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[Kathleen]

Hello ladies.

Apologies if this question has been asked before but I was wondering how you can identify progesterone intolerance if you have never taken oestrogen and progesterone separately?   I was post menopausal when I began HRT and every preparation I've tried has included daily progesterone so I've never experienced oestrogen on it's own followed by oestrogen and progesterone. My question is how do I know if my continuing symptoms are due to simply insufficient oestrogen or adequate oestrogen but an intolerance to progesterone?

Sorry if this is a daft question  but I'm hoping to see a meno consultant and I want to be as informed as possible.

Thanks in advance to all you wonderful ladies and wishing everyone well.

K.

[Dotty]

What are your continuing symptoms?

[Kathleen]

Hello Dotty.

Thank you for your reply. I still have flushes and night sweats, low mood, anxiety, tearfulness and mood swings. Lately I've noticed tender breasts. I usually feel awful during the day only improving late in the evening. I'm using two pumps of Oestrogel and Utrogestan orally at night. I suppose like many ladies here I am trying to understand my hormones.

Thanks again and take care.

K.

[Emerald2017]

Maybe Kathleen trying a seq type is a better choice for you?

[Kathleen]

Hello Emerald2017.

Thank you for your reply.

I am not sure I qualify for a sequi regime because I am 61 and haven't had a period for eight years.  I didn't have any problems until my periods suddenly stopped and didn't start HRT until I was two years post meno so I worry that I missed the boat on many treatments but I could be wrong.

Thanks again for your suggestion, much appreciated.

Take care.

K.

[Dotty]

hi Kathleen

I would say that those symptoms are all due to low oestrogen.  I use 4 pumps of oestrogen and I am 54 and 3 years post meno.  I upped it very quickly as I had already been on oral hrt for 4 months and it had done nothing.  I didn't improve until I was on on 4 pumps.  Even 3.5 didn't help me. 

[Tempest]

I have the same symptoms, Kathleen - mine ramped up again after my MS diagnosis and our need for estrogen increases under stress. Dotty is right - I'm pretty sure you need an increase, but addressing stress can help too to keep things on a more even keel.

I've just increased via 2 x 25mcg patches whilst I try to source my Estrogel (obviously 25mcg is a miniscule dose for surgical meno.)!

Taking prog. continually can lower the effectiveness of your ERT, so switching to a long cycle regime could possibly help instead of upping your ERT. I'd ask your new Consultant about this first if I were you, so long as you can cope with a bleed xxxx

[Kathleen]

Hello Dotty and Tempest.

Thank you both for taking the time to respond. I think you are right and I need to increase my oestrogen, I hoped that two pumps of Oestrogel would be enough but clearly not and I agree that the progesterone is  possibly cancelling out the benefits of the oestrogen. 

Thank you for your comments ladies,  you've given me the confidence to put this suggestion to my consultant.

Take care.

K.

[Dotty]

Kathleen - I would just increase the Oestrogel and see what happens.  I was really scared to increase mine but was told by my consultant that 4 pumps is still within acceptable limits.

[Kathleen]

Hello Dotty.

Thank you for your post. I have been afraid to increase my pumps of Oestrogel but I can't go on like this.

 I hoped that somehow my body would get used to low oestrogen and I'd come out the other side of the menopause and pick up the threads of my life,  instead I seem to have got stuck with only feeling slightly better. Having said that I've had days or parts of days when I've felt suddenly 'normal' and thought that everything was about to settle but then the horrible feelings always return.

 I'm reassured that your Consultant thought four pumps were okay but can I ask do you take Utrogestan and if so how often and by what method? I'm going to try to see someone privately asap and I'd be interested in your regime.

Thanks again for all your help, I really do appreciate it.

K.

[Dotty]

Hi Kathleen

Yes I take Utrogestan 100mg 25 days out of 28.  But I have read that you can take it every day.  I take it orally at night before bed.

I started on 2 pumps but didn't feel any different.  I was really poorly before taking the Oestrogel with horrific nausea and lots of other symptoms.  After a few days I went up to 3 pumps and that helped the nausea but did nothing for the total exhaustion.  So I tentatively went to 3.5 pumps.  I was terrified of using 4 pumps.  But my consultant said it was fine and was still within licence.  I immediately started picking up and feeling better and now I feel better than I have done for years.  I was worried about using the 4 pumps but my consultant said to keep it at 4 pumps and don't think about trying too reduce it.

