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[Tinkerbell]

I have been prescribed Estradot patches 50mg, but for 1st week I am to cut these in half.

My confusion is over the Utrogeston....100mg every day, but what I have read is that you take these for 25 days and then 3 days off.

I am 52 and my last period was in March, although that was scanty as was the one before ( January).

Worried about side effects with the Utrogeston, sleep is not a problem for me and am worried these will leave me hungover in the morning!!

Tried for a long time to get treatment, but am now frightened to take it!!

[Dancinggirl]

Tinkerbell - I am using Utro continuously - yes, one is meant to take it with a 3 day break each month but my gynae is happy for me to use it every day. I suspect that the 3 day break is to ensure that the womb lining has a chance to shed should there have been too much build up but you are using a lowish dose of oestrogen so you may be fine. Have you been told to simply take it every day? If not you could simply follow the 25 days on and 3 days off regime. 
I've been on this combo for the last 6-7 weeks and find I feel generally great.   I do feel 'relaxed' but not sleepy.  I have had spotting but this is normal when starting on any conti regime and I'm hoping this will settle in the next few weeks - it can take up to 6 months I believe.
Don't be frightened - you may be really surprised how good you feel. DG x

[Hurdity]

Hi Tinkerbell

I am on this combo (Estradot 50 and Utrogestan) - although I use utrogestan 200 mg vaginally every two months so a long cycle, and I'm in my early 60's

When you say the 100 mg every day - what did your doc actually prescribe? As Dancinggirl says many women on a conti regime take this every day and don't bother with the 3 days break, and is there to allow a bleed just in case the lining has built up a little? Some women who are still peri-menopausal are also prescribed it like this ( or even 200 mg for eg 21 days) to control their bleeds a bit better.

You are not yet at menopause because you haven't been 12 months without a bleed. The one in March may have been your last, but may not have been. If you start HRT you won't know if you were going to have another one (as with me too and many women who start HRT). The three day break is a good compromise if you may be still peri-menopausal?

I started HRT at a similar stage to you - a bit older - I was almost 54, but because I had had a period 5 months previouslsy and the one before that was probably quite a few months earlier, it was recommended that I start on cyclical HRT.

This is a good thing in that you can discover whether or not the progesterone suits you. In my case it didn't (I started with Evorel sequi) so I changed to the progesterone which was then available - Cyclogest - and remained on a cycle until age 57-8 when my doc suggested I change to continuous combined. This didn't suit me either so I am still on a cycle even though in early 60's.

If you are worried about the side effects why not take it in the cyclical way at first ie 200 mg for 12 days and see how you get on with it. Remembering of course that 100 mg is half the dose of 200 mg so as Dancinggirl finds, this dose does not give her side effects. I do wonder what would happen if I took it like this but all in all as I am sleepy anyway in the mornings, I would not want to risk being even more tired if taking prog on a continuous basis!

Going onto HRT was the best thing I ever did - my flushes and sweats disappeared and I regained my energy, able to cope with life and do so much more than otherwise - no anxiety (although I do have worries - but don't we all!). I have only ever been on the 50 mcg dose which has suited me fine - starting at the same stage as you, and after the turmoil of peri-menopausal hormones had mostly subsided.

Go for it girl 

Hurdity x

[Tinkerbell]

Doctor said to take 100mg Utrogeston every night, but did say I could take vaginally if I wanted to.
I also have to take Vagifem daily for 2 weeks as well, so I guess I can't use both at the same time though.

I am so confused, will the lining build up if I don't have a bleed and if you don't know when/if your are going to get a period how do you start it?

Thank you both for your help.

[Hurdity]

Hi again Tinkerbell

It is confusing at the beginning isn't it!

When I am using utro (which I always use vaginally) I use the Vagifem in the mornings. My reasoning is - since having children the utro is more likely to drop out than the Vagifem which sticks to the vaginal walls!

The aim of continuous combined HRT as you have been advised, is that the continuous progesterone prevents the lining from building up and therefore you don't get a period. Some breakthrough spotting/bleeding is expected initially with any continuous combined HRT, and if you are not yet post-menopausal then your own hormones may break though at some point - but probably unlikely to cause a large bleed.

