Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Rosie500]

I'm 51, around 18 months since my last period. Was rather ignorant about the menopause; had 2-3 years when the debilitating fog etc would come and go but thought if I soldiered on I'd be fine once my periods stopped. Now I've educated myself a bit I realise this was not quite how it works and with hindsight I've been having issues for many years.

I went to my GP for HRT, he explored the anxiety/depression route but seemed to accept I was definitely hormonal when I told him I found mowing the lawn very scary! I have taken Elleste Duet Conti for 5 weeks, less hot at night but otherwise not much difference - I've just experienced a big dip and meltdown. I gather the "accepted" plan is to try different types of HRT for at least 3 months each; my instinct is I'd like to have a go with something bio-identical like Hormonin plus Utrogestan but that is way down the list of preferred options (more expensive!) and I don't know if I can take another year or so (on top of the previous few years) of feeling this way until I get to that, if indeed it would help me. I'm worried too what effect the NICE guidelines which are due out soon will have. I'm trying to track down a GP in my area who has an interest in HRT and may know more but have been unsuccessful so far. I just want to see a doctor who understands what I'm experiencing and can offer some suggestions as to what might help. One thing I've learned from MM is that menopause seems to be a really individual experience and rather complicated so maybe expecting a GP to be able to help is a bit unrealistic.

So I've been wondering if I should see someone privately; I'm in the West Country and I've come across the website of Dr Annie Evans who seems pretty clued up and I get positive vibes about her on this forum. It seems to me that a doctor who deals with this stuff all the time (and is actually interested in it) must develop instincts as to what will help certain types of women. Does anyone have any views on what might help me? I don't know what to think any more; I don't want to carry on like this but I'm almost afraid to get my hopes up. And my brain isn't functioning normally so decisions are tricky. I've got savings to cover this sort of thing so the cost isn't a big issue, though of course it would be lovely to have comprehensive treatment on the nhs 

Any insight/experience would be much appreciated. Nobody I know has used HRT - I keep asking! If I need to give any more info, do ask; I could write reams but have attempted to keep it brief-ish. Thank you.

[Rosie500]

Thank you so much sparkle - it's good to know I'm not alone any more. I picked the mowing the lawn example (from a long list ) as I knew he would realise this was my hormones affecting me. I gather it was mentioned in my notes; I did observe his eyebrows shoot up at the time.

[dazned]

Hi 

It is usual to try to stick it out for at least two if not three cycles to allow your body to adjust to the extra hormones your body is getting. Dr Annie Evans comes highly recommended but before you spend any money,as you say we shouldn't have to should we,if you can't get settled on elleste conti do try Femoston conti lots of women do well with this and has a much kinder progesterone part to it. Hope you soon get settled soon.

[Rosie500]

Thanks dazned, Femoston conti is second on the list, I was just a bit worried it is a lower amount of oestrogen. I thought (or hoped!) that dydrogesterone may suit better than norethisterone though. It's the thought of being like this for months, wanting to cry all the time, which tempts me to go down the private route. I so glad I found MM!

[Mary G]

Rosie 500, I would have no hesitation whasoever in recommending two things:

1) immediately book an appointment with Dr. Annie Evans to discuss HRT, she has been recommended on here and knows exactly what she is talking about; and

2) start using transdermal bio identical HRT asap, preferably 2-3 pumps of oestrogen gel every day (the best thing ever invented in my opinion and you can adjust the dose which makes it more flexible) and then 7 days of Utrogestan 100mg each month taken vaginally (more effective with fewer side effects).  You may also be prescribed Testosterone.  Dr Evans can prescribe this medication for you and you might have to pay for a private prescription but it will be money well spent.

Please don't allow yourself to be fobbed off with anything that is not transdermal and bio identical because it is cheaper - the reason that stuff is cheaper is because if has more side effects and does not work as well, believe me, I've tried plenty of them and this is the only thing that works for me. 

Don't suffer in this way, there is life changing treatment out there that actually works and makes you feel normal again.

[dazned]

Femoston conti is 1mg estrogen .

[Hurdity]

Hi Rosie500

  from me too!

When you first start HRT and you are post-menopausal - I always say that it's a good idea to start with a cyclical HRT because it allows you to distinguish between the side effects of the oestrogen (which settle very quickly) and the progestogen ( which may not). Also the continuous type means you are having progestogens all the time and can give rise to continuous side effects - and some schools of thought suggest that it also attenuates the beneficial effect of oestrogen. The downside of the cycle is putting up with a bleed - not fun in your 60's as I am - but the lesser of two evils ( ie conti prog!). The type you have been given contains the progestogen norethisterone - which causes all sorts of side effects in some women - but you don't know if this is the reason in your case.

Many women find that the physical symptoms of menopause recede first, but some of the psychological ones (related to the physical) - such as anxiety, mood etc, take a bit longer. Certainly you won't have felt the full benefits of the oestrogen yet, after only 5 weeks, but as I said this may be confounded by the effects of the norethisterone.

