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[Chi chi]

Hi everyone,

I was just after a little advice or people's thoughts as I'm totally confused 
I started HRT back in June, I take Oestrogel 4 pumps, testim 1 tube over 2 weeks and Utrogestan for 7/10 days each month. My initial blood tests showed my estrogen was low, my testosterone was very low and I am oestioporatic in one of my hips. I've been on the mini pill for approx 4 years prior to that I had the mirena but couldn't stick it for longer than a year.
I came off the pill 6 weeks prior to starting HRT.
I have 2 daughters and suffered with post natal depression after my first but not so bad after my second, I've never really got over the depression but just "got on with things" a couple of years ago I suffered an awful breakdown and couldn't function for weeks! Since then I've developed bad anxiety, mainly that its going to happen again! It totally came out of the blue and really really knocked me for six, I didn't know what was happening to me or why? It was the most terrifying time of my life.

Since this I've been/tried most AD's and also medication for anxiety, none of which has helped but I'm currently on Escitalopram 30mg and Lamotrigine 150 mg. I've spent the last 2/3 years trying to figure out what's wrong with me and what could have caused the breakdown??
I thought maybe it could be my hormones so I decided to go private to have them checked as my GP is reluctant and thinks its all in my head and just anxiety and depression 
Anyway, this is turning out to be longer than I'd planned lol so I'll try to condense it a little?
I started the HRT and around 3 months later I began to feel much much better! The black cloud of anxiety and pessimism that hung over me had lifted, I was happier, confident, more optimistic, and my libido had returned massively! My friends and family had noticed I was "different" but in a good way.
It was time to start the Utrogestan! 2 days into it I began feeling low again, agitated, anxious, miserable and my libido had gone! I felt I was back to square one and felt sad and angry as to why after feeling so good I now felt so bad again. I'd been told at my initial appt with Prof Studd that he thought I was progesterone intolerant.
We went to my follow up appt and I explained how I had improved so so much but now felt like I did before starting treatment, he told me it was probably the Utrogestan but I must take it unless I consider a hysterectomy 
My estrogen and testoterone has risen considerably and he's now reduced my test to 1 tube over 2 weeks but I'm still on 4 pumps of Oestrogel.
I'm not against having a hysterectomy but I do have concerns and don't want to jump out of the frying pan into the fire!

My concerns are
How can I be sure its the Utrogestan causing the problems?
Could it be that my testosterone level is too high now? As I've read this can cause the same symptoms?
Will or could a hysterectomy make things worse?

I've emailed Prof Studd with my questions and concerns and am waiting for his reply (took him ages last time) but in the meantime wondered if any of you had any advise or experience with any of this??

Sorry if this is way too long, I'm just desperate for some answers 

Thank you
Estelle 

[Winterose]

Estelle

Where do you live? There was an article yesterday in the Times about a London doctor Marion Gluck ( she has written a book on hormones etc) you can see her privately - think it said £280 for initial consultation but she might be an alternative to whoever else you are in touch with. My initial reaction would be absolutely no to hysterectomy, we need our ovaries and wombs unless its life threatening. In her article Dr Gluck says shes appalled at how many hysters there are done in this country. ( I had a hysterectomy and never really knew why.) I dont know about the progesterone part of HRT as I am on patches only due to not having a womb but am sure there will be ladies along soon who will give lots of info , seems there are different types , keep us posted,

[Hurdity]

Hi Estelle

I am not sure how we can help in addition to the answers on your earlier thread? I see you had great advice from Dancing girl about these issues and I added a little to it at the end.

The point is if you were feeling fine on the oestrogel and testosterone, and your bad symptoms began when you took the progesterone, and then disappeared a few days after stopping the progesterone ( once it had cleared from your system), then that point to progesterone intolerance. There have been women on here who have suffered similarly ie with sever progesterone intolerance and there are unfortunately few alternatives.

As Studd says, if you have a womb, and want to take replacement oestrogen ( which it sounds like you need) then you have to have progesterone. He tries to keep this to a minimum but shortening the length of time you have to take it - and along with this I expect he will offer regular scans of the uterus to monitor for thickening (which can happen with too little progesterone in relation to oestrogen).

If he has asked you to reduce the amount of Testosterone you take then you will be able to see if you feel any different. T is supposed too increase libido, not reduce it but I  expect there is a fine balance between the hormones and odd things can happen when they are replaced externally.

