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[Tc]

Hiya ladies.
I'm on 100 estradot which I upped to one 100 patch plus half a 75 because I've had worsening depression over the last few weeks and I wont bore you with the details but it is now severe.

The increase hasn't helped at all. I didnt absorb on the gel and it realy feels like I'm getting nothing from the patches. My physical symptoms are getting worse and worse as the months go by with not enough E.

But my immediate issue is the depression. whether to up the dose to two 100 patches as it cant get any worse or whether to stop utrogestan which I'm on continuously. Maybe after months on it continuously it has built up in my system I dont know if that can happen? But maybe that's causing the depression or maybe it's the low E.
My next gynae appt isnt til late MAy and my GP isnt great when it comes to HRT.

So whether to up the patch or stop the utrogestan.? I dont think I should do both.
Thanks for any advice/experience.
X

[racjen]

Oh dear, I was about to say have a break from the P. That's not very helpful is it, two contradictory bits of advice - sorry. But I definitely had the experience of Utrogestan building up in my system when I was taking it continuously, resulting in worse and worse depression. I now can't get thru more than 7 or 8 days on U without the depression returning. If I were you I'd give yourself a good month to 6 weeks break from U and see what happens. But that's just me....xxx

[Tc]

It sure does ladies. Thanks for your replies.
I will sleep.on itxxx

[Saffy]

I'm late again! On balance, I think I would go with Racjen's idea. Stick where you are with the oestrogen to give it a chance to build up in your system slowly and ditch the progesterone for a couple of months. Then you could increase the oestrogen further if necessary and reintroduce the progesterone on a cycle? It's tricky as I completely understand that feeling that you just want to dump the progesterone and whack on another patch to feel better faster .

[Hurdity]

Hi Tc - I presume you are on 100 mg utro (?orally or vaginally)? In any case there is no way that I would ever take progesterone continuously and because of its pronounced sedative effect which can cause other progestogenic sdie effects as it builds up - eg foggy head, headaches, lethargy and even depression in some women. The difference with how I feel when on the different phases is remarkable. Sometimes I sort of get used to the progesterone but as soon as it's cleared I think - ah yes- I feel (relatively!) nornal now!

I feel for you in your position though in surgical meno and retaining your womb because you want oestrogen to be high enough but then you need to have high enough P to protect your womb.  Is it due to endometriosis that you are taking it continuously? I would seriously think of going to a cycle and preferably a long one if you can keep your womb lining helathy ( under medical supervision). At least then you can assess whether the oestrogen dose is sufficient for you. Also sorry I can't remember if you are taking T too - this could be the missing link?

I hope you manage to get this sorted soon so you feel better....

Hurdity  x

[Tc]

Thank you ladies. My  gynae was horrified when I suggested a cycle and tried to scare the life out of me.
 I havent got endo hurdity. Would a long cycle be 12 days on 200mg? I am taking it orally.

I have testogel but I havent started it yet as I thought if E levels were low it would just convert but maybe that wouldnt be a bad thing for me. Conversley someone said on here that non absorption of E might be due to SHBG and that T can help lower it.so youn then absorb patch better.im a bit confused about that.

I was trying to get E up before throwing T into the mix.
Maybe I should start the T before changing P. To see if it helps mood but  It still doesnt solve all  the other symptoms of low eastrogen though. I feel as though every cell in my body is screaming for it. .bit dramatic I know but that's how it feels.
 I must say it's hard to find advice on surgical meno at my age. My gynae says that levels of eastrogen as low as mine are found in women my age post natural meno not on HRT and the only difference is the T. and she may be right. Surgical meno maybe more akin to natural in a woman of 53 than in a woman of 33  and who's to say I wouldnt have ended up having just as bad a time in natural meno. I cant accept tho that she seems to think its o.k that my levels are the same as someone not on HRT and feel like shouting at her "but I AM on HRT.!!!
Why oh why am I not absorbing

[Hurdity]

Hi Tc - a long cycle means going longer than 4 weeks between your first dose of utrogestan. The normal menstrual cycle happens on average within 4 weeks from start to finish and including the rise and fall in prog together with the bleed. Some gynaes stretch this to a calendar month ( eg starting prog on the 1st of each month) and some of us stretch further with medical supervision - the longest being 12 weeks or even 3 months although not generally favoured by medics.

