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[linz57]

Some of you will remember that I recently had a totally unsuccessful appointment with a gynae regarding my hrt. Basically he was anti hrt so wouldn't discuss how to help me except recommend natural products.
Anyway, I have heard back from the department after putting in a complaint and the team are standing by what the gynae said....no surprise there now. They say they cannot help me further and basically that's that.

One of the things I had wanted to discuss was my problem with what I believe to be a hormone imbalance, I feel I am not getting enough progestogen from my conti patch to balance the estrogen. ( I am getting shows of old blood every couple of months so the progestogen is not sufficient to keep my endometrium thin enough and it's building up.

However, over the past couple of weeks I have started to feel nauseous, feel like when I was first pregnant, I get blood sugar dips and I have to keep snacking to hold the nausea down. I seem to be constantly hungry. I'm also fatigued, anxious, full if aches and pains and I'm even starting with a couple of spots on my face.

I know I mentioned part of this problem in another post the other day but I'd like to know what you well informed ladies would do in my position to address this estrogen dominance
Would you leave off the hrt conti patch completely ( I don't really want to keep adding more and more estrogen) or would you ask your doctor for a low dose estrogen patch alongside Utrogestan?  How do I get things back balanced is what I'm basically asking.
I'm so frustrated with the lack of help I'm getting from gynaes and although I have an appointment to see my own gp on Tuesday I don't really know if she will know what is the best thing to suggest. Right now I feel like giving up on the hrt full stop but I know if I do I will get the awful meno symptoms returning

[CLKD]

Make a list of symptoms and how current regime is helping each one - or not.

Decide which symptoms you need to sort first.  Make that list.

Could you ring Nick Paney or Professor Studd for advice?  Maybe consider paying if your GP isn't helpful?

[linz57]

I've made a list of my symptoms today so I will take it with me next Tuesday. I may be wrong ,but it just seems to me that either my hrt has interfered with my thyroid function or I'm getting symptoms of too much estrogen in relation to progesterone as peri women do. I'm about six years post meno so its got o be the hrt I'd have thought.

 I did read online earlier that being on hrt awhile can cause low progesterone levels . It said initially estrogen makes us feel better as it activates the progesterone receptors, but as this wears off with time, estrogen becomes dominant. Apparently it's due to Progestin, the synthetic hormone causing natural progesterone to drop. God knows if it's true, theres a lot of quackery on the net.

I suppose I could see one of those gynaes if I get nowhere in the near future but to be honest I'm losing faith and if I ended up paying £250 to £350 and still felt I hadn't got to the crux of the problem I'd be even more frustrated than I am now.

I could do with a hormone level and a comp!ete thyroid test I think , at least as a start, but will the NHS fund the hormone test?

In the meantime I'm taking my patch off to see if that helps reduce the nausea, I can always go back on later. I'm just fed up feeling so bleurgh.

[Mary G]

linz57, how frustrating for you, it sounds like they are all singing from the same hymn sheet.  My unsympathetic GP virtually told me to sod off when I asked for HRT so I had to resort to doing my own thing for a while before seeking help privately which is not satisfactory at all. 

Two options spring to mind, first of all low dose Oestrogel (1 pump) and cyclical Utrogestan used vaginally or maybe a Mirena coil with low dose oestrogen?  I wonder if it might be worth a try.

Your point about synthetic progesterone undermining your own progesterone is interesting.  I managed with the BCP and a Mirena coil for contraception pre-menopause but as soon as my own hormones levels dropped, I started getting silent migraines which I now know are only caused by synthetic progesterone.  I can only give you my own personal experiences here but I wonder if synthetic progesterone reacts differently and becomes overly dominant when our own hormones become very low and causes problems for some women?  It is as if our own hormones protect us against the side effects of synthetic progesterone.

Re thyroid, again, I think there is some connection.  I find that I have better thyroid readings with higher oestrogen levels and no synthetic progesterone but obviously this is not necessarily the case with you.  I would definitely ask for the full set of thyroid tests (not just TSH but T3 total/free and T4 total/free) vitamin B12 and also a full set of hormones just to see how much oestrogen, progesterone and testosterone you have in your system.  Then you will be in a better position to move forward and decide whether to change your current HRT regime via your GP or seek advice privately. 

[linz57]

That's what I'm thinking Mary G, the longer I'm on my combo, the more the synthetic progestogen is suppressing my own. Hmmm, it's a lot to discuss in a ten minute appointment with my gp  ( they dont do twenty minute ones) but I'll see how it goes.
I did think of going for a low dose estrogen patch and separate progesterone and seeing how things go and another thing I've just read in a medical paper online is that northisterone is one of the stronger progs and I'm wondering if that might be better? I know it's one of the less well tolerated though. Nothing is easy is it?

