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[JSc]

Hi all. I'm new to this forum and hrt but have been reading around the site and other forum posts. I just wanted some advice/support re changing to sandrena gel 1mg. My GP prescribed elleste duet 1mg about 7 weeks ago after I requested hrt in the hope of sorting my life out a bit! I am 50 with irregular periods and have been having hot flushes at night for years with the occasional hot flush during the day, mostly in the mornings. Apart from not sleeping at night without some sort of help (half a nytol or a nurofen - I am very sensitive to anything that makes you sleepy and could sleep for days on a single nytol!), and lots of aches and pains I thought I was managing the perimenopause ok. Until 8 weeks ago when I had a stressful event and then spent 4 days at home in floods of uncontrollable tears for no apparent reason. After searching around on the internet and reading lots of posts on this amazing forum  it suddenly dawned on me that it was likely my hormones were causing all this.
So, long story short, I asked my GP for some hrt and she prescribed elleste duet 1 my which I took for about 7 weeks. Felt sick and dizzy with the first couple of weeks but after the first couple of  a days slept a baby for the first time in years and no hot flushes. Then took the progesterone tablets and felt even more sick and dizzy, but kept going. Onto the second pack and managing to hold it all together, then out for dinner last weekend and was engulfed by hot flushes, nausea and dizziness. Then last week sitting at work with hot flushes coming at me every couple of minutes, feeling very sick and dizzy. Next morning, major panic attack, nausea, and crying all the time. Saw another GP who was lovely and listened sympathetically as I used up all her tissues (!) and then suggested I try sandrena gel 1mg with 200mg utrogestan for 12/14 days a month. Moved over to these on Friday evening starting with the utrogestan as I had already taken 2 of elleste duet progesterone tablets, and then used the sandrena gel on Saturday morning. Same routine Saturday night and this morning.
The utrogestan made me feel a bit heavy headed Saturday morning which eventually wore off and same this morning but less so, so looking good as nausea and dizziness has eased up _ hurrah! However, I have been sitting here all morning with wave after wave of hot flushes which has unsettled me completely and I feel panicky and weepy (the latter most likely because I was really hoping to get back to work tomorrow as I feel such a fraud).
Oh dear this has turned into such a long post - so sorry. My question (finally!) is whether it might be that the Sandrena gel just isn't doing it for me? I thought that 1mg in elleste would be the same as 1mg sandrena. Or is it just that I've got it bad this week? I can honestly say I have never felt so bad!
I'm struggling to leave the house, which is so alien to me.  Can I opt out of my 50s and jump straight to 60?!
Any advice would be appreciated.
Thank you

[CLKD]

 

Sounds 'within normal limits' from where I'm sitting  and flushes can make a lady feel really ill.  It may take a few days B4 you get relief with this new HRT regime.  Well done on finding a GP who listens ........

This too will pass.  Some ladies find that keeping a mood/symptom/food diary useful.  Gentle exercise.  Regular food intake.  Remain hydrated.  Rest when you can.

I'm sure that someone who takes HRT will be along, in the meant time you could use the 'search' box and put your regime in to see the other threads.

[JSc]

Hi CLKD
thank you for such a quick reply.
I've had a look around the forum for others with the same regime and generally positive so I'll persevere with the current levels of Sandrena and hope all will be well. I was just surprised at having worse flushes than before the hrt and that my aches and pains have also come back with a vengeance.
I'll start the mood diary too; good idea.

Off on holiday in 10 days time, so need to get on top of things so I can get on the plane!

I never realised it could all be so complicated,  but the support and advice on this forum is amazing.

Thanks again. I'll post with an update in a few weeks time which will hopefully show an improvement.

Xx

[Hurdity]

Hi JSc

 

You can't really compare the oestrogen levels in tablet HRT and gel as they are absorbed differently and how much oestrogen gets into your system from each method varies individually. With tablet oestrogen a lot is lost to digestion and is metabolised through the liver, whereas transdermal oestrogen is absorbed directly into the blood stream . How much you get from the gel depends partly on your skin and the application area as it has to be absorbed before it dries. I expect also your body will be adjusting to these different ways of getting oestrogen.

Keep on with it and you should ideally give it 3 months before deciding whether or not it's for you - although you should experience relief from flushes and sweats very soon.

However if you are taking the utrogestan orally - some women do experience more side effects this way and it's quite a high dose for that amount of oestrogen (low/medium dose). Also some women find their hot flushes increase on the progestogen part of HRT, although perhaps more with the synthetic types rather than Utrogestan although I think Stellajane ( hasn't been on here for a while I realise - might be on holiday  ) gets this when she takes utrogestan and increases her gel at this point in her cycle which seems to do the trick I think? Maybe Cassie too? You may find applying a little more when on the utro is helpful

You may well find that once you've stopped the utrogestan and you've got back to normal - you should feel OK again ( take a few days to get it out of your system). You say 12-14 days - is this up to you? If so I would go for 12 days max.

Hope it all works out for you and have a great holiday without worrying about menopause

Hurdity x

[JSc]

Thanks so much Hurdity,
I had such instant relief from the flushes and aches and pains from the elleste duet that it took me by surprise. I expect that the hot flushes are fuelling the anxiety symptoms and/or vice versa.
The option of 12 or 14 days utrogestan was suggested by the WHC nurse as I contacted her asking about the best way to switch to the new hrt and to ask about how to take the utrogestan - my GP had put on the instructions that I should take 100mg throughout the month with a few days break. After reading around this site I felt that was wrong as I am peri and the nurse confirmed this. I think my poor GP was getting confused after I had spent 20 minutes sobbing in her surgery!
I would dearly love to reduce the utrogestan as I have the morning fug but the WHC nurse said 200mg was the correct amount and it was better this morning. I might try upping the gel to see if that helps. I have to say that I feel more human on the utrogestan; just wanted to kill everyone when taking the green elleste tablets!
One other question if you (or anyone else) has time: is it ok to take evening primrose oil as well - looking to hit this with everything so I can get back to work, and on that plane!