If you want to continue with a cycle (ie have a period) then take it for the 25 days per 28 ( although if you are very late peri you may well still not get a bleed) or double the dose for 12 days out of 28 (again if used vaginally you still may not get a bleed). Some evidence from scientific literature shows that less utrogestan is needed with vaginal use as more is absorbed this way - and especially directly to the uterus - but reduction in the licensed dose should only be done under doc supervision or if you know from your own cycle and past scans that there is no endometrial build-up. My gynae GP (NHS) is happy for me to do a long cycle and use Utro vaginally.

Is this even more confusing? I hope not!!!

Hurdity x

[grumpyjane]

Yes I´m still confused!

I have a private doctor appointment next week here in Venezuela, as my symptoms have become unbearable and I´ve decided it´s time for action! (58 and post meno, never used HRT) I´m doing lots of research into what I MIGHT like to take - no, I won´t self-prescribe - and then looking at generic names to see if available here. Obviously a doctor here might have completely different ideas to one in the UK.
I´m also not very fluent in Spanish and as for medical terms ha! Luckily fluent OH will be going with me.

Anyway, my confusion is... 

I would like to try patches, but do I need vaginal oestrogen as well?, or does it depend on symptoms?. I have bad VA which makes sex very painful.
Then I suppose I need progesterone to protect the womb. Can this be take vaginally as well? Or in patches? Utrogestan is progesterone, right? I would prefer not to take anything orally. Hurdity, what do you mean by long cycle? Please!

Gawd help me...

J x

[Hurdity]

Oh grumpyjane!!! I know how you feel - it's taken me years to get to the stage where I understand it all ( well a little anyway!).

Firstly - do you need vaginal oestrogen as well? The answer is not necessarily. Local oestrogen alone is sufficient for some women with VA, and similarly systemic HRT ( ie pill patch or gel) is also sufficient on its own for some women with menopausal symptoms and VA. Some of us need both. I am one of them. Personally in your position I would get going with vaginal oestrogen asap because it acts quickly on this area directly.

I've forgotten if you have other menopausal symptoms too. Depending on when your last period was you might want to acclimatise to added oestrogen gradually eg start with the Vagifem and then move on to patches etc if you want - unless your other symptoms are also bad. Alternatively you might want to just go for it!

Yes you do need progesterone to protect the womb. This can be done in a variety of ways - look under Treatments/HRT preparations - top menu. Combi patches ( Evorel and Femseven) have oestrogen and a progestogen. If you want to take them separately then you would take a pill, patch or gel for the oestrogen ( look at oestrogens - top menu) with separate progesterone (also same menu) - either a synthetic one (MPA), or micronised progesterone (Utrogestan). In UK the licensed use of this for HRT is orally although elsewhere in Europe it can be used vaginally and private gynaes also prescribe it like this - for those who experience side effects with oral use.

By long cycle we mean anything longer than the standard 4 week cycle - most HRT aims to replicate the timing of the natural 28 day menstrual cycle. Some of us even though post-menopausal still continue to have a cycle because we don't want to be on  continuous progesterone because of the side effects. Because of this also some of us therefore find the 28 day cycle too often to have progesterone and then be bleeding so with doc's approval we have a longer gap between the progesterone part so the withdrawal bleed happens less often.

If you are post-menopausal it is usual to actually take the progesterone and oestrogen every day which avoids a bleed (although there is some spotting often to start with).

However if you are starting HRT for the first time my experience (as one who doesn't like progesterone) means I would recommend anyone in your position to start off with a cycle for the first few months at least - and then you can sort out what any side effects might be due to.

Does this help at all? Hope it's not too repetitive or rambling!

Hurdity x

[grumpyjane]

Hurdity, not at all rambling, and I need repetitive!

Well, at least 4 years since my last period so it might be a good idea to start gradually. I do have other symptoms too though - flushes, insomnia, tearfullness, clumsiness, irritability, loss of libido, VA.... Will see what the doctor recommends, and I think if I start to some improvement in SOMETHING it will help no end, and I won´t feel so desperate. 

I´ve already printed of loads of stuff from the top menus, and have been busy with my highlighter pen.

I want to avoid the tablet option, at least to start with. I agree with you - and I´m sure many others - that it´s better to get direct to where you need it, not in my stomach/liver.

I must say, having found this forum and all you lovely ladies I´m feeling much more positive. 

I´ll let you know how I get on!

J x