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[sheila1955]

Hi everyone

Been menopausal for 22 years now - will it ever go away!  Got an early memo at 34. Used HRT for fifteen of those years - it was a life saver. Have now been off it for the last seven years as advised by my GP and cannot cope.

I have tried everything from eating soya food, taking more exercise, using homeopathic, getting acupuncture and have used other medication from my GP but nothing works. The worse part is not sleeping especially as I work it means I cannot cope. The flushes are the worse especially at night. I virtually get no sleep.

My GP advised that I come off HRT due to being on it long term and age. I even took a short break to see if it would help but nothing still. They have basically said that I either have to suffer - which I am or use HRT have a heart attack, stroke or get breast Cancer. what a dilemma!. I cannot make that decision knowing that if I take HRT it could kill me so I suffer instead. what a bloody life!.

Apologies for moaning but don't know what else to do.

Sheila 1955 

[Hurdity]

Hi sheila55

 

Sorry to hear your are suffering and especially that you know that it is due to lack of oestrogen.

Current thinking is that under the age of 60 the benefits generally outweigh the risks and you will see on this site links to the British Menopause Society consensus statement - summary found here:
http://www.menopausematters.co.uk/newsitem.php?recordID=145/BMS-Council-Consensus-Statement-on-HRT

Following links can lead to the full information.

This is good news because you will be able to take this information to your doctor and ask to be re-started on a low dose and gradually increase.

There other many other risk factors such as unhealthy diet, lack of exercise, smoking, too much alcohol and being overweight - which can have negative health impacts. It is a question of minimising these and then weighing up the improved quality of life you will experience by replacing oestrogen.

We all do things knowing there are risks.....

What type of HRT did you take before? The risks are thought be less in the long term by using transdermal methods. Here is what is says in the link I gave above:

If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration.

I know you are not yet 60 but perhaps think about gel or patch oestrogen? Finding the right progestogen is sometimes tricky but presumably you were OK on the one you used for 15 years?

I would research what type to take/use and go back to your GP saying you have read up on it, and that professional opinion now is that it is OK to re-start HRT (provided no medical reason not to in your case)

Good luck and keep us posted

Hurdity x

[Joyce]

Hi there. I have been on oestrogen only for many years. Had a break a few years back, which was awful so was put back on it. I take it in patch form now having used gel until a year ago.

Current thinking is as Hurdity says.  My gynae consultant told me I could stay on it until I was 60, although I'm currently trying to find lowest dose I can cope with, with a view to coming off it eventually.

GPs do not always keep abreast with current findings, in fact only one at my surgery agrees with me continuing.

I had to push for some time for referral to a meno clinic. We don't have one, but I was referred to a meno specialist at local hospital.

Maybe you could ask for a referral.

I wanted quality of life back and made an informed decision.

[sheila1955]

Hi Hurdity, Cubagirl

Thanks for your replies.

My GP's are really quite good. They sit and listen when I moan but leave the decision to me. I have asked for a low dose HRT but they have said that the risks are still the same. I will be honest I am to scared to make the choice so I suffer. I don't want to go down the road of were in a few years time I get Breast Cancer then say "well its my fault for going back on HRT" I can't take that chance. I know there are risks with everything in life but to make a decision like this can be fatal.

I will read the links you provided for peace of mind and will let you know if I decide to go back on it.

Cubagirl you mentioned getting a referral. This was done just before I came of the HRT as I wanted to know what else I could take. They basically told me that I had to come of it due to the length of time I had been on it. They advised me to take Soya products etc but as I said before nothing else works.

I will keep you posted.

xx Sheila 1955 

[Hurdity]

Hi sheila

I understand your concerns but the link between HRT and breast cancer is still unclear.

The recently published paper I referred to earlier has this to say:

Breast cancer. In the WHI estrogen and progestogen study, a small increase in risk of breast cancer was detected after five years of usage of HRT of approximately 1 extra case per 1000 women per annum.

In the WHI estrogen-alone trial, a small but statistically significant decrease in breast cancer risk was detected.

