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[dht240]

Hi, I've been a member here for a few years since I started getting bad symptoms a couple of years ago. Long story short - night sweats, hot flushes, weight gain, moods, low self-esteem and the doctor prescribed Mirena. I went a little loopy with it. I don't respond well to any level of progesterone, it would seem. Mirena was removed after 6 months (and a battle).

As of now I'm 14 months without a period. My body apparently has a sense of humour, I have what feels like all the symptoms...and some.

I have spoken to the doctor - anti depressants, HRT and alternative therapy are my option. I've been doing the alternative therapy since mirena went and it's not working suddenly. Anti depressants - no way. And so HRT.

My questions...how long does it take to find the right HRT option?
I'm 47, so will my options be limited?
I don't tolerate progesterone at all well...are any of you the same? How have you handled HRT? What options (if any) were you given to combat the intolerance?
And, finally, will I ever sleep again?

I'm sorry for so many questions. I am keen to read, research and learn before my appointment next week.

Thank you!

[Bluebell]

Hi dht240, when you say you don't respond well to progesterone - how did it make you feel?
I was put on Evorel Patches in April and they were brilliant for the hot flushes and nightsweats but they made me feel very anxious, lying awake during the night feeling totally wired. I've since come off them but I'm still feeling anxious and the palpitations and sweats have returned even more ferocious?!
I've been told there are different options to try but the thought of maybe having that experience is putting me off. I wish there was one HRT for everyone with no side effects .... life would be good then.

Reading through some of the posts I've found Hurdity to be very knowledgeable regarding HRT.
Hopefully she'll see yours and answer you. X

[dazned]

Unfortunately it's different for everyone . You may have to try a few different ones before finding the right one for you. Have a look at the types listed above under the treatments tab. He prepared to stick to one type for at least 2/3 months before swapping. You might be lucky with the first one though. Try to accept that it probably won't get for of all symptoms sometimes you have to just go with the best one for you which Will only be found out once you start trailing some. Good luck.

[Dancinggirl]

Hi dht240 - for a start, I don't think you should have been given the Mirena without some oestrogen alongside to counter the down sides of the progesterone.
Just because that progesterone didn't suit you doesn't mean there isn't one that will - it's trial and error.  You may find that with oestrogen alongside things aren't so bad.
In your situation, I would not do any non bleed HRT or continuous hRt regime until you are sure a particular progesterone suits you.  So.... go for a sequential HRt and put up with monthly bleeds.

Many find Utrogestan good for the progesterone but I found that the most problematic - we are all different. Oestrogel with separate progesterone for 10-12 days each month would perhaps be your best option - so use either Utrogestan or Provera with daily Oestrogel - both are kind progesterones and could suit you better.
At your age HRT is the appropriate treatment - ADs are really not the right thing - you've just got to find the right regime.  Print off all the info under TREATMENTS (don't forget to look at the 2 sections on Oestrogens and Progesterones) on this site to discuss with the GP.  Good luck. DG x

[Hurdity]

Hi dht40

Good advice already - and I echo what dazned says that no HRT regime will be perfect ( after all we didn't feel perfect throughout our menstruating years) but as she says the important thing is to feel better overall on HRT than off it. In addition at your age you should be taking it ideally at least until the average age of natural menopause of 51/52 to help protect your heart and bones.

When I was in your position ( well I was late peri-menopause at 53/54) I researched the different options ( this is 10 years ago now) and decided I didn't want the horse urine types of oestrogen (those beginning with PRE-) and also wnated a nil-by-mouth approach - to avoid the HRT going through the liver, so I started on patches (Evorel sequi). As it turns out i was one of the women who was senisitive to the synthetic progestogen in these so changed to oestrogen patches with separate progesterone (back then - Cyclogest -  before utrogestan was available, and later Utrogestan) and I have been on this more or less ever since.

At first because I was peri-menopausal I took the prog on a 28 day cycle and I have to admit I didn't like it and had a migraine more or less every cycle. However I still felt better for more of the time taking it than before. Later I found that I didn't bleed on this regime so with the help of my doctor (GP) - who initially suggested I went onto continuous combined HRT ( and I tried this for a few months) eventually decided on a longer cycle which is what I do now.

I use Estradot patches (approx 50 mcg) along with utrogestan taken vaginally every 6-8 weeks to give s short bleed - and I am now in my mid 60's.

The main advice I would give is to stick with a cycle to minimise progestogenic exposure. Problem is the variety available. If you're happy with tablets Femoston is a good one so you could start on the 1/10 dose and increase if needed. The annoying thing is that dydrogesterone is not available separately so there is no possibility of a longer cycle with this one.

Apart from Mirena the only other alternative ( to Utrogestan) is Provera tablets.

