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[Peggy]

Hi I am new to the forum.
I have been on HRT for 7 years. I started with pills, now I have patches. My experience with HRT has been positive, and I have had no problems, until recently.
I am fine during the day, but have been experiencing hot flushes at night. I have a very stressful job and (as we all do) I need to sleep.
My patches are Evorel Conti 50. The last time I went to the Dr and mentioned the night sweats, she suggested I went to the health food shop and ask the assistants what natural remedy I could take to ease my symptoms.
They suggested black cohosh, but when I did some research I read you should not take this with HRT.
Before I started to take HRT I tried all these natural things.
If anyone has any advice about this I would be grateful.

[Annie0710]

I was under the impression you shouldn't mix as well

Usually when on hrt and any symptoms return it usually means it's time to increase the dose, is that a possibility for you ? X

[CLKD]

Some ladies find that 'alternatives' ease symptoms initially but once their own hormones kick in, it overwhelms any benefits.

I would not see this particular GP again.  She should know that HRT and 'alternatives' shouldn't be mixed  and black cohosh shouldn't be taken for long periods anyway.

Maybe keep a mood/food/symptom diary so that you have something to discuss with your GP?

[Peggy]

Thanks for your replies. I will visit GP again.
I didn't want to take a higher dose, because I tried Evorel 75 and found it gave me painful breasts.

[CLKD]

Have a browse to see what other ladies have found useful?  Make notes 

[Hurdity]

Hi Peggy

 

You haven't said how old you are - this would be helpful, as well as knowing whether you have been on Evorel conti all this time and where you were in menopause (re periods, cycle etc) when you first started HRT.

Following the last period (or the last ovulation when the ovaries pack up - if on HRT you may not know when this occurs), oestrogen on average drops dramatically over the next couple of years until it falls to a new low and sometimes at this point women begin to experience symptoms for the first time, or they worsen.

In addition some women find that some of the progestogens interfere with the beneficial effects of oestrogen and this could be worse with a continuous combined HRT type. This wouldn't explain your worsening of symptoms now though - unless it is due to your own body changing.

I have never taken continuous progestogen as part of my HRT ( except very briefly once for a few months) and like some other women on this forum, prefer to remain on a cycle ( even though I am in my 60's) to avoid this - but have to put up with a withdrawal bleed instead as the lesser of the evils!

Depending on your age and inclination you might think of changing your HRT type to one with a different progestogen and see if this helps. I have always been fine with 50 mcg patch from late peri-menopause in my 50's until now.

If you had separate oestrogen and progestogerone it would make it easier to tweak doses. For example you might find an increase to 62.5 mcg (this involves judicious snipping!) might do the trick - but you wouldn't want to do this with a combi patch because the progestogen would increase too.

Definitely avoid the natural remedies - Black Cohosh anyway should not be taken long term.

Hurdity x

[Peggy]

Hi thanks for the advice I am 57 and started hrt at age 50. First I had elleste which had progesterone in the pack as well as oestrogen. Then because I met a man and needed contraception I was given a marina coil and elleste solo. I then no ed house and changed doctors and the new Dr suggested evorel 50 patches. Then after having the marina coil for 5 years they wouldn't replace it, so I now ha e evorel conti patches. As for the date of my last period I am not sure. Not for ages, but I used to get the odd bleed about once every 4 months.
Whenever I go to the Dr they talk about coming off hrt,but I am a teacher in an inner London secondary school and I need to be on the ball.
That is my history.
I really appreciate all the replies and advice.
Thank you

[CLKD]

Why won't the GP prescribe another Mirena?

Also, a lady can be on HRT for as long as possible as long as they have been warned of any assumed risks.

[Peggy]

Not that they wouldn't prescribe it, but the nurse didn't feel confident in fitting it. I got sent to a clinic but they refused to fit the coil for menopausal reasons.

[Hurdity]

Hi again Peggy

In that case it is perhaps surprising that you have recently experienced a resurgence of flushes - but maybe as you don't know when you reached menopause (could it have been 54-55?) you are now noticing the fall in oestrogen levels?

You docs are quite wrong in not allowing the Mirena. It is licensed for the progestogen component of HRT. I have read on here that some FP clinics will not fit to women over 50 - presumably because they no longer need contraception. If the nurse at your practice does not feel confident in fitting it then it is your right to be referred through them to someone that does, if this is your progestogen of choice!

The information is here (scroll down):
http://www.menopausematters.co.uk/to_progestogens.php

Really though, at your age and stage you should not need to increase the oestrogen and my bet would be on the progestogen somehow interfering with the beneficial effects of oestrogen - though quite how is not known. I exepct you would not want to return to a cycle especially as you are teaching - as experimenting with a long cycle takes a bit of trial and error and I can see you wouldn't want to risk feeling rough.

If you were happy with the Mirena I would press for this through the relevant channels ie your doc and insist on your right to have this. You do not need to stop HRT as the benefits are throught to outweigh the risks for women under 60 if symptoms are still present: http://www.menopausematters.co.uk/balance.php . Since most women of your age will need to work until 66 before reaching pension age - the old thinking has been updated ( due to the NICE Guidelines on menopause 2015)  although I know teachers retire earlier ( still at 60?). You still need to be in the best of health to cope with such a demanding job and docs should be aware of this!

I realise this does not answer your Q about oestrogen dose but hopefully if you get the Mirena again this will resolve itself?

Good luck and let us know how you get on!

Hurdity x

[CLKD]

I find it hard to believe that a Surgery has a Nurse who won't fit a Mirena ! she should ask the GP to do so.  Or get a referral to a Gyanecologist for a fitment.  Go back to the Surgery and ask for a Nurse who is competent, if she can take a smear test, she should be able to fit a coil!  Is your GP aware that she can't do this?

[Peggy]

The poor nurse read in my notes that I had had to have an injection, and that my cervix needed to be dilated. She foresaw problems that she did not want to deal with.
The Dr sent me  to the local family planning clinic and I made an appointment. At the appointment the Dr there informed me that they do not fit mirena coils unless for contraceptive reasons. I then went back to Dr and asked for a combination patch because I thought I needed both hormones.
Having had to wait for ages to see a Dr in the clinic I was none too pleased to be informed that it was a complete waste of my time.
And to one of the kind ladies who replied to my post. Unfortunately we teachers don't get to retire earlier.
I must say I am overwhelmed by all the help and advice you are kind enough to take the time to send.

[CLKD]

Would you consider asking your GP for an appt. to a Gynaecologist?  You shouldn't need to see the GP again, he can send the appt. letter as 'usual' .

[flutterby]

Hi Peggy just wanted to say, stay firm with the GP when they mention coming off HRT. I retired a year ago at 63.5 and came off HRT 9 months later, I had been on it for 16 years. Although my symptoms aren't too bad, I know I would have struggled badly to do my job and cope with the lack of sleep.
Good luck Flutterbyx