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[Goosieloosie]

Just need a bit of advice as I swapped from Evorel conti to Femseven conti a few days ago & I feel so awful  . I don't know if it's just a temporary blip due to the change over or if I'm just not suited to Femseven or synthetic progestins ?? . I wasn't happy with the Evorel as my boobs were sore & huge, I was weepy once again (I had picked up loads and was really happy at the start of taking Evorel but could feel myself getting lower & lower moods) plus I was fed up with the on/off erratic bleeding so I swapped to Femseven only 3 days ago & omg I'm so much worse already, not only am I still bleeding but I feel sick, my mood has plummeted and I'm crying at the slightest thing, I had a big row with DH last night & honestly I could've murdered him....I feel exactly like I did before I had any HRT...the only thing atm that has improved with HRT is the constant hotness & joint stiffness, other than that I feel pretty rubbish  . I'm so so disappointed as I felt fantastic the first 2 weeks on HRT.
What do I do next?? Do you think it's just the transition between Evorel & Femseven and it will settle or do you think possibly I'm intolerant to progestins?? The constant sickly feeling I've only had while on Femseven.
I'm so desperate to have that feel good feeling again that I had at the beginning, reminded me of my younger days 
Thank you for any advice or reassurance anyone can give me as I'm truly feeling really low 

[Hurdity]

So sorry to hear about this Goosieloosie. Unfortunately it may well be the synthetic progestogens causing the problems. This is one reason that many of us choose to remain on a cycle even though many years post-menopausal (in addition to the sometimes irregular bleeding/spotting that can occur). The feeling sick I thought was usually due to sudden increase in oestrogen especially as you are receiving hormones transdermally - but I might be wrong there - in which case this usually settles fairly quickly. It could be that you are absorbing the oestrogen slightly differently with the two patches. However increased oestrogen does not cause low mood - that is not its function ( although sometimes HRT preparations can cause blips due to dosage and delivery method).

My view would be to try to ride through the next few weeks and see if these side effects settle - tell yourself (and your DH!) it's the bloody hormones and see if you can get through. If after a few weeks you still feel the same or no better I would seriously consider changing to a cyclical HRT - either Femoston (if you are happy with tabs - can't remember how old you are), or patch/gel with separate progesterone. I have been on this combo for years and my mood is stable.

Of course during peri you will still expect mood swings but the aim of HRT in addition to health benefits etc is that you feel better on the whole on it than without it!

Hurdity x

[dazned]

No advice sorry but just wanted to send you a  and to empathize with you.
Its all trial and error Im afraid and what works for one might not work for another unfortunately ,if only.
But you do need to give each hrt time ,at least a couple of months ,if you keep changing your body wont know which way is up.

[Goosieloosie]

Thank you both, Hurdity I am 54 and post meno & would prefer not to take tablets as I'm a migraine sufferer. I forgot to add in my original post that i have also been getting headaches every afternoon  though my migraine has improved since being on HRT overall.
I bashed my elbow just before. (not so hard though that normally I'd cry or anything) but I burst into tears & felt overwhelmingly sick, I'm fed up and feel I want to rip the patch off 
Obviously it would be sensible for me to persevere a few weeks to see if all this settles down but I just don't like the person I am atm and don't know how long I will be able to function feeling like this 
Hurdity...If I was to go onto a separate oestrogen patch & Utrogestan how many days would I take it for to have a cycle?? Would it be 2 weeks the same as the other progesterones? And would Utrogestan taken as a tablet every day be ok with me suffering migraine?

[dazned]

You can use utrogeston vaginally so should overcome any migraine issues.

[Goosieloosie]

You can use utrogeston vaginally so should overcome any migraine issues.

How many days would I have to use it for? Is it 2 weeks ?

[Tinkerbell]

I was prescribed 100mg Utrogestan to be taken continuously, but pharmist  queried that as it is normally taken for 25 days,  I had my last period 10 months ago.
In the leaflet it said alternatively 200mg could be taken for 12 days.

[Mary G]

Goosieloosie, if you are a migraine sufferer, chances are, synthetic progestins will make them worse.  Do you know why your doctor prescribed this type of HRT, was it because you don't want to have periods?

Your previous HRT contained norethisterone which is notorious for creating low mood, breast pain and migraines (although you say the migraines improved when you too Evorel?) but your new HRT contains the same progestin as the Mirena coil but obviously unlike the coil, it is not mainly concentrated in the womb and will circulate around your body.

The fact that your migraines have improved overall since taking HRT would indicate that you are the same as me, you need oestrogen to stop the migraines but the progestins ruin the good work that the oestrogen does. 

Did you have migraines during your reproductive years and if so, where they just before a period?

After years of being on the wrong medication, doing my own research/trials and seeing Professor Studd, I now know that I must have a steady dose of oestrogen and a minimal amount of progesterone in order to avoid migraines - silent migraines in my case which consist of migraine aura without headache.  I am not a migraine sufferer per se, I only get migraines if (a) my oestrogen levels fall too low and (b) I take synthetic progestins.  I never had migraines during my reproductive years despite taking the BCP because apparently my own natural progesterone overrode the synthetic stuff.  It was only when I stopped producing my own progesterone that I started getting the migraines when taking progestins.  Synthetic progestins alter the brain receptors and cause migraines in some people.