I would perhaps start with a monthly cycle - use utrogestan vaginally and take it from there.

Also ask for vaginal oestrogen ( in addition to systemic HRT) especially if you are experiencing problems there.

Yes my sleep improved completely once the night sweats were banished! I sleep like a baby now - and in fact deeper than a baby as I rarely wake in the night - (but that's another story - nothing to do with HRT!).

Hope this helps but do ask if you need any further advice

Hurdity x

PS also agree with Dancinggirl - posted as I was writing mine!

[Mary G]

dht240, why on earth did your doctor prescribe a Mirena coil without oestrogen?  What was the thinking behind that?  It sounds completely wrong.

Considering you don't tolerate progesterone well, you are post menopause and you are currently not taking HRT, why don't you ask for the new, period free, progesterone free HRT called Duavive?  Read up on it, I think it could be a really good solution for you.

I am currently trialling Bazedoxifene (the SERM/progesterone subsitute part of Duavive) with 2 pumps of gel every day and so far, very good indeed!

[dht240]

Hi everyone,
Sorry I disappeared! Life got kind of busy and I'm struggling with silly things like getting home from work and being exhausted. I haven't been switching on the computer or looking at my iPad at all. The lack of sleep is really messing with my head AND my body. But, I'm still getting up at 5:30 to make sure I work out and get that in. It's the only time I really feel like me.

Thank you all for your replies. I can't tell you how much it means to be able to learn from you and see your replies. You've all given me lots to think about. I'm going back to the GP today to see what options she offers me. I've read up on all the tips, tablets, gels etc. that you've mentioned and I'm very very grateful to be armed with that information.

To answer some of the questions I was asked:
My reaction to progesterone tends to be quite extreme. I become irrational, moody, short-tempered, I sprout hair from places I've never been hairy and I seem to gain weight with no rhyme nor reason to it. That's most frustrating as I'm a fit, healthy, calorie/macro-tracking, strength-training fitness obsessive!

Why did they prescribe Mirena?
I've had gynae issues since my 20's and have had a couple of operations, tried and failed to conceive, hormone imbalances & other things. The GP when I went with a whole host of different symptoms said (and I quote) 'We don't do surgery for that anymore. At your age options now are Mirena coil or the pill.' I went away and tried acupuncture (which I've been successful with previously), but I had no luck. I'd basically had a never-ending period for about a year... And 6 months later went back to the GP. I had no need for birth control (never have - can't conceive), but I felt so down/depressed/exhausted and out of options that I agreed to try Mirena. Looking back, it feels like I was bullied into it.

So, there we have it. I'll report back once I know what the lovely GP has to say today.

Thank you all again,
dht240
xx

[dht240]

Well,the update is that I have Evorel Conti patches. The doctor wasNt keen to put me on anything that would bring a monthly bleed back. She also went theough the different progesterone options - her advice was to try these. So, we're going to try them and see how I get on - I know there can be issues with them, but I have to hope! Today's been another day of hot flushes every 30mins, so I'm looking forward to seeing how this goes.

Thanks again, I'll keep you all posted.

Dht240
Xx

[peri]

Hi dht240

Sorry to hear you've had such a hard time.  The only thing about evorel conti is they contain the progesterone noresthisterone, and this can be a problem. As you have stated you don't do well with progesterone you may struggle with this, as it can cause irritability and anxiety - it certainly did for me when I tried it.  I then switched to evorel 50 patches (oestrogen only) and utrogestan for progesterone (vaginally) as the others have mentioned.  I've tried lots of hrt's and I've found this one the best so far.  See how you get on but remember you can always switch if it's not working.  Wishing you well x

[dht240]

So, a little update from me a couple of weeks in. I got Evorel Conti patches and I'm pleased to say I've gone from hot flushes every 30 mins (all day and all night) to about 5 a day. I'm less tearful. I have had a couple of decent nights of sleep.

So, still a work in progress. I'm watching for the familiar reaction to progesterone...but this isn't levonorgestrel this time. Fingers crossed I'll continue to progress.

I did have some spotting today though, which was quite a shock as I'd had no period for well over a year.

D.
Xx

[Dancinggirl]

Pleased to hear things are going ok so far. A shame you are trying the conti first but you may be fine - time will tell.
Erratic bleeding is quite normal for up to six months on any conti HRT and can sometimes be an ongoing issue for some women but norithesterine is one of the most powerful progesterones so possibly better at keeping the womb lining thin.
Your reaction to the progesterone in the Mirena may well have been because you didn't have the oestrogen alongside and side effects with the Mirena do take up to 6 months to settle.
It's great to get some quality sleep - this can make such a difference to everything.
I suspect you have simply needed oestrogen all along - hopefully spotting/bleeding will settle in a few months and you continue to feel better generally. DG x