I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.
To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.
Hi bebbo
To add to the other posts.
First Premarin is one of the old-fashioned types of HRT ( made from pregnant horse urine for those how don't know) and is the oestrogen that was used in the controversial Women's Health Initiative trials whose results (in terms of increase in various health risks) led to drastic reduction in HRT being prescribed until relatively recently. Judging by posts on this forum it is rarely prescribed now in UK, rather, the bio-identical estradiol is recommneded and available in several methods of delivery and dose.
Second - there is no exact comparison between estradiol and premarin as the latter is a mix of horse oestrogens (including estradiol). However looking at the dose chart here:
https://www.menopausematters.co.uk/treatafter.php, 0.45 mg premarin is somewhere between low and medium dose whereas what you are now taking - in effect 0.37 mg per day, is ultra low dose - look at Femoston here:
https://www.menopausematters.co.uk/postmeno.php (0.5 mg estradiol per day). Given the same absorption, then the equivalent tablet estradiol would be approx 1.5 mg so yes it is understandable that you are noticing an increase in symptoms.
Thirdly - 500 mg prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking. The standard daily dose of Prometrium (which is the same as our Utrogestan I understand) for continuous combined HRT is 100 mg - yes you see it - 100 mg! This can be increased (to 200 mg) if it does not control bleeding though with low doses of oestrogen it is less likely to happen (ie poor control of bleeding).
Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.
So in terms of the standard approach - you're not getting it - neither before nor recently!
Take a look at the options available in uk that I linked to - HRT preparations for post-menopause, and the separate oestrogens (transdermal) and progestogens, There will be the equivalent in US - many patches are available....
As for the age thing - I have nothing to add to that - I am approaching that age myself and don't intend to come off HRT provided there are no heath reasons that mean it would be advisable (to stop).
Incidentally it is heartening to read of other women approaching and post 70 still on HRT - including especially those who still have a uterus as this is more challenging, due to the need to take progestogens.
All the best bebbo - do let us know how you get on
Dr Currie - thanks for alerting us to the new statement by BMS - and joziel for the link must have a read....
Hurdity x