[Kathleen]

Hello Dotty.

Thank you so much for your swift response. Funny that you should mention nausea as I get a little of that as well.

 I think part of my problem is that I've lost confidence in the whole business, my GP is lovely but out of his depth and so far HRT hasn't helped me as much as I'd hoped so I've started to despair and worry that I'll never feel better.

I'm pleased to hear that you are doing well and once again thank you for your time.

K.

[Hurdity]

Hello ladies.

Apologies if this question has been asked before but I was wondering how you can identify progesterone intolerance if you have never taken oestrogen and progesterone separately?   I was post menopausal when I began HRT and every preparation I've tried has included daily progesterone so I've never experienced oestrogen on it's own followed by oestrogen and progesterone. My question is how do I know if my continuing symptoms are due to simply insufficient oestrogen or adequate oestrogen but an intolerance to progesterone?

Sorry if this is a daft question  but I'm hoping to see a meno consultant and I want to be as informed as possible.

Thanks in advance to all you wonderful ladies and wishing everyone well.

K.

Kathleen - sorry to hear you are still feeling rough.

I know we have had this conversation several times and you started on Evorel conti and briefly tried utrogestan in the past but didn't get on with it?

The answer to your question is you won't know unless you take oestrogen and progesterone separately for a while - which is what I have said to you in the past when you were on Evorel conti. I know we are all different but at the point you started HRT for most older post-menopausal women  I am sure 50 mcg patch would be sufficient to eliminate flushes and sweats but taken with a strong synthetic progestogen the same dose may not do so. Taking progesterone all the time means you may well be getting progestogenic side effects or not getting the full benefit of the oestrogen.

In yuour position and at your age personally I would not increase the oestrogen yet - unless you know you are not absorbing it from the gel - but I would definitely try a cycle if you could bear a bleed - and it depends which is the lesser of the two evils?!

Hello Emerald2017.

Thank you for your reply.

I am not sure I qualify for a sequi regime because I am 61 and haven't had a period for eight years.  I didn't have any problems until my periods suddenly stopped and didn't start HRT until I was two years post meno so I worry that I missed the boat on many treatments but I could be wrong.

Thanks again for your suggestion, much appreciated.

Take care.

K.

Many of us as you know continue with a cycle well into our 60's - I am mid 60's and have only ever briefly tried a continuous combined regime. I started with 50 mcg patch in my mid 50's late peri-menopause and have always been completely happy on this regime - but I have had the benefit of weeks of oestrogen only.

Paradoxically sometimes when I have tried to increase my oestrogen my flushes have returned. I had a brief dalliance with Sandrena gel but my flushes came back ( and it was too darn sticky!) so returned to my beloved patches and all is well.

Do consider this option ( a cycle) before increasing oestrogen because you may find that you do not get the same protection of the endometrium with the utrogestan once you increase the oestrogen to a higher level, and I imagine you would not want to take Utro vaginally on a continuous basis?

Do not despair - I am sure there is a solution out there for you but I have long felt that you would benefit from trying a cycle. Even if you are not strictly progesterone intolerant - it may just be that you will continue to feel sub-optimal when you take it all the time (like me).

Hope this helps - these are just my thoughts and my perspective on your situation!

Hurdity x

[Tempest]

Hi, Hurdity.

Just want to comment that I was interested to note that your flushes came back on Sandrena.

As you know, I spend a lot of time elsewhere online talking to ladies balancing HRT who are in surgical menopause (some for many years post surgery).

The experiences they share are that it is not nescessarily the amount of estrogen, but the delivery method and fluctuations that cause flushes. Your body had got used to a regime of continous dosing over a 3.5 day period with the patches, and then you switched to daily dosing with Sandrena which would of course have caused disequilibrium in what your body is used to.

I'm betting this was your problem, not nescessarily the amount/strength of the preparation. xxxx

[Kathleen]

Hello Hurdity.

Thank you so much for your response which was thoughtful as always.

I'm sorry to go on about the same old problem, I must sound like a broken record  ( that reference certainly ages us lol ). I take your point though and I appreciate your insight.  I hope to see my consultant very soon and I will certainly discuss your suggestion.   I have never used oestrogen without progesterone so I've never been able to identify the different ways that I react to these hormones so I could easily be undermining the  benefits of oestrogen by using continuous progesterone.

Wishing you well and thanks again for your interest ( and patience ). Take care.

K.