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[Peaceluvva]

Hello

I have just registered but this forum has been so helpful for me and I thank you all.  I hope you can benefit from my experiences...

A bit about me:  I am 48 and still having regular periods, now lighter as I had endometrial ablation recently.

I started having hot flushes, insomnia and dryness at 43, and was put on Premarin 0.625mg, very successfully. 

By 47 I needed a higher dose due symptoms returning and Premarin was upped to 1.25.  This caused a bit of abdominal weight gain but I felt so good otherwise that I tolerated that. 

Recently Gynae became edgy about the fact that I was not taking progesterone alongside the Premarin even though I had a regular cycle.  I am progesterone intolerant and can't even tolerate the Mirena, or indeed my own natural progesterone.  I have always had debilitating PMS and never managed to take the pill.  I used the copper coil instead.  I tried bio identical Prog cream but I can't tolerate that either.  I am terrified of progesterone.

I agreed to try Angeliq (1mg E / 2 mg P) as I appear to tolerate the Drospirenone in it, and I stopped Premarin.  All my symptoms returned as the Estrogen dose is so low, and as its a continuous combined, I began to bleed nonstop.  I had an ablation and went back to Premarin 1.25.  It is still great, and I sleep like a baby on it, but as I am getting older it's not enough somehow. 

Note though for all the Progeterone intolerant women out there, Drospirenone is good and Angeliq is a great Postmenopausal continuous combined regime.  Definitely worth a try.

My own hormones are diminishing rapidly - I used to swim 3 times a week and had a lot of energy but nowadays all I can manage is work and the sofa.  I have lost all muscle tone and gained 10 kg.

GP has now put me on Femoston 2/10 and I was too weak to argue. I started it a week ago and stopped Premarin.  Now I can't sleep again!  On my 3rd night with no sleep and still working full time in IT - I'm at the end of my tether!

I have never tried Utrogestan, but I am aware of the regime promoted by Prof Studd, and it will be my next port of call if I am intolerant to the Dydrogesterone in Femoston - I hope it won't have to come to that though.  I hear Femoston is well tolerated.

Questions: 
- How long will it take for the Femoston to build up, and will it ever reach the wonderful levels of the Premarin? 

- If not, can't I supplement it with a gel or something to get that Estrogen level high enough for me?  It would be great to see an accurate comparison chart of the different forms of Estrogen with equivalent doses.  I seem to need a lot of E to function.  Ideally a medium dose of Premarin alongside Femoston would be fantastic as Premarin is really good.

- Will a pea sized dollop of Testrim help with energy/muscle tone?  I'm happy to get it on the internet if I have to as I am tired to arguing with GP's.

Thanks again,
P
 

[Hurdity]

Hi Peaceluvva

 

I can understand your consultant/doc prescribing you with Femoston - or at least some form of progestogen, because the ablation is not the same as a hysterectomy and you do need a progestogen as you know, from what you've said - even though possibly at a lower dose?

Re needing a higher dose. Premarin 1.25 is a high dose - and as you know not comparable with pure estradiol as it is a mix of horse oestrogens, extracted from horse urine. It isn't possible to give exact equivalents as the amount absorbed is so variable between different women from the same product, and also even with the same woman the amount absorbed from the different methods ( eg tablet, patch or gel) will vary. The general rule of thumb is to look at low, medium and high doses of each type and take it from there. The oestrogen only preparations are listed here:

https://www.menopausematters.co.uk/treatafter.php

and those combi HRTs for peri-menopause here:
https://www.menopausematters.co.uk/perimeno.php

It will take your body a while to adjust from the horse oestrogens in Premarin to Femoston and according to the table  Femoston is considered just "high dose".

Higher doses may be achieved through patches or gel oestrogen ( with separate progesterone) but may not be a good idea to supplement the Femoston - although your consultant/GP may allow this as you've had an ablation - provided your womb lining is monitored? Not sure what happens when there is over-stimulation from oestrogen after an ablation?

