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[Anglichanka]

hello all
I have grade 4 endo (mostly asymptomatic) and have been on HRT for 3 years. I'm on 200 mcg estradot (two patches, changed twice a week); and I take 100 mg utrogestan for 12 days a month. I get a regular withdrawal bleed. But I hate progesterone like lots of women, it makes me fat, depressed, tired and ravenous, so for a couple of months last year I skipped it. This was per advice from the Newson Clinic, where I was told that to skip a couple of months was perfectly safe. They are the ones who put me on the 200 mcg dose of estradot, as I was having severe dysfunctional depression that was interfering with life. Anyway, I recently had an ultrasound to check my endometrial lining, as my GP, formerly a gynae consultant, and very nice, had kittens that I'd skipped two months of progesterone. The ultrasound found a slightly thickened lining and a new cyst on my left ovary to accompany my consistently cyst-y right ovary, so I was sent for an urgent hysteroscopy. The hysteroscopist, a nurse who said she was being trained to be a menopause specialist, was horrifed I was on 200 oestrogen, she said that was extremely high and she'd never ever encountered anyone on that amount. She also thought I was on too little progesterone, even though I pointed out I was taking the utrogestan vaginally so didn't need 200 a day (again, on medical advice from Newson clinic). The nurse was pushing me really hard to get a Mirena, which I don't want. I've spent years trying to get some stability and now I have some (as I now take ADs too, which are helpful), I don't want to mess with anything. She said at my age (52) I was probably post-menopausal by now and so I should consider going continuous not sequi.

I've never heard this before. Nor has any GP expressed any concern about my oestrogen or progesterone doses.

So, my question is: are any of you on 200? Has any medical person expressed concern that this is too high? Or that 100 taken vaginally is too low?

I'm really unwilling to mess with my regime for now, I need stability this year (got a book to write) and I don't want to f*ck with the progesterone either.

I'd be really interested in your views.

My womb was apparently fine, by the way!

[sheila99]

Apart from suggesting you change to conti I agree with the nurse. If you've had blood tests that show you don't absorb well then it's different but for most people that would be too much. I was told up to 6 pumps by a specialist but haven't needed more than 4. Few GPs will prescribe more than 4. Have you had your levels tested? 
   Some women do need a higher level than others to feel well and I'm sure your specialist knows more than I do.

I do get a little concerned about the Newson advice about utro. The manufacturer says the dose is the same regardless of delivery and it's likely they've done more testing than she has. It's even less likely there has been enough testing of those on a very high dose like yours. Many post meno women use a long cycle (6 weeks) which may be a better option than skipping cycles, maybe worth discussing with your gp. Given the endo I'm not sure a mirena would be the answer as I don't know it would control anything outside the uterus?

[CLKD]

If the regime is working, why change?  Could you make a phone appt. with Dr Newson for advice, mayB suggest that she contacts your GP to discuss the way to proceed?  If you don't want a Mirena? this is your body and you are entitled to say "I will wait a while before deciding".

Let us know how you get on.

[Anglichanka]

Thanks both. I forgot, I did have blood tests and they did show I don't absorb much oestrogen so presumably that is behind the high dose. I did tell the nurse I'd consider tapering down to 150 and ultimately to 100. I can't afford a Newson appointment at the moment, not even a phone one.

Of course I'd be able to make better decisions if I knew whether I was post-meno or not, but the only way to do that is to stop HRT so I'd have schedule a year to go completely batshit again. And that's not going to be this year.

[CLKD]

Nope.  If it ain't broke ......... you could send an e-mail to Dr Currie on here for a fee asking if how you take HRT is OK? 

[Floo36]

You are on what’s classed as high dose but if you don’t absorb 100% then it’s not. Dose should be lowest amount to make you well and control symptoms.  There can be a ten fold difference between us in how we absorb, I don’t absorb any.  Don’t be afraid of replacing your own hormone, you are only trying to get back what you have lost. Too many of us suffer and left withiutbour hormones.  It’s not a dangerous drug but our own hormone.

Keep going if it works for.

[sheila99]

Is you gp happy to continue with this regime? As above, it isn't the dose that's important, it's the amount you absorb. As you have blood tests to show you're not absorbing too much you have a strong case to continue as you are. If your gp won't prescribe you could ask for a referral to an NHS meno clinic (expect a long wait) or you could send an email to Dr Currie. A letter from her should be enough for your gp. Given that you don't get on with utro I'm not sure why you want to be on it continuously? Many women in this situation stay on a sequi regime in meno so the have more 'good' time on oestrogen only.

[Angelasurrey]

Anglichanka,

I do think there is a lack of education around HRT even amongst nurses, gynaes, GPs. I’ve recently had a private meno specialist say that I can’t increase HRT dosages.

All the very best
 

[CLKD]

Did he/she give a reason Angelasurrey?  Lack of knowledge mayB?

[Angelasurrey]

Thanks dear. She said that it’s more than a tablet would be. Also that she wouldn’t go over the amount as it’s too much Estrogen. She’s a london based Meno specialist and honestly only money minded.
I’m completely drained with it all x

[CLKD]

I would try an NHS meno clinic?   She doesn't seem to know much about HRT!  Private practice is often set up money oriented.

[sheila99]

Is she on the BMS website? I think (hope!) anyone on there is a genuine expert.

[Cassie]

I take 100mg of Utrogestan ever other month for 12 days, am on 1 pump of gel, I am not sure how that compares to your patch. 1 pump of the gel contains 0.75mg of oestrogen.  What is a mcg how does that compare to an mg, I get so confused, always have done, but then again, physics was always my weak point.

[Sooty]

I'm on 2 x 100mg patches as well as 3 pumps of gel. I did have the mirena fitted though before lockdown but I was told that 1 utrogestran was sufficient (I took 1 every night).

This was under a BMS nhs specialist. Though I had a bit of a fight on my hands as they do not believe that levels need to be over 200 pmol/l and that anxiety / mood swings caused by decrease of oestrogen cannot be remedied by hrt

[Anglichanka]

do you still have the mirena? do you get on with it?