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[Love_vodka]

Thanks for all your replies. Just working my way through and trying to make sense of it all.  I'm factor 5 so the Dr was really cautious when prescribing the estrogen patch and prescribed the 50 as a middle ground?
My symptoms have got progressively worse over the last month. I'm really not familiar with brands or even how the hrt works. I just naively presumed I would stick on the patch and it would take any symptoms away and make me feel better.
Btw love_vodka is just a user name I've had for ever.
Thanks again for your help xxx

[Tempest]

Hi, Love Vodka!

In your case and with the clotting risk, I would return to GP probably and ask for Estradot, as it's available in 37.5mg as well and it's surprising how a little jump down might make all the difference. Sorry if things got a little 'political' on your thread there! And don't apologise for your forum name - we're entitled to call ourselves whatever we want! There are a LOT of things I used to love before this meno. rubbish thwarted me, and it's a good thing I don't use one of those as my forum name as members would have a fit! Hugs!!!! xxxxx

[Love_vodka]

Thanks Tempest. I've just been looking at specialists in my area. I'm doing everything I can to help myself and refuse to just put up with feeling crap indefinitely! I was literally crawling to the end of the day at work last week
Weirdly, despite all the flushes,sweats and tearfulness my sex drive has gone through the roof, which doesn't add up to low oestrogen levels does it?
Xxx

[Hurdity]

Hi again Love_vodka

Because you've had a hysterectomy - you don't have periods or lack of them to tell you where you are in menopause but the extremes you are feeling are typical of peri-menopause. Your hormone levels will be fluctuating up and down as you ovulate - and you may well only feel good when your oestrogen peaks at ovulation.  Oestrogen will not be low all the time if your ovaries are still working well - but will fall to a low level just before your bleed would have been and in the first part of your cycle. Initially in early peri-menopause (and even before this) some women do find that flushes start as oestrogen levels crash - because sometimes they actually go even higher just before peri and in peri - but only at certain points ie mid cycle. Some women do find that libido increases just before menopause  and this would be an indication of normal/high oestrogen levels (at the peak). I think it is the ovaries last ditch attempt in achieving fertilisation before they fail - and accounts for many a late unexpected pregnancy for women in their 40's!

HRT is intended to iron out the crashes during peri-menopause and to give you a baseline level of oestrogen so you do not become oestrogen deficient with all that entails.

There is information on peri-menopause here:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

Also on estrogen types here:
http://www.menopausematters.co.uk/treatafter.php

You will see that I recommended Estradot if you want to continue with patches and Tempest has also done so. Perhaps to explain in view of some of the comments:

Estrogen comes in a variety of different preparations and doses as you will see from the list.

Pills come in different doses and even types of oestrogen - horse oestrogens (Premarin), estradiol valerate, and estradiol as well as some which are a mixture.

Patches come in different brands and doses but all contain estradiol. Some patches are very big, and some are a different type - the micro version like Estradot. They are all designed to deliver the same dose of oestrogen if they have the same number eg 50 mcg - but the total amount of oestrogen can vary and because the patches are different sizes women seem to absorb differently. I think many gynaes who recommend patches would recommend the micro ones such as Estradot. I mean given the choice - a smaller patch is defo preferable I would say (from experience!).

Gel - is available as two brands in slightly different concentrations - and different gynaes/GPs and women -  seem to have their preferences.

Hope this helps

Hurdity x

PS please do not be alarmed about the advice given on this forum despite some caveats expressed! Tempest reported from her consultant -  a leading gynaecologist who chaired the committee that produced the NICE Guidelines on menopause, that this forum is highly respected. Since it is the chat/informal advisory part of the main very well respected website managed by Dr Heather Currie, the mods would soon intervene if anything was amiss and if anyone was overstepping the mark re advice. Also anyone who is reading - there is info in the forum information about what we can/cannot post:

Members are kindly requested to give references (eg links) to any health/medical information they provide, when it is not personal experience. Personal experience is anything the person has undergone himself/herself.

Information posted by members must be true and correct to their knowledge.

All members are, by default, considered to be non-medical professionals.

http://www.menopausematters.co.uk/forum/index.php/topic,8308.0.html

No-one needs to reveal their background or qualifications because we are all equal on here - but as you see we are asked to provide back-up to any scientific or medical information. As always - we advise anyone who is concerned about a problem to consult their GP - but in some cases we provide information that corrects the errors made by some GPs!!!

