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[Momo]

Hello folks
wonder if anyone can help? I am about to go and see the Doc next week to talk about going on HRT,  I am so worn out with lack of sleep , night sweats and anxiety that i just feel i need some help.

But in the past i have not got on when taking contraception i was on Mirena and Depo-provera ( at different times) among others in the past but in the end had to stop taking it and ended up choosing to be sterilized because nothing worked.  When taking these I had diabolical migraines, acne, terrible low mood and my god the facial hair - i sound so  so glamours don't i?  so i am worried that HRT might bring some of that back.

 I am fuzzy about what possible effects that taking hormones i might expect and  will go back to those dark days - is there a type of HRT out there , that i should look out for and talk in more detail with the Doc?

any advice , or stories from  anyone who has had similar experiences would be appreciated

thanks and best wishes to everyone

Momo

[Mary G]

Momo, I had similar problems to yourself when taking the contraceptive pill in my 20s and grew hair in unmentionable places including my face but I didn't have migraines at that point.  I also had a Mirena coil in my 30s pre-menopause and was OK with it (apart from heavy, painful breasts) until my hormones levels dropped in my 40s and then I suddenly developed silent migraines.  I struggled on with it for a while using oestrogen patches but I couldn't get enough oestrogen out of them and still had migraines so I had it removed.  It transpired that I had developed a severe intolerance to all forms of synthetic progesterone post menopause.

After much research and seeing various specialists, I finally ended up with Oestrogel (2 pumps of gel that you rub on your skin) everyday, testosterone everyday and 100mg Utrogestan which is micronised progesterone that I use vaginally for 7 days every 5 weeks.  It has taken me a long time to get there but this is the only HRT regime I can take without side effects and I have to seriously limit the use of progesterone and only use it vaginally otherwise it triggers my migraines.  I also take 25mg DHEA tablets (recommended by my gynaecologist and migraine specialist) everyday because it is important that I produce some of my own hormones which seem to protect me from the ill-effects of artificial progesterone.  It has taken a long time to get a regime that works but so far, so good.

From what you have said, it sounds as though you have always had a problem with synthetic progesterone and it also sounds as it triggers your migraines so I can understand why you might worry about taking HRT.  Obviously I can only give you my personal experience but I can honestly say that I feel much better now aged 55 on this HRT combo than I ever did on the pill or with the Mirena coil pre-menopause.  Apart from migraines if I take too much Utrogestan, I haven't had any of the side effects I had in the past so I hope that gives you some encouragement because it is a brilliant HRT regime if you can find the right dose that suits you. 

We all react differently to all types of medication and of course there is no guarantee you will be the same as me but I would definitely recommend you try this regime if you suffer with migraines and low mood.  You may well need a different dose to me but this is a very flexible regime and you can quickly and easily adjust the dose of each product. 

I hope that helps!

[Hurdity]

Hi Momo

As Mary G has said the progestogens you took before were all synthetic and the Depoprovera is high dose - so may not be suitable for you. Also some progestogens (the ones derived from testosterone) can have androgenic effects ie the facial hair, acne etc.

Depending where you are in menopause you would start a cyclical HRT which gives a withdrawal bleed (for those who have not yet reached menopause ie have not yet been 12 months without a period) - and in any case it is best to start this way even if post-menopause so that you can see which progestogens you can tolerate.

It is a matter of preference and how well you absorb HRT with the different methods, but if you prefer a simple daily tablet - then Femoston would be the best one. The progestogen in this one (Dydrogesterone)  is very similar to our own progesterone, and the oestrogen is estradiol. It has fewer side effects and is not androgenic.

Otherwise there are transdermal (through the skin) HRT types available. All the different kinds are listed under TREATMENTS/HRT PREPARATIONS above (GREEN BANNER) - and between us we have tried most of them!

Like Mary G I use micronised progesterone (Utrogestan), and along with this an oestrogen patch (Estradot) which suits me fine. If you started down this route ( separate oestrogen and prgoesterone), initially you would start with the licensed dose of hormones and see what sort of bleed you get. After a few cycles with the consent of your doc you might be able to reduce the progesterone dose (if you are intolerant to it - you might not be!).

