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[Belladonna]

My ovaries shut down when I was 30 due to cancer treatment. At first I was put on HRT patches called Estalis. They were ok, controlled hot flashes etc but after a while my ass just shrunk and disappeared, my hair was very thin and I got acne which I had never had before in my entire life. I definitely felt that I wasn't getting enough female hormones and knowing that HRT is made for women twice my age it seemed clear I needed something stronger and that meant BCP.

My gyn prescribed Yasmin and to take it every day without any breaks. I was on Yasmin before I got cancer and had done well on it, hence why we chose it. I have now been on it for a few months and my skin is clear again, my ass is coming back and my hair is starting to look better. However, I have also gained 5 kilos! It terrifies me. I eat healthy, usually between 1500-1700 calories sometimes 2000 but very rarely pig out. I am 5'9". I can't exercise more due to health problems and I am getting desperate as to what I can do to stop the weight gain. It is so depressing.

Did anyone else gain weight on Yasmin? Are there other BCP or HRT that are more suitable for young women in premature menopause?

[Freckles]

Hi Belladonna

I know a little about Yasmin although BCP are a distant memory for me!

Just wondering why, if your ovaries  have "shut down" and Estalis patches didn't work effectively you were prescribed Yasmin?

Given the health risks with BCP?  I know HRT can have risks but they are minimised if you are on the right treatment at the right dose with the minimal amount of progesterone required for a monthly necessary blled  (it's the progesterone that causes the negative side effects and possible health issues, not oestrogen HRT only)
I know Yasmin is cited to cause side effects of weight gain (my niece is on it and gained 14lbs in six months and she runs marathons!) and it contains synthetic (rather bio identical) versions of oestrogen and progesterone.  These can cause problems in themselves being synthetic.
I had very thinning hair, brittle nails, lousy skin, eyes like two dead oysters, looked like an older version of my mother (she's alive and 74), as well anxiety, low mood, no libido, no motivation, etc.,  when I was on oral HRT (Femoston 1/10) which was totally inadequate for me.
Long story short: didn't have enough oestrogen,  switched to the Oestrogel/Utrogestan regime back in April this year and it's significantly improved my physical and emotional symptoms.
I know transdermal oestrogen (e.g. gels or patches) are safer and more effective than oral hormones. 
Also, being a bit of a geek, I've read up in clinical papers that the BCP doesn't help PMS symptoms in younger women in premature menopause, but transdermal oestrogen does, plus  the gel is bio identical and easier to adjust dosage than patches.
Maybe read up on some of the threads on here and consider going back to your gynae with a view to discuss a prescription change?
Good luck and let us know how it goes?  x

[Belladonna]

Thanks for your reply.
I am not supposed to bleed at all (anemic) and I don't now. On the patches I would sometimes bleed after sex so clearly my vaginal tissues are in better shape with the increase in estrogen.

According to my doctor there was no transdermal alternative that was stronger, then it would be two patches (tried that, got very bloated and it was hard to find places to put them that they would stick to), or HRT pills which I very much doubt would be bio identic. The doctor is an oncologist first, gyn second. So not exactly a hormone expert. My GP won't do anything with my hormones, says it's not his field and he won't go against what the gyn/onc has prescribed. I didn't have a hormone sensitive cancer, my ovaries just died from all the radiation and chemo. So hormones are as safe for me as anyone.

Do you mean that there are patches that give a higher dosage of hormones?

[Belladonna]

Here is a link to the patch I was on. The 50/250.

http://www.medbroadcast.com/Drug/GetDrug/Estalis

I know yasmin is a low dose bcp according to the pill ladder, but have no idea how to translate transdermal vs pill and the different types of estrogen and progesterone?

[Freckles]

I'm not a medical doctor and don't know your medical history but think Yasmin as a BCP doesn't give very much synthetic oestrogen as compared to the synthetic progesterone it has?

As I said I am a bit of a geek and having read up in the past, think your oncologist is not entirely correct re increasing the dosage of bio identic HRT and that there "was no transdermal alternative that was stronger".  That's clinically challenged thinking to day the least!
There's plenty of clinical research to suggest that women who have their ovaries removed or in your case "close down" need more oestrogen than their peers.
Some members on here found patches to be difficult to use, sticking to their bottom, falling off, leaving a mark, etc. whilst the bio identical gels (e.g. Estrogel) easier to apply (takes a minute to dry on the skin) and to adjust the dosage.
The usual dosage is 2 pumps daily although I'm currently on 3 pumps daily (due to bone issues) and some women are on 1 pump daily.
I'd advocate the gel rather than patches to consider. 
If your GP is so unhelpful and your specialist is primarily a oncologist, then maybe read around on here, then either see your oncologist again (although sounds he is unlikely to be a specialist in the field of HRT) with suggestions for the Oestrogel regime?
Or maybe (and I have to be careful here as some members apparently get distressed about me suggesting seeing a private specialist, which I did and got sorted out after years of feeling so awful) actually seeing a private expert in HRT?
I saw "He Who Shall Not Be Named" privately in April this year and it's changed my life.
I get all his treatment regime prescribed on the NHS.
Oestrogen gel only HRT is very safe, effective, and protects against health issues, such as osteoporosis, heart attacks, coagulation in the liver, no increased risk for breast cancer and better skin, mood, etc. 
Maybe something to consider?  xx

[Hurdity]

Hi Belladonna

 

Sorry to hear about your health issues. I presume you are US perhaps as that brand of patch is not on our list. However it is no wonder you had side effects because you were taking a continuous combined HRT which contains one of the synthetic progestogens - and it is often these which cause the sdie effects - especially if the dose is doubled.

Unfortunately you are between a rock and a hard place re what to use. If you want a high dose of oestrogen but don't want to bleed then you have to take a high dose of progestogen - whatever oestrogen preparation you use.

