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[Emm225]

On doctor's advice as the utrogeston is making my hair fall out and become thin , I am changing my meds.  Main reason for HRT is hot sweats and anxiety.  So, she told me just to stop taking the tablets and don't put another patch on, which I did 2 days ago.  Crashing, nagging  headache for 2 days...I do get migraines anyway (meno ones as didn't get them until about 3 years ago)

Has she told me to come off correctly?

[Floo36]

Hi,  everyone is different but my hair was falling out because I wasn’t absorbing the gel so lack of Estrogen was causing it.  It can take months for it to happen and also months before it starts to improve, In my case anyway.  Hope things start to improve.  Can you see a menopause specialist as a lot of GP’s don’t have much of an idea when it comes to Menopause.

[Emm225]

I guess I could pay and go private, I was put off as I read someone who went private said was total waste of money as all they did was tell her to increase her oestragen...and obvs private prescription meant more £££s.  Doc said I could go on anti dep if all I needed was swea and anxiety control and hair loss reverting.  Only not taken HRT for 2 days so far, could be imagination but feel am starting to dip,  haven't taken anti deps yet as not sure.  I just want to cry, don't really want to take anything but life was so horrid for me up until started HRT, so tearful and sad and anxious then when Mirena removed hot sweats kicked in massively, every hour at least and wasn't sleeping.  Just don't know what to do or where to turn...HRT does worry me but if it's the only option would still take as my quality of life is so horrid without it 

[Sammiejane]

emm225

how often were you taking utrogestan as i was put on alternate day regime and found this to worsen hair loss as taking it then not then taking it then not my body needs consistent daily dose so take it daily 2.5 pumps gel but hair has thinned dramatically since starting hrt even before adding progesterone so i would say for me it’s the gel causing it as still thinning now but isn’t worse adding progesterone i recently added testosterone every other day but again feel i need this daily other wise get ups and downs but told to stick for 4 weeks but i may well stop and take natural route i only started hrt for watery discharge little vaginal dryness which i also use ovestin for so would stick on this if i stop hrt and hope hair improves as i’ve lost that much it feels like fluff now on head no weight to it x but makes me so upset as overall feel better despite weight gain and hair loss just wish the hair loss would stop for almost 2 years been thinning xx

[Mary G]

Emm225, your doctor sounds pretty useless not to mention lazy.  She is taking the easy option and just bunging you on ADs without really thinking about it.

Presumably this doctor knows you previously had a Mirena coil so she should have suggested you stop the Utrogestan and revert back to the coil or try a different type of progesterone. 

What dose of patch are you using?  Did you have migraines before HRT?

I would not take ADs at this stage, I would get my hormones sorted out first and then filter in ADs later if needed.

[Emm225]

Funnily enough my husband said the same re Mirena.  It was taken out as I was spotting and they were worried re cancer etc.  I am 54 and the scan showed a good thin womb lining and they could only see one ovary (common apparently ) I 've had the Mirena for many years...about 18 (not the SAME one!) and it suited me v well.  Had it for v heavy bleeding and it was a miracle for me as periods stopped.
Yes, I do feel the doctors aren't really interested or knowledgable...but I feel bad phoning again as I feel they think I am bothering them all the time.  Is so difficult in covid times as I find it hard over the phone...which is all that is offered.  I don't even know if they are fitting Mirenas at the moment...although I guess for people who really need it they are.  They weren't back in May when I asked about it.

I am on the lowest dose of utrogeston(100)  and the patch and was told to use it continuously.  Pill every night and patch twice a week
I am at my wits end tbh and don't know what to do, been in tears again this morning as am starting to feel v sad again....

[Mary G]

Emm225, your doctor sounds even worse than I originally thought.

In your situation, I would have no hesitation in phoning the surgery and telling them you want a Mirena coil fitted as soon as possible.   I would not be asking them, I would be telling them, politely of course.

Your doctor has left you in a lousy position so don't feel guilty, she should be doing the job she is paid to do.  If she refuses to play ball, you could obtain a Mirena coil on the NHS and arrange to have it fitted privately as others on here have done.

What dose of patch are you using?   In your situation I would continue with the patches while you are sorting out the coil problem.