[Annie0710]

Hi love Vodka

I'm a classic example how just oestrogen doesn't work to make me feel better !

Hysterectomy when I was 32, kept ovaries.. within 6 months I was waking drenched in sweat, extremely itchy skin, knackered etc
Doc did bloods and I had low oestrogen levels.  She said the blood supply to my ovaries had been compromised and although still ticking over they weren't as efficient as they were pre hysterectomy so gave me 1mg oestrogen tablet.  Within a couple of days I was back to my old self.  Within a few weeks symptoms were coming back so she gave me max dose 2mg

I felt great for 13 happy years when suddenly ahe 45 I felt like I'd been run over by a steam roller, no night sweats but omg so many aches, pains, extreme dizziness, anxiety and low mood

Drs did bloods and said I was in peri, ovaries finally packing in and nothing they could do because I was already on max dose oestrogen.  I kept asking was there anything else alongside it they could give me ? Just antidepressants which I refused.
Anyway I think I became post meno quite soon after although this wasn't official until a couple years ago.

Why, when ovaries were producing 'some' progesterone and testosterone alongside my oestrogen hrt did I feel great but suddenly didn't ? I think my body needed the balance
Anyhow I was only offered high dose patches of oestrogen against my almost zero progesterone levels

It's said we don't need prog after hysterectomy, well no we don't for  the uterus but I believe some women do need it for the balance

Last year I sourced my own progesterone tablets and felt much better.  I fessed up to the nurse about and she said I mustn't take them. I asked what harm they'd do and she said none but I don't need them. I felt resentful that I wasn't allowed them yet I felt better

Fast forward and I am trialling Tibolone and although early days and I'm not perfect a damn sight better than on oestrogen alone.  Oh yes I had a scan last year and my ovaries have shrivelled and disappeared.  Personally I think they went around age 45 when these symptoms arose out of the blue

We are all different and vary greatly in our needs of hrt and doses.  Whatever you try always start low and build up .  For me oestrogen only hrt is distrastrous, it makes me a nervous wreck

[Love_vodka]

Thanks for sharing your experiences,it does help knowing I'm not going completely insane! Hurdity I do suspect my hormones are fluctuating. I was told I was definitely post menopausal due to my high levels but who knows 
Because of the factor 5 I think I'm advised to use patches rather than pills, I'm not sure about the gel but will look into my options.
I do think I might need a higher dose and haven't suffered any side effects at all from the patches.
I'm also going to try eating little and often at work and see if that helps my energy levels this week. I do eat breakfast, snack at half 10,small lunch, so might help having something mid afternoon. I know my blood pressure is low too so not sure if this is adding to the feeling of crapiness.
Thanks again xxx

[Dancinggirl]

Love_vodka - you sound pretty sorted to me - your plans for the coming week are good. So much is made of high blood pressure but low blood pressure can bring side effects e.g. lethargy,dizziness, headaches etc.  Eating small amounts often is a good strategy - keeping the sugar levels up can be tough when meno hits - I try to have a banana, and a handful of nuts or seeds mid afternoon. 
We are taught about puberty and what to expect but nobody prepares us for what happens when our oestrogen levels drop and it is a shock for many of us. This site is great for getting you through this maze - we all learn so much.
You are still at the early stage of trying HRT and, as I mentioned before, it can take time for the levels to build and do the magic.
If you look under TREATMENTS at the top of this page you will find all the different oestrogen options available - so it can be good to print this off to discuss with your doctor. As others have mentioned (i think it was Tempest) Tibolone (Livial) might be an option for you if nothing else works.
It might be worth trying to find the research regarding the risk factors of oestrogen and DVT.   Oestrogen is known to protect the heart as it helps to stop the arteries furring up. Can someone help me out over this???  I know that the DVT risk increases if we start HRT too deep into post meno but I'm just questioning whether you are actually at more risk from a DVT without oestrogen at your age? Could be worth asking to see a specialist about this - GPs don't always understand the full picture.