I have been taking 12 days x 200 mg vaginally every 6-8 weeks ( ie total cycle length) but currently trialling a shorter cycle than this and lower dose to try to reduce bleeds and side effects. With oral progesterone I'm not sure how well a longer cycle would work on that dose - I do it because vaginally more of the utro gets to the uterus so I'm satisfied (and my doc is) that enough is getting to where its needed to protect the endometrium. Taking 200 mg orally will also increase the chanes of side effects (fatigue, lethargy etc) if you are sensitive to it. I still get side effects taking vaginally but presumably not as bad (have never taken it orally).

You could discuss gradually lengthening the cycle to see how your bleeds/uterus responds - but not sure doc would refer for scan on NHS unless abnormal bleeding?

I'm not sure about all this conversion of (exogenous) testosterone to oestrogen with low oestrogen levels - I'd want to see evidence of that. Just because T is the precursor to O does not follow that all exogenous T will be metabolised to O - it depends on what the limiting factor is and in which tissues this happens. I don't know enough about that - the finer details nor about SHBG except in relation to binding free T and a vague idea about relative affinities for it! Sorry that's not much help is it!!!!

I get what you're saying about the gynae but I presume what she is meaning is that your levels are at least up to what they would be in the absence of HRT - with surgical meno you have a much lower starting point even post-menopausally. This is presumably why in surgical meno much higher doses are needed - to get your levels to where they should be for a post-meno woman on HRT - or rather so that your symptoms can be minimised!!!

Personally I would want to be on cyclical HRT before starting T - the sedative and depressing effects of P will surely counteract some of the benefits of T? Your choice though!

Hurdity x

[Tc]

Thanks hurdity. Very helpful reply as always 
I'm thinking I will try the utro vaginally for a week. Do you think that's long enough to see if it makes a difference, to mood? If it doesnt I will switch to cycle. I'm going to add the T anyway. It's a given that surgical meno ladies need it so with hindsight I should've just added it anyway instead of waiting for  what has turned out to be a non exsistant rise in E.
All the best to you xx

[Ladybt28]

Tc - how long have you been on hrt now?  (Yes indeed I'm alive ) cos you know what I'm going to say don't you.... Its boring I know.... but it's that P word again.

Yes try the Utro vaginally, nothing to lose and everything to gain and get on with the testogel.  Yes, "normally" we would want to get oesteogen levels up but then we all know that "normally" doesn't apply to some of us!  We just have to different from normal but frankly who cares if it works! huh!.  I thought that some testosterone in the system helps oestrogen increase or metabolise?  Maybe its your missing element?  No doubt Hurdity will set me straight if I've read that wrong somewhere  and whatever I've read that's not what it means....which sometimes happens....alot!

[NorthArm]

Hi Tc

I wrote a really long reply, but it seems to have disappeared before I could post it!

I’m just wanting to describe the Oe, P and T and SBHG connection....

Progesterone (natural and the progestin Norethisterone) have low binding affinity with SBHG.

Oestrogen has high binding affinity.

Testosterone has the highest binding affinity.

So it’s probably not that you’re not absorbing the Oe, but that it’s binding with the SBHG and not leaving enough free (useful) Oe to be used by your body.