There is a BCP called Qlaira in UK which contains Estradiol - the same oestrogen that is in our bodies, as opposed to the stronger synthetic oestrogens used in most BCPs,  but which would still cause a bleed. This could not be taken back to back as it is what is known as tri-phasic - three different pills containing different does of hormones (think I've got that right!).

Is there a problem with having a regular bleed? I mean can you not take extra iron to ensure you do not get anaemic or is this problematic with your medical history?

Evene if you changed to oestrogen gel ( as Freckles suggested) or another patch ( there are some very small ones - I think Vivelle Dot is the equivalent US patch to the one I use) you would still need to take progesterone, and for high doses of oestrogen if taken continuously this would need probably need to be more than the 100 mg usually prescribed.

Sorry I can't be more helpful here but best of luck with what you decide and hope you manage to sort something out!

Hurdity x

[Belladonna]

Yes it's so hard to work out what to use. I am in Sweden actually and it seems to be a country that is very much behind the times when it comes to all kinds of hormonal therapies. I don't know how to find a specialist or if there even is one. So I feel very much left to my own devices. If I want to change something I have to come up with an alternative myself and hope the doctor okays it.

The patch I was using had estradiol 50 mcg but I don't know how that compares to the 0.03 mg ethinyl estradiol in yasmin? That might be helpful as a start. Same thing about the progesterone, how does 250 mcg norethindrone compare to 3 mg drospirenone?

Bleeding is not good for me as I struggle with anemia and have trouble tolerating iron supplements.

Apart from the weight gain I would say that the yasmin is working better for me than the patch. But I do hate the weight gain and I am terrified that it's just going to continue.

[Belladonna]

What are the names and strengths of good estrogen and progesterone cream or gels?

How do I work out how much to use? Can I use them continually in an even dose?

[Hurdity]

Hi Belladonna

It's impossible to compare the doses of different synthetic progestogens and progesterone - well - as far as HRT is concerned one can go by the amounts used in the different HRT preparations as a guide (see the Treatments tab/HRT preparations) - so look at low medium and high. Most of the BCP types have different progestogens than HRT so difficult to compare although members have talked about the "Avon Pill ladder" which looks at the relative proportions of oestrogen and progestogen (all synthetic) in different brands of pill (I think!).

For HRT - the different doses are usually given as Low, Medium or High and the oestrogen ones are listed here:
http://www.menopausematters.co.uk/treatafter.php

Progestogens here (for use with oestrogen only preparations):
http://www.menopausematters.co.uk/to_progestogens.php

The combined ones are on the other tabs for peri and post-meno.

Progesterone cream is not licensed for HRT as it does not provide sufficient for endometrial protection. You can use progestogens continuously (the two types listed - Provera and utrogestan) but you may well get side effects from the progestogen or progesterone at high doses. I don't know what is available in Sweden.

Hopefully there may be women on here on continuous combined HRT with a high dose of progestogen (eg Provera) or progesterone, and high dose of oestrogen - and might share their experiences? if you don't get an answer to this specific point then maybe start another thread with a different title, to catch their eye?

Hurdity x

[Belladonna]

I found this comparison chart but I can't really wrap my head around it, just feel so confused. https://www.earlymenopause.com/hrt-equivalencies/

So my patch was 0.05 mg estradiol which is the same as 1 mg oral estradiol which is the same as 0.01 ethinyl estradiol. Although it says on that page that: Estinyl estradiol -- as in birth control pills -- is generally said to be at least 3 to 5 times more potent than the other forms of estrogen used in HRT.

Yasmin has 0.03 mg ethinyl estradiol (and 3 mg drospirenin). So that means I am getting at least 3 times as much estrogen now, is that right? And if I wanted an estradiol pill I would need one that is 3 mg?

I went and had a look at the available combination continuous estradiol preparations with the highest estradiol content in my country:

Angemin 1 mg estradiol, 2 mg drospirenon.

Femanor 2 mg estradiol, 1 mg norethindrone acetate

Activelle 1 mg estradiol, 0.5 mg norethindrone

Indivina 2 mg estradiol valerate, 5 mg medroxyprogesterone


There aren't any available that are more than 2 mg.

Do I understand you correctly that the higher the estrogen, the higher the progesterone has to be? Ie I can't take the Angemin and add on some estradiol gel?

[Belladonna]

Also want to add that my problems on the patch were acne, hair loss and loss of ass and boobs.

I don't know if this was due to not enough estrogen or too much progesterone that is too androgenic?

So maybe I can't have norethindrone?

[Hurdity]

Hi again Belladonna - whatever the table says - the actual absoprtion is variable from woman to woman so eg for gel some women achieve very high oestrogen levels on one pump but others do not on 6 pumps! Some women need patches to get the right dose, and others gel, and yet again others tablets. There are so many variables that the tables are just a guideline and based on average values.

re hairloss - certain types of progestogen are more androgenic than others  because they are derived from testosterone - norethisterone and levonorgestrel - (used in some HRT) are among them. I think Estalis contained one such.  I am not familiar with the BCP nor the progestogens because they are not primarily within the realms of this website. There are members who are, but who not posting just at the moment.

Yes normally the amount of progestogen needed to keep the lining thin is dependent on the dose of oestrogen. The higher the oestrogen the higher the progestogen needs to be. Sometimes the HRT types do not bear this out though ( ie some have the same dose of progestogen for 1 mg and 2 mg oestrogen!) - but you would need to consult a specialist about what you are suggesting.

I haven't looked back on all the thread but why don't you try a Mirena coil which will definitely keep your lining thin and then adjust your oestrogen dose to suit?

Sorry I can't be of more help but hope you manage to sort out a regime that works for you.

Hurdity x