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[justaboutcoping]

Hi all, just joined today and wanted to say hello to everyone. This site is fascinating and a godsend I'm 49 (50 in a couple of months) and have been peri for around 18mths I reckon.
Have been getting bad hot flushes and night sweats (at their worst a hot flush every 20mins or so!). Also some bladder problems and (whispers..) painful sex problems...
I've been trying to manage without hrt because of the scare stories but did a bit more research and found this site and decided it was worth giving HRT a try, why go through all these problems if I don't have to! I work full time and mainly with younger guys so the flushing/sweating stuff can be pretty embarrassing.

My GP recommended HRT anyway because of my age (and I also have some hp and knee problems) so she thought i should take it for osteoporisos protection as well as help with my symptoms, along with the fact that my FSH level had shot up - she said a level that indicated post meno, I think it was about 180.. (although in our next phone call she then thought maybe I don't need it for my bones as I am nearly 50!) It all gets very confusing.

I am still having periods but irregularly. I wanted patches rather than tablets so I've been prescribed Evorel Conti but am nervous about starting them so haven't taken the plunge yet!! After reading some posts on here am thinking about maybe using half a patch to start with, but also wasn't sure whether I should have been given sequi rather than conti (confused again  )

Anyway, just wanted to say hi, and great to find somewhere I can finally find some sensible info and help.

Cheers everyone!
Tracy x

[Dancinggirl]

Hi and welcome tracyn
Great post - you've obviously done some homework which is fab.  I think you are right about the conti patch you've been given. If you are still getting periods, even if they are erratic, then you should be on sequi HRT - I'd get back to the GP before using these patches.
My only thought to put to you is that patches tend to come in medium dose and it is wise to start with the lowest dose when you are peri menopausal.  Your own hormones will still be fluctuating and if you start low then as your own hormones drop you can increase the dose if need be.  I know that transdermal patches are often preferred but unfortunately they have the more problematic progesterones. Many on here recommend Femoston(pills) as a good HRT to try as it has a kinder progesterone(close to natural progesterone) that brings fewer side effects. Femoston comes in different doses as well.
As an alternative you could have a Mirena fitted and then use oestrogen in patch or gel form which gives you greater transdermal control over dosage and the Mirena means there is less systemic absorption of progesterone - it also takes care of contraception as well.
There are other progesterones like Utrogestan but if I were you I would try Femoston first as it is the easy option. Keep posting and let us know how you get on.  Dg x

[justaboutcoping]

Hi Dg and thank you for the lovely welcome and the great info.

It's reassuring to know that I'm not just stressing over nothing I should also have said though that I do get migraines (not loads - maybe 2-4 a year - but pretty bad when I do get them) and also have acid reflux that I need to use prescribed meds (ppi) for.

I did want to start on as low a dose as possible but as I'm nervous about taking HRT anyway my preference was for the patches because I understand as the hormones bypass the liver some of the side-effects are less. I guess my case is not straightforward (along with so many ladies here) and it will be a case of trying things out to see how I go. I understand though that's it's also not good to change things around every 5mins.

I did email Dr Heather and she thought that with the migraines and my stomach problems, and the severity of my symptoms, that the medium level conti would be a good place to start. I have gone back to her though to check whether the everol sequi would be better bearing in mind my age and the fact I'm still having periods (the packs says no periods for 18mths which certainly isn't the case for me but those leaflets are so flaming scary anyway lol). Am now thinking maybe an oestrogen patch with a kinder progesterone pill? (Hope it's ok to post that info - let me know if it's not and I'll delete )

Also just read shouldn't be using the patches before an op and I'll probably be having some sort of hip operation in December (had forgotten about that along with everything else going on and my foggy brain!!) so am now thinking not sure whether to start now or leave it until after the op. Could be having a surgical hip dislocation or hip replacement, and I don't think either are great for a while circulation wise, sigh 

I think I will probably have to go back for another chat with my GP..    xx

[Dancinggirl]

If Dr. Curries has advised you then I would definitely go with her advice - though I'm sure she will confirm you do need the sequi, not the conti. Unfortunately the kindest progesterones is either Utrogestan or Dydrogesterone which is in Femoston.  Utrogestan, if used orally has to be taken on an empty stomach at night and I believe often brings reflux/acid issues.  Many women use it vaginally (though this is not licensed here in the UK) - you use the same pills but insert them vaginally - I doubt many GPs would sanction this unless advised by a specialist.
Unfortunately Dydrogesterone(kinder progesterone) only comes with Femoston which is a shame. The info about the different progesterones is under HRT Preparations to the left of this screen.
The Mirena offers a good alternative as, though it has levonorgestrel ( which in pill form can bring PMT type side effects) can result in fewer side effects as less is absorbed around the body - the progesterone is just going where it's needed and there is far less released in the first place.
You do have a dilemma with an upcoming operation - I think you are wise to consult your GP about this.  You need to go back and ask for the sequi anyway. I think you could still start HRT for the next couple of months to see how you go - if you feel better then you will be in better health to face the operation in the first place.
BTW - You haven't written anything that you shouldn't - don't worry, all sorts of very personal and often controversial things are discuss on this site - as long as we are kind to one another.
Try not to be frightened of HRT - for many women it gives a far better quality of life but it can be trial and error.  DG x

[Kathleen]

Hello tracyn and welcome to the forum.

