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[shoppingqueen]

Hello
I have been on Femoston 2/10 for 2 and a half years and it literally saved me from terrible symptoms. However, I have recently visited a consultant endocrinologist for issues relating to hypothyroidism and she feels that I may have developed tachyohalaxis (basically it's no longer working for me) and has suggested a switch to transdermal, especially in light of having now to take thyroxine and having existing digestive issues.
So, my question is have other experienced an effective HRT stopping working after 2-3 years?
And secondly, advice re patches or gel? I still have my womb and had previously not had periods but am getting a withdrawal bleed (occasionally) on Femoston.
Thanks in advance
SQ

[shoppingqueen]

Hello all
Would anyone be able to help with the above? I'd really appreciate any input as I'm back with the endocrinologist on Weds and guessing it?ll be a change in HRT so was hoping I could get some thoughts on here.
Thanks

[Dotty]

Hi HRT can stop working as you go further into menopause and need more oestrogen . I have a friend who was on oral HRT for many years and then had a return of symptoms . She changed to gel and it increased her oestrogen and she got rid of the symptoms again x

[Alicess]

Hi Shoppingqueen,

I don't know how old you are but it's possible that your own oestrogen levels decreased further and you need a higher oestrogen dose. Besides the withdrawal bleed do you feel other symptoms are returning too? I believe it happened to other ladies on this forum  and I hope they will respond.

If you mean tachyphylaxis?
According to WikipediaTachyphylaxis is a medical term describing an acute, sudden decrease in response to a drug after its administration; i.e. a rapid and short-term onset of drug tolerance. It can occur after an initial dose or after a series of small doses. Increasing the dose of the drug may be able to restore the original response.

I don't know if a different route of delivery (of oestrogen ) will change your respons if it is indeed tachyphylaxis. In both cases you will need a higher dose. Regarding gel or patches; every women response differently  on gel or patches. It's trail and error, I'm afraid

Alicess

[Hurdity]

It would be strange to develop tachyphyllaxis on that dose of oestrogen. John Studd refers to it in the context of oestrogen implants and "supraphysiological levels" of oestrogen ie very high levels that can occur - higher than naturally during fertile years. However if you are post-menopause then as ovulation ceases, over the next couple of years or so following the last ovulation oestrogen levels decline so some women find they need a hike in dose at this point if symptoms ramp up?  - As Alicess said. This could be what is happening. I don't think we become sensitised to oestrogen as such ie unresponsive?

Do give it a try re different route and also it is possible to increase the dose easier with patches (or gel) if using a seperate progestogen.

What symptoms are you experiencing which your enodcrinogologist feels are due to unresponsiveness to oestrogen? Presumably yout thyroid hormone levels are being monitored too? After oral HRT you may need increased thryroid hormone supplmentation - I read a paper about this - due to increase in thyroid binding globulin (I think) on oral oestrogen???  - so this could be playing a part?

Hurdity x

[shoppingqueen]

Hello
Thank you Dotty, Alicess and Hurdity!
I truly appreciate your help.
I've been extremely poorly with hypothyroid symptoms but they are very similar to meno- tingling, numbness, pins and needles, excessive and debilitating fatigue, pressure headaches, muscle weakness etc I could go on
Endo feels it's a combination of things- post viral fatigue, under medication for thyroid and less effective HRT- I did have these symptoms in two big blocks 2017
(when I switched to Femoston after Premique discontinued)  and 2015 when I first went on HRT.
I'm 51 now so it could be later stage meno. She has tested my hormones  so it?ll be interesting to see results as I've not had these done since suspected peri at 42. I think transdermal has to be a better try and honestly I couldn't feel worse, so nothing to lose I guess. it's been difficult leaving 4 hours after thyroxine to take my tablet so hopefully transdermal will mean I don't have this faff.
Hurdity, that's interesting as someone mentioned HRT reducing effectiveness of thyroxine so 🤞 I?ll get a hike in that on Wednesday. I'm still on a low dose there so probably a perfect storm across the board. Hormones in free fall.
I did try patches once for a week when impatient and having horrid symptoms- it was very hot weather and I could not get them to stick. I launched from one thing to another in a general hysterical fashion, panicking, but I now KNOW you have to bite bullet and give things chance to do their job, so hopefully more patient this time
I am interested in gel too. Either way, I'd need prog. I have dydrogesterone at the moment in Femoston but don't think this is available separately. What is best tolerated by most? I know we?re all different, but is there a general favourite? And one that's available?
Thank you all for help
Xx 

[Mogster71]

Hi Shoppingqueen!

My own personal experience is that the patches (for me) definitely gave me a "neater" dose of oestrogen. I was on Femiston 1/10 and then prescribed Estraderm MX50's which in itself was a jump from low dose to medium dose. Probably why I felt such a surge. I cut the patches in half and that seemed to do the trick, although of course less scientific than a metered dose. Sadly it was only for a day or so before I had to add in the utrogestan as I am still peri and have to cycle. I do not do well on progesterone full stop!! I'm bucking the trend here and going from transdermal back to Femiston as it was the only thing that made me feel stable progesterone-wise.

I think the oestrogen patches would have been fine for me if I didn't have to add that bit in!! As Hurdity says you can alter the dose of the oestrogen much easier using separates. I think my own hormones have been running riot as well (late peri) and I don't have the added thyroid issues to contend with that you have. I'm unfamiliar with thyroxine in terms of other medicine, do you have to leave 4 hours either side? It may mean you have to use the utrogestan vaginally as it is supposed to be taken at bedtime?

Wishing you all the best for your appointment and hope you can get things settled soon x

[Hurdity]

Hi again shoppingqueen

To be honest your symptoms sound more like thyroid to me rather than classic signs of low oestrogen - unless you are taking one of the anti-depressants that also helps reduce flushes in which case this wouldn't be the first symptom you experienced?

I would definitely go for patches or gel with separate progestogen and no if you're here in UK as most of us are, you can't get dydrogesterone separately - but there is MPA ( Provera) or the Mirena coil ( in addition to progesterone itself = Utrogestan). However I would make sure your thyroid is sorted out first as I said before - it can be affected by oral HRT.

Let us know the outcome of your appointment and what you decide?

Hurdity x