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[BeckyB]

Hi everyone
I am now on my 5th brand of HRT following total hysterectomy 2years ago. Cannot fault my GP at all, she's been great but as she was struggling to find something that agreed with me, she's referred me back to my consultant because 'he's the expert'. Cannot fault him either, lovely and supportive, I feel very lucky. He prescribed me with Progynova 1mg-increasing the dose to 2mg when I went back to see him. He says I can still increase by way of a patch in addition to taking the tablets. I don't feel as though the Progynova help me very much, all physical symptoms of menopause have gone but the mental/cognitive difficulties are really worrying. I've talked to him about this and he's very empathetic. My question is really is anyone else on  Progynova? There seems to be very little info on it if I research it, even the chemist asked me what it was for! I'm wondering if it is an old-fashioned HRT and why it's never mentioned anywhere? The most common use for it seems to be for ladies who are trying to conceive! I'm tempted to question my consultant and ask for something else (Femoston has never been mentioned to me, not sure why) but he really is an expert so I don't want to insult him! Any ladies ever tried it...or even heard of it? Thanks in advance x

[Dancinggirl]

Hi BeckyB
Progynova seems to be just oestrogen valerate - so a particular type of oestrogen. Taking oestrogen following a hysterectomy will reduce the flushes, night sweats etc. and will protect your heart and bones for the longer term.
Controlling anxiety and low mood, if directly related to the menopause, seems to be the most challenging meno symptom to control - I'm afraid many women seem to need an AD/SRRI alongside the HRT to really tackle the mental issues.  Increasing the oestrogen dose won't necessarily help mood. If your flushes etc are under control then this HRT is doing it's job.
Have you struggled with low mood, anxiety etc in the past or has it just started since the hyster?
Femoston is a combined HRT in pill form and has a kinder progesterone that many women do well with but if you have had a hyster then you don't need progesterone.
Some have reported that adding in some testosterone may help with energy - whether this would help with low mood I really don't know.
I assume you have tried patches and Oestrogel? Transdermal oestrogen often absorbs better and can be more effective overall. 
I would discuss perhaps trying something like Citalopram (my gynae recommends this group of SRRIs)  to see if this might help - although it can be trial and erro with ADs/SRRIs as well. 
DG x

[Hurdity]

Hi BeckyB

You haven't said how old you are but I imagine quite young still? As Dancinggirl says oestrogen acts fairly quickly at the right dose to deal with symptoms of flushes and sweats but the mood issues can take longer. Also the dose at which flushes and sweats are alleviated may be lower than the dose needed to promote good mood. Low oestrogen definitely is responsible for low mood and therefore I would look to increasing the dose. 1 mg is pretty low. Also I read somewhere that you get less oestrogen from estadriol valerate than pure estradiol - but the information is not consistent on this. If this were the case then 1 mg of Progynova would be pretty low.

I agree with Dancinggirl that transdermal oestrogen should be the way to go for best absorption - you haven't mentioned which other types you have tried? Re patches - Estradot are probably the best if you need a higher dose as they are so small, so somewhat more discreet!

I would not go down the route of ADs at all if you are not depressed - to me this is a slippery slope to lifelong dependence! Increase your oestrogen dose and depending on whether you kept your ovaries or not - explore the possibility of added testosterone ( off licence) if the consultant you see is willing to prescribe it. Low T leads to low libido, but also depression, low mood, tiredness, muscle weakness etc. if you've had your ovaries removed then you are v likely to be deficient - and if you are in your 50's (but kept your ovaries) your levels may well have declined due to age.

Hurdity x

[BeckyB]

Hi
Thank you so much for your replies. I'm 47 and did have my ovaries removed, I had endometriosis so initially I was advised to have hrt that contained progesterone. After trying a few my Gp suggested it was worth just trying oestrogen only as she said progesterone can cause low mood etc. I didn't experience the low mood, anxiety, acne, insomnia etc before my hysterectomy. I feel like I'm wading through treacle, it is very hard to summon up any interest in anything and feel like I can't cope with my job/life. I'm trying to keep focus that my hormones (or lack of) are doing this to me and I'm not actually depressed. I take on board what you say about antidepressants and I think they would help but am scared to go down that line and become dependent on them. Your comments are really interesting as I had (wrongly)expected the oestrogen only hrt to help with mood. I am particularly interested in what you say about testosterone, when you say to ask to try it 'off licence' what does that mean? And when you say transdermal does that mean patches? My consultant did seem quite enthusiastic about trying patches in addition to oral tablets if the increase to 2mg didn't help. I've had 2mg for about ten days now and don't feel any different but I know it takes time. As I said in my previous post I feel very lucky to have a consultant who is supportive and interested and I don't want to come across as a moaner/hypochondriac! I am trying to remember what I've tried to date, as I remember I've had Tibolone, Prempak C, Premarin, Kliofem,Climaval and now Progynova. Just want to thank you for your replies, so helpful to be able to chat with someone

[Dancinggirl]

BeckyB - Sadly on the NHS, they are not usually keen on giving Tesosterone but I believe the new NICE guidelines do mention that for many women, such as yourself, the testosterone can often help with energy and libido - so generally help on all fronts - could be worth asking your consultant about this.
Hurdity can advice more about testosterone.
I agree with Hurdity about ADs/SRRIs and would not be keen myself but it is worth considering trying them if nothing else works.  I think it would be worth trying either patches or Oestrogel instead of the pills - Oestrogel gives the ability to adjust dose which can be very helpful.  I must also say that 10 days isn't long enough for the latest pills do work on mood.  Do you do any relaxation techniques, have you had a good look at your diet as well - we often think we get all the nutrients we need and unless you get at least 20 minutes of full sun every day of the year then Vitamin D deficiency will result and this will give low energy, low mood, aching joints etc.  Perhaps have a blood test for Vitamin D, B12 and Iron?  DG x

[dahliagirl]

Hi - I have a friend who had a hysterectomy (plus other operations) with severe endometriosis.  I am not an expert.  She has been on oestrogen patches for a number of years, having tried gel and tablets before.  She has to have the lowest dose that will do the job and so far the endo has not come back.  I think sometimes you end up having to have more oestrogen to combat the progestogen.

[BeckyB]

Thank you both Dancing girl and Dahlia Girl, you are very knowledgeable!  I agree about having a blood test, as it's never been mentioned to me I have the feeling my docs don't think I need one so I'll have to ask. I don't do any relaxation techniques as I can't relax!! I've tried yoga and Pilates, and in my job mindfulness is very popular but I just cannot find something that works for me-I have trouble remembering to breathe! I am outdoor a lot because I have animals but it's hardly ever sunny lol. Like you say, 10 days on the higher dose is nothing,  it's just that I feel defeated before even trying. Sounds like patches are something I should try, and Oestrogel (never heard of it!). A big thank you for your replies xx