I think the menopause is generally a very confusing time in our lives so you are not alone there. This site is great for information and support so you have come to the right place.

Keep posting and take care.

K.

[Hurdity]

Hi justaboutcoping



I imagine Dr Currie will have suggested Evorel conti to try to eliminate bleeding if possible. She feels that bleeding is unnecessary and I understand some women start on conti preparations when they are having irregular periods.

There is no harm in this - after all it's like the Mirena ie continuous progestogen - but if periods are still happening then the irregular bleeding as your cycle breaks through can be inconvenient - which is why most docs prescribe sequi until you ae post-menopausal.

Personally, though, I would not start with conti HRT for the reason that, if there are side effects , you will not know if they are due to the oestrogen or the progestogen so if you go for Evorel, I would start with sequi for a few months until your body has got used to the extra oestrogen in this way - and also the progestogen.

Re patches vs pills - I have only ever taken HRT transdermally (since age just under 54 - now 61), not orally  - but Utrogestan was not available when I started (I used to have Cyclogest pessaries/suppositories). Now I have Estradot 50 mcg patches and utrogestan 200 mg vaginally 12 days every 6-8 weeks.

It may well be that oral utrogestan does not upset the stomach in the same way as other HRT combi tablets, because it is a suspension of micronised progesterone in oil so probably gentler on the stomach. Taken at night also so peak concentrations occur when you are asleep.

Hope this helps

Hurdity x

[justaboutcoping]

Thanks everyone - all the advice is really helpful.

Hurdity - it was my GP that prescribed Evorel Conti, when I spoke to her today she hadn't heard of Evorel Sequi, I've given her the details of this site so she can read up, and I'm going back to see her this week so we can talk everything through, particularly in relation to my expected op, she feels it might be better to wait until the op as it's fairly major and I probably wouldn't want any hrt withdrawal symptoms as well as coping with the op.

I think you're right, it'd be better not to have conti so I see how the progestogen affects me. Estradot patches with utrogestan vaginally sounds interesting and like it might work for me - is the utrogestan the kinder progestogen? And then I could start on low dose rather than medium too...

Anyway will chat through with my GP later this week, hopefully will be able to make some decisions soon. Have had so much going on over the last 2 yrs with all this starting and also hip and knee ops, would love to try and deal with some of these symptoms now. I just feel so tired and achy all the time and that with all the other symptoms is really getting me down. Got a holiday to look forward to soon though - maybe in Spain I won't notice the hot flushes lol x

[Hurdity]

Hi again

Just a quick one - Utrogestan is micronised progesterone - ie bio-identical to our own. It is the only progesterone licensed for use as HRT. Btw not licensed to use vaginally as HRT in UK but does the same job. The other compounds are all synthetic progestogens and not identical molecules to our own progesterone - but dydrogesterone in Femoston is very close.

Progesterone is unstable so cannot be given in transdermal preparation or as a tablet - but micronised in oil as a small capsule as I said below (a bit like cod liver oil!).

Hurdity x

[justaboutcoping]

Ah ok, got it Thanks Hurdity xx

[justaboutcoping]

Off to see my GP tomorrow to discuss what type of HRT to try - Dr Heather says I would be ok with the Evorel conti as periods very infrequent and would prob be better for me than tablets because of my migraines, but I'd also like to explore some lower dose options I think.

Am tempted to give low dose femeston a go though as it seems well tolerated, or poss Estradot patch with Utrogestan. Also need to make a decision re whether to start now or wait until after my hip operation in December, think my gp will def be taking the cautious approach there. I don't think she wants me to start then stop because I might feel worse again if I stop and will also be recovering from the op.

Will talk it all through tomorrow though and keep you updated. Nice to be able to chat about all this on here as most of my friends (and family) are very anti HRT. Hubby though is very good, he'll let me make my own decision, either way

[Dancinggirl]

Good luck.  Keep us posted.    DG x

[justaboutcoping]

Helloooo again!

Just to say been to see doc and had a good chat. Have been prescribed a different regime and have posted in all things menopause