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[CrispyChick]

Omg... Sam has now left.

Seriously, one after the other the contacts I have made here who are using bhrt and can support me, have felt the need to leave this forum.

It's a sad day. 

[Hurdity]

Oh dear! It is ALWAYS this topic and issue that causes problems on the forum

Let’s just clear this up.

Booblet asked for advice on what dose of OTC progesterone cream she needed to protect the womb as she is taking proprietary oestrogen gel. Hellsbells responded with some advice about the quantity/proportion needed on the basis of her own private prescription. I then responded with advice I would give, with a warning about using OTC products like this for the purposes of womb protection. Having looked at my response again I would say the same thing again.

I’d like to be clear as I said, that whilst I wish everyone well in this difficult time of our lives, and women/we - get through it in the best way that they/we can, I feel a moral responsibility towards the poster – Booblet – as well as all the other women reading the forum and who might act on the advice given – to correct any misconceptions, if I am able to, just as sheila99 says so much more clearly than I can actually - and also regularly puts the medically accepted view. And I do not feel the same responsibility towards women who can afford and are getting private treatment – because they will be fine, because they will be monitored and can afford to be monitored. It’s those that can’t afford expensive treatment and are trying to find a way through that is safe and recommended, that I am talking to here, as sheila99 too.

Hellsbells – I’m sorry if you feel attacked and undermined by my comments – that was certainly not my intention and in fact I wasn’t addressing you at all in my post – I appreciate your position, and sorry to hear about your health issues. However you will see I was critical of the advice given to Booblet for the reasons given. Your specialist private advice given to you in your very specific situation is not applicable generally. As we all known the Newson clinic is also private and there are lower doses of oestrogen widely available on NHS – for example patches start at 25 mcg and could be cut down to build up gradually. Referral to a menopause clinic – if there is one in your area, would enable you to receive personalised treatment taking into account your situation.

Yes the doses are fairly standard but can be tweaked to suit, especially with gel. I do agree that the progesterone situation is not ideal and we are forever talking about proprietary lower doses such as 50 mg that should be available on NHS, for those who don’t tolerate it well.

I also agree that it is better to have oestrogen than the drugs for osteoporosis if this is possible – though for some this is the only option.

As always the problems arise when members giving their personal experiences get mixed up with members giving advice and the overlap between them, and the difference between being critical of a treatment and advice, and criticising an invididual - they are not the same.

To reiterate Hellsbells – I am glad you are finding a solution that is working for you with your health needs and I hope it continues to do so, and  I hope you can see that I was not criticising you personally nor your regime – as it applies to you, just its transferablity to others, and not least through concern (expressed regularly by forum members including this thread) about spending money unnecessarily on treatments.

Enjoy the rest of Sunday !

Hurdity x

[Mary G]

I am very sorry if Sam has left MM on the strength of this, she was a much valued member and I hope she does not feel she was being judged in any way.

I have mostly said my piece on my compounded hormones thread but I will say this.  Some of us, myself included, cannot tolerate the dreaded Utrogestan under any circumstances and it's a case of switching to compounded (or latterly in my case, branded progesterone gel) having a hysterectomy or giving up on HRT altogether.  I would add that very often,  a hysterectomy is not the answer and women often find they need to use transdermal progesterone.  Obviously it's a different matter for women who are severely progesterone intolerant.

Of course compounded/branded progesterone creams and gels should not be the first port of call and everyone should try the conventional progesterone route first but if they find it intolerable as I and others have, what are they supposed to do?  Shut and and put up?

As others have said, the NHS are wedded to high doses of progesterone and I think that is  because that are unable to monitor women via uterine scans.   They only scan women if they have a problem.

In theory, my HRT regime is not supposed to work but it does. 

I was told by a gynaecologist that if you never take progesterone, it could build up to dangerous levels but if you take progesterone continously and it is not quite enough to counter the oestrogen, you will simply bleed.   Progesterone acts like a monitor in the womb and even if you don't take quite enough, your lining will shed once it breaches a certain level - in my case I know it's 8mm.

So to recap, yes, women should have transvaginal scans and if on a continuous combined regime, your lining should be 5mm or less.  If you are on a cyclical regime, it should be no more than 5mm immediately post bleed.

In a free and open forum, we should be free to discuss anything menopause related and all types of HRT.

[CrispyChick]

Your last sentence sums it up for me Mary:

"in a free and open forum we should be free to discuss anything menopause related and all types of Hrt"

I don't feel this is the case, with MM. We are not 'allowed' to openly discuss bhrt, for fear someone new will run off and try it.

Those of us that turn to the bhrt sector are forced to because the mainstream system has failed us. Not because we love spending money or have surplus money. In fact Hellsbells has mentioned how she had to prioritise money for this from her savings. I am in a similar position - spend hard earned savings or endure no quality of life.

