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[KatieS]

He mentions ruling out sleep apnea about three times...well, IMHO that in itself is first order advise. Does transvaginal estradiol absorb better systemically than transdermal ("often poor absorption")? Also, I was confused on the ALA dose of 30-60mg (did the Kindle version drop a zero?). He does emphasize that you do not have to follow the entire protocol, but do note what works, follow objective measurements (need to start online brain training) and tweak. The antidotal stores are inspiring as well as his tribute to our forum.

[Stavia]

yes vaginal oestrogen is absorbed better into the systemic circulation than dermally applied oestrogen

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[KatieS]

But the transdermal patch releases the slow continuos amount, unlike the vaginal bolus?

[Stavia]

But the transdermal patch releases the slow continuos amount, unlike the vaginal bolus?

true. But the patches can give "patchy" absorption wise if the woman gets sweaty, it slides off, hair gets in the way of absorption, or the site rotation isn't using consistently the same thickness skin or subcutaneous tissue.
He may also be referencing the compounded creams which are just rubbbed on and give notoriously inconsistent absorption.

I guess the vagina doesn't sweat, is hairless, mucosa is consistently thin....

I personally stick my patches on and cover them with paper tape so they can't come loose, and always use the same two symmetrical lower abdominal areas to get consistent absorption.


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[circular]

He may also be referencing the compounded creams which are just rubbbed on and give notoriously inconsistent absorption.

Has this been formally studied and established? I always had the impression it was a realistic potential problem but more hypothetical. It wouldn't surprise me, just wondering. TIA

[SusanJ]

circ, I don't have a study in hand, but personally, when I switched from a compounded, bio-identical estrogen cream to Vivelle (lowest dose patch), my estrogen levels went from <10 to 50.

[circular]

Hmmm, I wonder if the compounder makes a difference, depending on the mixing equipment they use etc. My levels are normal using the compounded cream, which isn't to say I test so frequently as to be sure they're consistent.

[SusanJ]

Maybe, but I did use two different compounders, including Lakewood Pharmacy in Denver, which has a great reputation.

Always felt it was really hard to get it rubbed in well, and if you didn't, you're probably just rubbing a good bit off with clothes.

[Stavia]

Circ great question. Issues such as the patches actually coming off are common. If I don't stick mine on with tape and wear jeans they rub off completely. My gynaecologist told me hers come right off after a run so she takes it orally instead.
Then about the variable absorption with differing subcutaneous thickness - this is well known amongst doctors that prescribe them, but I can't find a reference. But once a woman is settled on a patch and symmetrical sites, her levels should be fairly consistent within a range. Ive tested mine frequently in the first few months and there was quite a variation despite these measures - I ranged between 180 and 220 of my units. I think heating the skin eg spa or long hot shower influences absorption.

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[KatieS]

When my pharmacy switched me from Vivelle to the generic estradiol patch by Sandoz, I anticipated more problems keeping the patch on, but the opposite occurred. Now I can swim three hours a week, sauna, sweat, tight jeans, etc...and the patch never comes loose. I'm delighted that I no longer have to tape or remove the patch before swimming. I apply on my outer fatty part of the buttocks as fat might modulate the absorption rate (?). On the other hand, maybe my skin is just drying up with age, since my mom has never had patches come off either.