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[TillyD]

I last posted a couple of months ago and everyone was very supportive so thank you.

I am on oestrogel and had a Mirena inserted a couple of months ago. Although I was frantic about it, the Mirena has seemed ok so far.

But over the last 2 or 3 weeks, the hot flushes have returned. And so has the insomnia, the night sweats and having to go to the loo in the night. All these things were original symptoms that disappeared after starting HRT.

Because the progesterone is now locally delivered am I now suffering from too LITTLE progesterone in my system?

I am SO unhappy again. I thought (after 3 years) I might finally have got everything sorted. I'm finding it very hard to deal with. The new term starts on Monday (I'm a teacher) I've got a broken leg in plaster and now this again!

[TillyD]

Hi Stellajane, thanks

I am seeing 2 consultants (long story - one does the prescribing but doesn't do surgery any more so I had to see another for that bit!) and I have emailed both.  One replied - secretary says will reply when returns from holiday - and the other has predictably not replied - I suspect because he doesn't get paid to reply to emails!

I'm not planning on going to GP because they know nothing about HRT, quite apart from the impossibility of getting an appointment and actually getting there.

My last blood results from 3 months ago gave fairly high oestrogen readings at 796, which made me question whether I have too much oestrogen and not enough progesterone any more. 

The best I ever felt was when I started HRT a year ago and I had the same amount of gel coupled with Utrogestan.  The only reason the Utrogestan was changed was that it wasn't "strong enough" (I think, I've never quite got  the bottom of the reason) and eventually I ended up with a thickened womb lining, hence the Mirena.  Sorry if TMI.

Anyone else got any ideas?  I have plenty of gel and Utrogestan hanging around.  I could easily change my dose myself

[TillyD]

Is there anyone else who may be able to offer any advice ?

[Hurdity]

Hi TillyD

I am sorry I can't really help - I think you need specialist advice. When it comes to high oestrogen levels this is a tricky area. I presume you mean p mol/l ? This does not seem high enough for tachyphyllaxis which is the syndrome which can occur at what is known as supra-physiological levels ie levels higher than would normally occur in the menstrual cycle. At this point oestrogen cease to become effective.

Prof John Studd talks about this in his article on implants:
http://www.studd.co.uk/implants.php
You will need to scroll down.

What I don't understand about all of this is what effect a consistently high estrogen level such as yours has on the body (but not reaching these supra-physiological levels). I mention this because in the natural cycle oestrogen cycles between a much lower level and the peak it reaches at ovulation. It is important to findthe "sweet spot" (just the right amount!) but in your case I think it would have to be trial and error.

If the Mirena is preventing your womb lining from thickening up then it is doing its job locally. Whether or not your body would benefit from some bio-identical progesterone from time to time is another matter.  The synthetic progestogen that is absorbed from the Mirena does not fulfil all the functions of progesterone, as I understand. Its functions in the body aside from its reproductive role in maintaining pregnancy are not fully understood or lack of it at menopause - although because of oestrogen's major role in women most menopausal symptoms (short and long term) are relieved by oestrogen. I'm not sure I would want to be having a Mirena and utrogestan though - but if you are not absorbing any from the Mirena you may feel OK.

This is a very complex area and I don't have the knowledge or understanding to be able to advise.

Yes I would speak to your consultant and read up all you can about this!

Just an afterthought - are you still applying the gel in the same way as you did 3 months ago or have you changed anything that you use close to your skin? Just checking that you are in fact getting the right amount through, since the blood tests were a while ago.

Personally I would say patches give a more consistent dose of oestrogen but many women prefer the gel.

How much utrogestan were you taking and with how much gel, to give you a thickened lining, and I presume you were scanned for polyps or fibroids?

Sorry this is a bit of a ramble but hope it is a little bit helpful!

Hurdity x

[TillyD]

Thanks for replying Hurdity. I think you've confirmed what I suspected - because no one actually knows and specialists disagree, we are all participants in a drug trial effectively.

I was on 100mg utrogestan for 7 days a month and at that time my oestrogen level was 270 or so. That was when I felt good. But prof Studd wanted to change me to noresthisterone, maybe I wasnt bleeding at the predictable time or something. Anyway after months of that I then developed  a thickened lining anyway and a polyp, which has been removed.

Yes the oestrogen levels were pmol/l

The levels are at the mid to high range for a normal cycle so it's like my levels ate consistently at the mud cycle range which is obviously not natural. That's why I'm thinking it may be too high. That and the fact that my breasts have grown 2 sizes since starting HRT and that I was getting sore breasts almost throughout the month when on the previous regime

Something us clearly out if balance but I don't know what.

I also can't sleep until about 4 in the morning and when I go back to school it's not going to be possible to survive on 2 hours sleep

I am seriously desperate and just don't know what to do

[TillyD]

Well I've actually just managed to speak to Prof Studd, who was typically brusque. But anyway, first he suggested that I go to see him again for blood tests. When I explained that would be difficult because of term time and my leg in plaster, he just said to increase the oestrogel to 3 measures.

This might sound strange , but I really hope he know what he's doing 

[Rowan]

Not very helpful of him, you could have done that without the cost of a phone call!

Not sure what to suggest as we are all so different in our response to hormones, to my mind you have enough estrogen in your body as you say you have swollen and sore breasts.

If this were me I would be thinking of having Merina coil removed and starting over, with a lower dose estrogen and  oral progesterone.

This might cause an out cry but I am not so impressed with Prof Studd, he is fine when his regimes (private) suit the client, but not so patient when they do not suit the woman, and she is having problems. I have read about this on other forums.   

[karenw]

I've had a bad spell with my hot flushes/dripping sweats over the last few weeks too.  Here the weather has been quite humid and I think they're related to this.  The last two days have been less humid and I've felt better.

Could this be the case for you too?

[TillyD]

Ah silverlady, this has been my experience with Prof Studd. He's quite impatient when you don't respond in the expected way.

I went to him in desperation but I have now moved house. I may be able to find a consultant closer to home now, which I was already considering. I'm not keen on consultants generally but the one who did my surgery seems ok. But when I told Prof Studd her name, he made a big "tut" like he was dissing her, which I didn't like. All of them have a tendency not to listen but the last time I saw her, she gave a good impression of wanting to be helpful.

In any case, I would like to pay less than Studd's extortionate fees!

[honeybun]

I am surprised that you were only on the 100 utrogestan for seven days of the month. It's usually that amount for 25 out of 28 days. Perhaps this was not sufficient to shed your lining effectively and that caused the build up. If you wanted a bleed then it would be the larger dose of utrogestan for half the month and then a withdrawal bleed.
I am also surprised that he prescribed norethisterone as it has so many more side effects.

So many doctors just seem to want us to agree and have no opinions of our own. They belong in the dark ages to be honest.
I can't give anymore advice than the others. Just wanted to say sorry you have found yourself in this position especially after having paid to get expert advice.
Have you considered getting in touch with Dr Currie. She really is the expert. You could then go back to your GP to get them to prescribe.

Honeyb
X

[TillyD]

Thanks Honeyb

I've not thought of contacting Dr Currie but might do that

I was on a low dose of utrogestan because Prof Studd is anti progesterone. He believes that it is progesterone which causes the breast cancer. Therefore he uses the lowest dose possible and only for 7 days.

He is not keen on noresthisterone either but he had a reason for using it with me, I think he wanted me on a stronger progesterone to try to curb heavy bleeding. It didn't!