Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[racjen]

Thanks Hurdity, I think I count as post-menopausal - chemotherapy last year clobbered my ovaries and I've not had a period for 14 months. I've had a consultation privately with Dr. Sarah Gray down here in Devon ,and will try to see her again soon to check all this, but in the meantime I'm giving my body a couple of weeks break from utrogestan and then will try the 12 day cycle. Today I started bleeding and am finally feeling a bit better - just hope it lasts.

[Katia]

There does seem to be a lot of variations in progestegens. I find it strange that the American Angeliq has a quarter of the amount of progestegen to the British one which has almost as much progestegen as Yasmin pill. Although I shouldn't jump to conclusions, I did wonder if the UK was overdosing women on progesterone/progestegen to ensure not having to pay for scans. If this is the case, I think they should explai. That and give women the choice of reducing and paying for their own scans. I am struggling with finding a progesterone/progestegen that doesn't either knock me out, or give me a rash. I think it's hard to find balance, especially when HRT progestegen is almost as high as the pill and the estrogen so much lower. Just my two cents worth.

[Hurdity]

Although more scans and investigations would be a consequence of reduced progestogen doses surely it's more a case that a dose is set to ensure that as few women as possible run the health risk of endometrial hyperplasia and therefore cancer? Of course the NHS has limited funds, but the doses have been set through trials to minimise problems and safeguard our health. Better to have to suffer a few side effects or have to do a bit of tweaking etc under medical supervision than run the risks? The amount absorbed from the different types and modes of delivery also varies so much from woman to woman, not least because of our weight/size differences as well as digestion (for oral types) skin etc

Racjen - sorry to hear about your cancer and hope you continue to feel better . Let us know about your gynae consultation.

Hurdity x

[Katia]

HI Hurdity, I get what you're saying, but the drug companies in the USA do tests too.  BRitish Angeliq has nearly as much P in it as Yasmin and yaz.  Might as well take half a Yasmin. I actually wish the progestegen came on its own as it worked for me in Yasmin, but I can't seem to get in too well with estradiol. 

[dangermouse]

I've always thought that the HRT progesterone is too high. (Perhaps just in the UK?). Why would a woman on a higher oestrogen pill (already producing her own oestrogen) need less progesterone than a woman taking ERT who is likely to have much lower natural level of oestrogen? It doesn't makes sense.

I know different progesterones exert different strengths (there used to be a great pill website with the formulas) but I tried Provera once (and I mean once!) and it was like taking a strong sleeping tablet. It frightened the life out of me once I woke up!

As Utrogestan and Provera are taken for just a few days, perhaps this is a bit like the morning after pill where you have a megadose to suddenly clear the excess oestrogen, as opposed to little and often to stop things building up in the first place.

[Dancinggirl]

Dangermouse - do read Hurdity's last post on this thread again.  She explains things extremely well.  There is no ‘one size fits all' so naturally dosages of any treatment ( HRT is no exception) are set at levels that are the safest and most effective.  Tailoring of any treatment has to be done under professional supervision to ensure minimal risks. If a women is super sensitive to a particular oestrogen or progesterone then this brings real challenges when treating meno symptoms - it will always be benefits versus side effects with any treatment - nothing will be perfect. DG x

[dangermouse]

Yes, this I suppose confirms the need for compounded hormones, when the standard dose may be too much for an individual.

Sometimes side effects are just too debilitating to handle for some but we are, of course, very lucky that we have the good old NHS for when we fit into the standard!

[Alice]

Katia, after nearly two years of trial and error with HRT and suffering the many side effects of various combinations and doses, I have done just what you queried and have committed to half a YAZ daily.   I tolerate the Drosperinone progestin very well and calculate 1.5 g is equivalent of 150g progesterone and 10mcg Ethinyl Estradiol equivalent to 1mg Estradiol.  Like you, I cannot accept that the Australian Angeliq is 1mg Estradiol plus 2mg Drosperinone whereas the US version is 1mg Estradiol to 0.5mg Drosperinone.  Then again, nothing much has made rational sense to me or my body these past two years as I enter menopause!  I am having regular scans and thus far uterine lining is 2mm so hopefully will remain.   I have little to no depression on this regime and feel very stable.  Doctors are 50/50 on whether this is a good idea but can't explain why not particularly when compared to Angeliq. 

[LizzyD]

Aannndddd......after trying to follow all that I'm sorry to say I'm even more confused and not understanding at all.....
I'm newly on Angelique, but the South Africa one, which when I look is the same dosage as the Australian version.
Can any of you direct me to any more reading about the doses and implications so I might get a better understanding?

Thanks all x

[Mary G]

Katia, it's interesting that the US brand of Angeliq contains 0.5mg drosperinone, I wish I could have tried it.  I had the standard European brand and didn't get any symptom relief so I topped it up with a 50mcg oestrogen patch and it was slightly better but clearly the US dose would have suited me better.  I asked Professor Studd what he thought about my taking half an Angeliq tablet everyday and topping it up with Oestrogel and he said 'it is eccentric but there is no reason why you can't try it'.  Unfortunately I couldn't tolerate even that much progesterone but others might find it works really well - Alice, for example.

Dangermouse, compounded hormones sound like a great solution for those who need a more tailor made prescription and as you (I think it was you!)  have said on here before, they are improving all the time and not the same as the bog standard progesterone creams that don't protect the womb.  This is an interesting development. 

We know that there are millions of women who don't have a problem with progesterone in HRT preparations and are happy with standard forms of HRT offered by the NHS but this debate is about those who are not and are looking for solutions.  Common problems debated on here are progesterone intolerance, lack of symptom control (in my case due to too much progesterone) and post menopausal women who can't cope with having periods and/or progesterone any more, give up on HRT completely and then have to live with menopause symptoms again. 