[Emm225]

I am on estrodot  25 microgram and utrogeston 100...oral..taking continually.  She said not licensed in the dose I am on for vaginal and tbh I am wary as would wonder if I was protected properly if not taking as advised.    AS I said, my hair has become very dry and thinning since going on it and I have put on weight around my middle...I have never had a spare tyre but boy I have one now despite doing more not less exercise in lockdown!
I forgot to answer to another post...yes I did have igraines before, but only for the last 3 or 4 years or so...my mum also got them at this time of life.  I take a triptan for them if I get one....I donlt get loads...a couple a month and have to watch I eat regularly and don't get over tired.

[Emm225]

So...as I understand it, despite what my doctor said, the mirena can be used as part of a HRT regime? I have never met the doctor I talked to in my life as our practice seems to have employed lots of new doctors since lockdown.  The doctor I wanted to speak to, who prescribed HRT in the first place is off long term sick they said when i asked to speak to her...

[Mary G]

Yes, the Mirena coil very definitely can be used as part of your HRT regime and you are very lucky because you know it works well for you so in your case and with a history of heavy bleeding, it's a no brainer.

Your current progesterone/oestrogen is out of sync in my opinion and personal experience but it's all academic if you are not going to be using that regime from now on.   That said, it could explain the hair loss and weight gain because the oestrogen dose is very low and probably being knocked out by the high progesterone dose.   To give you an idea, I am on 50mg progesterone every day and one pump of Oestrogel with good oestrogen blood levels (300 pmol) which I find to be the right balance with good endometrial protection. 

If you did consult a private menopause specialist, I can guarantee they would not prescribe ADs but recommend a Mirena coil with a higher dose of oestrogen and probably testosterone.   They would then look at ADs if and when needed.

Re the migraines, it's very common for them to start at menopause due to fluctuating hormones - this is when my silent migraines started.   Generally speaking, migraines with aura are caused by oestrogen spikes and migraines without aura are caused by progesterone intolerance/spikes but either way, hormone stability is what you need to aim for.   

For you info (and this may interest others too) the 37.5 and 75 mcg Estradot patches have the most stable delivery.  I'm not a patch user myself but my migraine specialist is and she mentioned it in my last follow up appointment.  I came across this graph on Wikipedia:

https://en.m.wikipedia.org/wiki/Estrogen_patch#:~:text=An%20estrogen%20patch%20(oestrogen%20patch,metabolized%20differently%20than%20oral%20preparations.

I hope that helps.

[Hurdity]

Hi Emm225

Sorry to hear you are struggling and also the terrible advice from your doctor.

Just to reiterate - you absolutely do not need to go privately to get HRT and you really don't need the ADs. They are not the first line of treatment for menopausal symptoms - unless there is a good medical reason why you can't take HRT!!

Re vaginal utrogestan - please rest assured that you are MORE protected when using it vaginally than orally. If you want more information I can provide it and there are various threads. I think I've already spoken to you on this before though maybe?

If the Mirena suited you I would  DEFINITELY contact the doctor and insist on having another one as part of your HRT. Never think you are bothering them unnecessarily. This is their job and if they have chosen/have to do things differently because of Covid - they still need to give you a good service. Write down what you want to ask and your reasons before you speak on the phone and if they cannot or will not provide you with what you want then ask them to refer you to someone who can. The level of ignorance is shocking and they need to step up. Hopefully there is someone in the practice who is knowledgeable about HRT and maybe you can ask to speak to that doctor? Our practice lists everyone online with their qualifications so you can see who has had at least basic training.

The other thing is, your oestrogen dose is very low - but I'm not sure what stage you are at in menopause. If you are barely into peri-menopause and it's just a top-up then it may be OK. The standard post-menopausal dose is normally 50 mcg so I would suggest you try for a Mirena + 50 mcg patch and chuck the ADs (well put them to the very back of the cupboard!).

I'm not clear whether you started the patches after the Mirena was removed or not? If you had spotting and scan showed a very thin lining ( did you find out the measurement?) - did they give you a reason for the spotting? Sometimes it can be caused by an overthin lining and if you were post-menopausal this could be an explanation. In that case low dose oestrogen would help.

Please don't be sad - there is help for you out there but you might need to be a little bit persistent and insistent. Remember it's your health and your body.