Earlier I recalled reading a post that said Nick Panay does NHS work at the Che!sea and Westminster hospital so I may ask my gp to refer me there. Would I see Nick himself though?

[CLKD]

Ring his secretary and ask?  [We don't bite ;-)]

[Hurdity]

Hi linz57

Sorry to hear you are still feeling rough. I must say I agree there is a lot of unsubstantiated quackery on the net - and you might have been reading some of it!!

The thing about oestrogen and progesterone - that whole oestrogen dominance thing was a marketing ploy to sell progesterone cream and a whole industry is devoted to it. You are right in saying that you need to have sufficient progestogen to balance oestrogen - but apart from in pregnancy, this is only needed (in excess) to keep the womb lining thin and lack of it should not cause any symptoms. It would be more likely to that the reverse would cause symptoms ie too much progestogen.

You are on a conti patch ( can't remember which) but both involve a continuous amount of progestogen going into your body - which can lead to continuous low level progestogenic side effects which maybe worse with the synthetic progestogens as these have an effect elsewhere in the body that does not necessarily mimic that of "natural" (bioidentical = same as in our body) progesterone.

Oestrogen does not make us feel better because it activates progesterone receptors - well that's a new one on me - I mean we would not feel so well during our menstrual cycle in the week or so leading up to ovulation if this were the case - because progesterone is at its lowest then and oestrogen at its highest!

If you are still ovulating while on HRT then you will still be producing your own progesterone. I haven't read that synthetic progestogens reduce the amount of progesterone produced by the corpus luteum (after ovulation) but I would be interested in a link to research (not a site selling prog cream though!) if you have found something about this? Even if the synthetic progestogen was inhibiting your own progesterone this wouldn't matter because it should be enough to thin your lining?

You are right norethisterone is one of the more potent progestogens in keeping the womb lining thin, but can also cause unpleasant side effects in some women especially when taken all the time.

I think you'd be better off perhpas going back to a cycle - or as Mary G says trying a Mirena with separate oestrogen.

Rather than have an expensive consultation with private gynae, you could of course have a consultation with Dr Currie as can anyone on here - and it only costs £25!! (info on home page) - and would give you something to take to your GP. if you can get an NHS referral to Nick Panay then that's great too although sometimes there is a long wait (seems to be quite variable though). Not sure if he sees everyone though - I think there is usually a team? Someone else should be able to help here?

Sorry this sounds a bit disjointed but your post raised a lot of questions and some a bit confused re oestrogen and progesterone ( I think I am at this point!!!).

Hurdity x

[linz57]

I think I've confused myself now Hurdity!  Maybe then my symptoms are due to altering my dose up and down recently. It's just over a week now since I returned to my usual 50mg dose so maybe it will take awhile longer for my levels to settle. I never gave much thought to it being  too much progestogen but I did have a decent bleed last week.......probably caused by the increase in prog.

As for the link, I don't know how to post them on here, sorry,  but having gone back to have another look it does look to be quackery and,  although I can't see a link to buy progesterone cream, the site is called Progesterone Therapy. Hmmm, enough said hahaha.

Why do I go googling? This site is so much more informative and reliable. Thank you and Mary G too, I will go ask my gp for one of those regimes. I will of course still ask for the blood tests

[Dana]

Hi linz

I did a google search for that site name and I think I found the one you might have been looking at. Yes it is definitely a dodgy site. These sites are very tricky, and can look really legitimate, but if you look hard enough you will always find a link to something that is trying to sell you something. If you look right down the bottom there is a link to "progesterone cream". When you click on it - you guessed it - it takes you take a page where you can buy it. Grrrrraaaaagggghhhh - these sites make me so mad!!!!!!!

Also, it's often hard to work out who is actually behind these site, but if you click around enough you will usually find some kind of "back story". This one has been started by some woman called Wray Whyte, and when you read her story she is just some random woman who has absolutely no medical qualifications at all. She doesn't even claim to have any naturopathic or herbalist qualifications, so I don't know why she thinks she has any business prescribing hormone treatment to women.

Anyway, I agree with Hurdity. I think you would be best off going to a cyclical routine where you are keeping your estrogen and progestogen doses totally separate. That way you get to work out what is causing what benefits or what side effects. It's too hard when you are taking a combined HRT because you have no idea what is doing what.

Once you get a routine worked out, that works for you, you could look into going to a continuous method then.

[Elizabethrose]

Hi linz

Just a quickie as my brain is out of action today.

