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[PollyH]

Hi everybody,

Don't know where to start. I have posted here before and feel really bad that I only come on when I feel really unwell. I am 50 and been on hrt for 8 years -I have taken quite a few and ended up on femoston 2/10 which seems to have helped me a lot. Recently I seemed to have had more bad days than usual as I know that hrt is not a 100% cure. I decided to wean myself off (forgot to say I am post menapause) to have my thyroid tested as symptoms are very similar and also to get a true reading. My results have come back as normal. I am now off work so ill without hrt and have doctors appointment on Friday and feel that now it looks as if I will be on hrt for ever that I should choose the safest option. I do have problems with progesterone therefore I take sequi hrt even though I am post menapause and I never have bleed on femoston 2/10 - don't even know if that is supposed to happen.
Can anyone give advice on oestrogen patches/gel and types of progestogen -which is the kindest and safest to take as I don't think I will ever be able to come off hrt!

You are all so kind.
Thank you in advance.

Polly H
Xxxxxx

[PollyH]

Hi Stellajane

Thank you for replying -maybe you are right and I need a higher dose of oestrogen, but I am already on 2/10 and am worried about taking a higher dose. If I change to patches or gel do you not need as high a dose, and which is best -patches or gel, I have doctors appointment tomorrow and feel under pressure to make a decision and can't seem to think straight.

So am I right in thinking because I feel bad on the progestogen part of hrt, that I can ask the doctor if I can take it every other month, and this will be enough? Also what do you recommend for patches or is gel better? I have been on femoston for about 3 or 4 years and never seem to have bleed (two weeks of oestrogen and two weeks of progestogen - am I right calling this sequi). Don't you get so sick of yourself -seems to take over your life.

Thank you again for your reply and hope you are feeling ok.

PollyH xxx

[Sarah2]

Hi Polly

Re. patches or gel, it is a bit of a personal choice. I've used gel for over 5 years and it was my dr's choice for me and I am grateful for that as I love it! You can also change the dose very easily by using more or less.
I started on it at almost 54. I don't fancy using patches at all because they are visible ( even if only to us) and I just don't like the idea of having something like a plaster stuck on me 24/7. However, some women don't like gel because you have to wait 5 mins for it to dry each morning /evening and the can is quite big if you travel a lot. They are both safer re. blood clots than oral tablets.

You can carry on with sequi - mr dr says that 15% of women on monthly sequi regimes do not have a bleed.  This suggests that you are having not enough oestrogen to build up the lining but if you feel ok then you are having enough to control your symptoms. You might like to ask about a DEXA bone scan to check you are absorbing enough oestrogen and that your bones are okay because you did have a very early menopause.

If you are having more bad days it does sound as if you need a slightly higher dose than you are on now.

If you take a separate progestin you could reduce it to 12 days in a month or even 10 days every 2 months if you were able to have regular ( annual) scans because there is a risk of the lining building up more with lower doses of progestins.

I wonder if it's worth asking your GP to refer you to a specialist because you have had an early menopause and maybe need someone with more knowledge after 8 years on HRT and a return of symptoms? Ideally you need some blood tests to see what your oestrogen levels are like now.

[Hurdity]

Hi PollyH

I am one who didn't bleed on a sequi HRT by the time I was post-menopausal. If your womb is healthy with no abnormalities eg fibroids etc and the progestogen is high then as has been said either the oestrogen is too low to build up the lining or the progestogen is thinning it!

I'm a patch girl myself. Have used them since almost 54 which is now over 7 years! Estradot are very small - unlike all the others. I definitely wouldn't want to be bothered with remembering every day and waiting for it to dry! Patches also deliver the most consistent dose of estradiol into the system or rather are not so dependent on the user getting it right, than with gel - where the area of spread can determine how much gets through - although with trial and error I'm sure it's fine too as posters below have said! Just a matter of preference.

I also remain on a cycle and only tried conti HRT for about 6 months when I was 57 or 58.

As Stellajane said you would need separate progestogen - and many of us prefer the bio-identical progesterone than the synthetic progestins - and the bio-identical type (micronised progesterone - marketed as "Utrogestan") would certainly be recommended if you are progesterone intolerant.

All the different types are listed here:
http://www.menopausematters.co.uk/treatment.php

Look at the tabs below the main HRT preparations menu and look for oestrogens, and then progestogens, and scroll down for the non-tablet preparations.

Hope this helps

Hurdity x

[PollyH]

Hi Sarah2 and Hurdity,

Sorry I handn't got back sooner -always something going on.

When I read both you replies before tea time I was laid on the couch and just burst into tears (and I don't cry easily). I think it was the realisation that somebody REALLY understands and wants to help as you can feel so alone. I know so many women who don't have any symptoms and sometimes you feel you are being judged. So thank you so much.

Enough misery - back to positive thinking. I will definitely ask about a dexter scan tomorrow Sarah2 and maybe think about upping my dose, but not sure what the equivalent is going from tabs to patches or gel, guess the doc should know. I think I will also keep to sequi as don't like progestogen.

Hurdity,

Have you found that estradot is the best one -so scared of trying anything - think I read somewhere that this one comes from soy. Also I tried utrageston once and nearly passed out on the 200mg, but I maybe ok now or should I ask for a lower dose. Whatever happens after 11 years since peri-meno began its time I opted for the safest route.

