with the lead pharmacist, and Estradot was available. By that time, I was up to three patches twice a week, and I was running out of real estate because you have to change the location with each application. The solution was a mini-dot, brand name Grove Pharmaceuticals. That was small and stayed on. It was thin and flexible. My only problem was that I needed a higher dose, and wearing four dots at a time was impractical. That was when they switched me to injectables.

I just did a quick search, and the Evorel patches have mixed reviews about staying stuck, especially on sweaty skin. The Estradot reviews claim the patches are small, thin, and stay stuck.

Depending on skin sensitivity, the Estradot sounds like the way to go if you have a choice. When I had problems keeping patches on, my doctor recommended applying Tegaderm over the patches. That was an epic fail. The Tegaderm was too thick and only compounded the problem. When it started to peel off, it would pull the patch off with it.

We went back to the Head Pharmacist with this problem. She suggested an IV film. It is thin, flexible, and waterproof, yet perforated so the skin can breathe when worn for several days. It worked great! They are also available in different sizes, so I could use one IV cover to hold two patches on at a time. You would need to see what brand they might have available. Mine was Smith & Nephew IV3000.
https://www.amazon.com/Dressing-IV3000-Standard-Inch-Square/dp/B002YKHE9O 🔗

Hope this helps.

Hugs!