The other thing is Elleste Duet conti is 2 mg oestrogen which is quite a high oestrogen dose to start with for some post-menopausal woman who have been without it - but if you didn't get any side effects from this then great! It's usually better to build up slowly. Tablet HRT especially can cause more side effects sometimes because of the breakdown products from going through the liver first - only a small amount of the oestrogen in the tablet actually gets into the system as Estradiol - the one we want.

Re looking for the right type. I'm with Mary G on this one. I was always nil-by-mouth for HRT right from the start (almost 54) - having researched the different types - as being the most natural way of gettng into the system and avoiding all that metabolic stuff not to mention digestive problems (stomach) which seem to affect some women.  If you want to continue with oral oestrogen I'm not sure that I would choose Hormonin. I can't see why estrone needs to be part of it, since much of the estradiol in oral HRT is converted to estrone in the liver so can't see the rationale behind this one.If you are wanting a bio-identical HRT, then rather than Hormonin, a patch or gel would be preferable (I use a patch). Which of these you choose comes down to personal preference, lifestyle and perhaps even your skin! Each has its devotee! I have only ever used a 50 mcg patch oestrogen which I started when I was very late peri-menopause - and have never needed a higher dose to eliminate symptoms. Some women like a bit more than this 

In terms of the private re NHS - I would always advocate NHS route - because all of this should be available to any woman - the product of her choice, and indeed the choice of whether or not to take HRT. If your GP has offered HRT and you want to try a different type - what you need to do is go back to him and explain that you've read about it now and you prefer to take "bio-identical" HRT - and you will need to explain that you mean the molecules that are identical to our own body, ie estradiol and progesterone.  Say you do not want to take synthetic progestogens - full stop. And then be absolutely firm. This is your right!

All the mainstream HRT I have used (and it does include products not licensed for HRT - before utrogestan was available) has been from my NHS doctor - one that specialises in gynae issues. When I friast asked for utrogestan I saw my regular GP who hadn't heard of it but looked it up in her book and then prescribed it  - because I said that was what I wanted. It can be down as the generic "micronised progesterone". Print off the relevant parts of this website ( look under Treatments/HRT preparations - top menu) if the doc is bemused at your choice.

Why are you worried about the guidelines? They (hopefully) will confirm that it is for you to discuss and agree the best way forward for you with your doc.

West Country - I'm a WC gal too - but it's a big place  . You probably don't want to say where on here - but once you've made 10 ("useful") posts (not this and that and humour) you can send a pm. Annie Evans operates in Cornwall and Bristol ( once a month for a couple of days - the latter) and if you have savings, she's not expensive. I understand that maybe she can write a prescrption to send to your doc so you only have to go once.  (She does write to your doc anyway). She doesn't do blood tests. I only went to see her for testosterone because that isn't available on NHS although provision is there in the draft NICE Guidelines for forward thinking docs to consider it!

I agree - no need to suffer - I only ever felt good on HRT - once I'd found out that Eovrel sequi wasn't good for me ( the first 3 months - I didn;tlike the norethisterone either)

Hope this helps - sorry I'm not good at being brief!!!

Mary G - do you still see Annie Evans regularly or just the first time you got HRT?

Hurdity x 

[Mary G]

Hurdity, I consulted Professor John Studd (London) but I have heard good things about Dr. Annie Evans and many have recommended her.  As you say, geographically, she is ideal for those in the west country.

[Trufflecat]

Hello. I am new here too!
Utrogestan is not expensive, so don't be fobbed off by that. I asked my GP the cost and it is more than coveted by the prescription charge.

[Mary G]

Thanks JoyceBarnaby, I'm glad you have liked my posts!  I would like to think that my personal experiences will be helpful to others.  Thank goodness for professionals like Professor Studd, where would we be without people like him? 

Stellajane, 7 days of Utrogestan 100mg per month is the minimum but when taken vaginally it is far more effective and hits the spot.  You may remember from my previous posts that I am severely intolerant to all progestins (and Utrogestan to a lesser extent) so that is why it has to be kept to a minimum and I do have regular scans.  There is no reason why other women who do not have this problem can't take 200mg for 7 days instead. 

Trufflecat, you are right, Utrogestan is not expensive and if you buy it in Spain, is only costs about €4.00 per box. 

[Rosie500]

Thank you so much for the welcome and the very detailed and helpful answers Hurdity and Mary G. Lots to take in! I really don't mind having a bleed so the idea of the cyclical HRT to start with sounds sensible: I've read that some women feel bad on "the green pills" (I think) so it would be a useful way  of establishing whether or not I was someone who had a problem with certain progestogens.

As for NICE guidelines I'm worried because a) I'm generally worried at the moment! and b) I'm very aware of the ridiculous amount of pressure put on GPs to cut prescribing costs/referral rates and I do wonder if there will be any advice to hold off prescribing bio-identical HRT until the cheaper avenues have been explored. I mentioned Hormonin in a fairly random way, not being very au fait with the drugs; utrogestan was the only progesterone I came across! I don't mind at all how my HRT is delivered and your explanation of the advantages of transdermal vs. oral makes sense.