The Million Women Study (MWS) raised concerns over the long-term safety of HRT from the perspective of breast cancer.

Recent critique of the WHI and MWS has clearly illustrated a number of key flaws which limit the ability of the trials to establish a causal association between HRT and breast cancer.

It referes to the major study which caused all the fuss about HRT 11 years ago or so, and led to a decline in its prescription and usage.

In addition to flaws in the design of the study, the HRT in the study was conjugated equine oestrogens (from horse urine) and synthetic progestogens taken orally.

There is increasing evidence that using bio-identical estrogen ( oestradiol) and progesterone are in general associated with lower risks, especially when oestrogen is used transdermally (patches or gels). These are available on the NHS and are in the green menu on the left under HRT preparations, and is what I use ( Estradot and Utrogestan). I make sure I minimise all the other risk factors below and would prefer a better quality of life now, and hopefully fewer problems in old age, if I live that long.

If I do get breast cancer I won't know whether it was due to HRT or whether I would have got it anyway. We can only go on the available studies and make an informed decision accordingly.

I would be interested to know what HRT you were on before?

Remember you have another 4 years to go before you are 60. I understand current thinking anyway is not count the time before age 51 ish as years on HRT because this is before the average age of menopause and you are only replacing what your body should have been producing anyway. Therefore in my book that means you haven't had any beyond average post-menopausal age!

I hope this is helpful in making your decision.

Hurdity x

[sheila1955]

Hi Hurdity,

Thank you for the information.

I cannot remember the name of the HRT as I used  it a long time ago - I think it was Trisequens 40 - the one that stops you having a bleed. Initially I used the Trisequens which made you bleed then went on to the higher dose that stopped the bleeding. This tablet was excellent there were no side affects - I was lucky.

Why is the bio-identical better to use? is is because its a gel or patch. Please explain.

What about heart attacks and strokes are the risks still low for the bio-identical or what?

As to my age, I am 58 this year. I have been off HRT now for the last 8 years. I cant believe its been that long.

I am very grateful for the info that you are providing. I think the more I know about this the better it will be for me to decide.

Regards

Sheila 1955

Hi sheila

I understand your concerns but the link between HRT and breast cancer is still unclear.

The recently published paper I referred to earlier has this to say:

Breast cancer. In the WHI estrogen and progestogen study, a small increase in risk of breast cancer was detected after five years of usage of HRT of approximately 1 extra case per 1000 women per annum.

In the WHI estrogen-alone trial, a small but statistically significant decrease in breast cancer risk was detected.

The Million Women Study (MWS) raised concerns over the long-term safety of HRT from the perspective of breast cancer.

Recent critique of the WHI and MWS has clearly illustrated a number of key flaws which limit the ability of the trials to establish a causal association between HRT and breast cancer.

It referes to the major study which caused all the fuss about HRT 11 years ago or so, and led to a decline in its prescription and usage.

In addition to flaws in the design of the study, the HRT in the study was conjugated equine oestrogens (from horse urine) and synthetic progestogens taken orally.

There is increasing evidence that using bio-identical estrogen ( oestradiol) and progesterone are in general associated with lower risks, especially when oestrogen is used transdermally (patches or gels). These are available on the NHS and are in the green menu on the left under HRT preparations, and is what I use ( Estradot and Utrogestan). I make sure I minimise all the other risk factors below and would prefer a better quality of life now, and hopefully fewer problems in old age, if I live that long.

If I do get breast cancer I won't know whether it was due to HRT or whether I would have got it anyway. We can only go on the available studies and make an informed decision accordingly.

I would be interested to know what HRT you were on before?

Remember you have another 4 years to go before you are 60. I understand current thinking anyway is not count the time before age 51 ish as years on HRT because this is before the average age of menopause and you are only replacing what your body should have been producing anyway. Therefore in my book that means you haven't had any beyond average post-menopausal age!

I hope this is helpful in making your decision.

Hurdity x

[Hurdity]

Hi sheila

I don't think they do that version of Trisequens any more - just the one that gives a bleed.

That contains the bio-identical oestrogen - estradiol - together with a synthetic progestogen - norethisterone.

