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[Mandee]

Hello all,
I am 51 and had been on Evorel Sequi 50 patches since december 2014 which gave me bleeds just after finishing the pack and no cramps. I have now been on Evorel 75 and Utrogestan pessaries for the first 12 days of the month for the past 3 months. I am also on Vagifem and Testogel. I don't have any other symptoms other than bad sleep since last september which hasn't improved even after trying the 100 patch dose for a month in February. I've been on the Testogel since 2012 due to no libido and it worked great for 2 years but pretty much stopped working a year ago and I'm still using it.

I have recently finished my third course of the Utro but instead of having a bleed just after the end, it starts around 10 days later with cramps and lasts around 4 days. I have searched around online and can't find any other cases of this, only earlier bleeds during the course or at the end. Does this happen to anyone on here?

[CLKD]

   I am surprised that none of the ladies on here with HRT Knowledge have answered you  .

There is a search box - maybe type the products into it and see what pops up?  Could it be that your own hormones are joining in and over-riding the HRT?

[Lizab]

I found this, which seems to imply your estrogen is low.

http://www.cemcor.ubc.ca/resources/cyclic-progesterone-therapy

Why did you bump up from 50? And was the month of 100 a problem? Interesting that you were regular on the Sequi 50 but not with the 75. I assume your Utro is 200 mg? I really don't have any idea and not much experience to answer, but find it interesting. Hopefully someone more knowledgeable will answer.

[Hurdity]

Hi Mandee

 

I'm not a lady but I will try to help  !!

The main thing you haven't said is where you are in menopause or what your periods were doing when you started HRT? If you were not post-menopausal (ie no period for a year) when you first started then it is likely that your own cycle is coming into play and your own progesterone is delaying the bleed? Norethisterone - the progestogen in Evorel sequi - is a more powerful progestogen than progesterone in acting on the endometrium (womb lining) to keep it thin. Some women actually get more cramps with this than with the "natural" progesterone you are using.

I presume you are having the utrogestan vaginally (as you refer to pessaries) - but you don't give the dose - as Lizab says - I am interested also in the dose - whether 100 mg or 200 mg?

You don't have to worry if you are taking the licensed dose of progesterone and the oestrogen dose is not very high, and if you are getting a bleed - because it shows that the lining is being shed. I presume you are seeing a private gynae due to your prescription so a query in their direction might be an idea in case a scan is advised?

It would well be that your own testosterone levels are continuing to fall - hence the reduction in libido - what a blow eh? How much do you use? The other thing to consider is your response - is this still good? I would say my libido has not really changed but the response most definitely has - perhaps that's the best we can hope for with hormone replacement?

Hurdity x

[Mandee]

Thanks for your replies. 

I started having symptoms at the very start of 2012 with feeling very tired in the day and had no libido at all (never really had any all my life anyway). I saw my gp who then arranged a blood test and it showed that my hormones were dropping so he prescribed the Sequi 50 patches which did absolutely nothing and he took me off them after a month. I was still having regular periods.
 I then asked him if I could try some testosterone for the libido so he referred me to a meno clinic in October who prescribed the Testogel (a quarter of a sachet a day measured out using a 5ml syringe). Within a few weeks the libido shot up and all the tiredness vanished at the same time. This continued until December 2013 when my periods suddenly stopped and then restarted in May 2014. They stopped again 6 months later in November along with the libido so I saw my gp again who retried the Evorel sequi. They worked this time and the periods returned a few weeks later, the libido came back even higher than before but that only lasted a few months then vanished again in May 2015.
I kept on with the patches but the periods were getting lighter and closer together, around 25 days apart. I started getting tiredness again along with sleep problems and waking up at 3am so assumed the patch dose was no longer high enough to help. I had to wait till September for an appointment at the meno clinic and she put the dose up to 75 by using 1 and a half Sequi patches. This did help improve the libido a bit but nothing like it was before unfortunately.

Lizab, my sleep gradually got worse until I was waking up around 4 times a night (as I still am doing now) and my hair started falling out so the gynae increased the patch dose to 100 in February this year and started me on the Utrogestan vaginal 200mg pessaries. My hair loss then got ridiculous on this dose and the sleep was no better plus what little libido I did have completely vanished so I went back down to Evorel 75 patches (along with the Utro) after only a month and the libido started to come back again. I started using Regaine along with Nizoral shampoo at this time and within a couple of months the hair loss stopped and has been fine since and growing back again. I reckon the 100 dose was too high hence the big increase in hair loss at that time.

I saw the gynae again but she said she can't understand what's going on with the sleep and she's never come across it before. I assume she meant why the hrt wasn't doing anything to stop it. My gp now thinks it's not hormones causing it and I've had blood tests which show up nothing. I am totally confused because both high and low estrogen can cause the same symptoms, hence trying out all the different doses. I'm still no further forward in knowing whether it's too high or low so I'm stuck in this state with no idea what to try next.
 I asked my gp if I could be tested to find out the estrogen level in my body but he said it would be inaccurate due to the hrt, but I would have thought we'd get some idea what the hell is going on.

Hurdity, I asked the gynae if I could increase the Testogel dose a bit and she said I could try going from a quarter sachet up to a third but advised against it incase of side effects. I've been on the quarter dose 4 years now with no side effects apart from a slightly husky voice and more body hair but it's not excessive. I just shave it off and pluck the few upper lip hairs out when needed. The sex response is fine and the libido seems to increase mostly when I'm on the progesterone.

Mandee