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[Carolina]

Hello ladies, this is a great resource and thanks to everyone who contributes. I'm a relatively new member and would appreciate some advice. My question is about general suitability to HRT and how to deal with changes in dosage.

I'm on my fourth combination of HRT. I'm 10 months in. The first three were unsuccessful because I got very angry and depressed. I started considering HRT because I am relatively young, 45, and we have a high incidence of osteoporosis in the family, so it's in my interests to find something that works.
 
Without boring you with unnecessary information, I have been on Lenzetto (a transdermal estrogen) and Utrogestan 100 mg for about 3 weeks. The gynae (who I feel at least cares, after 2 who I felt didn't really know what they were doing) had started me off on 200 mg Utrogestan and I could hardly put one foot in front of the other. He then increased the estrogen spray and I got migraines and was very nauseous. He told me to tailor off the estrogen completely but when I did I got a bad reaction so decided myself to stay on the current regime until I see him at the end of the month, just to see what happens. I am still having flushes, still no sex drive and still feel very, very down. Also I can't sleep and when I do I wake up every 2 hours. Gynae had suggested antidepressants and I'm coming round to the idea because after 10 months fiddling about with HRT and with suicidal thoughts (but not intending to do anything, if that makes sense) I just want to find something that makes me feel better. I take sleeping pills but they are short acting and just serve to get me to sleep. I am reluctant to increase either the estrogen or progesterone because of the side effects I had before.

I suppose what I'm asking is whether if I stay on this regime for a while can/should I then increase and is there a chance I will not have those side effects, or indeed whether the dosage I'm at now will stabilise and actually start doing something for me? I'm not sure what cumulative effect they have or whether one builds up a tolerance. I've tried to research but this HRT business is a minefield and with the brain fog, I'm worried I'll not navigate it correctly! So any help you can give me would be much appreciated, thanks. Also - very importantly - after 10 months of trying HRT should I assume it's not for me and just give up??? I'd love to know whether a magical "clicking into place" HRT plane exists!

[Dancinggirl]

Hi and welcome to MM Carolina

You haven't told us what you periods were doing before you started HRT?
It sounds as though you are progesterone intolerant so sticking with a sequential HRT regime(instead of a conti regime) and putting up with a monthly bleed might be your best option.  You may even be able to do a long cycle if you are under supervision and having regular scans - this might mean you have oestrogen all the time but progesterone for 12 days every 5-6 weeks.  Many women simply cannot tolerate progesterone used every day, so even women in post meno stick with the sequential HRT to reduce the progesterone side effects that often result in PMT, low mood and anxiety. Do you use Utrogestan orally or vaginally? Whilst it might not be wise to use Utrogestan vaginally on a continuous basis, using it vaginally for 12 days each month (100mg dose is often enough when used vaginally I believe) you are reducing the amount of progesterone absorbed systemically and this means fewer side effects.   

You should probably start some local oestrogen as well to help prevent urogenital atrophy and help maintain the sex life. Vaginal moisturisers are also essential - SYLK or the YES products are best and use these daily.  You might like to discuss the option of adding a little testosterone to your regime with you gynaecologist, as some women find this helps with libido. However, I believe libido is helped more if you are feeling healthy, more energetic and also feel attractive and desirable. It's very difficult to feel sexy if you are tired, depressed and have low self esteem. Get the HRT regime right and the libido may well emerge. Your partner does need to make an effort to make you feel desirable though.
It is trial and error, as with so many treatments, and if osteoporosis is in the family and you have already gone in to meno so early, then HRT is a good idea.

Anti depressants will dampen libido so this should really be you last resort.

I think it's using progesterone all the time that is you problem.  DG x

[Carolina]

So kind, I really appreciate all your advice, Dancinggirl. I will explore the sequential option with him.

I am already taking estrogen vaginally, sorry, the meno-brain omitted that part. My last ultrasound in January, when I started the HRT, was so painful I screamed and nearly passed out.

Unfortunately my husband is having a crisis of his own so he's not in a great space to support me. I don't blame him for that at all, but it is difficult in a marriage when you are both having problems.

The periods were either every 3 weeks or every 3 months, until I started HRT in January. They had been doing that for between 2-3 years and I was anaemic from the heaviness of the bleeds. More latterly they were still heavy but only lasted about 4 days. I don't mind having a period if it means sorting myself out in other directions, but on one of the HRTs I was bleeding constantly for the entire 3 months I was on them and that wasn't such fun.

