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[Sazzy]

I'm new to the forum.  I'm 44 and have been having symptoms since I was 39. I've taken many different forms of HRT but most recently for the last year have been on elleste and using progesterone pessaries called Cyclogest, vaginally for 14 days every month.  I was using the pessaries every 3 months and bleeding after each round but my consultant said this was an untested method so insisted I went back to using them 14 days in every month.  I found this regime unbearable. I didn't feel human at all.  I had only one week in every 4 when I wasn't using the messy pessaries or bleeding.  In addition to this I have gained loads of weight, (for me), my breasts are unbearably tender and heavy (almost like when breast feeding!) So I have decided having discussed with my gp that I am giving the hrt up. My gp has suggest a Mirena coil might be an option  for the future but I would need to be sedated to have one fitted. (Another story..)
I would be grateful for any hints/tips for coping without hrt! I exercise regularly (cycle and gym) and have a healthy diet.

[Dancinggirl]

Hi and welcome Sazzy
I had a premature menopause so I can sympathise. I struggled to find the right HRT and found Oestrogel daily with progesterone tablets for 10 day search month was my best option for many years.  When all those scares came out in 2002 I eventually decided to come off HRT at 49.  I struggled on without HRT for 3 years and eventually went to the local meno clinic and after trying different conti HRTs I had a Mirena fitted and used Oestrogel again every day.  I have to say the Mirena was my best option at this stage so it may well be something you could seriously consider.  I didn't get the sore breasts or other PMT type symptoms I experienced with other HRT combinations.  The other plus of the Mirena is that after the first few weeks it tends to result in little or no bleeding at all.
My worry for you is that you are very young to be without oestrogen. Oestrogen deficiency can cause long term health risks for your bones and heart. I am surprised your doctors haven't been more diligent in trying to help you find a good solution for this problem!!!
If I was you I'd have that Mirena fitted and get your life back.  DG x

[2cats]

Hi Sazzy,

I'm a very similar age to you and start with premature menopause mid 30s so it's been a long haul!  I have just used my last round of cyclogest as I too could no longer stand the messiness for 2 weeks plus period and all that goes with that! (Also, I'm pretty sure there is quite a lot of positive research on only using progesterone several times a year, just to keep the womb lining down (thinking Prof. Studd?)
However, I'm now going to try Utrogestan tablets which many ladies on here find very suitable and with less side effects.  I live in hope!
Again, the mirena coil can have different effects on different women - I tried it in my 30s and I felt like my body was rejecting it with terrible womb pains every day and I did not feel good at all.  Same thing happened with my sister. I ended up having it whipped out (ouch) and the pain disappeared!
Obviously it may suit you very well but it might be worth considering an oestrogen patch (oestrodot - v. small and discreet) with utrogestan?
Trouble is , hrt is mostly trial and error which can be v. frustrating!
Good Luck 

[Sazzy]

Hi thank you for your support.  I think I will return to some form of hrt I was just feeling very bullied by my meno clinic consultant. I feel like I need to step away and reassess. I have tried so many variations and combinations I cannot remember the names but it includes 2 types of patches and possibly 3 brands of tablets. I will get a list from my gp when I next see her!  My 'period' is still extremely painful and can be heavy for a day or so, is this normal?  I have to use the largest size tampon plus towel in case of disasters. I do feel nervous about the Mirena because of the horror stories I hear, but some swear by it.  What is oestrogel? How do you administer it?
I have a review with my doc in a few weeks and want to go fully prepared with questions.

Thanks 

[Dancinggirl]

Hi Sazzy
I assume you are still peri menopausal? When you are not on HRT do you still get periods? Are you getting other menopausal symptoms e.g. flushes, night sweats etc.
Finding the right HRT can be challenging. Is it heavy bleeding that is the main issue for you? What side effects made you reject the various HRT combinations you tried?
When I was using HRT sequentially I got quite bad period pains but the bleed was never heavy.
Oestrogel is an alternative form of oestrogen - you were using elleste before, so this would be the same but is a gel you apply each day to inner thighs or arms.  Many prefer using oestrogen in a transdermal way - either patch or Oestrogel - as it is often more effective(it doesn't go throughout the liver so can work better) and you can adjust the dosage to your needs.  If you do decide to have a Mirena then you wouldn't have all the mess of the pessaries, any bleeding you get would be less and you can then use any oestrogen you want - either pills, patch or gel.
Just a thought; have you tried Utrogestan for the progesterone part alongside oestrogen?
Do read up all the info under the headings to the left of this screen. DG x

[CLKD]

The Mirena can be removed if necessary!

