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[Grumpymum]

Well ladies, I have just been to the doctors following a scan I had last week. Not sure if I don't understand HRT or the doctor doesn't!

I am currently on estradot 50 patches and Utrogestan 200 days 15-26 and have done three cycles so far. (Having been on different types of HRT pills and patches for a year now). I have been having very little bleeding on this regime and had been having some off-and-on mild period type pain occasionally, hence the scan. My lining is ok, I have a bulky uterus and two small fibroids, none of which is a problem.  I am having difficulty mainly with mood/anxiety etc but also general aching and lack of motivation.

Since the scan I have been wearing 1 1/2 patches increasing the dose to 75 mg and I think my mood has improved, but I am also on the utro phase so don't know if that is making a difference. My doctor has agreed to increase my patch to 75 mg, but says I can't go higher as they don't make one bigger?! She also said I need to be wary of ever wanting to increase the estrogen dose and getting over-use symptoms plus the concern about cancer.

I mentioned that the internal scan I had was very painful, not on entering (shall we say!) but when the probe was moved around, felt like it was jabbing into me deep inside causing pain. OH and I don't **** at the moment and I would be a bit scared to after that pain. The doctor said she expects it's because I'm dry and the HRT would sort that. I mentioned vagifem but she said that I can't use both together. I thought I had frequently read of ladies on here doing that, or am I imagining that?!

I also questioned about a conti regime, in case my improved mood was being caused by me agreeing with the utro but she said if I wanted a conti regime I would have to have a tablet alone, and not a patch/tablet regime. Again, I wasn't at all sure if that was correct.

The doctor thinks my tummy pains might be bowels/IBS and has given me a leaflet about that.

I have also been on citalopram 20mg daily for some time now for mood but she has given me a prescription for escitalopram 10mg as she thinks that might help. Does anyone have any knowledge of this.

I'm starting to think that if I don't improve within the next few months I will have to seek advice privately.

Sorry, a lot of different ideas/problems/requests for advice here, but it all seemed a strange conversation with the doctor!

Hopefully someone out there will have some words of advice! Thank you.

[ancient runner]

I can only help on one bit, which is that systemic HRT often doesn't do the full job on your vagina/bladder and it's perfectly valid to use local oestrogen there in addition. 

[CLKD]

Have a browse of the menus, make notes and go back to your GP and ask for local vaginal HRT! or have a word with a Pharmacist locally and check, trouble is, each prescription costs the Practice money (not that I'm cynical  ). 

Why has your GP altered your AD, I think a hike in dosage is all that is required, they are after all the same 'family'  .  Do they help anyway?

I can't see why a lady can't have HRT as well as local vaginal treatment because that's what is is, local 

[dazned]

You definitely CAN use both systemic hrt and local estrogen. When will GPs get clued up ! 

[Grumpymum]

Thanks for the responses. CLKD - My doctor suggested changing my AD because I was on 20mg citalopram but she says that due to new research connected with hearts you shouldn't go above that dose, and I did find some evidence of that thanks to Mr Google! She says the new one has fewer side effects so I thought I would try it, but I think I might hold off for a few weeks because if I change my dose of HRT and the AD then I won't know which has worked, if either(!).

[CLKD]

Does your GP recommend weaning off Citalopram?

Let us know how you get on!

[Grumpymum]

From what I understand, escitalopram is just a newer, refined version of citalopram and both are SSRIs so I am just moving from one to the other and from what I remember the doctor said, and what I have read, escitalopram is better at dealing with anxiety, so I will have to wait and see if it has any effect.

I will still have to go back to the doctors and fight the battle to get vagifem though!

[CLKD]

It shouldn't be a fight, don't go in all guns blazing but 'I've read on MM Forum that …….  ' so I've come to ask for a prescription to ease symptoms '