I always got migraines on the withdrawal phase of the progesterone in the past, and sometimes when taking it - even when using "natural" progesterone  - but still prefer to take the ones that are bio-identical to the hormones produced by our own bodies ie estradiol and progesterone.

Good  luck and let us know what you decide and how you get on with the doc - if you have any more questions do ask again.

Hope this helps

Hurdity  x

[Momo]

Thanks ever so much Hurdity and Mary G
that really helps. I haven't had a period for over a year now, so i will make sure i talk to the doc about the suggestions you make. I can't insert anything easily vaginally as the pain is too much, but that has always been a problem for me. So i am hoping for a gel /pill patch things to try and sort this all out. As you suggest it will probably be a bit of trial and error, and I am really nervous about this and i really appreciate the time you have taken to share your experiences.
I am seeing the Doc tomorrow, so fingers crossed!

all the best Momo

[Hurdity]

You might want to try some sort of cream such as an estriol cream (as well as systemic HRT) for the vaginal area which you can rub in yourself to help plump up the tissues - because if inserting anything causes pain, this could make treating vaginal atrophy difficult in future.

Good luck with the doc tomorrow and let us know how you get on

Hurdity x

[Momo]

Hello Ladies
just back from the Docs and she has suggested Elleste Duet Conti tablets- the non bleeding type because I have  finished my periods ( over a year since last one) so going to have a read up and decide whether to cash in the prescription tomorrow. 

She was very understanding  and I explained about my problems in the past. I am conscious that this is the first step on the HRT trail and it might not be for me but feel I am ready and hopeful that this might just help, I expect I shall read all the horrid side effects and be freaked out, but I think I have got to try something otherwise I will just feel miserable and nothing will ever change.

thanks for all the kind words  and support
good luck to everyone for their experiences

cheers
Momo

[Mary G]

Momo, thanks for letting us know how you got on.  Probably best to see how you get on with this regime and go on from there.  All the HRT medication has lots of warnings so don't be put off by them! 

Good luck and if for any reason it is not what you thought it would be, there are plenty of others to try.

[Hurdity]

Hi Momo

The type you have been given contains norethisterone which is one of the more androgenic progestogens - and therefore more likely to cause the side effects you mention ie excess hair, acne and sometimes migraines. The continuous progestogen in this (ie the norethisterone) can build up and give continuous low-grade side effects to sensitive women and you might well be one of these, from your history. However it is at a lower dose than the contraceptive pill/injection.

Here is the information from this website:

PERI-MENOPAUSAL SEQUENTIAL COMBINED THERAPY

Used in women with an intact uterus (womb) who are not yet postmenopausal, i.e. have some periods due to continuing ovarian function. Products contain daily estrogen and cyclical progestogen.
Progestogens which can be used cyclically are of 3 main types:

Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
Less testosterone related - Medroxyprogesterone acetate(MPA).
Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

Side effects are often experienced during the progestogen phase of treatment and can be reduced by using a product containing a different type or route of progestogen.

http://www.menopausematters.co.uk/perimeno.php

Personally, although you may well be OK with these, from what you have said I would not actually take this particular type. Instead I would choose one of the less androgenic ones - Femoston which contains dydrogesterone (see above). Femoston conti only comes in low dose (1 mg) but the sequential type which gives a withdrawal bleed comes in 2 strengths - 1/10 (1 mg) and 2/10 (2mg). Depending on your age I would maybe start with one of these - or at least the Femoston conti, rather than the Elleste Duet.

Hope this helps

Hurdity x

[Momo]

Thanks Hurdity, it is all so confusing isn't it? I am 46 and haven't had a period for over a year, could this make me bleed again? I hope not.
The doctor said the reason she prescribed it was because I am not bleeding any more. Will have to see how it goes. Fingers crossed, but great to know about the alternatives. I shall be monitoring it to see what happens. The doc was very clear and said if I didn't feel it was right , to go back and we could look again. Must admit, I feel a bit of medical experiment , but then I guess we all do with this menopause lark!

all the best
M