Appreciate all the advice and support.
Xx

[Hurdity]

I took evening primrose oil years ago for breast pain during my fertile years but I'm not sure it did anything. It used to be available on NHS for this purpose but was withdrawn apparently due to insufficient evidence of efficacy for this purpose.

Personally I wouldn't take anything like that - but concentrate on getting a really good varied diet with lots of fresh fruit and vegetables, cut out or down sugar and refined carbs as well as processed foods, and eat plenty of fish. In winter I sometimes take pure cod liver oil (the stuff in a bottle) but not sure I need to.

Hurdity x

[Mary G]

JSc, I don't know much about Sandrena because I use Oestrogel but I think they are similar. 

I have only ever used 100mg Utrogestan (vaginally) for 7 days because I am intolerant to all types of progesterone used in HRT preparations - this is a common problem and one of the main reasons for women giving up on HRT altogether.  I would never take Utrogestan orally because it gave me far too many horrid side effects including breast pain.  My (German) gynaecologist thinks that Utrogestan should always be used vaginally and she also thinks it works better for womb lining clearance/thinning when placed next to the cervix using an applicator - this is common practice in Germany.  When Utrogestan is used vaginally, it is more targeted and hits the spot meaning you can get the same (or better) results by using half the dose i.e. 100mg as opposed to 200mg because half of it gets lost in your digestive system when used orally.

You don't want to ruin your holiday and you need a quick solution to this so my first port of call would be to reduce the Utrogestan to 100mg (vaginally) for 10-12 days each month and increase the Sandrena dose. 

You don't have to go out and buy more Utrogestan, it's the same capsule for both oral and vaginal use.  For some bizarre reason that nobody has ever been able to adequately explain, the UK is the only country that does not licence Utrogestan to be used vaginally, that is why is only states oral use on the UK boxes. 

I really do think you will feel better with more oestrogen and less progesterone.  Please give it a try and read Professor Studd's website, he talks a lot about lower dose progesterone and progesterone intolerance. 

One more point, make sure you are well clear of Utrogestan before your holiday because you will probably have a period a few days after taking the last capsule. 

[JSc]

Hi Hurdity. I'm probably just clutching at straws, trying to find anything that helps! I am a fruit and veg person already, drink mostly water, (gave up the caffeine years ago) and cook everything fresh which should hopefully stand me in good stead as this journey progresses.
I am feeling better on the utrogestan and after a couple of fuggy mornings my dizziness and nausea have cleared up enough to allow me to get back to work. One thing I have noticed is that I get terrible hot flushes in the mornings which is when I apply the Sandrena gel. It just goes on and on for about an hour or so. I am wondering if the oestragan boost is too much in one go. It settles down and I don't get any more hot flushes later in the day. Thinking of trying half a sachet twice a day instead.  Are you aware of any downsides of doing this?
The other thing I have noticed is that I have to eat something every 30-45 minutes to stop myself feeling sick. It's a bit like being in the first trimester of pregnancy - and I thought I would never have to go there again!  Hopefully that will subside too as time goes on.

MaryG
Thank you for your reply too and your great advice. Great to hear from someone who also takes utrogestan.  It does seem strange that it is not licensed for vaginal use in the UK. I think if I can reduce the dose then the background, slightly dizzy feeling I have might go away and that will make me feel so much better. Incidentally, I always got a bit light headed and dizzy about a week before my period so it's probably my natural response to progesterone.
I am going to discuss professor studd's regime with my GP when I see her next. She was great when I saw her last week and I am hoping she might agree to a scan of I reduce the dose so that I can be sure it's working properly. I am hoping I am near the end of the peri stage so can maybe ditch the utrogestan sometime in the not too distant future.

Thanks to you both. Better go and sort out some packing for us all!
X

[Hurdity]

Hi JSc

Unfortunately you won't be able to ditch the utrogestan once you become post-menopause. All women who still have a womb and are taking oestrogen need to take a progestogen to protect the womb lining from overthickening.

I have only ever used Utrogestan vaginally and have been using it for 6 years (now in mid 60's) but always dread the cycle when it comes round. Fortunately my doc agreed that I could be on a long cycle so only take it every 6-8 weeks on a medium dose oestrogen ( patch) which works well for me.

I can't comment on the effect of the gel and increase in flushes as I have only ever used patches and they have always worked like a charm .

Have great hols

Hurdity x

[JSc]

Oh dear, I have so much to learn!
I actually seem to be tolerating the utrogestan much better now, although I started a bleed last night and I'm only on day 7 of progesterone (3 days of elleste duet followed by 4 days of utrogestan when I moved across to the new regime). Felt rather happy last night and even managed to eat a small meal. Feel dreadful today though!
Just need to get these hot flushes during the day under control and I will feel I am on my way! I only ever had hot flushes at night but now there are none at night and loads during the day - that's not what I was expecting.
Oh well, I'll stick with it and will hopefully be able to post here in a couple of months time that all is going well.
Thanks for all the advice and support. Just writing these things helps.
X