Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Tingly]

Hi there
I wonder if you would be kind enough to help me as I am now desperate.
My gp practice has gone down from 7 to 2 doctors now ( retirment, lti and relocation), and it is almost impossible to get an appointment, and when you do its with a male until september when new docs are coming through

I have also tried seeking a female private gynaecologist in nottingham to no avail, am willing to go private if you could recommend anyone.


I have a few straightforward questions which although i have tried googling , cannot get an answer to.


I have been on combi hrt for over 2 years, i have just turned 49 and i have estradot 100 ( but use about 75) and utrogestan for 12 days per cycle.
I have no flushes but mainly vaginal dryness , trouble with progesterone phase , no sex drive and one or two mystery urinary tract pronlems ( cytology and scan came back clear)

I am fed up with living with this now and cant get a straight answer

1. How do i know i am getting the right dose of oestrogen ? Is there a reliable test?
I have no sex drive and am fairly dry and non flexible,but dont have sweats or anything-- does this mean i am not taking enough oestrogen to settle the vaginal problems?


2. Why do i have a withdrawal bleed whilst still in the 12 days of the progesterone, not after ive withdrawn from it.Is this normal! And when you do have a bleed do you shed all your uterine lining?


3. How do i know if i am through the menopause if i am taking combi hrt?

4. How do you get vaginal atrophy confirmed? I've got a feeling i've got it as ive got no sex drive and am quite dry below, but then again because i'm not interested in sex , could that be the cause?

5 if i cut down on my patches, reducing the dose, do i cut down on the progesterone as well? The progesterone already makes me feel rough so am worried if not got enough oestrogen to counter act it

6. Tibilone is sometimes recommended for post menopause, but again , how do i know i am post menopause if i am on hrt?

[CLKD]

   your GP should be able to refer you to a gyaneacologist, you should not need to go privately but if this is the way to get information 
Why has the Surgery not employed any other GPs?  This is a serious concern - I expect they are waiting until the new output qualifies in September  ...........

If you have time, reading the menus left of screen might give you a starting point.  Making a list to take to your next appt., do you have a Practice Nurse?  I am sure that someone else who has been on HRT will be along too.

[Taz2]

Hi Tingly.

I can answer number 6 - you have to be aged 54 before a continuous HRT such as Tibolone is prescribed unless you had gone a year without periods when you began HRT.

You don't know if you are through meno when you are on HRT but it is thought that by the age of 54 you will be post-meno.

I would say that if you are only using 75 of oestrogen then you are not using enough to help with the vaginal problems. The symptoms you have of UTI's without any infection or problem showing up via test or scan is typical of VA. I have gone through stages, though, of needing both full HRT plus Vagifem to keep everything comfy.  I wouldn't have thought that no sex drive is a symptom of VA but it is a symptom of menopause and HRT can dampen down sexual feelings.

I'm not sure why you want to cut down your patches if you already have dryness and I'm not sure how you balance out the progesterone element to "fit" the cut down oestrogen levels.

Not sure if any of that helps but welcome to the forum!

Taz x

[Limpy]

Hi Tingly

Welcome from me too

Re number 3 & 6 - I don't think the standard blood tests for menopause - FSH being the main one that springs to mind, can be done if you are on HRT or other oestrogen containing products. I had to leave a gap of 6 weeks between finishing the pill and getting my FSH done. Even then, and with a highish FSH of 103, there was lot's of head shaking and "we can't be certain" I had to get it repeated 6 months later before it was confirmed, I was 54 at the time, seemed like a lot of faffing at the time.

Re number 4 - I had VA diagnosed when I was being checked for thrush, and the GP said I can see dry skin down here and gave me Gynest cream to use, it did help. Your UTI type issues with no infection being detected sound like VA, a local oestrogen cream would probably help to sooth those too.

Is there a meno clinic anywhere near you? The "find a specialist"  in the menu at the top right hand side of this page may be able to help you there. Also, as CLKD said, the practice nurse who does the smear tests could be a useful person to speak to. My last smear test was spent with the two of us comparing notes about meno.

