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[Ciscola]

Hi, May I ask a question please?
My doctor has prescribed me Prempak-C for my Insomnia & Mood swings.
The first 2 weeks (with 1.25mg Estrogens only) I began to sleep better & was a little less moody.
When I then added the .15MG Norgestrel it all went t**s up. My sleep patterns were back to non-existent & I was sooooo moody. I also had a lot of breast pain.
I looked up why they Norgestrel is needed & saw that it protects the user of Estrogens from potential Endometriosis or womb cancer. So I can't just stop that part.
But I was wondering if there are any alternative HRT treatments, using different drugs. I'd like to check this before I take it all to the doctors.
Can anyone help please?

[Galadriel]

Hi Ciscola and welcome to the forum.

Have a look at the green menus above - there's a whole range of options for you to look at. You can try other tablets, or patches, or gel, and separate progestogen pills to protect your womb or you could try Utrogestan - this one is identical to our own progesterone. Some ladies take this orally and some take it vaginally.

Just to say it can take three to six months for side effects to settle down.

Galadriel x

[Dancinggirl]

Hi and welcome Ciscola
do look under TREATMENTS at the top of this page to find out about the different HRTs.  Prempak is one of the oldest types of HRT and the progesterone is rather harsh.  I would suggest you try Femoston as the progesterone is kinder and suits many women really well.  It is trial and error before we find the right HRT. 
DG x

[Ciscola]

Hi Ciscola and welcome to the forum.

Have a look at the green menus above - there's a whole range of options for you to look at. You can try other tablets, or patches, or gel, and separate progestogen pills to protect your womb or you could try Utrogestan - this one is identical to our own progesterone. Some ladies take this orally and some take it vaginally.

Just to say it can take three to six months for side effects to settle down.

Galadriel x

Thanks Galadriel,
That is really helpful. I'll have a good look.

[Ciscola]

Hi and welcome Ciscola
do look under TREATMENTS at the top of this page to find out about the different HRTs.  Prempak is one of the oldest types of HRT and the progesterone is rather harsh.  I would suggest you try Femoston as the progesterone is kinder and suits many women really well.  It is trial and error before we find the right HRT. 
DG x

Thanks DG,
It's a minefield isn't it.
I'll have to give it the 3 months that he has prescribed I think. Then I'll discuss an alternative if I need it. In the meantime, I'll be looking at the Treatments & trying to get my head around it.
By the time I go back to the doctors, I should be an expert, lol.

[Ciscola]

Hi and welcome Ciscola
do look under TREATMENTS at the top of this page to find out about the different HRTs.  Prempak is one of the oldest types of HRT and the progesterone is rather harsh.  I would suggest you try Femoston as the progesterone is kinder and suits many women really well.  It is trial and error before we find the right HRT. 
DG x

Thanks DG,
Well I had a surprise last week. My first period in 10 years. I'd quite forgotten what happens. I was flooding for 3 days. I wonder if this is what I can expect each month now using Prempack.
I'm due to be on holiday at the beginning of May & that would be very bad timing. I do have to go back to the doctors before then to pick up my next lot of tablets. So I'm going to talk to him about slightly altering the time I take the second part of the pack, so that (hopefully) it will delay any period that may begin then.
I wondered if anyone else has come across this 'holiday' period problem with a combination HRT?

[Hurdity]

Hi Ciscola

Yes you have been given a cyclical HRT which is for women who are not post-menopausal ie who have had a period in the last 12 months and are probably under 54. They are designed to give a withdrawal bleed. It is also a high dose one as well.

How old are you? if you haven't had a period for 10 years either you've been using a Mirena coil or you are well post-menopausal and wonder why you haven't been given HRT before this?

If you are truly post-menopausal then you can have a no-bleed (continuous combined) HRT  - although if you've been without oestrogen for a while there is often some irregular bleeding or spotting to start with. Many of us though prefer to keep on with a cycle because we don't want to take progestogens the whole time for a variety of reasons - but mainly due to the ongoing side effects and sometimes negating the beneficial effects of the oestrogen.

Personally I would not wait the 3 months on this type - it is not natural to us as it's made from horse urine and contains a mix of horse oestrogens.

I agree with Dancinggirl - I would change asap to Femoston - ideally at the start of a new cycle - and depending on your age I would start on 1/10 and build up to 2/10 if this does not treat your symptoms. I wouldn't stay on this type (Prempak)  for long otherwise you might have problems switching, because it is a strong dose and different from all the other HRT types pretty much.

Hurdity x

[Ciscola]

Hi Hurdity & thanks for your information.
I'm 59. I have been in my menopause for about 10 years & I think that I still am - not post as yet. I had not been using any HRT until recently. I had been managing without. It's for the insomnia really.
Your suggestion seems to be the way to go.
I'm going to try to get an appointment with my doctors to change over to Femoston. Fingers crossed.