Thank you both again i feel so much better - hope you are both well. I can clearly see that you both help so many people on here - you are angels of the meno!

Will report back soon

PollyH x xx

[Sarah2]

Glad you feel that you are getting some ideas now!

When you took Utrogestan, did you take it before bed? I took 200mg once and didn't go to bed as soon as planned and almost fell over when I stood up- made me very dizzy for a few moments. But taking it almost as my head hits the pillow is fine.

Just to make sure you ask for the right thing- it's a DEXA scan- bit about it here

http://www.nhs.uk/conditions/dexa-scan/Pages/Introduction.aspx

2 pumps of gel is 1.5mgs of oestrogen - and that is the same as 37 patch. The beauty of gel is you can self-dose - so if 2 pumps aren't enough, you can try 3 for a week and see how that feels- right up to 4 a day. I know not everyone likes gel-some people find it messy or can't be bothered with it, but for me it's just part of my morning and evening after-shower routine- put it on then and while my deodorant dries, the gel dries and I clean my teeth at the same time. But- it's what you like and everyone is different. I was prescribed it so that I could begin with a very low dose as first HRT then could work up to a level where it controlled my symptoms. But my dr was quite happy to say that it's not a perfect choice for all women, it's what suits each person.

Have a chat to your dr and if you don't get any response ask if they can refer you maybe?

[Hurdity]

Hi PollyH

I've only tried two patches - the first time I went onto HRT I was given Evorel - but these are huge by comparison - and since then I've had a look at the leaflets  of most of the others and they are also big - so yes Estradot is the smallest and I think it sticks really well. It is available in strengths up to 100 mcg.

As Sarah2 says - Utrogestan should be taken at bedtime. In those who suffer bad side effects even taking it at night, then vaginal route is recommended (in the French product info) - although vaginal use is not licensed in UK for HRT (ridiculous!), just for fertility, and is not to everyone's taste.

It could be possible to split the dose ie 2 x 100 mg twice a day - but then one of the doses would have to be taken in the daytime so may still cause problems initially.

The actual dose is worked out depending on how much oestrogen you are taking because progesterone acts on thinning the uterus in a dose dependent manner - ie the more oestrogen you have the more progesterone you need to protect the womb - but it's not an exact science and doses can be varied under specialist supervision ( gynae or GP).

Hope this helps!

Hurdity x

[PollyH]

Hi everybody

Thank you so much for the advice. I have been to the doctors and he has given me 50mcg estradot patch and 200mg utrogestan. I asked about the 'no bleed' and he wasn't concerned. I also asked about the Dexa scan and he said the age to have one is 50 - which I am so he asked me to remind him the next time I go - don,t know why he didn't sort it there and then. I am also a bit confused about where I am up to in my cycle. Because I felt so ill coming off hrt, I had some femoston tabs -1mg spare, so I decided to put myself back on it as I couldn't cope anymore. So by the time i got my prescription, I had already taken 1mg of oestrogen for eight days. I decided to start the patches as above on Sunday evening - but how long do I carry on with the oestrogen part before I take the utrogestan - I am so confused and also has he given me the correct dose of patches?

Also ref to the utrogestan - I mentioned about feeling really faint and dizzy and asked him if I could take a lower dose. His reply was to try this first.

I also read the instructions as to whereto put the patch and it recommended lower abdomen, just below the waistline, think I rad somewhere on here that the bum is best.

Thank you
PollyH x x x x

[PollyH]

Hi everybody

Need advice re previous posts can anyone help with this ?

Thank you
PollyH

X x x x

[Sarah2]

Hi Polly

will try to help you- not quite sure what you are wanting to know - is it the timing of the Utrogestan?
How much are you supposed to take?

Did your dr not say how many days per month?

It's hard to advise- look in the pack at the leaflet. It may say take 200mgs for 14 days.

This would normally be day 15 of the cycle through to the end ( day 28)

You carry on with the oestrogen every day- don't stop- but you are now in theory 8 days in ( at least ) with unopposed oestrogen- so you should take the Utrogestan by the time you get to day 15.

How much to take depends on the regime. If you have 100mgs capsules then the dose is supposed to be 25 days out of 28.

Some women take different amounts ( fewer than 14 days in a month)  if they are allowed to by their specialist but this is because they are able to have scans or monitoring more easily if there is any unexpected bleeding etc which might be a sign of hyperplasia.

Does this help?

[PollyH]

Hi sarah2

Thanks for replying. I hope I haven't confused things. To simplify - I have taken eight days of femoston 1mg eostrogen tablets and when I got my prescription for eostradot patches i started them on Sunday so by this Friday i will be on day 15. The question is do I take the utrogestan 200mg (as I am doing the day 15 to 26 option) or do I carry on taking the patches for another week - they are 50mcg. Does this make sense.

Thank you

PollyH

X x x x

[Sarah2]

Yes, I thought that is what you meant!

You start now because you have had 15 days of oestrogen- it doesn't matter how you got it!

[PollyH]

Hi. Sarah2

That's what I thought but wasn't sure because I had taken just the 1mg of femoston for eight days  and wondered if that was enough together with the 7 days of 50mcg -but that's fine I will take utrogestan tomorrow night, and I'll have spare patches.

Thanks so much, I'll keep you posted how the utrogestan goes - seem to have period pains already.

PollyH
Xxxxxx