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[MissKitty]

Ladies,

I'd like to share something with you and ask your thoughts...

I have been on HRT for about 3 years with varying success. I've been peri menopausal probably for 5 years. I' 49 now.

I have posted about mood swings (suicidal on occasion), weight gain, night sweats, hair loss over the last few years - you all know how it is.

In addition to this, about a year ago, sex became almost impossible; painful, unenjoyable, unpleasant. Previously, my partner and I had enjoyed a healthy very pleasurable sex life and I wasn't about to give it up so I have been fighting to get someone to do something for me about the sex thing and the other symptoms.

The NHS have been worse than rubbish; ending with a letter to the Ombudsman a month ago. I have wasted nearly a year and got nowhere!

My wonderful GP, Dr Ferguson at Datchet Health Centre suggested the private route and actually I have just been provided with PMI via a new job.

I went to see Ms Whitcroft at Surrey Park Clinic who was very informative; I'll share below but keep at it as some of it might get you a bit lost...

She suggested that some of the problems that menopausal women face is due to the conflict between increased insulin levels impeding the absorption of hormones. Lower oestrogen levels in the body also support increased insulin levels as your body starts to store fat. There is a link between lower oestrogen levels and fat storage. In addition male hormones increase relatively to oestrogen and that also results in fat storage around the middle (like men). In addition increased insulin impacts the absorption of estradiol, another female hormone. Estrodiol also has an impact on skin elasticity hence some of my intercourse problems.

None of these things in isolation are insurmountable but put together, along with a number of other hormone related menopause issues can result in lots of the problems we seem to face - hot flushes, mood swings, night sweats, insomnia etc. etc. etc.

I have  just come away with the following drug therapy and wondered if anyone else has had anything like it:-

Elleste Duet 2mg (I was taking this already as I am perimenopausal)
An oestrogen based cream that is administered internally to try and treat the intercourse pain (this didn't work AT ALL - bloody ridiculously low oestrogen level)

In addition I have now got:-

Elleste Solo 1mg (to be taken in the morning - Duet 2mg is taken at night - this is additional oestrogen)
the oestrogen cream but only to be used as a moisturiser externally in the area to help combat slitting / tearing
Vagifem pessaries - (2 per night for 14/21 days then 2/3 times a week) much higher dosage of oestrogen to be applied internally
Evorel 25 - this is a patch to be used twice a week for 3.5 days each patch - this adds estradiol to my therapy
Gloucaby - 50mg every morning to help even out the insulin highs and lows which in turn should support better absorption of the hormones prescribed. This tablet should be taken before breakfast and breakfast should be predominantly protein based with very very minimal carbs.

I'm very hopeful having spoken to Ms Whitcroft. She seemed to know her stuff both in terms of drugs and what she cold ascertain when examining me.

I'd really appreciate some feedback on the drug thing and just your thoughts in general really.

Thanks and take care, Karen

[dazned]

Goodness me that's a lot to remember! 

Hopefully it will soon start to work for you ,think I would get lost with what to take when 

Thanks for it though,please keep us updated .

[CLKD]

Did you have to pay for this treatment or have you been referred back to the NHS?

[Morwenna]

I'm no expert but that seems a big increase of oestrogen all at once. I would have expected to be put on Vagifem in the first instance (which should definitely make a difference) and take it from there.

[peegeetip]

I'm pleased to see your private doc is confirming the approach I've previously mentioned.

"Elleste Solo 1mg (to be taken in the morning - Duet 2mg is taken at night - this is additional oestrogen)"

I'd have possibly thought she might have tried you on 1mg solo in the morning then 1mg duet in the evening first though.

The idea of having local estrogen is great too

My only question mark is on the additional patches ? Did she say why ?
The only thing I can think of is that the absorption from our tablets in stomach are often not as high as we'd think.

Sounds like you have everything covered. Would like to know what PMI you have if it covers you

 

[MissKitty]

Hi All,

Thanks for reading and commenting

Stellajane - I will watch out for that - thank you.

Peegeetip - I had the same thought around Duet 1mg but I'm happy to give it a go and see what happens. The patches are more about estradiol I think which is a big factor in the intercourse problems and my shrunken insides. That was my main reason for the referral - AXA cover vaginal atrophy.

Morweena - yes it is but my levels were very low - this is a three month therapy plan. Then I'll go back and see how things are. Trying to combat the intercourse issues - especially as I am getting married in July.