[louie2]

Hi all, suffering greatly from the dreaded night sweats, low mood etc.. have been on Evoril conti for around 14 months, the sweats went but have returned with vengeance, I notice on the forum there is a lot of mention to vaginal gel, am I right in thinking I may need more progesterone to stop the sweats?

[Hurdity]

Hi Ciscola

You are post-menopausal if you have been without a natural period for 12 months (ie if you are not on HRT nor have a Mirena coil or anything which suppresses bleeding). So - when you say you think you are still post as yet - this is how to define it. You would be having a very late menopause if you have not reache dmenopause at 59. When was your last period?

Also at 59 it would be better to start with transdermal HRT as you are only just in the window for starting HRT and transdermal HRT is less risky.  At your age I would actually start with an oestrogen patch and separate progesterone (Utrogestan) especially if you are going to be in this for the longer term - and depending on what your periods have been doing, you might be better off having a cycle and a withdrawal bleed.

Utrogestan also has a sedative effect and some members have reported improved sleep when taking  it.

Hurdity x

[Hurdity]

Hi louie - I've posted on your other thread. Increasing progesterone especially synthetic one, is unlikely to help with sweats and most likely will cause the reverse!

The gel women are talking about is Estrogel which is not used vaginally but spread on the body to be absorbed systemically in the same way as a patch. Vaginal oestrogens (such as estriol cream, or Vagifem pessaries) are designed to alleviate and cure vaginal atrophy and associated symptoms by plumping up the vaginal tisssues and changing the acidity of the vagina.

Hurdity x

[Ciscola]

Hi Ciscola

You are post-menopausal if you have been without a natural period for 12 months (ie if you are not on HRT nor have a Mirena coil or anything which suppresses bleeding). So - when you say you think you are still post as yet - this is how to define it. You would be having a very late menopause if you have not reache dmenopause at 59. When was your last period?

Also at 59 it would be better to start with transdermal HRT as you are only just in the window for starting HRT and transdermal HRT is less risky.  At your age I would actually start with an oestrogen patch and separate progesterone (Utrogestan) especially if you are going to be in this for the longer term - and depending on what your periods have been doing, you might be better off having a cycle and a withdrawal bleed.

Utrogestan also has a sedative effect and some members have reported improved sleep when taking  it.

Hurdity x

I hadn't had a period for 10 years until I started taking the Prempak-C. But have been having the mood swings, night/Day sweats & insomnia for all of that time & am still. Maybe it's just the words that are confusing me as to whether I'm post or not. Never mind. I don't suppose it matters.
I've managed to get a doctors appointment for this Friday. So the plan is to ask him to change me to Femoston. Unfortunately I will have to go with whatever he says. He's very hard to deal with & I'm at his mercy as he is my link doctor. It's unlikely that he'd suggest Ultogestan. It was hard enough getting the Prempak. Doctors eh!

[Hurdity]

Yes you are post-menopausal Ciscola. No reputable gynae would have prescribed you high dose sequential Prempak C at your age and stage. You are on the cusp of the "window of opportunity" for HRT re cardio-vascular protection - which is within 10 years of menopause or under 60. After this stage risks increase and if started on HRT transdermal route is preferred ie patch or gel (the latter with separate progesterone).

Please do not accept you are at your doctor's mercy - shame on him if he is being that difficult.

If you think you might encounter problems - firstly can you go to another doc in the practice? Secondly if you can afford it (it costs £25) I would have an e-mail consultation with Dr Currie http://www.menopausematters.co.uk/index.php (scroll down) and ask her professional opinion - explaining your age, years since menopause, what your doc prescribed, and how you felt on the Norgestrel. You can then print off her reply and take it to your doctor.

She will most likely suggest a transdermal HRT - patch with separate progestogen. Evorel conti is a combi patch HRT but the progestogen in that one is similar to the Norgestrel so I wouldn't suggest that. Femseven conti is another combi patch that some women find they tolerate better.

If you are happy having a withdrawal bleed then oestrogen patch or gel with separate progesterone (Utrogestan) for part of the cycle could be the way to go - but the utrogestan can also be taken continuously.

At your age I would also start low and build up if necessary eg you might find that 25 mcg patch is sufficient - and the oestrogen only patches do come at this dose. All the preparations are listed in the top tab under Treatments/HRT preparations - and the various sub-tabs.

Hope this helps - good luck and keep us posted

Hurdity x

[Ciscola]

That is fantastic info Hurdity. I feel pre-armed now to go for my consultation.

I think it is unfortunate the GP's have to have an all round grounding in different aspects of medicine. So that they can't really be expected to be all singing & all dancing in everything. In my case I'm sure he did what he could. But he isn't a Gyne doctor by any stretch of imagination.

[Ciscola]

So,after a few problems with availability I am due to collect Kliovance tomorrow & am looking forward to not having a massive period each month & seeing how it works for me. I've read a few bits about it now on here, which has been quite positive. So onwards & upwards