An HRT patch discussion

On the whole, I've got on well with HRT patches, although not everybody I know has. I've been told about patches that won't stick, patches that irritate the skin, and patches that are difficult to obtain on prescription. Now and then I've had all of these problems myself, and they are real issues. And there are many people who don't like the idea of attaching a plastic square or rectangle to their skin, and much prefer the neater, invisible solutions of gel or popping a pill. 

Maybe in practice it comes down to discovering, early on, whichever hormone delivery method works well, and then staying with it, without necessarily ever getting round to trying an equally-good alternative. 

That's certainly how it has been with myself. I was a Patch Girl from the start. And I liked them. I had no trouble whatever with the Estradot brand I then used, and appreciated the convenient fact that they were changed only twice a week. In any case, pills were out of the question, as my liver was already being hammered with the daily statin tablet I took. Gel remained a possible alternative, but I've never yet had to check it out. But one of my friends swears by her gel. 

I used those little Estradot patches (a Novartis product) for a long time, but after they rationalised their UK production facilities the 100mcg patches I used became difficult to obtain, and eventually impossible. I was forced to try other makes. There was FemSeven, for instance, which at first I liked because using it seemed even more convenient: you applied a fresh patch only once a week. But I found that after five or six days the patch started to look tired and unflattering. More importantly, it made my skin underneath it red and itchy. So I moved on to Estraderm, which restored the twice-a-week regime and was kind to my skin. Presently I use Evorel, a similar product, which is very satisfactory. 

Mind you, to deliver 100mcg of estradiol, the FemSevem, Estraderm and Evorel patches are all on the large side. None of them are as small and neat as the Estradot patches were. On the other hand, being larger, they are slightly easier to handle and apply. 

One friend told me some years back how she found herself wasting patch after patch because they wouldn't stick. Well, there must be people with skin characteristics that make it hard to apply anything adhesive. But I suspected that she wasn't properly following the standard instructions to press the patch against the skin and keep pressing for a while. I found that I'd need to count to eighty (using my voice: 'one...two...three...four...' and so on) in order to ensure bulletproof adhesion. That would take the best part of a minute, and I wasn't sure whether she was doing that. But I didn't like to push 'my' method at her. She loved having the patches, exulted in their beneficial effects, but wasn't terribly receptive to well-meant advice. But then who is?  

Now that I have my FitBit Versa 3 smartwatch, I have abandoned counting by voice to eighty, and just set the countdown timer to fifty seconds, which is the equivalent amount of time needed for pushing the Evorel patch against the Melford flank so that it will stay put. 

Using the smartwatch, which vibrates silently when it's done, means that I don't have to turn off my morning-wash music while applying the new patch. In the old 'counting-by-voice' days, any background noises - and most definitely a Force Ten cacophony from my JBL speaker - would distract me and make my counting go wrong. Now the raunchy music can continue, and yet the patch will still get precisely fifty seconds of skin-bonding pressure. Proper job.

There's another issue I want to touch on in this post, the dirty underside of patch use. The thing that nobody talks about.

Yes, this:

That's a magnified view of the Melford bottom (all you're going to get), showing what's left when a patch that's been in position for three or four days is peeled off. A scummy ring of dark fluff. Mainly, of course, from my black M&S knickers. In days of old, when knights were bold, I'd attempt to wash this ring off using various soaps or creams, scrubbing some of it away and picking at the residue with a fingernail. This often didn't do my skin much good, and matters became worse after the FemSeven patches made the skin red and sensitive. I sought a gentler way. And found it. 

So this is my current method for removing that unattractive dark ring. Having peeled the old patch off, I let the spot recover for a day. Meanwhile, the new patch goes on - using the smartwatch timer - somewhere else on my nether anatomy. 

Then, next day, I take this rubber (or 'this pencil eraser', if you are of the American persuasion) -

- and I stroke it lightly over the dark ring. It's done with a little more firmness than 'lightly' implies, but in no way stressing the skin, which should not start turning red with abrasion. The ring - fluff held together with patch adhesive - should roll away under the rubber, leaving clean, unblemished skin.

It works for me. And frankly I prefer this 'dry' method of cleaning up my skin to the messy soapy-water-and-flannel method. 

I should mention that I don't have a conventional bath at home, and take showers instead. If I had a luxury bath to sink back into, it would be possible to soak the dark ring off in the course of an hour, while quaffing champagne and munching caviare. No doubt this is what most people in fact do. But, being bathless, a practical solution like that is denied to me, and I have to do the best I can. Sigh.