Re the testosterone - the answer is yes! It may well help but please do not self-medicate and buy from the internet. You don't know what you're getting and it should be prescribed especially as there is no product licensed for women at the moment. Your GP is your first port of call and after that referral to a menopause specialist clinic if there is one near you. If you have reduced or no libido this is a sure sign your T is low.

Also have you had your thyroid function tested recently as weight gain and exhaustion  are also symptoms of underactive thyroid? Feeling cold would be another obvious symptom.

Hope this helps

Hurdity x

[Mary G]

Peaceluvva, I am also progesterone intolerant and I also found that I was able to tolerate Angeliq better than other HRT preparations but I too fell over on the low oestrogen dose.  I then topped it up with a 50mcg patch which was better but still not enough oestrogen to keep symptoms away so I then switched to Oestrogel/Utrogestan.

Because you have had an ablation, perhaps you could do a very long cycle of 3 months?  This would mean that you can take oestrogen only and then do a course of Angeliq every 3 months to make sure your womb lining is not building up.  There is no reason why you can't use Angeliq cyclically for this purpose if you are severely progesterone intolerant, I was told I could.  This could be a painless exercise for you because you won't have a bleed afterwards either.

I can understand why you are frightened of progesterone, I feel exactly the same.  It is lethal for those of us who react badly to it but you might feel less scared if you can use Angeliq. 

See how you get on with the Femoston but if it doesn't work out, you could consider Oestrogel (very dose flexible and easy to attain high oestrogen levels) with cyclical Angeliq or even Utrogestan vaginally but you may decide play safe and stick to a progesterone you know you can tolerate.

[Peaceluvva]

Thanks Hurdity and MaryG for your replies.

In answer to your question Hurdity, yes I have a thyroid problem and I oversupplement with natural dessicated thyroid. It used to keep my weight down but these days its not. I do keep a close watch on my thyroid and I really think the weight gain is hormone related.

I'm eager now to try the testosterone and I will ask my GP about it. As long as I don't grow a goatee...!

I note you say I could have a lower dose of progesterone...if the dydrogesterone doesn't suit then I will bear that in mind.

I was also wondering about the 3 monthly progesterone regime.

@MaryG, how long a course of Angeliq would I need every 3 months, and would I have to alter my usual E dose during this time as Angeliq contains E? I inderstand dose alteration is easy with pump dispensed gel, but could you do it with E tabs?

Thanks again for your time and patience.

P

[Mary G]

Peaceluvva, some women take more oestrogen during the progesterone phase to counter the side effects so I would not worry about reducing your oestrogen dose while using the Angeliq, the extra oestrogen will not do you any harm.   I would not cut them in half because you might not get an even distribution.

My gynaecologist tried to get me onto a 3 monthly cycle because of my progesterone intolerance but it didn't work because I get breakthrough bleeding once the womb lining gets to a certain measurement.  Off the top of my head, she suggested 200mg Utrogestan for 12 days but I do have regular uterine scans and of course she is aware that I don't need much progesterone to get good clearance.  Angeliq contains 2mg of progesterone so that would be enough. 

Because you have had an ablation you should not have a problem with breakthrough bleeding so a 3 monthly cycle could be ideal for you.  If there is any womb lining build up the progesterone would make it shed. 

I think the ablation idea is a good option for women who are severely progesterone intolerant because you can do a very long cycle making it more bearable and of course you probably won't get much of a bleed at the end of it.  I am still considering the idea myself - it seems to be worth trying before going for a hysterectomy. 

[Peaceluvva]

I agree, Mary G.  Heavy bleeding is horrible and depletes your iron.  I see a lot of women do really well after ablation and I do think its because their iron stores build up so well.  I went from heavy bleeding, flooding, for ten days or so, to a light 2 day bleed.  Some women stop bleeding altogether, but I like my light bleed because it tells me where I am in the menopause stakes.  I feel I can still monitor myself.