Sure somebody will be along soon to help with your other questions

[Tingly]

Hey everyone, thanx for the valuable advice on q 3and 6 ...fantastic!
Re why surgery has no doctors... I have reported it to the appropriate authorities and am awaiting an answer
Re why i am taking only 75 out of 100 patch... This is because the oc who originally prescribed them said 75 wasnt widely available and to stick to 100 and cut them
So i guess q7 is.... If 100 would get rid of the v atrophy, if that is what ive got, am i safe to take 100? Indeed is 100 the maximum dose?

Again, i cant thank you enough for all the advice as i am really fed up of guessing!
Heres hoping someones got the answer to 1 2 4 5 and 7!
( shame about the tibilone, i rather fancied having a year of haing a sex drive again! )

[Hurdity]

Hi Tingly

Taz & Limpy have already answered several of your Qs - and the others - because they are interrelated.

Re Q 1 & 4 These are also related. As Taz says ie you would need quite a high oestrogen dose to get rid of VA through systemic HRT, and re Q4 she said the test for VA is the presence of symptoms.

And like Taz and Limpy I also need local oestrogen ( ie vaginal) in addition to the oestrogen replacment through HRT (which eliminates the other symptoms and protects your heart and bones) and this has been suggested to you. The preparations are on the left here:
http://www.menopausematters.co.uk/local.php

if you want opinions on the different types then maybe start another thread.

Sex drive as has already been said has nothing to do with VA - only in that you mught not feel like it if you are dry. In addition to some HRT decreasing sex drive as Taz says, some increase it, and in addition as Taz says this is a common in menopause and a shock to many of us. It is thought to be due to declining tesosterone but this is not often tested for either by GPs or meno clinics and there are few proprietary preparations for women around. Here's some info on it:

http://www.menopausematters.co.uk/testosterone.php

Re Q1 there is no such thing as a right dose. Our bodies cycled monthly through lowish to very high oestrogen levels at ovulation and it is impossible to re-create this at menopause. Well very difficult. Most HRT aims to give a constant dose to boost overall levels and to minimise symptoms. This is often less than the optimum feel good amount.  No reason why you can't have 100 mcg patch at your age. All increases in oestrogen need to be opposed by sufficient progestogen to protect the womb.

Re Q2 - this does seem to happen with quite a few women. I don't know why. One explanation is because you are peri-menopausal then it is your own cycle breaking through and this may well happen less as you progress through menopause. You may not shed all your lining if you have insufficient progesterone but usually the dose is designed to ensure that there is sufficient to oppose the oestrogen dose. However your own horomones could still cause the lining to build up as during peri-menopause there are often anovulatory cycles (no ovulation) therefore no progesterone, therefore the lining may continue to build. We are all unique!

Re Q3 to add to Limpy - simple answer - you won't while you are taking HRT. However your bleeding should get less unless you have problems eg fibroids or polyps. When you get later into your 50's the doc may suggest beginning to reduce your dose eg to 75 and then to 50.

Re Q5 - how progesterone makes you feel is a completely different issue to how much prog is needed to oppose oestrogen, They don't interact with each other and cancel out. If prog makes you feel bad (in what way ??) then more prog will make you feel worse irrespective of how much oestrogen you take. Most of us get some sort of reaction to prog or withdrawal from it - but if it's no worse than mild pms then that's the best you can hope for. Most gynaes would not recommend reducing the utrogestan dose from 200 mg if you are on 75-100 mcg oestrogen. If you are severely progesterone intolerant and under an NHS or private gynae for this, then they can do so at their dioscretion but you would need regular scans to ensure your lining didn't thicken.

Hope this helps and maybe start individual threads on specific issues if you want more info as it's a lot to read (and write!!)