Hope this helps and be sure to let us know how you get on

Hurdity x

[Emm225]

Thank you so much for all your advice.  I had not put a new patch on after the last one and stopped the oral utrogesten but felt so appalling after a day or 2 (not sure if physiological as seemed a bit soon?) ,...started with the sadness and hopelessness, tearfulness,  so upset, and the sweats were starting to come in again, that I slapped a patch back on and took a pill after 3 days. 

Re the Mirena, I had it taken out because of spotting.  Various tests etc and scans but nothing serious so the hospital doctor decided as it was due to come out he'd take it out.  My lining was thin but I don't know how thin.  I wonder if the spotting was because of vaginial atrophy? (I have some vagifem I use 2x a week now as the doctor did say I had a bit of that)

I also had ...I think it's FSH... measured to see where I was menopause wise (sorry can't remember but you will know what I mean) as I don't have periods due to the coil. This was measured whilst I still had the Mirena in. The nurse said the result showed I was pretty well through meno she thought (but then added the levels of FSH (?) flutuate so wasn't always a reliable test)  I did mention having the mirena back in when I phoned in May (started HRT in March) but doctor said wasn't an option anyway due to covid.  Had blood tests etc as they were worried spotting and bleeds were something more serious.  I did say at the time, were they due to Mirena.  Once Mirena was removed bleeding stopped.

I cannot seem to speak to a doctor on the phone I know, and my practice seems v loathe see people in person ...not sure why GPs aren't doing this as hospitals are seeing people?   The doctor who originally put me on HRT seems to be still off and unavailable.  She didn't really discuss HRT with me however, but I guess they don't have much time in an appointment. I was meant to have a follow up appointment to see how I was getting on and if it was the right dose etc but that didn't happen as we were in lockdown then. I was just given a repeat prescription.  When I phoned to discuss in early May I think it was the doctor said no coils were being inserted and she didn't know what to tell me.  Since then  2 doctors have tried to put me on different anti deps there instead of HRT as they said less risk and if all I needed it for was sadness /anxiety and hot swets then there were many anti dep which carry less risk than HRT and would do as well.  Last week the lady doctor I spoke to on  the phone (never heard of her name before ) said she didn't know why I had been put on HRT and why I wasn't on combined oral HRT but on patch and pill.  She then prescribed anti dep.  It's hard enough to get a phone appointment with our doctors let alone a face to face one .

Migraines....I have got those over the last few years, especially if tired /stressed/over busy or miss eating.  I hate them and have never had them before.  I also get more headaches in general.  Not sure if connected to meno...and I just don't generally feel as well or full of energy as I used to, not helped by my not liking the way I look particularly...hair/weight etc!

I am active, I walk a lot and run and cycle , try to eat fairly healthily and not drink alcohol much.  So I am trying to help myself but the NHS doesn't seem to want to listen to me and I feel I am banging my head against a brick wall.

[Mary G]

Emm225, you could try speaking to the practice manager at your surgery and explain your situation.  I'm pretty sure others on here have had Mirena coils fitted on the NHS recently.  You could ask if you could have it fitted at the local family planning clinic if they refuse to do it at the surgery.

If you want to have a Mirena fitted quickly, the only other option is to ask the NHS to provide the coil and then you can pay to have it fitted privately.   Google places in your area that offer a coil fitting service.

I recommend you increase your patch dose.  Could you do this via a telephone appointment with the surgery?

Keep plugging away!

[Emm225]

Thank you all so much for your advice...I have a phone appointment in 2 weeks time  with the original doctor who prescribed the HRT.  I only managed to get it because the clinical pharmacist phoned me when I put a prescription in for Vagifem as she was concerned about what I was on.  I told her I hadn't had a review etc and she said she really wasn't happy and would phone the surgery and insist I spoke to the doctor I had first seen, who had originally prescribed the HRT. I told her I had tried to make an appointment but hadn't managed to and had been told that appointments had to be made on the day and it was pot luck who you spoke to.

 Funnily enough she managed to get me an advance appointment.  As it happens, when she phoned, I was just writing out a timeline and all the different advice and medications I had been prescribed since February, my concerns and my symptoms,  which i was going to send to the practice, asking for help.  I am still sending it to the doctor as I feel that at least then she has a clear and consise idea of what I am talking about.  The utrogesten is making me feel sick too, which isn't ideal. So, fingers crossed.

[Hurdity]

Do keep us updated Emm225 and hope the outcome is good for you.

Hurdity x