I think we need a review and a multi-pronged approach to this problem.  Peri-menopausal women who fit into this category need a more tailor made dose of progesterone and post menopausal women either need to consider the new Duavive or a SERM (progesterone substitute part of Duavive called bazedoxifene) and a separate oestrogen which I am currently trialling. 

[Hurdity]

Yes, this I suppose confirms the need for compounded hormones, when the standard dose may be too much for an individual.

Sometimes side effects are just too debilitating to handle for some but we are, of course, very lucky that we have the good old NHS for when we fit into the standard!

You can vary the standard amounts on NHS with oestrogen and progesterone - which is what was being discussed. That's the whole point of having oestrogen patches and gel of different strengths. It is not a question of NHS = standard licensed = limited, private (including compounded) = tailored individual dosing = the sky's the limit. Not that black and white - it is the COMBI tailor-made preparations that are there (private or not) for "when we fit the standard".  You can individualise your dose on NHS - as Dr Currie herself pointed out in her intervention ( ie that individualisation was important). The most important thing is that this (individualisation) has to be done under medical supervision - which can be done on the NHS and the more women push for this (from the bottom up  as well as from the top down) the more things will move in the right direction.

As has been discussed many times before compounded hormones are not recommended for reasons stated and I'm not going to go through them again. Anyone new to the concept - please read this thread:  https://www.menopausematters.co.uk/forum/index.php/topic,37209.0.html and especially posts by Dana and Dr Currie's blog, and also recent position statements by BMS and others.

LizzyD - maybe start a new thread about Angeliq?

I agree Mary G - it does all need reviewing and more products and dosages (of progestogens) being available - but women do not need to go privately in order to vary from the licensed dosages eg me for one. Hopefully the gynaes and research establishments are working to improve things -and especially with the upsurge in use of HRT following the NICE Guidelines. I really don't like the thought of women despairing and thinking there is no hope - and that relieving their symptoms is going to involve credit card loans etc.

Perhaps those women on here who see menopause specialists (NHS or private) at hospitals can ask them if they know what could be in the offing - if anything?

Hurdity x

[Katia]

If you google individual progestegens there's a Wikipedia page that comes in that had all the conversions of the different progestegens.

We are all so different and from what someone previously posted it takes trying quite a lot to find the right one.  HUrdity, you're right, it definitely needs a review.  The HRT progestegens are mainly the older 1st and 2nd generation ones, which are the ones that are more androgenic and have more side effects. In peri and earth menopause our androgens are high, so this isn't what we need.

Mary G, I am currently taking half an Angeliq with Premarin, which I calculated based in the US dose.  I'm still having problems wi that bit of estradiol though so it might not work out. I may like you Alice resort to half a yaz or half a Femodene. That is a question that is in my next email to the consultant. I have no other options.  Dangermouse, I liked provera.  It was so much better than Utrogestan and didn't make me at all groggy, but it make my hair shed something terrible so I had to stop it. I was scared to persevere and see if it got better as it was getting worse.

Alice, do you find you have any night sweats with half a yaz?  The 1mg estrogen in yaz will be more potent, so I imagine it would come out a bit higher. I took yaz in the States and then Yasmin in the UK and both were fine.

[Katia]

Alice, do you get any breakthrough bleeding taking half a pill?  Hmmm, think I may just do this with Femodene, although I do love Premarin, but can't find a progestegen. 

[Alice]

Katia, thanks for your message I am unable to send a PM for some reason so will reply here: 

No, I don't get any breakthrough bleeding on half or even 1/4 YAZ and my ultrasound shows a healthy, thin uterus lining and I feel emotionally stable and physically strong.   

FYI: I started taking YAZ at 50yo start of peri menopause as I was feeling erratic and exiting a difficult relationship.  My Doctor, rightly, said YAZ would keep me stable and it was brilliant for 5 years.  I think my body adapted to it.  At 55 Dr suggested I come off YAZ and try a more natural bio identical HRT.  For two years I sent myself mad with depression, anxiety, palpitations, hot flushes, joint pain etc as I trailed alternatives.  Angeliq seemed to make the most logical sense as I tolerate Drosperinone well whereas Ultrogestin made me feel suicidal however, the Estradiol at 1mg is not strong or targeted enough to balance 2mg Drosperinone.  My doctor recommended topping up with another 1 or 2 mg Estradiol in tablet form but I felt this defeated the purpose of my attempts to minimise oral HRT and progestin - and, like you, Estradiol made me blow up.  Also, health issues (clots, strokes etc) seem to be caused by progestin and not Estradiol so this suggestion did not make sense to me.  Why not reduce progestin rather than increase Estradiol?

Ideally, certainly by 60yo, I would like to take transdermal only though have not had success with the patches and cannot find a progesterone/in to suit. 

My doctor recently gave me a script for Duavive which I am reluctant to try as I do not like the idea of how the Estrogen  in this formula is made and, if I change, would rather not oral HRT.  As you tolerate Premarin, this might be worth trying for you though if you can stand more trial and error!  I would consider an Estradiol patch or gel plus oral  bazedoxifene (which is progestin alternative in  Duavive).

As I mentioned in my earlier post, 50% of doctors I have seen do not recommend continuing YAZ but none are able to give me a logical reason why and studies I have read suggest 10mcg Ethinyl Estradiol is the minimum amount to take daily to counter osteoporosis and VA.  There are HRT tablets available that use Ethinyl Estradiol though Estradiol is  more commonly used.

What a minefield!  I agree with all who say life is short and carpe diem.