Most HRT types contain the bio-identical estradiol - which can be given orally in tablet form (as you had) or transdermally - patches or gel.

The only types that don't contain bio-identical oestrogen are the Prem types ( Premarin, Prempak etc) that are made from pregnant mares urine to produce conjugated equine oestrogens.

Most HRT types are given in a combi pack with either cyclical or continuous progestogen and most of these are synthetic. The most commonly prescribed bio-identical progesterone is micronised progesterone marketed as Utrogestan, but must be taken alongside an oestrogen (estradiol) patch, gel or tablet.

All of these different types are listed under HRT preparations in the green menu on the left:
http://www.menopausematters.co.uk/treatment.php

There are lots of papers and information about all of this but the best summary at the moment is the paper to be found here ( which I have downloaded to my computer and printed off!) "The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy" by Nick Panay et al

http://min.sagepub.com/content/early/2013/05/23/1754045313489645.1.full.pdf+html

There is too much information for me to quote here but throughout the paper there are references to the merits of transdermal oestrogen, and also progesterone rather than progestogens - especially for older women. If there is anything in there you don't understand please ask!

Re HRT and stroke the paper states that studies are conflicting - "caution should be exercised when prescribing HRT in women over 60 (that's me) particularly when they have a risk factor for stroke or thromboembolism. In these groups, current evidence would suggest that the transdermal route may be advantageous"

Re Heart attack:
"Early harm can occur when therapy is commenced in women over 60 with relative overdose of oral oestrogen" This was from the WHI study using oral - equine oestrogens and a synthetic progestogen.

In relation to this it says:
"When prescribing HRT for the first time in women over 60, the lowest effective dose should be used"

Re bio-identical. My use of the term (for "body identical" hormones available on the NHS is not to be confused with compounded bio-identicals used and sold at great expense in America. The paper says:

"Unregulated compounded bio-identical hormones are not recommended due to lack of data for efficacy and safety"

I hope this helps clarify a little!

Hurdity x

[sheila1955]

Hi Hurdity

My that was very informative and very interesting! My head is buzzing lol

Just to recap after reading the link you sent me. I can take the bio-identical estradiol transdermally in patches or gel along with a  bio-identical progesterone- is that right? 

I need to be sure in what I take and to also know what to say to my GP. Can you also tell me if they will make me bleed or have side affects. I suppose I will have side affects but don't fancy the idea of bleeding after all these years.

Thanks


Sheila1955

Hi sheila

I don't think they do that version of Trisequens any more - just the one that gives a bleed.

That contains the bio-identical oestrogen - estradiol - together with a synthetic progestogen - norethisterone.

Most HRT types contain the bio-identical estradiol - which can be given orally in tablet form (as you had) or transdermally - patches or gel.

The only types that don't contain bio-identical oestrogen are the Prem types ( Premarin, Prempak etc) that are made from pregnant mares urine to produce conjugated equine oestrogens.

Most HRT types are given in a combi pack with either cyclical or continuous progestogen and most of these are synthetic. The most commonly prescribed bio-identical progesterone is micronised progesterone marketed as Utrogestan, but must be taken alongside an oestrogen (estradiol) patch, gel or tablet.

All of these different types are listed under HRT preparations in the green menu on the left:
http://www.menopausematters.co.uk/treatment.php

There are lots of papers and information about all of this but the best summary at the moment is the paper to be found here ( which I have downloaded to my computer and printed off!) "The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy" by Nick Panay et al

http://min.sagepub.com/content/early/2013/05/23/1754045313489645.1.full.pdf+html

There is too much information for me to quote here but throughout the paper there are references to the merits of transdermal oestrogen, and also progesterone rather than progestogens - especially for older women. If there is anything in there you don't understand please ask!

Re HRT and stroke the paper states that studies are conflicting - "caution should be exercised when prescribing HRT in women over 60 (that's me) particularly when they have a risk factor for stroke or thromboembolism. In these groups, current evidence would suggest that the transdermal route may be advantageous"

Re Heart attack:
"Early harm can occur when therapy is commenced in women over 60 with relative overdose of oral oestrogen" This was from the WHI study using oral - equine oestrogens and a synthetic progestogen.