Welcome by the way ……….

[Sazzy]

Hi

I presuming that I am peri. As I have had enforced bleeds I have no idea? The last progesterone i took in tablet form gave me migraines every month, a common side effect apparently. The natural progesterone in the pessaries did alleviate this.  Previous issues have been heavy, prolonged bleeding.  I also had a very painful and traumatic episode with what I can presume was a polyps being passed.  It was similar level of pain to labour.  This again is a known side effect of some hrt, as far as I know?
I will get back to you once I something to report, I would like to feel like I'm in control of my body again.  Mirena and oestrogel do sound like a good option. 
Mostly I wish I didn't have to think about it at all. I'm hoping that I will shed a few pounds too and drop a bra size. 

[Dancinggirl]

Hi Sazzy
It may be good to have a couple of months without HRT to actually see where you are in your menopause journey.  After 6-8 weeks I'd ask for a blood test to see what you FSH and oestrogen levels are. If the FSH level is high and the oestrogen level is low then you'll know you are either well into peri or actually post meno. You may find you even get a bleed.

As I mentioned, I was peri menopausal from my mid 30s. I tried all sorts of different HRT types and in the end went to a private meno clinic.  They took me off everything and after 4 weeks I did get a bleed.  They did blood tests after these 4 weeks and the tests actually showed I was well into peri menopause.  This is when they put me on just one pump of oestrogel per day and 10 days of progesterone each month. I got some period pain and headaches with this progesterone but it was the best option for me at the time - they told me I really needed to use HRT if I didn't want to get health problems later.
I came off HRT at 49 partly because of the scares going round at the time and also i thought I could manage without HRT.  I struggled for 3 years before finally giving in and going back on HRT.  This time I was well into post meno so tried the conti HRTs. I did't like any of the combined pills or patches - like you I had sore boobs etc.  Eventually the doctor at the meno clinic persuaded me to try the Mirena and use Oestrogel again alongside.  This turned out to be my best option at the time as after a few weeks I had no bleeding and apart of having very occasional tummy cramp (nothing bad) it was nice not to have the hassle of thinking about the progesterone.  I didn't get the sore boobs or put on any weight. I know some women have issues with the Mirena but there are very good reasons why it is a very popular choice, especially if you are progesterone intolerant and suffer with heavy bleeds.
Having had a break from HRT you will hopefully feel better able to make a decision about what you want to do.
You could give the Mirena a go and if you don't like it then it is easy to remove.
The alternative would be to use Utrogestan alongside Oestrogel.  Utrogestan is bio identical progesterone which is very popular with many women on this site.
Keep us posted.   DG x

[Sazzy]

Thank you, that is incredibly helpful to hear your journey. I have no friends that have taken hrt so I value your input. I haven't had a blood test in a while so that is a good idea. 

[Hurdity]

Hi Sazzy

Just catching up with the forum as have been busy for a few days -so  from me too!

Lots of issues have been raised here as well as your story.

To me the bleeding is a separate issue from everything else and may need to be treated aside from the HRT for menopausal symptoms.

I am also very surprised to hear that your meno consultant advised (bullied you say?) to stop using HRT especially at your age - as has already been said - if you are advanced in menopause. However if you are still very peri-menopausal then the urgency is less (to take extra) ie you may be one of those that experienced symptoms early on in the journey while your oestrogen levels only dropped a little.

The only way you would know as Dancinggirl says is to stop HRT for a few months and see what happens (re periods) - but unfortunately if you are sensitive to a small decline in oestrogen then your symptoms may return very quickly.

As an aside have you read the excellent article on peri-menopause on this site? here is the link:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

The heavy bleeding may well be a combination of the extra oestrogen you are taking to control symptoms, as well as the possible lack of progesterone during cycles when you don't ovulate when heavy bleeding would be expected anyway, but I would say any unusual episode of painful heavy bleeding that is as painful as you experienced would need investigation. I haven't come across what you describe about polyps being passed, nor this being a side effect of HRT - never heard of that.

I am a past Cyclogest user. They can be used as suppositories - less messy but the remains will be passed next morning! I used to get migraines from them because I think the dose generally prescribed by those that will prescribe them for HRT is too high. I used to get a withdrawal migraine too fairly regularly so I sympathise with your problems.

Someone mentioned the 3 month cycle - actually I think gynaes do not favour this because of endometrial thickening - I think there is some research ( maybe Sweden - apologies for vagueness on this) where this happened. Gynaes like Studd would go for a normal length cycle usually but a shorter course of progesterone where women are intolerant. There is still a danger of thickening but it needs to be monitored, and the period of unopposed oestrogen is shorter. I am on a long cycle but it's not ideal - even though I am post-menopausal. eg if you have small fibroids ( I have one) then they can grow.