Given you have a new GP who seems to be switched on and receptive to new treatments, if I were you I'd stick with her at the moment and give her a chance to treat you. I have had extensive private treatment over the years but only because my case was beyond the knowledge and capabilities of some of the NHS docs I saw when all kicked off. They were the first to recognise this. I am passionate about the NHS and know from experience that 'the right man' can treat you equally well whether private or NHS. Equally I have seen poor docs, the most recent told me I couldn't possibly be menstruating at my age and that I must have a polyp causing the bleeding! These people are always proved wrong and I bat them off like flies!

Nick Panay has an extensive team at Chelsea and Westminster. You may see him or one of his team, who all have a specialism in peri/meno/hormone requirements etc. If you feel on the day that you really need to see him, things are flexible, just state your case on arrival at the clinic. However, I don't know where you live: if convenient to London it's then easy for return/follow up visits but if a huge distance then it's less convenient. Obviously they could set up the initial treatment plan which your GP could follow BUT she may be flexible re prescribing that anyway.

The ladies above have offered excellent advice and I am not an expert re HRT. My experience with it was disastrous and it was being managed by excellent docs. What I do know is that we are all very different and will react in our own unique ways. The slightest increases and decreases made me react violently and it sometimes took some while for things to settle (if indeed they were going to). All is very confusing especially when you read a wide range of experiences and recommendations. What suits one person won't suit another!

At the beginning of my journey I was given excellent advice: keep detailed daily records. This info proved invaluable to the specialists treating me. They could see exactly what was happening at each stage in my cycles, what changes in dosage were doing to me and were also able to measure bloods to confirm what my symptoms were telling me was happening. My body works like litmus paper, so easy to read.

I really wish you well, you've fought hard to be treated properly. I do wonder at the fact that you were unable to find an online record of the idiot consultant you saw. I would most definitely look into this further.

All good wishes to you x

[dangermouse]

Just to add that if you do at some point find the need to go private, your GP may do your bloods to keep costs to consultation fee only. I am planning to see Jan Toledano (private endo) and I attached her sec's email to a blood test form and I got them all approved, including DHEA and testosterone. Was shocked!

I think exogenous hormones do lower our own endogenous ones but it's not clear to what degree. The more questionable sites do indeed talk about oestrogen attaching to prog receptors and vice versa because they mimic each other but I feel the opposite when I take either oestrogen or progesterone, so this certainly isn't happening in my body!

[linz57]

Thank you all dear ladies for taking  the time to answer me, explain things, give great advice and generally help me keep positive at the moment (when I could so easily throw my hands up and give in). I have taken everything on board and it's making me feel more confident of approaching my go with different ideas now. Yes it is a fight but hopefully it's one I will win, with your help I can be much more prepared for when I do see my GP and maybe a meno specialist further down the line. Your caring advice means much more to me than you will ever know, so often I feel like I've been banging my head up against a brick wall.
I shall start with my new GP, see what she has to say and what she thinks of my suggestions of changing to separate estrogen and progesterone. I know last time I saw her I mentioned a sequi regime but she wasn't keen given the length of time since my last proper period. However, I will broach the subject again and take things from there. If I am not fully satisfied I shall ask for a referral to Nick Panay's clinic. I live about a two hour train journey from Londin so it is doable.
For now, I've taken my combo patch off just to give the hormone levels a little time to level out and then I will hopefully start on a new regime soon.
Elizabethrose, yes I am not happy about being unable to find any mention of the gynae I saw either on the hospital website or elsewhere online. Maybe it is all above board but something just doesn't feel right to me. Another thing my meno brain has just remembered is the length of time I was in for my consultation....45 minutes! Ok it was a lecture in all things anti hrt and his personal beliefs etc but he had a waiting room full of patients and the nurse in the room had to twice remind him of the length of time he was taking. Would a regular consultant on the NHS do that? Hmmm, I still think they brought him in as a locum .

[Jenna]

Hi linz57 - have you checked here for your gynae?

http://www.gmc-uk.org/doctors/register/LRMP.asp

[CLKD]

I've checked for the gynae..  Hospital Consultants aren't usually time limited as GPs tend to be.  But pushing his preferences isn't on! 

Do give this GP a chance.  It's about building up a working relationship, she may be 'new' to many things menopause  and if your relationship grows successfully, then it may help other ladies in the Practice.  This GP may be interested in making womens' problems her speciality but she needs patients to work on  .

[linz57]

Yes, thanks Jenna, CLKD checked for me but it's interesting to see so I'll be bookmarking it.
Yes this new gp does seem interested in woman's issues so I will have a good chat with her next week. It's just a pity she doesn't do double appointments,  but then again it's probably better if I don't overload her with too much at each visit . I can be her guinea pig