And your reasoning is perfect regarding the 3 month bleed post ablation - the lining shouldn't build up enough to cause a breakthrough bleed.  I will go and suggest this to the GP.

Ablation is an excellent alternative to the more serious hysterectomy - it was painless and after 2 days I had completely recovered from the surgery.  I have given away all my SUPER PLUS tampons. I will never need them again I hope!

UPDATE on my situation, though - I am suffering with muscle pain - quite bad and I am limping a bit.  My legs and arms ache, even my finger muscles hurt, and my abdominal muscles.  It's not the sort of body ache you get with a virus - its more deep - maybe its bone pain?  I have no idea and I'm stumped.  Could this be related to coming off Premarin or to starting Femoston?  I am only 8 days into the transition and it started 2 days ago.  I've not reached the combined pills on the card yet so its nothing to do with progesterone.  Any ideas??

Peaceluvva x

[Hurdity]

Hi again Peaceluvva

I did mention this in my response to you - that changing from Premarin ie very high dose of horse oestrogens to Femoston medium/high dose of pure estradiol, is bound to affect you to some extent until your body acclimatises.

As long as you are being monitored through your consultant it's great to be able to try out alternative regimes such as extra oestrogen than is usual or a longer cycle. In fact many women would be interested in the extent to which a cycle can be lengthened safely after an ablation, without thickening the womb lining - such that is left.

In my case - I have compromised having a higher dose oestrogen because I want a longer cycle - and at the moment mine is 6-8 weeks - trying to do 8 weeks more often when I can. I could probably go longer on that dose of oestrogen but for me, having a bleed in my 60's is not great fun so that's why I compromise.

re your thyroid - if you have an underactive thyroid and are gaining weight still, then perhaps your medication needs adjusting? There is an interaction between oestrogen and thyroid metabolism and especially re tablet oestrogen. I am not fully clear as to how it works and probably not the same for every woman - but sounds like increasing your dose might be worth a try after consultation with your doc and perhaps some blood tests to monitor how your thyroid hormone levels have changed?

I hope the pain eases soon.

Hurdity x

[Peaceluvva]

Hello

Here's an update on my situation. I'm still not managing more than one sleep cycle a night. Not feeling tired at all until around 1am, then sleeping few hours and wide awake at 4. Needing naps during the day when I can manage it, which I can't on work days!

Premarin 1.25 completely took this insomnia away and I could sleep all night. It was like a magic cure.

I've found that the 2mg Estrogen in Femoston makes me feel a lot better in other ways, more alive and aware mentally. I just think I need a bit more so that I can sleep at night. I'm obviously one of those ladies who needs a lot of Estrogen. And as I'm hypothyroid and I take high levels of thyroid hormone, a doctor once told me that you need more Estrogen if you take Thyroid hormone. They compete with each other and use the same carrier.

Anyway now I'm thinking of one of 2 solutions...

Option 1
I could ask the GP to let me continue the the Estrogen daily every day but supplement as follows:
Day 1-14  one pump of gel
Day15-28  Angeliq (1mg Estradiol/2mg Drospinenone)

Option 2
Just take the 2 mg Estradiol alongside Angeliq every day as continuous HRT. My recent ablation could mean I don't bleed with this.

Any ideas please?

[Hurdity]

Hi Peaceluvva

I don't think any of us are able to comment on these non-standard regimes as a lot will depend on the extent to which your womb lining reacts to the extra oestrogen, without the usual amount of extra progesterone, since your ablation. The first option sounds like you would be giving yourself the extra progestogen (from the drospirenone) to help protect the womb from the added oestrogen. The second option wouldn't give you enough progestogen and would need close supervision - unless you mean Femoston + Angeliq? Not sure how the body would react to these two types of HRT and prog?

Why don't you go back to the Premarin and try taking sequentially with Provera as the progestogen? You might find you tolerate it OK? It sounds a bit complicated mixing and matching with different typres really. Alternatively try a higher dose gel or patch along with Provera?

Hurdity x