I am not getting worked up by this latest argument - there must he something good happening with my hormones. But I do sooo wish we could have a 'safe' place to discuss our own experiences with bhrt on this forum. It is vital support for those of us who need to try things outside the box

Perhaps we should stick to the alternatives section (although I fail to see how bhrt is an alternative, when the forum  is for menopause not hrt), but even over there, we get the usual interjection.

Perhaps we could all agree that we can be left to discuss our own bhrt experiences, in peace on the alternatives section???  I, for one, would find this very useful and supportive, being someone that doesn't fit the mould. 

I think there are plenty of posts in the alternatives section that already contain the warnings raised here 

Booblet. May I suggest you start your own thread in the alternatives section and those of us that have experience of bhrt may be able to offer some guidance and support and, if required, point you in the direction of a reliable clinic who could oversee your use in a safe manner. 

[Mary G]

Thanks Crispy, I agree, it's best and safer to stick to the alternatives section.   I decided to put my compounded hormones thread on there because I knew what was coming my way!

I hope others don't feel they were being judged either.

[Furyan]

I have been prescribed low dose estrogen/testosterone 0.2/0.2 and was originally given 20mg of progesterone but this has been increased to 40mg. I would go for 40 on that basis.

HellsBells, that’s really helpful, thanks for sharing your prescribed ratio. I have an upcoming appointment with a specialist and was worried that I’ll be spending my cash on advice that might get me in the same boat as the conventional proportions advocated for on the NHS. I must remember to keep an open mind….

Hi Furyan

What are you seeing the specialist for and is this a BMS recommended clinic/specialist? See my post below about the ratio. I've no idea what Hellsbells has been prescribed but sounds like a private compounding pharmacy dose - and none of this is recommended by the British Menopause Society. All the products - bioidentical oestrogen and prgoesterone are available on NHS and no-one needs to spend lots of money they don't really have or can't really afford to go to one of these overpriced unregulated clinics!

Dosage can be tweaked to suit and nowadays there is a plethora of different products available -  eg oestrogen in the form of gel, spray, patch or tablet, and progesterone as oral or vaginal capsules (though some is  off-licence for HRT as I mentioned below).

Obviously everyone is free to do what they like -  but just trying to correct some misconceptions here, and don't want the regular visitor to the forum to feel that this "specialist" (= expensive) treatment is necessary for them to feel well.

As always I wish everyone well!

Hurdity x

Hi Hurdity

I’m seeing a specialist as I am so fed up with my ever increasing size as a direct result of taking HRT. I’ve tried tweaking the estrogen and/or utrogestan and continue to swell up to the point where it impacts on my mental health, exercise tolerance and general confidence. In truth, the regime that gave me less headache in the swelling department was Evorel Conti (half patch) but I want to find a 100% body identical route. My GP definitely can’t help me tweak the hormone amounts/ratios and I’ve already spent money on a menopause clinic that is prescribing exactly the same standardised doses as the GP will offer. The regimes I’ve tried are clearly not working for me and this can’t continue as I feel I have no control over my body in some respects. There may be a view that the BMS is the holder of all interventions that are ‘best’ for all people in every situation, but that simply isn’t my view or experience and, frankly, isn’t realistic either. Sometimes a broader perspective is needed because not everyone fits neatly into the standard ‘bell curve’ of treatment.

In a nutshell I’m looking for that broader perspective from a professional who’s just as medically qualified and has clinical experience and research in broader regimes so I can make a more informed decision about a way forward that’s all. Maybe I’ll end up with a combined compounded/standardised NHS regime. Or perhaps think ‘sod it, I’ll go back to Evorel Conti’. I have no idea and I just need to keep an open mind about things, as I think the real danger is in closing our minds off to possibilities that could potentially make a difference.

If anything, reading these posts, I’m thankful that I’m more aware of the need for regular monitoring of the womb so I’ll definitely ask about this when I have my appointment. Hope this is clear, I’ve rambled a bit…

[HellsBells]

I take the view that we are all adults with agency. We all have access to free healthcare and advice from practitioners. There is a wealth of advice and support from charities too. There is no doctor who can clearly state what will happen on any regime for an individual - modern medicine is all about the big numbers and statistics. When we are told 'the benefits outweigh the risks' for example, doctors mean the herd, not you as an individual. We should all take ownership of our health journey - and it is written into law now that the process should be 'collaborative'. Doctors are required now to note when patients DON'T want details or give consent without understanding treatment fully. It used to be the other way - if they question too much they are trouble.

There is a paternalistic approach to this subject  on the Forum which sometimes seems like we are being treated like children, unable to think for themselves or research our own conditions. None of us have the answers and research is changing views all the time. HRT was once a lifesaver, then the risks were overstated, and now attitudes are softening again. Low dose and ultra low dose HRT is being used when once it was considered 'ineffectual'.