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[Morwenna]

I have been on cyclical HRT for four years and am now nearing 55. For one reason or another I've decided a change to a continuous regime may benefit me, however am disappointed to see that Femoston is only available in a 1mg oestradiol version - at present I am taking 2mg (Femoston 2/10). I've also recently changed to Vagifem 10mg from Gynest cream as it wasn't working. Does anyone know why Femoston conti is only offered in a 1/5 (and lower 0.5/2.5) version? And has anyone changed from the sequi to a lower conti and had any negative after effects? While I think not having a monthly bleed will help my IBS and bladder issues I'm worried that lowering the dose of oestogen might bring back menopause symptoms   

[peegeetip]

Hi Morwenna

I'm not quite at the stage where the conti is an option yet.

However I have pointed out on another post recently that medium and high options for post meno are limited.

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

The Progestogen is reduced to 2.5 in FEMOSTON CONTI as you'll be taking each day - rather for only part of the 28 days.

There are lots of posts that seem to indicate dropping down to lower Estrogen levels will see a return of the symptoms we took HRT to prevent in the first place So best not to go there if you don't want to.

The best option you have is to go with FEMOSTON CONTI* 1mg and ELLESTE SOLO 1mg.

This would have various benefits.

1) you can continue with the Progestogen that already suits you.
2) you can take the Femoston Estrogen/Progestogen in the morning then in the evening the ELLESTE Estrogen - thus spreading out your intake and avoiding any drop off/sweats later in the day and overnight (easy for your body all round).
3) you can also see if taking just the FEMOSTON in the morning will suffice in a controlled way - by having the ELLESTE SOLO as backup should the 1mg for the whole day not be enough. You would likely see the difference pretty quickly.
4) conti option has additional benefits to you also and the sooner your on that and stable again (without new side effects).

There are a few drawbacks.

1) convincing your doctor to do this
2) avoiding the doctor pushing you to reduce your HRT
3) possible extra cost for the addition of ELLESTE SOLO 1mg to keep you to the 2mg Estrogen total per day

Just keep pushing for what your happy with. Its your choice, not the doctors.
 
 
 

[Morwenna]

The combined hormone dose in Femoston conti is 1mg Oestradiol and 5mg Dydrogesterone daily. The Femoston sequi dose (which I'm on at the moment) is 2mg Oestradiol daily and 10mg Dydrogesterone for 14 days - this adds up to exactly the same amount of progesterone over the 28 day cycle but only half the oestrogen in the conti version. Does the Oestrogen dose in continuous combined therapy need to be lower to stop the uterus lining building up? I note Indivina does a 1/2.5 ratio version, a 1/5, and a 2/5 so maybe not? I can see where you're coming from peegeetip when you suggest supplementing with a further 1mg dose of Oestradiol. I'm not confident my GP will know the answer either and my appointment is soon - guess I'll have to 'suck it and see' - I can always change to a medium dose conti if menopause symptoms break through but unfortunately Femoston don't do one so it would mean changing the type of progesterone which is a shame (unless my GP can see no harm in supplementing with a further 1mg of Oestradiol, which I doubt as he tends to 'go by the book') 

[peegeetip]

Hi Stella/Morwenna

there was a detailed article on ladies going "private" in the uk last year - due to the nature of some nhs gp's and their treatment of meno.
It was an option used to spread out and balance the intake of Estrogen over the whole day to avoid a hit then fall off of the benefit at the end of the day.

If you look at the post meno UTROGESTAN its set to 100mg which is half of what is need in the 200mg peri dose. No mention of having to increase that depending on the Estrogen intake?
Also INDIVINA has the same amount of 5mg mpa for both 1mg and 2mg Estrogen versions.

As Morwenna has already pointed out the overall amount over the month is the same.
But as the Progestogen is taken for the whole month it should prevent the build up in the first place.
Morwenna's doctor can monitor her over first 6 months and check if there is any build up. If there is no increase or a reduction then all good.
Also if Morwenna was not getting enough of the Progestogen then she's likely see bleeds that would continue after the first 6 months on conti.

Personally I think all docs should screen for the thickness prior to starting conti HRT.
Those who come back later with thickness issues probably had them prior to starting.
Same goes for blood tests, as a lot of docs are effectively prescribing blind.
But as usual all this costs extra

Morwenna I really hope the doc is able to help you continue with what you want.

 

[Morwenna]

Thank you both for your input. Some interesting points there. An endometrial scan would be a good starting point I agree but I'm sure the budget won't stretch to that and there would probably be a long wait. Who knows - now my prescribed vaginal therapy has been changed to Oestradiol from the slightly weaker Oestriol and seems to be doing its job, I might actually feel better on a lower dose of oral Oestrogen? I just don't want the change to a lower dose to cause me more problems than it solves 

[Morwenna]

Just as a matter of interest - has anyone on here managed the transition from a sequi to a conti without experiencing breakthrough bleeding?

[Hurdity]

Hi Morwenna

I started HRT at just under 54 but as I wasn't post-meno was put on cyclical HRT - which I didn't think about until when I was 58 the doc said I could go onto conti. By that time I wasn't getting any bleeding on the monthly regime. I waited until the end of the cycle ie a few days after stopping the progesterone and went onto conti and did not get any bleeding/ However as I was post-meno and only on 50 mcg oestrogen this wasn't surprising.

If you get a substantial bleed each month and you remain on the same dose (of oestrogen) then you might experience some spotting but as your body is already used to that dose then maybe not?

Re the dosing of oestrogen and progesterone. Personally I can't see anyone advising taking extra oestrogen without extra progesterone if you are post-menopausal.I can't see any problem with doubling the dose of Femoston conti (and if you wanted to spread the oestrogen dose you could take one in the morning and one in the evening) - or eg if you wanted to start reducing the dose, then one x 1 mg followed by one x 0.5 mg (the ultra low dose).

I agree there is inconsistency re the various doses and the different methods but they have all been trialled and I would not want to take extra oestrogen without progesterone, however much I don't like it, especially with tablet HRT where such a lot is lost in digestion.

Estriol is weaker than oestradiol but only in respect of alpha receptors. With topical oestrogen, estriol binds to beta receptors (present in the vagina) and the dose is worked out to be as effective as the estradiol in Vagifem. Individual women will have a preference as to which they prefer and which is more effective for her eg I prefer estriol!

Hope this helps

Hurdity x