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[Dancinggirl]

Hi all
I thought I would share my recent experiences with you all in the hope it might be helpful.
I started back on HRT last autumn after having a one year break from HRT. During the year without HRT I was a struggling with burning urethra/UTI type symptoms (despite using local oestrogen) and the flushes, loss of sleep etc. were making life tough - because of my age, the GP was relieved when I suggested I see a gynae privately for advice. I went to see a lovely eminent gynae in Norwich who specialises in meno - I have to say that if every women was given such excellent advice and treatment as I've received from this man, then the menopause would be a much easier journey.
I suffered an early menopause so have used HRT for over 20 years - I've tried just about everything and have always found the progesterone a problem. In my mid 50s I had a Mirena for 4 years which wasn't too bad but I still found I felt a bit sedated on this.

This lovely gynae started me off with Oestrogel (between 1-2 pumps per day) with Utrogestan, allowing me to try a longer cycle with only 100mg of Utrogestan for 14 days every 6 weeks. This was OK for the first couple of cycles but I did start to get some erratic spotting and the withdrawal bleed became rather longer and painful - he warned this might happen with a long cycle and this very low dose of progesterone.
At my next appointment he suggested I increase to 200mg of Utrogestan on a slightly shorter cycle. I did this for a couple of cycles but this also resulted in some erratic bleeding and spotting.

I saw him again today and he did a scan to check everything and my lining was fine (a relief to know).  Through all my visits he has explained the reasons for balancing the amount of hormones to give relief of symptoms with minimal side effects and, as I'd done my research on this site and learned so much from the many knowledgeable ladies that post on MM, this enabled me to understand all that he explained.

He has now suggested I try using Utrogestan continuously as I'm finding I feel quite good on this particular type of progesterone - such a relief to find something that doesn't make me feel I want to kill people!!! ;
My new regime will be one pump of oestrogel with 100mg of Utrogestan daily.  If the bleeding continues I have to increase the Utrogestan to 200 mg daily.

How do I feel overall being back on HRT? Well, calmer and more in control.  My burning urethra has improved so I now don't need the local oestrogen.  Though I haven't actually lost weight, my muscle structure is better, my joints ache less and because I have more energy I get more exercise.  If I can sort out this erratic bleeding then for me it's a 'no brainer' - HRT brings far more benefits. Oh, I forgot to mention  - libido has definitely returned a bit so I have a happy husband - I have to say it feels great to feel feminine again.

We hear so many horror stories about HRT and I still have to find the right balance of hormones but it is worth persevering.

Hope this info is useful for you all and I'll keep you posted about who I get on.  DG xxx

[CLKD]

  for the up-date! Your Gynae sounds knowledgeable and seems to be OK about working with you. 

[Dancinggirl]

I do get the impression that the gynae I'm seeing is one of those trying to educate the GPs and promote  appropriate treatment of the menopause. I know he is particularly concerned about women who experience early menopause or have had a hysterectomy when still young and are not given HRT to protect them in the long run.
It is very refreshing to be listened to as well - lovely man.  Dg x

[CLKD]

   he could be a Travelling Showman 

[peegeetip]

Great post , glad your on the up () and wonderful that you have a doc that is supporting you

[Sunnydays]

Hi DG, only just seen your post and I'm glad that you too saw an understanding consultant and  that it's working for you. In my post re gynae, I'm not sure if mine is so clued up on hrt but he seemed to know all about it and quite happy for the customised route. Could I ask if taking Utrogestan everyday prevents you from having bleeds? I'm a bit worried about this long cycle; mine has said 90 days! Oh dear, I know it's trial and error but it does get scary!

[Dancinggirl]

Hi Sunnydays
I am certainly no expert but having learned so much from MM it has enabled me to move forward in a positive way.
Re: Utrogestan - this is a bio identical progesterone and is seen by many as the best form of progesterone to use - especially when older and at 59 my gynae seems keen fro me to stick with this. However, for some it may not be ideal and I think there are issues around absorption which I think can lead to a greater chance of problematic bleeding.
Whilst MM members like Hurdity have managed a longer cycle (5-6 weeks) using Utrogestan it may not be the ideal progesterone to do the longer cycle of 3months (or just 4 bleeds a year).  My gynae explained that to get the uterus to shed properly then it is not just the right dose but also using it for long enough to make this happen. Provera is stronger than Utrogestan and if you are using progesterone to induce a bleed only 4 times a year then Provera in a high dose over those 12 days will probably be used to ensure the lining does shed properly. 
It is normal when starting a continuous HRt regime to get bleeding or spotting in the early weeks but now I'm using Utrogestan 100mg every day I'm hoping this will settle in the next 6-8 weeks - my gynae if expecting this to happen.   If it doesn't then I've been told I should double the dose which I am not keen on as Utrogestan does make one feel a bit sleepy on the higher dose. I would rather go back to having a 4-5 week cycle if this conti regime doesn't work.
I did respond to you on your post and my feeling is you should try the longer cycle first - use an oestrogen patch and the Provera progesterone for the 12 days and see how you feel.   Over thinking things is not good sometimes and you do sound very scared but I think you have everything to gain and nothing to loose - especially as the oestrogen will really help with the discomfort you are getting around your 'lady parts'.
You will probably feel much better being just on oestrogen patches for 3 months but do try to use 50mcg patch to really get the benefits. 12 days on Provera may be a bit tougher but as you've only used the really strong synthetic progesterones so far, Provera may not be as bad. You have been told to have a scan after the first bleed which is good and you will have a better picture of whether this is working well for you. If it doesn't suit you then you could try Utrogestan continuously.
Do be prepared for some tingling and strange sensations as your whole vaginal area wakes up and welcomes the oestrogen - it can feel strange.  You may get sore breasts as well but this will all settle.
You are doing the right thing so go for it and enjoy the benefits.  DG x