In relation to this it says:
"When prescribing HRT for the first time in women over 60, the lowest effective dose should be used"

Re bio-identical. My use of the term (for "body identical" hormones available on the NHS is not to be confused with compounded bio-identicals used and sold at great expense in America. The paper says:

"Unregulated compounded bio-identical hormones are not recommended due to lack of data for efficacy and safety"

I hope this helps clarify a little!

Hurdity x

[Hurdity]

Hi sheila

Yes - estradiol is bio-identical - well mostly. There is one that is estradiol valerate which is converted to estradiol in the body. It's only the Prem ones that aren't  - I think I mentioned.

As I mentioned too yes - the bio-identical progesterone prescribed usually on NHS is the micronised progesterone - Utrogestan - which is listed under progestogens on the left.

They are bound to give you some side effects as your body hasn't had much oestrogen and almost no progesterone for a long time.

If you decide, having read up on it, that you want to re-start HRT, hopefully the doc will suggest a low dose to start with ( eg a 25 mcg patch) and hopefully that would make you feel a lot better, but it usually takes a little while to settle.

You can't predict whether it will make you bleed. If you have a conti HRT - which will be recommended at your age and stage - then that is designed not to give a bleed, but sometimes there is a bit of spotting or bleeding to begin with which should settle. The disadvantage of continuous progesterone from the start is you won't know what might be causing any side effects - but I can see you wouldn;t want to start a cycle again.

Several of us on here do still have a cycle even late 50's and in my case 60, because we don't want to have progesterone all the time. I have mine on a two monthly cycle but that is a bit unofficial and you wouldn't be advised by the doc to do that anyway.

I don't want to influence you in any way as it is a personal decision, weighing up the pros and cons, possible risks vs quality of life - but I wanted to help you access the latest information so that you can make an informed decision.

Hurdity x

[sheila1955]

Hi Hurdity,

I have looked at the HRT preparations and have noted that there is one called Kilovance - I used to use that one too. Anyway as there are so many of them - gels or patches how do I know which to ask my GP for. I am aware that I need to use two separate patches or gels to get the full affect. But how do I know which to use.

Can you help once more.

Thanks


Sheila 1955

Hi sheila

Yes - estradiol is bio-identical - well mostly. There is one that is estradiol valerate which is converted to estradiol in the body. It's only the Prem ones that aren't  - I think I mentioned.

As I mentioned too yes - the bio-identical progesterone prescribed usually on NHS is the micronised progesterone - Utrogestan - which is listed under progestogens on the left.

They are bound to give you some side effects as your body hasn't had much oestrogen and almost no progesterone for a long time.

If you decide, having read up on it, that you want to re-start HRT, hopefully the doc will suggest a low dose to start with ( eg a 25 mcg patch) and hopefully that would make you feel a lot better, but it usually takes a little while to settle.

You can't predict whether it will make you bleed. If you have a conti HRT - which will be recommended at your age and stage - then that is designed not to give a bleed, but sometimes there is a bit of spotting or bleeding to begin with which should settle. The disadvantage of continuous progesterone from the start is you won't know what might be causing any side effects - but I can see you wouldn;t want to start a cycle again.

Several of us on here do still have a cycle even late 50's and in my case 60, because we don't want to have progesterone all the time. I have mine on a two monthly cycle but that is a bit unofficial and you wouldn't be advised by the doc to do that anyway.

I don't want to influence you in any way as it is a personal decision, weighing up the pros and cons, possible risks vs quality of life - but I wanted to help you access the latest information so that you can make an informed decision.

Hurdity x

[Hurdity]

Hi sheila

For oestrogen, if you have decided on transdermal, you need to decide if you want to use patches ( changed either twice weekly or once a week) or gel (applied every day - sometimes twice a day for preference) - whichever you prefer.

If you decide on patches then its a matter of preference. I use Estradot because they are very small - less are to cover! I had Evorel sequi in the past and these seemed huge in comparison, but the lower dose ones ( 25 mcg) would be much smaller.

