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[edelweiss]

I've read about other women on MM and hystersisters whose HRT stopped working, or isn't working as well as they'd like. A high percentage of us, it seems, have Hashimoto's too.

I've seen the famous consultants. Each has a different explanation, or no explanation, and some flatly deny it happens.

The most plausible explanation I had was from a Prof in Italy who has studied estrogen receptors all his long working life, he said:

"as you seem to know, a hormone induces its effect via interaction with its receptor; therefore, the lack of the effect may be the result either of the lack of the hormone or of the dysfunction/resistance of its receptor.

As estrogen replacement therapy keeps the level of estrogen within normal/high values, the lack of effect must depend on dysfunction/resistance of peripheral receptors.

There is an extremely rare genetic condition, the "Estrogen Insensitivity Syndrome",  in which the estrogen receptor is defective.

But in your case, the insensitivity is acquired, a condition analogous to resistance to insulin in type 2 diabetes, in which the lack of effect is due to acquired resistance of peripheral insulin receptor.

In conclusion, I would suggest that in your case the insensitivity to exogenous estrogen finds its origin in an increased resistance to the hormone.

You may ask why this happens. In the case of increased insulin resistance, various causes have been suggested, among which I would primarily consider chronic or long lasting low level inflammation as in the case of the so called "Metabolic Syndrome" (which includes insuline resistance) or in auto-immune diseases (including Hashimoto's disease), and older age in general, etc."

What I simply can't understand is that top consultants don't acknowledge it/agree.

And there's no literature anywhere on this phenomenon.

There's a wikipedia entry on Estrogen Insensitivity Syndrome, which is so rare it affected fewer that 10 people. But NOTHING on why women stop responding to HRT - and many more of us are affected. How come?

Anyone got any thoughts?
 

[CLKD]

Firstly - not everything you read on Wiki ....... is honest ;-).  It all needs careful filtering and cross referencing for something as complicate as hormonal up-heaval.

It could depend on where you are on the journey.  When your last monthly period was, what types of memo-symptoms you have experienced and what has been difficult to diagnose or deal with.  Eventually most oestrogen production disappears so it may not be HRT not working but that you no longer require it?

Which symptom for you is the worst right now?  Hopefully someone will be along with HRT knowledge or maybe, send Dr Currie a PM?

[edelweiss]

Hi CLKD and thank you!

Yes you're right re wikipedia, but I think the Italian Prof had a good rationale.

I emailed Dr. Currie. She was wonderful. What she said concurs with the Italian Prof, that sometimes the receptors don't work properly, so estrogen doesn't have its effect.

So it's a true thing. But no other consultants acknowledge it. I just can't work out why - cynical me says bad for business?

it's hard to pick a worst symptom. Probably insomnia, then depression/lack of mental acuity? xx

[CLKD]

My brain has felt fluffy for years  .  I feel tired all the while but that's probably my medication [taken since the late 1980s].

What is the treatment plan for your situation?

[edelweiss]

Hi CLKD, thanks for asking. I haven't got a tx plan now, having been around all the top gynae/endo/other consultants and none of their advice has helped. My current plan is a self-administered: "get from one end of the day to the other". xxx

[Annie0710]

I first went on oestrogen hrt at 32 after my ovaries failed after hysterectomy .  That sorted all my symptoms out 100% but at 45 it suddenly stopped working despite high oestrogen levels.  I've tried all sorts and the best of them all so far seems to be half dose Tibolone.  Not brilliant but better than the others.  When I asked why my hrt suddenly stopped working after 13 years I was told it was because I was going through a 2nd menopause which can be more severe

[CLKD]

Tnx Annie!

[Elizabethrose]

Annie, I've heard you mention your second meno before but I don't understand what you mean (sorry probably being totally dozy!!). If your ovaries failed and you went through your first meno, did your adrenals then fail to send you into a second? Blimey I've had enough trouble getting to my first, I sure as heck don't want to go through all of this again. Could you explain it to me please xx

[CLKD]

Menopause strictly is the years after our last period.  No more bleeding.  So one is considered menopausal after we haven't seen a bleed for 2+ years. 

Maybe Annie the HRT put the real menopause on hold?

[dazned]

I was on hrt happily for 4/5years and then suddenly it stopped working and I was back to square one with all the same horrendous issues that I had in the first place ! Namely anxiety,palpitations,insomnia,panick attacks,just feeling wretched. Tried numerous regimes and nothing worked again for me unfortunately hrt wise.

[Tempest]

Annie, in your situation I think its probably due to the Adrenopause - there are many scholarly articles out there about this. I'll explain more later!

Edelweiss, that's fascinating! I believe wholeheartedly that my estrogen receptors have become 'deaf' - I haven't responded well to any of the HRT's I've tried and levels on two different transdermal methods were miniscule! I'll be talking to Professor Lumsden about this when I see her in 9 days time. Thank you for sharing your knowledge! 

[Tempest]

Here's a study concerning the Adrenopause and the promising effects of DHEA supplementation (for men and women).

https://www.ncbi.nlm.nih.gov/pubmed/12649580

I have further in depth studies to post elsewhere for any of you that are interested.

We all experience the Adrenopause and I'm guessing the state of an individual's adrenal glands contributes largely to difficulties in the menopause. We all know high stress impacts the adrenal's terribly -so this is why developing stress management strategies is so important at this time of life as we''re getting hit with a 'double whammy'.

I'm also guessing this is why in your case Annie you seemed to experience a 'second menopause' as your adrenal function declined with age and you were experiencing high stress in your life at that time.

I can say categorically that I have first hand experience that this is a factor, as I had the ACTH Stimulation Test last Wednesday which is literally a stress test of the adrenals and since Thursday night, I have experienced hot flushes, feelings of doom and anxiety all of which were not present before. I hope it settles down! If you will, I've tested this theory first hand (so all of you don't have to)!

[CLKD]

 

The longer I live the less I know ! 

There was an article in The Guardian yesterday about how being surrounded by stress in our early years increases the possibility of life-changing illness at 'our' age 

[Annie0710]

Annie, I've heard you mention your second meno before but I don't understand what you mean (sorry probably being totally dozy!!). If your ovaries failed and you went through your first meno, did your adrenals then fail to send you into a second? Blimey I've had enough trouble getting to my first, I sure as heck don't want to go through all of this again. Could you explain it to me please xx

I really have no idea! When my ovaries failed I was never told I was in menopause just that because of the ovarian failure (or severe compromise of blood supply to them) that I had very low oestrogen levels that resulted in sudden symptoms (none were emotional, all physical) so max dose oestrogen sorted it and I never gave it another thought.  At 45 I was under severe emotional stress for about 5 months and to my knowledge coping with it better than some people I know would then when it was sorted my dad had a cardiac arrest and died suddenly (my mum had died 9 years earlier) and I went to pieces, clearing out their memories and belongings.  Anyhow about 4 months after that a hoarde of symptoms developed, different to the original ones and no one knew how to treat them.  A gynae (may have fobbed me off as he really wasn't interested) said it's a 2nd aggressive menopause and nothing can be done x

[Annie0710]

Aw Tempest I just wish I could understand all this, I'm reading it and not taking it in :-(. X