It sounds as though you could be similar and if that is the case, you need to take a separate transdermal bio identical oestrogen (gel or patch) and bio identical Utrogestan (preferably vaginally) for 7 days per month.  I now take 1 pump of gel every 12 hours (to get an even dose) and 100mg of Utrogestan for 7 days per month plus a pea sized measure of testosterone.  It does mean having periods again but it is a small price to pay for getting back to normal.  So far, it seems to be working!

Hope that helps.

[Goosieloosie]

Hi Mary, Thank you for that very informative reply. I was put on conti patches because I was 14 months without periods and I am 54 & because the patches are supposed to be better for migraines sufferers rather than taking tablets. Yes my migraines have most definitely improved both with the Evorel..... and so far on Femseven I haven't had one...but it is early days although before HRT I was getting migraines about 5 times a week sometimes. I started getting them in my late 30's when I was still having a normal menstrual cycle but I can't remember if they came just before a period or not  I do remember though that they became more and more frequent as I ventured into my late 40's (obviously peri menopause) & even worse after menopause although I never knew at the time that this was what was causing them. Not one doctor had ever suggested HRT to me or that they might be menopause linked.

If I don't feel better on Femseven I am dreading going back to my GP as she just didn't seem to have a clue, she had to look Femseven up despite her being of a menopausal age herself  so trying to explain to her about utrogestan will be a challenge I'm sure, I briefly mentioned gels to her but she looked clueless and said she would have to ask and find out about that if that was what I wanted  . Do you think I would be ok taking Utrogestan orally being a migraine sufferer? So 7 days a month would be all I would have to take it for?? And this induces a bleed when you stop?  I feel quite anxious at the thought of trying to explain all this to my GP if the Femseven doesn't work out 

[Worrywart]

Goosie, I had a lot of trouble with the progesterone in Evorel, and was switched to Evorel estrogen only patches and provera for 10 days a month. That worked for several years then I switched the prog to Utrogestan 200 14 days per month, and eventually 100 all the time. Ask at your GP surgery if any of the doctors have a special interest in menopause/women's health and ask to try using two products. The progesterone in patches is not nice but the estrogen part works very well. I hope you get it settled soon. It's very hard to think straight about this stuff when the meds themselves make you so miserable but see if someone with more knowledge can see you.

[Goosieloosie]

Goosie, I had a lot of trouble with the progesterone in Evorel, and was switched to Evorel estrogen only patches and provera for 10 days a month. That worked for several years then I switched the prog to Utrogestan 200 14 days per month, and eventually 100 all the time. Ask at your GP surgery if any of the doctors have a special interest in menopause/women's health and ask to try using two products. The progesterone in patches is not nice but the estrogen part works very well. I hope you get it settled soon. It's very hard to think straight about this stuff when the meds themselves make you so miserable but see if someone with more knowledge can see you.

Thank you for that, ironically the GP I chose to see at our practise is actually the one that deals with womens health & contraception & she fits the mirena coil so I thought she would be the best informed  I was actually gobsmacked at her lack of knowledge 

[Mary G]

Goosieloosie, yet another GP who knows nothing about the menopause or HRT, you are lucky she didn't start Googling, I despair.

Hormones are Professor Studd's speciality and he always prescribes 100mg of Utrogestan for 7 days per month for hormonal migraine sufferers and from what you have said, it would appear that your migraines linked to low oestrogen levels.  That is the minimum Utrogestan dose and it always produces a robust bleed for me.  It is much more effective when taken vaginally because most of it reaches the womb and it also carries fewer side effects like breast pain, headaches and digestive problems so I would recommend you take it that way. 

If you are happy with the oestrogen only patches then it would be better to stick with them and change to the separate Utrogestan.  Otherwise, you could ask for the oestrogen gel - the new NICE guidelines mean you should now be able to get the gel and the Utrogestan on the NHS.

Good luck!

[Tinkerbell]

Do you have to have a yearly scan if you only use it for 7 days?

[Goosieloosie]

Thank you Mary, I will try persevere with the Femseven if I possibly can & if things do not improve my next suggestion to my GP will be to try the Utrogestan. Tinkerbelle has a point, do you have to have a scan regularly if you only take it for 7 days? This seems such a short amount of time. So is the bleed quite long and heavy when you stop?

[Mary G]

Good question.  Professor Studd did not tell me I had to have a scan every year but it's a good idea to have one anyway and not just because of lining build up but to check for things like vaginal wall thickness, cysts and ovary health - the one I go to checks the bladder too.

I can tell you that 7 days of 100mg Utrogestan is definitely enough for me because I have been checked several times and it's always OK.  The problem with the NHS is they have to prescribe on a "one size fits all" basis so they will work on worst case scenario i.e. they have to allow for women to need a lot of progesterone to get a bleed.  The other point I would make is, for no logical reason whatsoever, the NHS has not licenced Utrogestan to be taken vaginally which means they have to prescribe higher doses of it because you need about double the amount to get the same result if you take it orally.