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[matildamouse]

I am 52 and 18 months postmenopausal. Been on BHRT (estrogen and progesterone) since Oct 2015.In the past, I seem to be very sensitive for estrogen and had to decrease and cease estrogen due to breakthrough bleedings only for the hot flushes to return with a vengeance. My scan showed a few fibroids. I restarted estrogen 2 weeks ago after being off estrogen for nearly 6 weeks due to relentless hot flushes which returned slowly but surely. Hot flushes are less since recommencement of estrogen but I have some minor spotting and periodlike cramps since yesterday. Breast was enlarged as well though better today. I am in Australia and being managed over the phone and by emails by a menopause centre thousands of kms away from me. Not the ideal I know, but the best I can do for the moment as BHRT is only prescribed by a few enlightened GP's who are fully booked months ahead. I have an appt in July.

My question is, must I continue with the same dosage of estrogen till the hot flushes are gone? Or decrease the dosage now and hope the longer I am on the estrogen, the less my hot flushes will become (despite the decreased dosage). I mailed the menopause centre as well but I have lost a bit of trust in them based on past experiences.... I trust the opinions on this board more!

[CLKD]

>wave< - sure someone will be along later 

[Hurdity]

Hi matildamouse

It's impossible to advise if you are taking non-standard HRT ie the compounded bio-identical HRT which varies so much and is not recommended in UK (nor US come to that!).

In principle the dosage of oestrogen is meant to be the least possible to limit symptoms - although often women need higher than the minimum to feel really good. It is a compromise though eg I have compromised on dose because I choose to have a long cycle and want to prevent a heavy bleed so I keep to the minimum dose (which in my case is a 50 mcg patch).

In terms of symptoms returning - I think you need to stay on a particular dose for a couple of months to see how you get on - it can sometimes take time for symptoms to completely disappear or to return. For example a few years ago I stopped HRT - and my symptoms returned so after 3 months I went back on it. However doc suggested trying a low dose as I was well post-menopausal - to see if that worked. She prescribed 25 mcg patch. Initially this worked and flushes disappeared but then they gradually came back so after 5 months or so I went back up to 50 mcg - which eliminated all the flushes and sweats again - and I have been on this dose for most of the 9 years I've been on HRT.

I realise you can't get utrogestan - bio-identical progesterone in capsules at standard doses - in Australia, otherwise I would suggest you try oestrogen patch or gel (which is available) with this, so that you can have a cheaper and more consistent bio-identical regime.

If you have fibroids then they can be aggravated by oestrogen depending on the dose - and it is sometimes recommended to take progesterone continuously for this reason - and to monitor them with scans.

Hope this helps a bit!

Hurdity x

[matildamouse]

Thanks Hurdity, your reply is really helpful, especially your own example of required estrogen therapy.

I have a review with the clinic next week, so decided to just carry on as now as to not have too many changes.

[Dana]

Hi matildamouse

It's impossible to advise if you are taking non-standard HRT ie the compounded bio-identical HRT which varies so much and is not recommended in UK (nor US come to that!).

It's not recommended in Australia either! You do have to ask yourself why it's so hard to find a doctor who prescribes it in Australia. It's because few doctors support it's use and those who do I'd be very skeptical of (rumours of kickbacks from compounding pharmacies etc). I actually had a couple of appointments with a GP who prescribed compounded hormones in Brisbane and he turned out to be the biggest scum on earth with the way he treated me (he claimed all my menopause symptoms were psychological etc). Have a look at this link from the Australian Menopause Society.

http://www.menopause.org.au/for-women/information-sheets/34-bioidentical-hormones-for-menopausal-symptoms

I know exactly the phone company you are talking about matildamouse because I had a "consultation" with them when I started this meno journey, and I was appalled at the way they do things. Talking to a doctor over the phone, whose credentials you just have to hope are legitimate, and then working only on saliva tests, is not a good way to go about all this. Plus they are hideously expensive. It's a bit of a racket to cash in on all the untrue scare tactics women always have thrown at them about regulated HRT.

It is a myth that you can't get "bioidentical" estrogen (estradiol) from a regular doctor. It is readily available as patches, pills or gel, plus because it is covered by PBS the cost is less than $15 per month.

It is true that a regulated progesterone capsule (Utrogestan) isn't available in Australia, and I understand Australia's caution about approving it, although I won't go into that here because MM is very in favour of its use. However, the transdermal progesterone cream you are using is not proven to be safe if needed to oppose estrogen. (See the above link).

IMO you should put aside using this compounded hormone treatment and seek advice from a regular doctor, especially if you have a fibroid issue.

[matildamouse]

THe menopause centre I use do not make use of saliva tests...ever. I am in the medical profession myself and extensively researched the GP's in my city who prescribe BHRT and are happy with the one I identified. There is a reason he is booked 6 months ahead!

I know I can get bio-identical hormones in Australia from my regular GP. This is not my issue. My issue is I need progesterone as well and that is only available from compound pharmacies. I am not using a Progesterone cream. I take a 150mg Progesterone capsule every night and my scan showed a very thin lining.

I decided to give BHRT a fair chance and if it works, it works. I am and have always been open for synthetic hormones as well and is at a point where I start to consider that. Getting BHRT in Australia is a hassle and very expensive. I think it is a disgrace and disservice to all menopausal women in Australia that Utrogestan is not available here as an option. I like to make informed and well researched choices about my own health with a GP I trust.