[Peterspots]

You give me hope.  Particularly with the urethra/bladder symptoms. I hope one day to post such a positive post

[andius]

DG:

What does your estrogen dose come out to daily do you think....25mg, 50, 75, or 100mg?....or in between those?

Are there days that you have to use more of the gel?  You said 1 to 2 pumps, so I am curious as to the avg daily dose you use with the continuous oral 100mg utro.

Andius

[Dancinggirl]

Hi andius - I use only one pump per day now. What dose that would be as a patch I'm not sure - possibly around 30mg.  I know that my oestrogen level is around 400-500 when on 2 pumps per day and I'm hoping my levels would be about 300-400 on one pump which is probably just right.  I apply to my inner thighs at night and take my 100mg Utrogestan at the same time. I have found I feel better on one pump rather than 2 pumps, which seems strange as so many women feel they want and need a higher dose.  We are all different and I think each women will absorb oestrogen differently. When I tried a patch I felt as though I got a big boost to start with and then it tailed off really quickly. I am now into my 5th week of continuous Utro and still getting some spotting which is a bit of a nuisance.  I have been told I should increase to 200mg of Utro daily if need be to control any spotting but I'm hoping that in a few more weeks things will settle and I won't need to increase the dose.
I have to say I'm feeling really good generally - much calmer, less discomfort around my lady parts and fewer trips to the loo at night.  Really glad I tried conti Utro.  Dg x

[Hurdity]

Wow Dancinggirl - if my levels could be 300-400 on one pump of oestrogel I would change to this like a shot! That is quite high for such a low dose of gel isn't it? No wonder you feel so well!!! Last time mine were measured on a 50 mcg patch they were 212!!! I think I've left it too late to increase now....

Hurdity x

[Dancinggirl]

Hi Hurdity - I don't know for certain that my oestrogen levels are that high.  All I know is that when I was tested before I was advised to come off HRT at age 57, my level on 2 pumps per day was 600!!! After I went back on HRT and had been on 2 pumps per day for around 4 weeks my levels were already about 475 so this is why I assume I must be at about 300 as I do feel good.  I think I must absorb the gel well!??  Dg x

[Sunnydays]

DG, I have only just seen your comment on here that was intended for me - thank you. I'm glad that you feel you are getting sorted to!
A couple of things (don't want to detract from your thread) when you talk about your levels- what levels are these? I looked back on the only blood tests that the GP did for me re the meno when i'd had no periods for about 6 months and the serum oestrodial was less than 50 pmol/L, the serum FSH 109 u/L and the serum LH 49.3 u/L. Gosh knows what these mean except the GP said "menopausal profile" Which one of yours is about 300/400?
This is purely interest, I'm not overthinking; just again realising how little I knew/know about the meno haha!
x

[Dancinggirl]

Hi Sunnydays - I think the first one 'Oestrodial' (yours was 50 pmol/L which would indicate a very low level) would be the oestrogen level and FSH is another indicator for menopause.  I'm not sure what the LH one is??
I know that the FSH level is more significant as if this is high then, even if your oestrogen levels are not bad, it shows that your ovaries are struggling to produce oestrogen - or at least that is my understanding.  So you could have a reasonable level of oestrogen but a high level of FSH and this might indicate peri meno.  Having said all this, blood tests can be misleading as in the peri meno stage they will fluctuate greatly so it is only in post meno that oestrogen levels will bottom out about 2 years after your final period.
Your reading seem to indicate post menopause as you have low oestrogen and very high FSH. My oestrodial levels on one pump of Oestrogel per day I believe are between 300-400 but that is only my guess based on my levels when on 2 pumps per day.
Hope that makes sense.  DG x

[dahliagirl]

LH is luteinising hormone.  It usually spikes at ovulation.  If it is constantly high, that is another indicator of menopause, like the FSH.