Hurdity x

[Tingly]

Hurdity, taz and limpy..... I cannot begin to thankyoy so much.
The withdrawal bleed thing has been worrying me, as has the levels and well, everything really!!
Hurdity thank you so very much for answering the remaining questions so fullly.
I only had two sessions with a doc... Firstly i was diagnosed with early meno , and later had to drop by to check in to get a repeat of the hrt. Sincevthen cannot get in for a check up and last week they just left a prescription behind the desk with a note saying i needed a check up. When i tried to book a date the receptionist couldnt give me one and said inhad to ring daily at 8am for a slot , which i have tried to no avail for the last 10 working days... Madness!!

Anyway , heartfelt thanks for answering...i actually feel rather lifted now!

 

[TillyD]

Hi Tingly

I can't answer everything but I'll try a couple of them.

Having a withdrawal bleed a couple of days after stopping progesterone is exactly what's supposed to happen. The lining is supposed to be shed as it is on a natural cycle otherwise it builds up and causes problems.

I had vaginal atrophy diagnosed on grounds of dryness and needing the loo constantly. Oestrogen was enough to sort it out for me. I was also prescribed Tedtosterone gel for lack of libido and energy.

None of this happened at the GP. I spent 2 years starting at the age of 41 trying to get some help and achieved nothing even after moving house and getting a new GP. Eventually I had to go private in London and pay a small fortune. That specialist was totally sympathetic and annoyed at the GPs for not making sure my bones were protected. I think there's a menopause clinic at Queens Med Centre isn't there?

Be aware you will have to fight hard to get treated by GPs if you are unlucky. Even after fighting hard I had to go down the time honoured route of flashing cash to get treated. Shame I'm not rich - that was my summer holiday gone, but I couldn't have enjoyed a holiday in the state I was in anyway so I guess it was worth it.

Hope that answers a couple of questions and helps a bit

[Tingly]

Hi Tilly
Thanks for the info... V useful.
Just out of interesr how much oestro did you have to have?
Btw the withdrawal bleed starts every month 3 days into taking the progest, not after i've stopped
Regards
Tingly

[TillyD]

My withdrawal bleed originally started 7 or 8 days into progesterone. I was told it should start 2 to 3 days after stopping the progesterone so mine was changed.

I am on 2 measures of oestrogel. It's a gel you rub in the skin. It doesn't have to be processed by the liver like a tablet. The Tablets I was given made me sick and the GP would not prescribe anything else.

[CLKD]

Ask your Receptionist whether the GPs are aware how difficult it is to get appts>?  I had this with our Surgery and my Doctor had no idea that patients were having problems getting by the front desk    ........... speaking with a Pharmacist could be helpful too, they usually have private rooms to chat with patients.  I did that a few weeks ago rather than battle to get an appt. when I wanted a 'yes' or 'no' reply 

[oldsheep]

Hi there
I also used to bleed during the progesterone and one of the consultants kept insisting that 'progesterone stops bleeding, not causes it, so this shouldn't happen' etc, whereas the other one said it was a too high dose - so they cut my Utrogestan from 200 to 100mcg and so far so good, no bleeding. So it may be the wrong dose?!

Isn't there a meno clinic at your local hospital? My guess is with not enough GPs, if you do some research and make it easy for whoever you see to refer you, he may just go with it.
I hope you can sort it out asap.

[Tingly]

Update!
Finally got to see a doc today.
She didan examination of me cos ihad had uti where the test came back blank
She also squuezed in a smear test

The answer seems to be that my bits and bobs arent as " utrogenized as they might be" and this she feels accounts for the uti
She also pointed out that when i had my fsh levels done at 43 they were high enough to indicate i was some way through the change at that point , therefore i may be post menopausal now
She also said on balance best to stY on hrt for a year or so to try and sort out my symptomsShe has also changed my oestrogen from estradot paches 100mg to hormonin tablets

I wonder why some oestrogen can sort things out down below more than another?
anyway it was  great consultation so thanks to all on here and fingers xd

Xx

[Taz2]

So glad you had a good consultation with your doc Tingly -  makes all the difference!

I have never heard of Hormonin tablets - interesting!

Taz x

[Limpy]

Glad you have spoken to somebody sensible.
Will they keep in touch with your GP?