Hi Trufflecat, re utrogestan, it doesn't seem expensive to me but I don't think us paying the prescription charge makes any difference for the GPs' prescribing rules, it's more of a tax really; the rules seem rather draconian and do seem to stop them doing what they might otherwise choose sometimes.

Mary G, I will have to look back at your posts too, they sound helpful. I had heard about being able to buy drugs cheaply OTC in some European countries!

Well I will continue on my quest to find out more. I just wish I'd started a few years ago; I'm so worn out now it seems quite daunting. At least I know a little more about my options though. It's so helpful to read about other people's experiences here - such an encouraging forum. Thanks again everyone.

[Hurdity]

Hurdity, I consulted Professor John Studd (London) but I have heard good things about Dr. Annie Evans and many have recommended her.  As you say, geographically, she is ideal for those in the west country.

Of course you do Mary G and sorry for not remembering - we had that er discussion the other day about THAT cream and progesterone in general on THAT thread . My brain really isn't working at the moment - just coming to the end of my 12 day bi-monthly Utrogestan and everything is a bit hazy and I'm very tired! (well that's my excuse for bad memory anyway!).

Rosie500 - it's a pleasure to try to help. Most of the time I am not worn out - on HRT- although more tired that I was but I am around 10 years older than you. HRT should make you feel on top of the world - well - compared to how you feel off it, and after side effects settle you should remain on an even keel.

My reason for patch preference is I don't feel the dose is as subject to the vagaries of the individual applying it in terms of dose and consistency - but I guess if you yourself apply the same amount in the same way - you should give yourself a consistent dose at least. As I said both methods have their devotees!

In terms of the budget pressures - I don't seem to have encountered this where I live in W Country so perhaps we are more fortunate here - but I think if you decide what you want, understand the reasons, then your doc should prescribe it. If necessary take someone with you as an advocate ( parnter, friend, relative) if you aren't feeling very assertive.

I agree with Stellajane re the utrogestan - if you are prescribed it on NHS, I would start with the licensed dose ie amount - if you have it on NHS. That way you can see what your bleed is like and then if necessary vary it, under medical supervision. If you are going privately then whatever they suggest - but the reduced dose is only recommended for those with progesterone intolerance as it is recognised that it can lead to more cases of endometrial hyperplasia, notwithstanding that vaginal use gets more to where it is needed. You might be OK with it though 

Good luck.

Hurdity x

[CLKD]

 

 

[Rosie500]

An update - I had a phone consultation with my very nice GP. I'd put down a request for bio-identical HRT in writing, with my reasons for asking. So I have a prescription for oestrogel and utrogestan on the way. I've been reading a lot and my poor fried brain is struggling to take it all in so I am slightly confused about the progesterone side - (I think) I know it is to protect the uterus and on this website in the treatment drop down bit it says 100mg for 25 days out of 28 for postmenopausal women. But I also think I've read somewhere this can be done differently. Basically I wonder that if my body doesn't like progesterone too much, could I take it for fewer days ?higher dose. Or is that for perimenopausal women? I really don't mind if I bleed. I just can't grasp how it works yet; there has been too much information going in my head during the last week. I may be totally fine with the utrogestan nearly every day but I just wondered if there was a choice of how to use it whilst protecting the uterus.

Thank you so much for the advice. I am slowly wading through the posts on the forum from you lovely people but it may take me some time  Your support gave me confidence to ask for what I think will help me. And I have the prospect of consulting Dr Evans if it comes to that - I always like to have a plan B in reserve.

Thanks again - you have given me some hope.

[Hurdity]

Hi Rosie500

Great news - and so pleased that we have been of some help to you

Yes you're right there is a choice - it doesn't matter whether you take utrogestan 200 mg for 12 days per 28 or 100 mg for 25 out of 28 ( or even 28/28 as some women do) if you are post-menopausal. If you look at the drop-down menu for peri-menopause it give the 200 mg dose. So - it's OK for post-menopausal women to have a cycle (as I do), but not OK for peri-menopausal women to take continuous combined HRT - only in that it makes bleeding more unpredictable if you are still having a cycle. The exception is with the Mirena coil which delivers continuous progestgoen to the uterus wherever you are in menopause and in many women stops bleeding completely.

What dose of gel have you been prescribed and is it oestrogel or Sandrena?

Some gynaes do not agree with bleeding (ie continuing to have a cycle for post-menopausal women) because of the increased risk of endometrial cancer, but for those who are progesterone intolerant, this provides the only option in order to reap the benefits of oestrogen. There is also the view that continuous progestogen increases the risk for breast cancer - but this may well only apply to the synthetic progestogens - there is still more research which needs to be done!

As I probably said upthread - lifestyle factors are so important and you can minimise all cancer risks by making modifcations and changes if needed to make sure you are as healthy as possible in other ways.

Good luck with your prescription and treatment and do keep us posted with how you are doing. 

Hurdity x