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[Mem]

I am posting this on behalf of a friend, who is having ongoing problems with HRT after many years, in the hope that someone on here might have some ideas. Bear with us while I tell the story!

Jan is 73 and went on HRT aged around 50. After around 10 years, she had several attempts to come off it, but found the overwhelming hot flushes and pouring night sweats unbearable (by her own admission she has a very touchy thermostat). In discussions with her GP(s) she decided the benefits of HRT outweighed the risks (she has no other health issues), so she has stayed on it with their support.

She went onto Premique Low Dose a few years back, and was very happy on this, with her GP's blessing. She was taking six a week rather than seven, hoping to be able to eventually come off altogether. However all attempts to reduce the dose, at a snail's pace, increased the flushes quickly to an unacceptable level. On six a week she would have maybe one hot flush a day, and one or two at night.

In November 2015, like many others on here, she had to change from Premique, after its withdrawal. She was prescribed Kliovance, but didn't take it when she spotted that a contraindication was fibroids, which she has. She researched on this site, and then asked her GP for Indivina 1mg/2.5mg. Her GP told her it was twice as strong as Premique Low Dose, and suggested she take one every other day. The GP has not made any mention of patches.

For the past two months Jan has been taking three Indivina a week.
   
On this dose she found that she gets 7-10 hot flushes every night, so her sleep is hugely disrupted, which makes her feel wretched. She has around 7-10 flushes each day. She is reluctant to increase the dose, and we had wondered if a menopause clinic might be able to help, with advice about a better regime for someone of her age and with her history.  Her GP dismissed this suggestion, saying that menopause clinics are for women who have difficulties with HRT because they have/had breast cancer or DVT.

Her GP has prescribed Venlalic XL 75mg, an antidepressant, as an attempt to control the flushes. She is hesitating over starting on this, having read the rather frightening patient info leaflet.

Thank you for sticking with this. Anybody had a similar experience, or have any suggestions or comments?

(We are both sitting here flushing away typing this…..)

Mem (65)

[Hurdity]

Hi Mem

 

Sorry to hear about your friend.

In fact the exact equivalence between Premique and other low dose hRT types is difficult because Premique contains a mix of horse oestrogens and tend to be stronger whereas the other HRT types mainly contain just estradiol. I presume she was on the 0.3 mg? They are all listed here: http://www.menopausematters.co.uk/postmeno.php

If they are approximately equivalent then the doctor suggesting only half the dose of the Indivina ie every other day is like reducing the Premique to every other day - and also the change in type itself could well cause symptoms and by reducing the frequency could make things even worse!

I can't find any reference to Premique being withdrawn though - maybe there were supply problems? All HRT with oestrogen can aggravate fibroids including Premique although continuous progestogen is thought to limit this. Here is the info on this site:

Fibroids   
    Fibroids are benign smooth muscle tumours of the uterine (womb) wall and are dependant on estrogen. They tend to shrink after the menopause but shrinkage may not occur, or they may even increase in size with HRT use. Increase is thought to occur in 25% of HRT users and mainly occurs in the first six months of therapy. There is some evidence that transdermal (patch or gel) but not tablet HRT nor tibolone may promote fibroid growth. [ref 24] Fibroid size can be monitored by regular examinations and sometimes by ultrasound scans. There is some evidence that the use of the progestogen releasing intra-uterine system, Mirena may cause fibroids to reduce in size. Mirena is often used in the perimenopause by women who have heavy periods and/or require contraception and can provide the progestogen part of their HRT.

http://www.menopausematters.co.uk/atoz.php#GlossF

It's absolute rubbish what the doc says about a menopause clinic! They are for any woman who needs specialist advice.

Personally I wouldn't take the ADs but continue to try different types of HRT - if Premique is still not available - but at the right dose!

Hope this helps

Hurdity x

[Taz2]

Hi Mem.

The other alternative to an anti depressant to control hot flushes is a medication called Dixarit http://www.netdoctor.co.uk/medicines/brain-and-nervous-system/a6603/dixarit-clonidine/  Two of my friends are on this and have no hot flushes at all.

If your friend does manage to get re-prescribed HRT then she should be given patches or gel. Pill HRT is not recommended for over sixty year olds due to the slightly higher risk of stroke.  I agree with Hurdity that a menopause clinic is for all women going through menopause but if the one I attended was anything to go by - and they were really lovely people and very helpful - then they would not be happy to prescribe HRT as I was told that after 60 I had to come off mine. Could she afford a private consultation?

I do hope she finds some answers soon.

Taz x

[Mem]

Thank you very much, Hurdity and Taz2.

And thanks for the welcome - in fact I have lurked on this forum for some time and have learned a great deal from posters such as yourselves.

Jan will be looking at your replies and I'm sure will find them food for thought.

Hurdity - yes, we did mean supply problems with Premique Low Dose, rather than actual withdrawal. She was indeed on the 0.3mg.

And I thought the GP was talking rubbish too.

We may be back!

Mem

[Mem]

After pondering your replies (thank you again) Jan has decided to start by increasing the dose of Indivina to every other day, as her GP suggested, and see how that goes for a month.

If she is still having such an intolerable number of day and night flushes after a month she will think again.

She has decided not to take the ADs for now.

The ideal solution, of course, would be for Premique Low Dose to reappear.

In the meantime she is researching a private consultation, starting with Prof Studd.

Would she need a referral letter from her GP? or can she just refer herself?

Does anyone know if he is helpful to women in their 70's? and what he charges these days?

And how otherwise to find someone who is likely to be sympathetic and knowledgeable? We are in the West Mids. Any suggestions very welcome.

Mem and Jan

[Taz2]

This is the Find a Specialist link from the top of the page http://www.menopausematters.co.uk/clinicfinder.php  You may find someone near you? I'm afraid I can't answer as to whether Professor Studd is helpful to women over 70 or his charges but I'm sure someone will be along soon who can help. You don't need a GP referral to pay for a private consultation.

Taz x

[Hurdity]

Just to add if you are in Midlands then you are fairly close to Bristol where Dr Annie Evans practices and she is much cheaper than Prof Studd!

Hurdity x

[Mem]

Thanks, Hurdity.

I had just come to the same conclusion!

I'll let Jan know.

Mem

[Mem]

Just to bring this thread up to date: my friend Jan has now made an appointment to see Annie Evans in Bristol in April. Fingers crossed.

In the meantime she is just staying on the Indivina 1/2.5mg every other day, and feels that she is sleeping a bit better.

Thank you to everyone who has given their help and advice so far - it has been very encouraging.

Mem

[Hurdity]

Thanks for updating us Mem and glad your friend is feeling better

Hurdity x