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[Jube]

I'm 52 and started taking Elleste duet 1mg about 2 years ago. At the time fsh was 75 and getting lots of menopause symptoms aches, flushes - on pill so not sure about periods. When not on pill previously they had been heavy and erratic - went 3 months without one. Have had night sweats for years ! Elleste duet worked fine  aches and flushes fine, light regular bleeding. But recently have been emotional, Worry about EVERYTHING, achey, pmt symptoms before bleed no libido.
I thought maybe needed more oestrogen. Went to doctor. Asked if may be I could have tridestra so I only had bleed every three months. She agreed I probably needed more oestrogen  due to symotoms and put me on elleste conti. I questioned it as I don't know whether I'm peri or post. She said if i bleed go back and she'd give me tridestra, if i didnt bleed conti  is ok !!!! ?? The thought of no periods is very appealing but not if there is a risk to my health.  She also said you should stop hrt at 56 as you don't need it. But if you felt really bad you could go back on it ? Would it be ok to be on conti if i had scans to measure womb thickness etc ?  Advice please 

[Dancinggirl]

You are getting very pedantic advice from your GP which isn't actually very accurate. If you were feeling good on the Elleste 1mg then, in your case I would have stuck with this unless you were starting to get flushes again.  Anxiety and low mood are common and are not always associated with hormones - I personally think we tend to get that way as we age anyway. Libido is difficult to treat - there is so much wrapped in with how we feel about ourselves and whether we feel sexy and desirable - some women need a bit of testosterone added to the HRT regime but you will seldom get this on the NHS without specialist advice. If more meno symptoms were breaking through (flushes etc.), then the obvious course of action would be to simply move you to the higher dose of Elleste sequi first - then onto the conti version. Sometimes using progesterone every day can lower mood, some find they feel great on conti progesterone as they feel more on an even keel - we are all different.   The conti Elleste is a higher dose and may well suit you as you got on so well with the sequi version, so it is well worth trying this.  It is very common to get some bleeding for the first 3-6 month when using a conti HRT, so some erratic bleeding in the first few months is normal and not an indication that you are still peri meno. If after 6 months you still get bleeding then you will need a scan to check the womb lining - you won't get regular womb scans routinely on the NHS.  I'm afraid you may have to ride the first few months and see how it goes - but this will be true for any conti HRT. 
Tridestra often seems like a tempting option but I believe one is more prone to problematic bleeding due to the longer time on oestrogen alone without progesterone.
The alternative, if you want a bleed free option with fewer progesterone side effects, is to have a Mirena fitted and use oestrogen as gel, pills or patch. The Mirena is suitable in peri and post meno.
As for the cut off at 56, well, unless you are struggling with HRT, if you have a busy life and meno symptoms interfere with your ability to work and get on with things, then I wouldn't be in a hurry to stop HRT until at least 60 and then only review with a break for 3 months or so.  The 5 year cut off is really not applicable these days and health risks are very, very small - there are only slight increased risks if still using HRT into your 60s. DG x

[Kkay]

I'm just going to jump in here to comment on the "stopping at 56 bit because you don't need it". I just don't understand how practitioners can make statements like this, given what is known these days about the relative risks of HRT and the protective benefits of estrogen in one's older years, and how difficult living without HRT is for many of us.

A healthy, estrogel-using friend of mine saw a renowned gynecological oncologist this summer in Paris - my friend is 64 - and asked him how long she should be on estrogel for. "Until the last day of your life" was the answer. "Let's assume you will live for 25 more years; you should use it every day for the next 25 years".

Best wishes

[Hurdity]

Hi Jube

To add to the comments already given - I presume you have been prescribed Elleste Duet conti 2 mg as the doc agreed you would benefit from increased oestrogen?

In addition - you would expect to experience pms symptoms even if post-menopausal when on cyclical HRT - it is caused by the withdrawal of progestogen as the body readjusts. Many women will experience this for a few days just before the bleed (usually during the first few days of the oestrogen only part of the HRT and just after stopping the combi tabs). Once the bleed has started you should feel OK again? Some synthetic progestogens also give pms type symptoms and these can be persistent if you take them all the time - as you would be doing with the conti HRT - although your hormone levels themselves would remain more or less stable (if post-meno) and more stable than otherwise if you are still peri.

Personally I would suggest keeping with a cycle while you increase the oestrogen dose and see how you feel on this generally ( pms aside).

Also re the libido - oral oestrogens have a greater dampening effect on this than transdermal oestrogen, due to the effect of the former on a compound known as SHBG, so before considering testosterone I would maybe switch to transdermal oestrogen. However there are only two medium dose patches so for higher oestrogen doses you would need to have separate oestrogen and progesterone ( Utrogestan or Provera). As Dancinggirl suggests - a Mirena coil may be a good option, as some women do not seem react to the progestogen in this compared to oral HRT.

I totally agree re the stopping at 56 - what a load of rubbish!! Roll on the time when GPs are better educated and up to date about all of this!!! The main problem with taking it for the rest of your life though - is for those who still have a womb - because it does entail taking progestogens for the rest of your life too - and the jury is still out on the long term effects of taking this well beyond reproductive age - especially the synthetic ones, let alone the fact that many women suffer side effects from the progestogen part and/or put up with a bleed.

I'm in mid 60's  and haven't decided what to do about taking HRT long term and continuing to have a withdrawal bleed! I suspect I will eventually try to reduce my oestrogen dose to less than optimal so that I can go onto an even longer cycle than currently - and therefore minimise the progesterone dose/duration.

You don't need routine scans if you take continuous combined HRT - only if the expected spotting and bleeding during the first few months persists longer than 6 months approx, I think the advice is.

Hurdity x

[Jube]

Thanks for advice everyone.
I've got a telephone appointment at and of October with a doctor who is 'interested in women's medicine' etc and is younger so hopefully more up to date with hrt issues.
Think I'll continue on my 1mg elleste duet and ask her for 2mg (and put up with bleeds to be on safe side)
I wish you ladies were my gp!!!!
When will i get a gp who knows about hrt ? !!

[CLKD]

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