I started using T in mid December last year (I’d ditched the P two weeks earlier because I was just fed up). So after those two weeks of Oe only, I added the T (Androfeme 1%, .5ml on outer thigh daily). It took about two weeks for that anxious, gnawing, horror anxiety to quieten. I still had it, but much reduced compared to how it had been. My self confidence improved too. After four full weeks of no P, I then re introduced P (Utrogestan 100mg) vaginally for seven days. This was much better, although erratic bleeding continued to be a problem (as well as symptoms during P week). I had a Mirena inserted on 3rd of this month. And I’ve not felt so hormonally stable in about 25 years, since my late 20s (taking Diane 35, an ocp with oestrodial and cyproterone).

I researched it beforehand as I’d discussed potential side effects, etc with the gynae. Apparently Levonorgestrel (the progestin in Mirena) has almost as high a binding affinity for SHBG as T, which is possibly why so many ladies get on with it. (I’m very aware that many don’t, too, but I decided to try it first, before dismissing it out of hand). It can take 3 - 6 months to completely settle so I’m not cracking the champers just yet.

So give the T a try. I put mine on in the morning, and before I change my patch. I’m on 100mcg like you - and I’ve also found that changing it in the morning, every third day is better (rather than 3.5 days) as symptoms would be returning on the afternoon of that third day. I just have to remember what day I’m up to lol.

As for the Utrogestan - perhaps give it a break for a couple of weeks whilst you’re introducing the T. You’ll likely get the P withdrawal and a bleed for the first week or so. Then once your serum levels of T are up (you should be able to feel it after about 10 days to 2 weeks) you can always reintroduce it vaginally like so many of the other ladies on here use it. I personally found vaginally was a better option symptom wise.

Good luck with it all xx

[Tc]

Lady and Northann thank you so much for your replies.
I think what you are saying makes perfect sense. Very helpful advice and experience.
Theres no point in me focusing solely on getting the E up any more. I've already gone almost as high as I can which quite frankly is worrying me a bit as i know i cant stay on that higher level for long.so i will try with the T and vaginal utro. I need to stop worrying about it and get on and do it. I wont know until I try.
Hope you are both as well as can be and have a good Sunday.
Much love xxxxxx

[Tc]

Thanks birdy. I was on femseven sequi for 3 months which got discontinued so went on the gel and utrogestan for 3 months. I've been on the estradot since late Feb/early March.
Glad to hear you've seen an improvement. Even though its slight its a step in the right direction.
Much love to youXxxxx

[Ladybt28]

Me too Birdy...glad to hear there is slight improvement  - it can be a long old haul but 2 months isn't that long in the scheme of things! If you feel you have slight improvement then it can only get better with time.  Took 5 months for my anxiety and panic attacks to subside and before that I asked my GP about Alzheimers loads of times and she looked at me like I was mad - but I didnt know what else it might have been.  I used to get halfway through a sentance and forget the words, not just for a seconds, just altogether.  My family were really taking the P but it's not funny, its scary, so I know how you feel!  Now all I'm left with is depression but that was an underlying issue anyway just made worse by meno and absolutely no libido which brings it's own problems.
Keep going Tc - you'll get there in the end....honest!    promise....honest!!!

[Tc]

Thanks lady. I think my depression might be underlying too. But I guess I will see. For me I jump between prioritising what is worse at the time. Anxiety is a real issue and its affecting my life but when the depression is getting bad as I've felt myself slipping again recently and like yourself I know its happening and it scares me so much that it becomes my priority to address it over everything else.
Has your depression lifted any further?
Xxxx

[Tc]

Me again. I've been writing down symptoms  for last couple weeks as our good friend CLKD always advises. I finally took the advice.
a pattern has emerged with the estradot. The only days I seem to see a minor improvement are on day 2 of the patch.  I change every 3 days. I thought they were supposed to give an even dose over that time.
I'm having a bit of an HRT meltdown the last few days so please excuse me ladies.  I've even found out I have been taking the vagifem wrong but that's another thread.!!
Has anyone else found the same thing with the patches. I dont know what the answer is and  I cant use the gel which I know some feel gives a more even dose.
Xxx