He wanted me to take the progesterone because I wasn't sleeping. I use it orally. He suggested dropping the estrogen out completely but I wanted to try this combination to see what would happen to me. I did suggest testosterone and he said no.

[Dancinggirl]

Too much Utrogestan will have a sedative effect and can effect mood negatively.  You could consider having a Mirena as this will give less systemic absorption (so fewer side effects) and will usually result in no bleeding at all.  Have you had a scan? Perhaps you have fibroids as there must be a reason you were having such heavy bleeds, even on HRT? 
Keep using the vaginal oestrogen but add in some moisturisers at other times as well. I like to use lubrication for sex - my favourite is Durex Perfect Glide which I buy online.

Whilst progesterone can aid sleep a bit, it can also give vivid dreams and a more disturbed sleep. Following good sleep hygiene rules is essential - so wind down slowly before bed, a dark, cool room with no technology etc. - I'm afraid I have actually moved into the spare room as my husband tends to sleep in the middle of the bed and he is like a hot water a bottle. He comes to bed late and then wakes early and fidgets because he tends to sleep a lot during the evening when watching TV!!!
I now have a quiet environment I can control to help me sleep and we have romantic intimate get togethers that are working quite well!!!

Oestrogen tends to be the ‘feel good hormone' whereas progesterone tends to bring the PMT and low mood - although a few women actually do better when on progesterone!!!

You need to feel good again to get the libido back and if your husband is going through a tough time that certainly won't help. There is a section on this forum for husbands and it may help to get him to read this.
Definitely try a sequential regime.  DG x

[Carolina]

Yes, I had a scan and all fine. Sleep has always been poor, so not surprising it is worse at this time in my life. Thank you for your helpful comments, Dancinggirl.

Any advice or thoughts on whether it's possible to feel horrendous at the beginning of HRT but have a breakthrough and then feel good, or is it more likely that if you don't feel good from the outset that it's just not for you? I'd just love to know whether it's worth persisting.

[Dancinggirl]

I suspect you are sill peri menopause so you own hormones are still fluctuating a bit and this can have quite an effect. It takes about 2 years after the last natural period for your own hormones to bottom out and after that it can be easier to find a better balance of HRT.
Here are links to the various options for you - there are so many to try and it really is trial and error.
https://www.menopausematters.co.uk/treatafter.php
https://www.menopausematters.co.uk/to_progestogens.php
https://www.menopausematters.co.uk/perimeno.php
https://www.menopausematters.co.uk/postmeno.php

Perhaps stick with a low dose of oestrogen with Utrogestan, used vaginally for 10-12 days each month, and see if that gives a better balance overall. Some women don't get on with Utrogestan at all (I didn't) and find that Provera is better.  As you are using an oestrogen spray (not used in the UK as far as I know) I'd be interested to know what oestrogen levels you are achieving?  Have you had blood tests to see what your oestrogen readings are on this spray?  Have you tried oestrogen patches or gel.  I'm just wondering if you are getting enough oestrogen??

Keep us posted.  DG x

At your age it is worth persisting with HRT.

[paisley]

Hi Carolina
Where do you live? I ask because lenzetto is not available in UK
I live in Spain & was also on lenzetto but found that it gave me too many spikes & wasn't stronge enough. It's hard getting it right because you don't know if it is the oestrogen or the progesterone still causing you symptoms. For me it was the progesterone part of HRT. I could not tolerate it all. It made me crazy. I am on a patch now which seems much better.

[Carolina]

Hi Paisley, I'm in Barcelona. Whereabouts are you? The gynae gave me this so as to avoid unnecessary side effects, apparently. Dancinggirl, one squirt of Lenzetto gives 1,53 mg of estradiol.

Given I am still having flushes, not sleeping and constantly thinking about throwing myself off the balcony (don't worry, I'm not going to but the fact I'm thinking this constantly does scare me) leads me to believe neither is strong enough but I am reluctant to increase either because on 200 mg Progesterone and two squirts of Lenzetto I couldn't function and was nervous and not myself.

This is such a minefield, I have no idea where to go from here! I really want to understand whether there can be a magical moment when things suddenly click into place or whether after a few weeks on this regime we know it's not working. I keep reading you should stick on it for 3 months. I do know that I have felt better during the periods where I've been taking nothing - only in the sense I don't want to murder people and having black moods, so it's tempting to throw them all in the bin.

Thank you both for your replies.