Ditto re gel - there is Estrogel and Sandrena - different concentration of Estradiol in each - I have no personal experience of this though but others have if you want to search or ask in another thread?

Re the progesterone. There is only one brand of micronised progesterone licensed for use - which is Utrogestan. Capsules (a bit like cod liver oil capsules) taken orally although some of us use them vaginally. Other non-licensed ( in the UK) forms of progesterone for menopause are Cyclogest pessaries (I used these for a few years) and Crinone vaginal gel - but if your doc isn't familiar with them is unlikely to prescribe them off licence. Progesterone doesn't come in a patch - only the synthetic progestogens are available in this form.

I would pm you so we can discuss this in detail but you can't reply or send pm's until you have 20 meno posts (not counting chat threads). Hopefully this is also useful to others!

Hurdity x

[sheila1955]

Hi Hurdity,

Thanks once again for the info.

I have looked at the other threads like you suggested regarding the patches and noted from one of them (elizabeth64 'confused about HRT') that it was suggested if people were having problems with HRT to take the Estradot on its own for a few months especially if the estradiol level is low. This would put the levels ups so that the progesterone can latch on to it. My concern would be the bleeding as I don't want to go down that road again. What do you think? It was also suggested from another thread that if you take the Estradot and the progesterone together and you get a bleeding to take the progesterone for 25 days instead of 12 to stop it. What do you also think about that?

I hope you don't mind all the questions as I just want to get it right.

Thanks

Sheila 1955

Hi sheila

For oestrogen, if you have decided on transdermal, you need to decide if you want to use patches ( changed either twice weekly or once a week) or gel (applied every day - sometimes twice a day for preference) - whichever you prefer.

If you decide on patches then its a matter of preference. I use Estradot because they are very small - less are to cover! I had Evorel sequi in the past and these seemed huge in comparison, but the lower dose ones ( 25 mcg) would be much smaller.

Ditto re gel - there is Estrogel and Sandrena - different concentration of Estradiol in each - I have no personal experience of this though but others have if you want to search or ask in another thread?

Re the progesterone. There is only one brand of micronised progesterone licensed for use - which is Utrogestan. Capsules (a bit like cod liver oil capsules) taken orally although some of us use them vaginally. Other non-licensed ( in the UK) forms of progesterone for menopause are Cyclogest pessaries (I used these for a few years) and Crinone vaginal gel - but if your doc isn't familiar with them is unlikely to prescribe them off licence. Progesterone doesn't come in a patch - only the synthetic progestogens are available in this form.

I would pm you so we can discuss this in detail but you can't reply or send pm's until you have 20 meno posts (not counting chat threads). Hopefully this is also useful to others!

Hurdity x

[Hurdity]

If your estradiol levels are low - well most probably no harm would be done from taking oestrogen on its own for a few weeks, but usually this would be done if you were going to have a cycle - since you would then take a higher dose of progesterone and shed the lining.

I don't really understand the last sentence.

You either take oestrogen on its own for part of the month and then take oestrogen with progesterone (albeit separately eg patch or gel + progesterone capsule) for the rest of the month, after which you will have a bleed a few days after you stop the progesterone. This is cyclical HRT with a monthly bleed (or a bit longer cycle which some of us do - either ourselves or in consultation with meno gynae)

or take oestrogen and progesterone ( lower dose) continuously - which should prevent the uterus lining from building up, provided you have no other issues eg polyps or fibroids. This is continuous combined HRT. Utrogestan is given (in the prescribing info) as 25 days out of 28 but in practice most women take it continuously and do not have a bleed.

Most post-meno women are on continuous combined and are generally advised to do so by the professionals unless progesterone intolerant or do who do not want to take progesterone continuously.

As I said before - when you start taking HRT, since you haven't had any for some time you may get some slight bleeding or spotting on continuous combined which should settle fairly quickly, although this is much less likely if you are post-menopausal since your natural hormones are stable.

Hope this helps

Hurdity x

[sheila1955]

Hi Hurdity,

Many thanks for the extra info.

