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[jo1488jo]

Hi ladies

I’m after some advice please. I am 44, and have been experiencing hormonal fluctuations for the last 4.5 years. I’m at a crossroads and not sure what to do next! Sorry this is a bit long.

My early symptoms were more frequent and heavy periods (cycle length went from 30 to 23 days most months) and debilitating anxiety and PMS, to the point I couldn’t function.

After about 2 years of tests and investigations and shrugged shoulders from GPs and gynaecologists, I paid to see a nurse at Newson Health who immediately put me on oestrogel, and my symptoms improved. I then tweaked the dosage, going from 2-4 pumps, and got a Mirena fitted. I was much better overall but still not great. I felt permanently bloated and my mood was up and down. My libido vanished, so they gave me Androfem but blood tests revealed I had a raised SHBG level which was limiting how much testosterone I could use. It was so expensive I decided to stop using it. I also started to wonder if I needed so much gel, but Newson couldn’t get me take enough. 

Earlier this year, I became aware of a rising anti-Newson sentiment across social media, and read a lot by Dr Annice Mukherjee, saying HRT isn’t right for everyone and the evidence doesn’t yet support it’s use for long term health protection. It isn’t a miracle cure and lifestyle factors are more important.

For some reason, I started to doubt I was doing the right thing, and decided to taper off my Oestrogel use over two months. I stopped using it entirely about four weeks ago. And I must say, I felt amazing! The permanent bloat I had disappeared, I lost about 4lbs and my mood was great! Libido still rubbish though.

Then gradually I started feeling a bit tired and achy. I got woken in the night feeling restless with the occasional sweat. I began to panic - is this my body telling me it needs the oestrogen? Are my bones withering away despite my good mood? My husband also started grumbling about the lack of sex.

So I decided to go back to two pumps a day of oestrogel, and almost immediately felt terrible. Swollen and fat feeling, irritable and tearful. The sweats stopped but that was about it.

Now I really don’t know what to do. Should I continue to go cold turkey and give it a bit longer to see where things settle? Or am I putting myself at risk given my age, and I should persist with the gel and let that settle again? Will my libido ever recover?

Would anyone recommend a blood test to see where my levels are at if I come off the gel for a bit?

Thanks in advance x

[Nik2502]

Hi

I’m also a patient of Newson and in a similar situation.
I feel awful on my current regime and they continually advise increasing oestrogen.
My anxiety, low mood and panic attacks are terrible.
I’m now considering coming off HRT to see what happens. It certainly isn’t the miracle I had hoped for three years ago.
You could ask for your oestrogen level to be checked. Newson say 350 is a therapeutic level.
Sorry I can’t be more helpful
Xx

[CLKD]

Of course HRT isn't 'right' for everyone, nor does every one require it.   Stopping and starting will put your body under added stress if hormone levels are 'about right', in that you will react to alterations in dosage.

It may simply be your hormones over whelming the HRT. MayB you don't require 'extra' at this time.  You could ask for a bone density scan of pelvis and hips to give a base line.

As oestrogen levels drop the body may become dry: inside and out; nostrils, deep in the ears, vagina, skin, scalp as well as muscles may become lax = aches and pains.  I find that 'nurofen' as necessary helps with the latter.  I also wear appropriate shoes and try to sit 'properly'  to avoid putting pressure on the spine.

HRT will help to protect heart and bones.  However, a good diet of diary, proteins, oily fish  and exercise  will also help. 

Vaginal atrophy is a different kettle of fish.  Replacing oestrogen will help - there are of course other ways than penetrative sex  so husband could become inventive ;-)

[Kathleen]

Hello jo1488jo and welcome to the forum.

I am sorry that I can't answer your specific queries but I can relate to your situation
and I believe there are a few of us here who are asking the same questions of HRT.

I am also with Newson Health and their approach seems to be the more Oestrogen the better. They also believe that progesterone should be kept to an absolute minimum and that if these strategies don't help then testosterone is the missing magic ingredient. In the few years that I have been with them I have followed every word of their advice but still struggled with anxiety and mood swings.

I was particularly concerned when my NH doctor insisted that I should have been feeling really good because my Oestradiol levels were 600 and she didn't have an explanation as to why that wasn't the case. Shortly after this I developed very tender breasts and heavy bleeding so I was forced to lower my dose of Oestrogen anyway.

