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[Shells99]

Hi
I have been taking tibolone for about a year now but feel it might be time to review my HRT. I also use vagifem twice per week.
I initially chose tibolone because of the testosterone component as I hoped to address my low libido and muscle weakness.
At first I felt better, aches seemed to improve, I felt stronger and sharper and reassured myself that the treatment would also protect my bones.  Then I had a couple of weeks of light bleeding about 6 months in. This was checked out with hysteroscopy and biopsies - all were clear and the consultant discharged me with his approval to go back on the tibolone if I wanted to.
I just feel that the effectiveness has waned this last few months;
My lower back ache is really persistent and getting me down, despite the extra measures I take to try to help (yoga, pilates, walking, light weight/resistance training).
My libido has gone completely - it improved slightly soon after starting treatment but has gone again this last few months.
These are the 2 issues that I want to address most - just try to improve my quality of life.
I have come to the conclusion that I might need to try upping the oestrogen which would mean switching to another treatment (I don't think the tibolone is available in higher doses). If I do this, I would prefer to avoid tablets and try gel or patches. I also want continuous (no bleed).
I'm going to be contacting my doctor soon to ask for a review so I would like to know what to ask for.
Please share your thoughts on what might be a good product to try for my issues. I realise that the GP will probably not be willing to prescribe testosterone and I'm open to going private if necessary. Also, should I ask the GP about blood tests for oestrogen/testosterone levels?
Just to add, I'm about 3.5 years into menopause, still have my womb plus a couple of fibroids who have been well behaved since menopause (apart from the brief period of bleeding last year). I was also diagnosed with osteporosis after my last dexa scan about 4 years ago. I'm 54.

Sorry for the rambling and thanks for reading 

[CLKD]

U ramble away >wave<

As oestrogen levels drop muscles may become lax = aches and pains.  I am currently having problems with lower back pains as well as apparently a bursisitis - physio exercises advised  .  Yesterday I had to resort to 'nurofen' as I was so uncomfortable and my legs were very cold.

If necessary you can use 'vagifem' as necessary, every night if symptoms are difficult to control.  Some find that a moisturiser helps too.

I think that you have to see a menopause clinic to be advised re testosterone, then the GP is covered to prescribe.  HRT should help protect both heart and bones, as will walking which I see you already do.  Same as with gums, teeth need something to work against, hence good chewing practice as gums can recede during peri menopause.

Hopefully someone will be along with advice regarding gel etc.. 

[Hurdity]

Hi shells99

There are plenty of options for you to try - all the alternatives are given in the menu on this website here:

Oestrogens (tablets, patches, gel, spray): https://www.menopausematters.co.uk/treatafter.php
Progestogens (synthetic progestogen tablets, progesterone capsules, Mirena coil): https://www.menopausematters.co.uk/to_progestogens.php
Combi treatments (tablets. patches or separate oestrogen and progestogen as above): https://www.menopausematters.co.uk/postmeno.php

Re continuous treatment - many think it better to try your new regime on a cycica basis for a few cycles to test whether any side effects might be due to trying a new progestogen - although with the Mirena coil it acts like conti HRT for the progestogen part, as well as contraception, if you still need this.

Some enlightened NHS GPs will prescribe testosterone initially (because the preparations available on NHS are off-licence for women) but yes you may have to go privately initially.

I've pretty much only ever used patches and a "natural" progesterone - firstly Cyclogest ( off-lcience) and then Utrogestan - since late peri when I was almost 54 and have been using HRT for nearly 15 years.

Hope this helps and good luck

Hurdity x

[Shells99]

Thanks ladies.

Hurdity, I have read through the guidance you suggested and drawn up some notes to use when talking to my doctor.
I notice that my current treatment (Tibolone/Livial), although listed, doesn't provide comparable dosage for oestrogen or progesterone. I did read somewhere that the oestrogenic and progestogenic compounds are 'weak' so I'm wondering does that suggest that the doses are quite light?

Q. Does anyone know if I could take additional oestrogen to supplement the current dosage in Tibolone? Maybe that's not allowed?

I prefer continuous dosage as I don't want any bleed (had enough problems pre-menopause) and because I understand it's safer to take the HRT transdermally I'm looking at the following gel or patch options (if I need to come off Tibolone);

1.Oestrogen + Progesterone - Combined - Patch - Evorel Conti or Femseven Conti
Can't see a gel listed for the continuous combined dose

2.Oestrogen - Gel - Oestrogel or Sandrena
   + Progesterone - Tablet - Provera or Utrogestan

Q.  Can anyone share their opinion/experience on any of these options?
Eg. Is it recommended to start on combined or separate?
      Are any of these known to be easier to settle on than the others (Oestrogel -v- Sandrena) or (Evorel -v- Femseven) or (Provera -v- Utrogestan)

I really appreciate any contributions and just want to be as prepared as possible when I'm talking to the GP as I don't know if they will have much knowledge and I'll not get much time  .

[Hurdity]

Hi shells

"Does anyone know if I could take additional oestrogen to supplement the current dosage in Tibolone? Maybe that's not allowed?"

In a word no. Well not without additional progestogen.

"Can't see a gel listed for the continuous combined dose"

There is no continuous combined gel. If you want to use gel as you see from the menu - your would use it separately with a progestogen.

It is entirely up to you whether you want to use combined - as you see there are fewer options - just two patches, and then the tablets. With separate combo you can adjust your oestrogen accordingly - ie tweak it, which isn't generally advised with the combi patches though some docs do permit adding  oestrogen to eg Evorel conti - so I recall.

In terms of what you choose - it really depends on what your priorities are. There will be women on here who are passionate about each of these in terms of their effect.

In my case I didn't want to take anything artificial and wanted to be "nil-by-mouth" - so estradiol and progesterone delivered transdermally and (utrogestan) vaginally was the only option.

Hopefully others will be along to share their experiences, though a search of many past posts  will give you a flavour of some of the different regimes ( bearing in mind that many women come on here because they have experienced problems and those who have found their ideal solution are off getting on with their lives

Good luck with your choice - and do let us know

Hurdity x

[Chloe]

Hello Ladies,

I've recently started on HRT (aged 52, perimenopausal -last period about 5 months ago) following anxiety++,depression as well as night sweats, insomnia etc. Tried oestrogen gels and pessaries but somehow they made me feel foggy and more anxious the next day so third time lucky I switched to Estrodot 25 patches which I cut in half and its been very helpful despite being on this extremely low dose. Taking a full 25 dose did not suit me.

I've been on 12.5 micrograms of Estrodot patches only for 5 weeks now. I have been advised to take 100mg of Utrogestan vaginally for 12 or 14 days in a 28 day cycle but frankly, despite knowing the risks, I'm terrified of going back to that dark place that many women seem to go when they take it.

I'm wondering if, given my very low dose of Estrodot, whether I need to take Utrogestan at all and if so, if anyone takes an even lower dose than 100mg? And if Utrogestan doesn't suit me, what other super low dose progesterones have other people taken that they've had a success with?

I hope someone can help.