I have a sneaking feeling that in a couple of weeks you will start to feel the benefits.  Keep us posted  DG xxxx

[Love_vodka]

Thanks DG. I really appreciate you taking time to point me in the right direction.  I'll check out the Treatment info and look at Tibolone.
My dr took advice from a specialist regarding my risks. Unfortunately there isn't much research in under 50s on hrt with factor 5 but I've been told the risk is 13-16 times higher than my normal 8 times higher risk with hrt. It's probable slightly higher than that in the first year and doubles after age 50. And then obviously I have the risk of osteoporosis because of my age. I have just had a bone scan because I have frozen shoulder at the moment luckily it all looks fine but get the results in a couple of weeks.
Thanks again xxx

[Catspelle]

Wow. Well I never thought about progesterone having continuously be told like many others because I had a BSO I don't need it. I've never thought about it like this so thank you. Will definitely ask specialist about this.

[Frankie41]

Hi everyone

Just jumping in here to pick up on the 'little bit of progesterone' point.  It makes great sense to me that to reach hormonal 'balance' we should be working with more than one hormone (ie estrogen), although I acknowledge the vast variability in all of our individual needs and the fact that some women feel more comfortable sticking with just estrogen.  Indeed at the moment, this is me, as I have so far been very intolerant to any form of progesterone preparation and appear also to suffer from my own progesterone production which is why I have my cycle suppressed (lucrin). 

However, before I started with mainstream HRT,  I was using progesterone cream and I do remember it calming my somatic anxiety symptoms (heart palpitations and aches etc) - for those of you using progesterone as part of your regime, how much do you use? I don't tolerate the amount needed to confer uterine protection but my Endo has said since my uterine lining is so thin I don't need to take progesterone (for now).  But I do wonder about adding in some cream again in tiny doses to 'round off' the stimulatory effects of estrogen.  My Endo has kind of rubbished the cream, but I am re thinking things following this thread.  Also, for those of you who have tried the gel - would you recommend against it for someone with a known history of not tolerating fluctuations? I didn't seem to get enough consistent coverage with patches and am now on pills but getting headaches and feeling pretty bad on them - the next step is gel.    Do people ever combine patches and gel??!! Am pretty sure my Endo would freak out at that suggestion but I think I saw someone here mention combining methods.....

Many thanks, Frankie 41  ps.  Apologies if I have high jacked this thread love vodka - I fear I have, but was just picking up on a couple of points people raised.   I'm 42 and peri - I was initially great on 50 patch then needed higher 100.  But I waited 6 weeks before increasing. 

[Murphydurf]

Hi Frankie 41 - I've used patches and gel together previously (tried everything quite frankly!), and I'm going back to that today. I'm using 50 patch and adding a pump of gel morning and if necessary evening. I find the patch blows me up in higher quantities but does seem to provide a continuous dose and I need around 2.5g/3G of transdermal E. I find the gel runs out after 6-8 hours so I'm trying this approach. I'm also trying alt day 100mg utrogestan oral route as I'm better with prog but only in very small amounts as I seem to metabolise it very slowly. I'll try to have a withdrawal bleed in around 4 weeks but I've not long had a Mirena removed so don't think my lining will be too thick just now. I'm also using pea sized amount of Testim gel daily. My biggest probs at the moment are joint aches/low mood/energy so I'll keep posting on results. Sorry for hijacking thread but some other ladies might be interested.

Mxx

[Hurdity]

Frankie41 There is nothing wrong with using a patch and gel together as long as you are aware that it is a higher dose of oestrogen, (and your doc has approved), and therefore needs a corresponding amount of progesterone to protect the uterus. Maybe start your own thread as it sometimes gets difficult having two convos going on at once and replies leapfrogging over each other 

Hurdity x

[CLKD]

It really is Trial and Error at a time when we are tired, hormonal, worried, seeking advice ....... at a time when it would be nice to have GPs reading off the same hymn sheet as well as being prepared to discuss us as individuals!

[Love_vodka]

No problem Murphydurf/Frankie41 power is knowledge and all that.
I'm keeping a diary,waiting till 4 weeks and then will visit my gp if no improvements.
Xxx

[abbyH]

This is such a good post TEmpest, I'm going to print out and show doc. When I finally get seen, still no joy, she didn't ring me back, and now first appointment is on 22 Feb.. I'm going to storm the surgery on Friday and see if I can get a prescription, this is ridiculous, I've been waiting/trying since june last year to get hormonal balanced. And yes you Re right get on E only is just wrong (for me)

Thank you thank you for writing this !

Abby xx