I think I mentioned on the other thread that Studd's view is that PND is caused by lack of oestrogen following childbirth, and many women similarly suffer from severe premenstrual syndrome for similar reasons, and compounded by progesterone intolerance for some women.

Sadly you may be one of these. However if you say it was only 3 months later that the depressive symptoms returned - I would have thought if you were severely progesterone intolerant then you should have experienced this as soon as you took it for the first month? I don't fully understand whether it has long term effects on the system even after it has cleared from the bloodstream (which happens quickly with progesterone).

Sorry if I sound confused too, but finding the right balance in each women is a tricky business as we all react so differently not only to our own hormones, but to their replacement, and the interplay with all of these in relation to libido, and a compound called SHBG (Sex-hormone Binding Globulin) which binds to testosterone in the bloodstream making it unavailable (I don't really know the details of all these interactions and the feedback mechanisms, but they are complex!).

I wish you well - but I would suggest to persist with the treatment and at least see if the reduction in T makes any difference at all.

Hurdity  x

[Chi chi]

Thanks again for the replies, winterose I'm in Oxford, I'll definitely have a look at Marion Glucks book 
I'm interested in trying the Utrogestan vaginally but dancinggirl has said that it irritates her bladder and as I already have irritable bladder syndrome not sure if it will be suitable to take it this way either? Worth a try anyway I suppose?
Hurdity, my symptoms returned 2 days into starting the Utrogestan ( ive only had 1 month of being on it ) and haven't really improved since  I'm due to start it again on 1 October which will be the 2nd course and I'm dreading it, just don't want things to worsen (in any way) and spiral downwards as I feel they have already 

Prof Studd hasn't said he will be monitoring my uterus? I can't see on any of my blood test results my levels of FSH except for one back in nov 2011 which was 6.8 iu/L  the range says 1.5 - 33 I'm not sure if this is normal or ok?? I could be wrong but isn't this useful for seeing how the ovaries are functioning?

I realise its difficult and we can only offer advise to a certain extent based on personal experience, its just nice to be able to chat with people who have been through similar and understand 

Still waiting for a reply from Prof Studd 

Thank you again ladies
Estelle 

[Hurdity]

Hi again

I don't really know much about FSH levels except that when you are at menopause they remain consistently high, but during peri they can fluctuate considerably so cannot be relied upon (so I understand).

Ah - so that means you only started the Utrogestan after about a couple of months on oestrogen only? That sounds sensible - and is a good test for progesterone intolerance. Definitely sounds like that to me - unfortunately.

I am sure that if your symptoms are really bad and Studd suggests 7 days per month, and you continued seeing him, he would suggest monitoring your uterus, because this is lower than the recommended dose for protecting the uterus especially for 4 pumps oestrogel. He advocates this on his website. The other alternative is to go for a longer cycle - but this would mean a longer course of utrogestan when you actually take it, and doesn't tend to be advised by the gynaes because of the longer period of unopposed oestrogen - which can lead to endometrial hyperplasia (uterus thickening which could lead to endometrial cancer).

Did you not feel any better a few days after stopping the Utrogestan and after your bleed?

I know what you mean - I always dread starting my course and my symptoms are nowhere near as bad as yours. Not sure if you've said how old you are? My libido is virtually non-existent -  and I keep wondering about testosterone..... progesterone is supposed to reduce libido as well as oral HRT - I gather women's libido declines during the second half of the menstrual cycle anyway - when oestrogen levels also drop.

Sorry I can't help further and hope things improve for you soon!

Hurdity x

[Chi chi]

The testosterone definitely helped with my libido! Hubby didn't know what had hit him lool must admit it really surprised me too, we were like teenagers again!  it went from maybe once or twice a month sometimes longer to every other night! Sometimes every night 

When I took my first lot of Utrogestan ( 1 - 7 sep ) i was told to expect a light bled around day 10 so around 10 sep ish, well I had a tiny tiny bleed for one night on 13 sep then nothing until the following sat ( 20 th ) and that's been quite heavy and only just stopped yesterday. Prof Studd reduced my testosterone though on 11 th so I don't know if that brought the second bleed?? I didnt feel any better or different when i started bleeding? just felt totally crap since that awful utrogestan and I'm due to start it again on 1 oct so will see if or when I get another bleed from that? And how I feel?
I just commented on another thread about trying the Ladycare, worth a go 

Estelle