Hi clare663
Sorry to hear about your sister's breast cancer. Did she develop breast cancer under the age of 40 as this can be a risk factor for close relatives?
Re the HRT - I still think you could do well to explore further options to see if there is one that suits you - since this is ideal to eliminate hot flushes and anxiety, rather than ADs at this point - provided you are not at increased risk of breast cancer. HRT is the first line of treatment for menopausal symptoms.
The good news is that once you are post-menopause it should be very easy to settle on the right type. However for many of us this does mean maintaining some sort of cycle with withdrawal bleed - because this means that you do not have to take progesterone (synthetic or not) for very long each cycle, and it sounds like progestogens do not agree with you. Both the types of hRT you tried recently were continuous HRT ie you took the progestogen most of the time. many women react to norethisterone (in the Evorel conti).
Have you thought of a Mirena coil? I am sure this will have been suggested in other threads? Only a little progestogen gets into your system but you might even be sensitive to this.
In your position I would either try the Mirena coil with added oestrogen, starting with a low dose patch - 25 mcg Estradot would be a good one - and then increasing little by little if this did not improve things. Some woemn need to build up very slowly when adding exogenous oestrogen ( from outside the body) - because even though it is bio-identical - it is being introduced without all the other hormones that work alongside it, so can throw the body into confusion in some women it seems!
Otherwise I would ask for a referral to a menopause clinic/specialist (if your GP is not sufficiently knowledegeable) or ask to re-start on a cyclical HRT if you can bear the bleeds, starting with 25 mcg patch and building up. As an example I use approx 50 mcg Estradot with utrogestan every 6-8 weeks vaginally for 12 days. This gives me a withdrawal bleed. My doc is happy with this. I am in my 60's and have been on more or less the same regime since late peri-menopause when I was almost 54 and it keeps all the flushes and sweats at bay and I don't have anxiety - I am a worrier but then many of us are - that is nothing to worry about as it doesn't interfere with life!
You could maybe discuss taking it for fewer days on a slightly shorter cycle and you may well find you feel well for most of the time. In your position I would not take continuous progestogen at all ( except as a Mirena).
It is better really to replace oestrogen for as long as you can than take medication - but again I emphasise only if you are not at increased risk of breast cancer and if your doc/specialist has said it is OK. If you are at risk and would prefer not to take HRT on this basis, then I would try any AD that works!
You do need to give HRT 3 months to settle though....
Also re what you said earlier - oestrogen does not build up as such once it reaches a steady state at the dose given as it is continuously metabolised. Actually you are one of the lucky ones (as I am) whose symptoms don't recur after stopping until several weeks later. Some unlucky women are sensitive even to very small changes (reduction) in oestrogen and get flushes when for example a patch need changing or more gel is needed.
Hope this helps
Hurdity x