Dazned - yes, a lot to remember; thankfully my memory still works

CLKD - I am covered by private medical insurance. The drugs were expensive but my GP will cover the cost for most of it in future.

Thanks, Karen

[Hurdity]

MissKitty

That is a very strange concoction and I can't understand why you have been prescribed all of that!!!

Firstly you have been given a much increased dose of oestrgoen without additional progestogen - which means your uterus lining could well end up thickening too much and you could get oestrogen breakthrough bleeding. Did she mention this and will you be monitored regularly by the clinic ie have regular scans to check on your uterus lining?

Also why give you an extra Elleste tablet and an extra oestrogen patch? All the oestrogen in the tablets and the patch is estradiol - it's just that patches deliver it more directly and consistently. I wouldn't have thought one would need three different ways of taking it including two different tablets   I can see the logic behind increasing your oestrogen dose with a patch but not the extra oestrogen tablet, and especially without extra progestogen?

Anyway she's obviously an expert but I've never heard of such a mixed regime as this - especially as you may not be absorbing the tablets as peegeetip says - in that case I would have changed to a completely transdermal method eg patches and gel.

Also no mention of testosterone? Many gynaes like to give this as well to help libido.. but maybe the high dsoe of oestrogen will also help in this respect. Will she be monitoring your estradiol levels?

Anyway do hope you feel better but still slightly puzzled by this

Hurdity x

[Kathleen]

Hello MissKitty.

Thank you for posting this information. It's always good to hear what is being prescribed by medics who are working outside the NHS as this gives us another insight into the treatments available.

Some time ago I read an article by the author Jeanette Winterson where she writes about her menopause and how incapacitated she was by the range of symptoms she experienced. She saw someone privately but said that she felt sorry for women who couldn't be offered tailored treatment because all they had to rely on were patches!  I think she concluded that the help she had should be available to all women.  Well Amen to that.

Wishing you well and please let us know how you get on.

K.

[peegeetip]

Hi MissKitty

thanks for that update
It is good to know that certain conditions might be covered.
I'm going to call my provider tomorrow to see as recent reports in the paper now seem misleading.

So sorry that you've had such a difficult time and really hope this helps you get back onto a good path again asap.
Take care for now.

 

[Suzyq]

I'm not an expert but would have thought if your estrogen was low despite being on hrt, you would as hurdity has said, just been switched to a transdermal method at a slightly higher dose! It does seem like a massive increase all at once and I know when I increase from say 50 patch to 75 I really feel it - and not in a good way!

Hope it works for you but I feel you may have a rough ride ahead of you ...

I see a private specialist but that's mainly because that's the way it all operates in canada but they are very knowledgeable I find.

[MissKitty]

Thanks again ladies - interesting the different repsonses.

Hurdity - my libido is fine  I just can't have sex cos it's so painful.

The high levels of eostrogen I think are because of the long term tissue damage / shrinkage. I am also on tablets to try and counteract the increased insulin production which in turn should allow for better absorption.

Yes, I am being monitored. I go back in 2 months.

I have to admit I as concerned about the high levels but honestly, given the awful treatment I have received at the hands of the NHS this was a welcome change and I just hope that it helps.

Thanks, Karen

[Suzyq]

I also hope it helps! And let's face it she knows more about the whole thing than we do!

[MissKitty]

Well a week in and I definitely have more energy which is good.

I have tried really hard to be balanced about my eating habits to make the most of the insulin balancing tablet and it seems to be working. I eat healthily anyway but I am more focussed on protein vs. carbs; for info though I can really tell the difference if I eat something high in sugar so I think that was a good call.

Vagifem pessaries are my new best friend - managed to have sex at the weekend (TMI? Sorry) and whilst it wasn't without discomfort it was SO much better than it has been for a long time and my DP said he can feel the difference inside me - softer, more accommodating, more "give" The best for him for a long time too.

Breasts very sore - that'll be the increase in oestrogen but it will calm down in a few months - I remember that from before.

Really vivid dreams - I get lots of nightmares but these aren't nightmares but they are SO real!

My weight has remained fairly stable so we'll see how I get on - up two pounds but given how sore my breasts are I'm not suprised and I am at the point in my cycle where I usually add a few pounds.

Had my bloods back - very low testosterone and high Homocysteine - they were the highlights but everything was a bit off too.

Thanks Karen

[hellen]

Hi, i just wondered how are you doing now, did it all work out well for you xx

[Sphere27]

Must check my private health ins! Didn't think menopause was covered?