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[Doris]

Hello.
I'm afraid I'm not a regular poster here, I hope that doesn't count against me!
I'm 44 but went into menopause at 27. Tried many different hrts but still haven't found my perfect match, so wondered what was new in the hormone world that I could try next.
I've been on tablets, gels and patches, dydrogesterone and utrogestan.... the list goes on.
I've been lax over the last year and not been on anything at all. Symptoms haven't been that bad, but I know I need to go back on hormones to keep my bones healthy and help my libido which has completely dissapeared. The final straw has been a long bought of cystitis and thrush, most likely caused by you know what...
Which is the most recommended treatment nowadays? Best for long term? I'd ideally like continuous as I haven't had a period for over a year.
Thanks for listening.

[Salad]

Hi Doris 

Are you under the care of any professionals to help guide you in what would be recommended for you? Have you had any blood tests to check levels?
My GP is my main support (as well as online sources ). I wouldn't hesitate in asking for a referral to a specialist clinic if we couldn't find a suitable HRT for me.

All I've learned over the last couple of years of taking HRT is that it is a bit like a juggling act to keep things balanced. I know I can't function without HRT as the symptoms literally leave me unable to carry on with my normal life.

I was allergic to the Oestrogen tablets so started with Oestrogel. I used that well for a year then things got difficult with symptom breakthrough. I am now using Evorel 75 patches which is giving me many more good days than bad so I'm happy for the time being.

Good luck in finding something that works for you x

[Doris]

I saw all sorts of professionals when fertility was top of the list, then again when menopause was priority. Now my youngest is about to start school, I'm concentrating on hormones again!
Pills were ok. Gel is good but I don't have time to let it dry properly, leave it for later then forget. I loved estradot patches, but they irritated my skin after a while. I've had blood tests in the past which confirmed menopause, fsh evels were anything up to 94 and estrogen was similarly bad.
I don't want periods any more so wondered what was new for that regime? What's the difference between estrodial and valerate? Which is the most recommended treatment/method, the first place to start? Its been a few years since I last looked into hormones as I've concentrated on babies for a while!

[Dancinggirl]

Hi Doris - What about a Mirena? - often used in post meno now, this is very popular these days as it means you won't have withdrawal bleeds (some spotting etc for the first few weeks) and you can use Oestrogen in pill, gel or patch form alongside. I know you say you don't have time to let the gel dry but I've used it for years and I just apply it to my inner thighs after a shower and wait 5-10mins before dressing.  I now do this at night and leave my legs free from nightie and bed linen for 10mins and read for a bit before going to sleep - it's about getting into a good routine.
If you really want something simpler, then try Femoston conti as the progesterone in this HRt is kinder and well tolerated by many women - this could be a good to try first and see how you feel.  It could be a good idea to use some local oestrogen like Vagifem alongside full HRT - I had a premature meno like you and despite systemic HRT I am still getting problems with bladder and VA and I'm 59 so use both!!!!
Dg x

[Doris]

I had been looking at femiston conti as I liked dydrogesterone previously, but doesn't it only come in the lower dose?
I know what you mean about getting into a routine, but I'm not a routine kinda girl unfortunately.
Does the local estrogen help with libidos symptoms too? I find it very difficult to become receptive (if you know what I mean) whether that's because I'm not on any hormones at all, or because its not right "down there" I'm not sure!

[Dancinggirl]

I didn't find local oestrogen helped with libido  - only full systemic HRT helps with this and some women need Testosterone which is not available on the NHS.  I do find I need plenty of lubrication for sex these days even with lots of oestrogen and I think many women are the same in peri and post meno. It could be worth trying the Femoston Conti - though it's quite low dose you may find it still helps with many symptoms and you could still have local oestrogen alongside.
At 44 you really need some oestrogen to protect your heart and bones and if you really need a higher dose then you may have to try some of the other conti HRT preparations but you could then have issues with the progesterone. As I mentioned, the Mirena could be a good option and you could then have oestrogen in pill form if you really don't want to use gel or patch.  DG x

[Briony]

Another option might be Qlaira? I was moved from HRT patches to this as my doctor felt being younger and oestrogen deficient, my body needed a lot more oestrogen which was powerful enough to control my own hormones rather than just top them up. I was reticent at first (especially as I am a higher risk patient - migraines and family history of stroke ) but now, 4 months in, I have to say that whilst it's not perfect (ie I don't feel like I did 10 years ago) it is a big improvement. It is the only pill to use HRT style oestrogen. Only problem is this makes it expensive so GPs tend to keep quiet about it unless you ask.

[Doris]

What's qlaira? I've never heard of that!

[Hurdity]

Unfortunately oral oestrogen suppresses libido more than transdermal HRT and I understand also progesterone does the same so continuous progesterone may not be the thing.

I would agree perhaps a Mirena as Dancinggirl suggests, together with Estradot - if you can avoid scratching the site where you stick them? I know what you mean about gels because I am now applying a very small amount of testosterone gel daily and it's very annoying having to wait until it dries and 5 mins before dressing. With small children I can imagine not wanting to do that! if you really can't get on with the Estradot again then that's your only option. Make sure the patch is stuck in a different place on the other cheek, each time and don't try to rub off the marks as this can cause irritation - I just leave mine!

Yes you definitely should also use local oestrogen too!

Qlaira is the only CCP to contain bio-identcial oestrogen (estradiol), but also contains high doses of progestogen (synthetic one). Not sure what effect it has on libido and also its use in post-menopause. The oestrogen dose is pretty high.

To answer your other Q estradiol valerate is converted to estradiol in the  body but somewhere I remember reading that you eventually get about 3/4 the dose of estradiol in the system as with estradiol etc, due to metabolic losses, but can't remember exactly! If that's right then a tab containing 1 mg estradiol valerate would give you less estradiol in your body than a tab containing 1 mg estradiol.

Hurdity x

[Briony]

In your 40s, I was told you need more Estrogen? That's why I switched from HRT to Qlaira. The dose is still lower than many other COC pills, hence reason I was encouraged to take this even though I cant take regular ones. In general, it has massively helped my problems - compared with Evorel which was too hit and miss. However, I am not yet 100% into menopause, so it may be different for you?

It's worth searching on here as, although it's not well known, those who use it seem to be positive about it (check out Pixiegirl's post from ages ago - in new members I think).

Good luck x

[Doris]

Hurdity, that's very helpful thankyou!
So, transdermal is better than pills, estrodial is better than valerate.
Maybe I'll start another thread to see if there are any patches less likely to cause irritation.
Not sure I'm keen on the mireena though.