As a last alternative I have ordered the free trial of 'Menno'. This may or may not work. I think It's HRT I really need to use - as I've tried everything else so don't see any harm in trying this.

If this does not work then I either need to continue to suffer or go to my GP either way I have to do something.

I would like to thank you for all the info as I was not aware of the Bio-identical or that you could us it transdermal. I would have just asked for HRT tablet form.

Should the Menno work of if I go back on HRT I will let you know.

Regards

Sheila1955

If your estradiol levels are low - well most probably no harm would be done from taking oestrogen on its own for a few weeks, but usually this would be done if you were going to have a cycle - since you would then take a higher dose of progesterone and shed the lining.

I don't really understand the last sentence.

You either take oestrogen on its own for part of the month and then take oestrogen with progesterone (albeit separately eg patch or gel + progesterone capsule) for the rest of the month, after which you will have a bleed a few days after you stop the progesterone. This is cyclical HRT with a monthly bleed (or a bit longer cycle which some of us do - either ourselves or in consultation with meno gynae)

or take oestrogen and progesterone ( lower dose) continuously - which should prevent the uterus lining from building up, provided you have no other issues eg polyps or fibroids. This is continuous combined HRT. Utrogestan is given (in the prescribing info) as 25 days out of 28 but in practice most women take it continuously and do not have a bleed.

Most post-meno women are on continuous combined and are generally advised to do so by the professionals unless progesterone intolerant or do who do not want to take progesterone continuously.

As I said before - when you start taking HRT, since you haven't had any for some time you may get some slight bleeding or spotting on continuous combined which should settle fairly quickly, although this is much less likely if you are post-menopausal since your natural hormones are stable.

Hope this helps

Hurdity x

[sheila1955]

Hi Hurdity

Hope you are well.

I had the worse sleepless night of my life last night. I found myself still awake at 6am so only had three hours sleep before going to work. I was absolutely shattered and angry. I was so tired that I cried. It like this every night I am so warm and cannot sleep so toss and turn. This makes me angry so cannot sleep for that too. 

I have now decided that enough is enough so will be going to my GP in the morning to get the transdermal patch like you suggested. I will ask for the lowest dose you can get. I am still very wary about using it but am also very annoyed that I cannot sleep. What else is there to do!

I hope you don't mind but can I keep you posted?

Regards

Sheila 1955

Hi Hurdity,

Many thanks for the extra info.

As a last alternative I have ordered the free trial of 'Menno'. This may or may not work. I think It's HRT I really need to use - as I've tried everything else so don't see any harm in trying this.

If this does not work then I either need to continue to suffer or go to my GP either way I have to do something.

I would like to thank you for all the info as I was not aware of the Bio-identical or that you could us it transdermal. I would have just asked for HRT tablet form.

Should the Menno work of if I go back on HRT I will let you know.

Regards

Sheila1955

If your estradiol levels are low - well most probably no harm would be done from taking oestrogen on its own for a few weeks, but usually this would be done if you were going to have a cycle - since you would then take a higher dose of progesterone and shed the lining.

I don't really understand the last sentence.

You either take oestrogen on its own for part of the month and then take oestrogen with progesterone (albeit separately eg patch or gel + progesterone capsule) for the rest of the month, after which you will have a bleed a few days after you stop the progesterone. This is cyclical HRT with a monthly bleed (or a bit longer cycle which some of us do - either ourselves or in consultation with meno gynae)

or take oestrogen and progesterone ( lower dose) continuously - which should prevent the uterus lining from building up, provided you have no other issues eg polyps or fibroids. This is continuous combined HRT. Utrogestan is given (in the prescribing info) as 25 days out of 28 but in practice most women take it continuously and do not have a bleed.

Most post-meno women are on continuous combined and are generally advised to do so by the professionals unless progesterone intolerant or do who do not want to take progesterone continuously.

As I said before - when you start taking HRT, since you haven't had any for some time you may get some slight bleeding or spotting on continuous combined which should settle fairly quickly, although this is much less likely if you are post-menopausal since your natural hormones are stable.

Hope this helps

Hurdity x