I wonder if by now there are sufficient women who have not had success with NH who are wondering if there is an alternative way to treat the menopause? Certainly I know of ladies who have not used HRT and appear to be doing okay. One woman told me that she had the shaking anxiety for six months and then it went and hasn't returned, I told her that I wish mine would do the same lol.

I am sure that other ladies will be along to advise you and to help you decide what to do next. This is a complicated business and I wish you luck.

Take care.

K.

[Mary G]

Do you still have the Mirena coil?   If so, that might explain why you felt good initially on Oestrogel but went downhill after that.

HRT doesn't work for everyone.   We have had women on here over the years who never find a regime that works for them.

Progesterone is a huge stumbling block for a lot of women and this is partly because (in my personal opinion) it is over prescribed - I think the NHS guidelines need to be reviewed but good luck with that.

I don't agree with Mukherjee.  To say that lifestyle is more important than HRT when someone has debilitating vasomotor symptoms is a bit of a stretch to say the least.   When I was at my worst and endlessly sweating buckets, all the lifestyle changes in the world were never going to help me.  I needed hormones, end of.

As for stopping HRT completely, it will very much depend on the individual and I can only give you my experience.  I occasionally stop everything to get a baseline hormone blood test and the same pattern always follows.   I feel good for a while and then I start to feel hollow and creaky after a while and I can feel myself slipping. 

There is no real alternative to HRT.  Some women find antidepressants mask their symptoms but normal practice is to start with hormones and only filter in ADs later if needed.   I now take amitriptyline (which is a multifunctional AD) for migraine prevention but that's a different story!

I hope that helps.

[Hurdity]

Hi jo1488jo

 

Sorry to hear about your woes

The thing is - going to a shorter cycle as you described is precisely the classic pattern of PRE-perimenopause and is known as the late reproductive stage. This is not peri-menopause as such because cycle length does not vary (early peri-menopause is defined medically as beginning approx when cycle length varies by more than 7 days each cycle).

This late repro phase - you are still ovulating each month, I understand, but hormones are beginning to go awry, and hence pms symptoms often get worse. Depending on your own natural oestrogen levels - maybe they are not dropping too far yet - maybe they plunge down low at the end of the cycle?

For some women - a low dose HRT at this stage can work - just to top up (I have read quite a few cases of standard patches Like Evorel or Femseven sequi or tablets like low/medium dose Femoston - doing the trick until peri-menopause really sets in), but for many HRT, at least high dose HRT, is not the answer AT THIS STAGE  and I can't understand why the Newson clinic seems to think it always is.

So it is not that HRT is not right - with the right product, it should be able to find the right dose and type to suit most women (all except the most extremely sensitive) - it's just that the standrad regime of high dose gel and going on increasing - may not be right.

This is again where I disagree with private medicine - not only are you paying for it,  and this is beyond the reach of most women in UK, especially now, but it does seem that there is some overprescribing going on - and I wonder if this happens at NHS menopause clinics?

I haven't read Dr Annice Mukherjee but there is plenty of evidence showing the long term health benefits of HRT - the British Menopause Society ( and the International Menopause Society) regularly trawl the scientific journals and review/update their evidence-based consensus views and statements. There is also evidence from what I recall of adverse effects of early menopause on various health measures - possibly even longevity (through association studies I think) but I'm a bit hazy here as I haven't looked anything up for ages.

In your position - being only 44 and pre-peri-menopause (at least when you started HRT), some menopuase specialoists prescribe one of the newer combined COC pills which contain estradiol - which is bio-identical and the same as in HRT. These tablets are not like the stronger synthetic pills. These have almost no tablet free days and will regulate the cycle and hopefully eliminate or at least minimise the dramatic hormonal  fluctuations that are beginning to occur. This could then take you through the early stages of peri-menopause when you could possibly then transfer to a more conventional HRT.

Stopping HRT for several months will tell you what your cycle is doing - if you could cope with this - but you don't need to do this, nor have blood tests to measure anything, as these tests will not be helpful at this stage and wouldn't be offered on NHS except under special circumstances.

Hope this helps and all the best

Hurdity x