I use Utrogestan 200 mg vaginally for 12 days every 6-8 weeks (along with Estradot 50) and get a bleed. It is difficult to work out what's best when you are still peri-menopausal though.

The weight issue is something lese - often discussed on here - it is possible to be on HRT and not put on weight - you just need to control what you eat and exercise more - your shape and fat distribution will be changing because you are approaching menopause. The bust size is probably due to HRT I agree.

Blood tests are unreliable around menopause and you would need several really. If you stop HRT and are experiencing symptoms and your periods do not return then you are peri - or menopausal as Dancinggirl says - but they do fluctuate during peri-menopause.

This has turned into a ramble - I often do this but hopefully it is helpful alongside the good advice you've already been given!

Hurdity x

[Sazzy]

Hi Hurdity

I think my story may have confused you.  It's hard to fit what seems like a lot of information into concise amount of writing.  It is me who was keen to stop taking the hrt at the moment. My consultant was keen that I carried on with the elleste every day and Cyclogest (14 days per month).  I may be being foolish, but I just couldn't bear the regime.  The whole thing left me only feeling human for 7 days in every 28.  Having only been off the tablets for a few days I just feel exhausted and emotional!!  I don't know if this is a withdrawal effect or if I am just tired.  I feel quite flat though. A couple of people have asked if I am ok at work.
The polyps being passed is something that was mentioned by my gynae, after the incident I had a scan and nothing was found.  I had suspected that it was endometriosis but seemingly not. The gynae suggested that as nothing was found it was probably something that was passed in my period.  Obviously I went straight home and did my own research and read up on polyps.  Many people have them but are unaware and it is only when a large one is shed that you find out!! 

The Gynae did not favour the 3 month cycle that I had been doing and you are correct, it is the endometrial thickening. I was unaware that this is a risk so don't really want to go with that option now. 

I am going to have to try harder to lose weight.  I do exercise but need to get to the gym a little more often and peddle a little harder on my cycle to work!

I shall let you know how I get on over the next few weeks, I hope I start feeling a little more optimistic!

Thanks for your support.
 

[Sazzy]

Hi All

I thought I'd give an update on how I'm doing.  I've had a bit of a cold with a temp so wasn't sure if I was having hot flushes or it was the illness!  I have now realised that I'm having hot  flushes in the night, not unbearable but it does mean my sleep is disturbed.  My main problem area is aching joints; knees,  hips and worst of all knuckles.  My hands feel arthritic and puffy.   I hadn't realised how much the HRT had alleviated this.  Does anyone know of any natural remedies that might help this?
Aside from that I'm doing ok so far but it's early days.  I've yet to see if I still have a period.
Trying to keep positive 😁

[Hurdity]

Hi Sazzy

Sorry to hear you are feeling rough and your symptoms are returning.

Really at your age HRT is the best thing to help protect your bones and heart, but in your case it is difficult to find a regime that will suit you because it sounds like you may be progesterone intolerant to some degree.

I think I mentioned I used to use Cyclogest and changed to utrogestan because I kept getting migraines and I hardly ever get them now (if I stay away from too much wine late at night  ).

Have you thought further about having a trial of a Mirena maybe as you were advised, or asking your specialist if you can try a shorter course of progesterone? Prof Studd suggests that progesterone intolerant women can have a short course of 7 days per month but need to be more vigilant re endometrial thickening - I mentioned this below. It would preferable to have eg an annual scan just to make sure all was OK but you mght then have a bit longer in the month when you felt good?

There was an article recently about taking HRT in which Dr Currie (who founded this site) amongst others, wrote in support of HRT before the menopause.
http://www.dailymail.co.uk/health/article-2800760/should-women-hrt-menopause-experts-say-s-best-way-ease-symptoms-avoid-long-term-health-problems.html

Some women do try natural remedies but at your age oestrogen is really the best thing to take if you can! I think fish oils are supposed to be helpful for joints but not sure if there is evidence for this - I haven't actually looked, as I know it has general health benefits. I take pure cod liver oil (from the bottle, not capsules) every few days. Also I started getting painful joints at one point some years ago and started taking more exercise using those joints and I haven't had the aches and pains since. However this was before I was on HRT so low oestrogen and approaching menopause could have been the cause and HRT might have helped rather than the exercise!

Yes do try to keep positive if you can - the best way to get through anything 

Hurdity x