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[sarahy]

Hi sarahy

Sorry to near about your anxiety - but I agree I would resist all attempts to try to put you on anti-depressants when it is likely, as you realise, your problems are hormonal.

The things is - firstly although oestrogen blood tests are not normally carried out - because they are inaccurate and docs should go by symptoms, in your case because you have both symptoms ( anxiety) AND lowish oestrogen levels - then adjusting the HRT would seem to me the first option.

In terms of actual levels - mine have never been 300 pmol/l since taking HRT - though I'm not sure what they are now! Mostly around 200 when they've been measured ( and less than this at patch change time - have since increased dose) - so it is what you feel - and I have always felt well on HRT with min 50 mcg patch.

So you have already been given an increased dose - off licence by presumably using 1.5 Evorel conti patches, which hasn't improved things?
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Hello Hurdity, Thankyou so much for your reply! I hope this is correct way to respond?
No it’s getting worse

One thing that has not been mentioned is progestogen intolerance. It could be that your anxiety is partly due to the continuous dose of norethisterone  - which some women react negatively to, so upping the oestrogen dose of the patch also means an increase in the progestogen. If you are a woman who is sensitive to this progestogen then no wonder you didn't feel better on the increase?

How do women know that it’s the progesterone they are intolerant too when there’s all the meno symptoms and oestrogen too?

Re: "but investigations have found no cause. So the doctor doesn’t want to up my hormones until the cause is discovered."

Bleeding is also tricky to control if you are on a combi patch - if the doses are not the right balance for you. Can you elaborate on what investigations you have had? You should have had a U/S scan + TVS (vaginal) and if the lining is found to be thickened or has any potential abnormalities, you should be offered a hysteroscopy and possibly biopsy.

I’ve had both, the lining is fine, no abnormalities found. I have got a 7 cm fibroid and vaginal atrophy that I’ve started  Vagirux for. But looking simply at NHS website, first cause of this bleeding could be vaginal atrophy, which they’ve continually told me I have. So I simply don’t understand why knowing that, and my low levels of oestrogen ( which b%§x doctor said weren’t that low) they can’t up my oestrogen now?

I can understand not wanting to increase dose until this has been sorted but this should be pretty quick in the case of post-menopausal abnormal bleeding on HRT?

My view would be to go for separate oestrogen and progestogen and/or cyclical HRT so that you can see which if any progestogen you tolerate best. This would enable you to tweak the oestrogen and progestogen doses safely and separately so that you both feel well and don't have bleeding.

I asked to be put on Oestrogel and Utrogestan and she refused saying the Everol Conti is supposed to stop the bleeding better, though it hasn’t.

I suggest you read up further about the different types of HRT ( menus on this site), decide what you would like to try, and after the investigations are complete, go to your doc (or a different one in the prctice) with your request (having written down your reasoning to help you remember!).


Hope this helps and ask if you need any further advice!

Hurdity x

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[sarahy]

Thankyou so much Hurdity! I have replied in quote on your message. I hope that’s worked X💐

[sarahy]

Thank you so much Mary G!
Doctor said it wasn’t even that low! But even on the print out the surgery gave me it said ‘low despite HRT and poor reponse to HRT’
My mother had osteoporosis so I’m very keen on being able to up my hormone levels. It’s been so long and such a struggle to get anywhere. And so difficult to understand where this menopause specialist is coming from, because you hope they must have your best interests at heart. But I’m seriously looking into moving to a practice ( all of which do not have menopause specialists) away from the one I have! Which sounds like madness! I’m so up the spout though I’m very lucky I can ask questions and anxieties here! X💐

[Mary G]

sarahy, you really aren't getting the help you need from this doctor.

100 pmol is a very low level of oestrogen and unlikely to do anything useful.  No wonder you are having problems.

Assuming this doctor is aware that your mother had osteoporosis, she needs to buck her ideas up and give you the preventative oestrogen dose that you need.   Unless she is completely clueless which I wouldn't rule out, she must be aware that the level needed to protect bones is a minimum of 250 pmol.   If you Google 'oestrogen level needed to protect bones' you will see that 300 ish is the level most menopause specialists aim for, Dr Louise Newson included. 

You would also be better off using Oestrogel in my opinion and preferably a body identical form of progesterone like Cyclogest which is dose flexible.

She has prescribed Evorel conti which contains a heavy duty, synthetic progesterone (which is probably why you have endless bleeding) and you are not absorbing the oestrogen component of the patch.  I despair.

[Claire MM]

Hi sarah, First I just want to say I feel for you massively on this and I think you are absolutely a self aware intelligent person and you know what is going on with your body. 100 is really low in terms of estrogen. I personally have struggled to get adequate health care for this through my GP and even the NHS menopause clinic. I had to go private and the private clinic then wrote to my surgery asking them to prescribe. Just because a GP is a 'menopause specialist' in that surgery I think that potentially means they just know a little bit more than average GPs (who don't seem to know much at all). If you look at the British Menopause Society and NICE guidelines - antidepressants are not the first line of treatment for anxiety/depression which may be caused by menopause HRT is, you as a patient are supposed to be listened to and have shared decision making in your care, HRT prescribing and menopause treatment is supposed to be tailored to the individual and it is recognised there is a vast difference in terms of absorption and metabolism of HRT between women and also different methods work better for different people. I would not have your care dealt with by a GP who isn't listening. There seems to be a lack of understanding of the huge impact on women's mental health. I would change either within the surgery or to a different surgery, or I would consider if you can afford maybe one consultation with a private specialist who will back you to the GP in terms of prescribing the levels you need. I know when you feel anxious how hard it is to deal with this kind of thing but I would shop around for a good doctor either NHS or not xx

[Claire MM]

Also I just read that you upped a combi patch and would echo what Hurdity said about progestogen intolerance and the overall ratio of P/E is unchanged by that increase so you won't really get the benefit of estrogen increasing. Having that systemic proestogen/ progesterone can be really hard for some people to tolerate x

[sarahy]

Hello Claire MM,
Thankyou so much for your message. It is virtually impossible to deal with this in my present state, you doubt everything especially yourself. The whole thing is vastly complicated by the fact I’m bleeding not much but continually, so the doctor is loathe to up oestrogen because of that mostly. But nothing thank goodness has been found and I’ve read in that situation you can up the oestrogen ( this I think is also contradicted as well though) I’m having at some point another investigation. I’ve had a really good recommendation yesterday from a lovely nurse going through similar who was taking my blood, for a menopause clinic. ( I will try sell some more prints/ paintings 🤗) Also wonderful affirmation that I’m not going mad re my doctor / hrt and anxiety. And am looking for another doctors. I am worried though that nothing is as black and white as it seems and I may be doing the wrong thing health wise. A lot she may be doing may be correct, and in my best interests, but the glaring contradiction to most others, have made me probable daftly doubt all. (She did say my levels weren’t that bad/low, which was not the comment typed on the results, or what anyone else has said!) 🤯 It seems sometimes as if you’re just reacting to each last thing and it’s all you can do because you can’t keep a thing in your head!
But Thankyou again!! Sxx

[sarahy]

Hello Mary G, Thankyou so much for your message! It does feel like an impenetrable vicious circle. I didn’t realise the progestin in the patch could be causing the bleeding ( I probably have read this and then read opposite and then forgotten both🤯)
Yesterday I got a very good personal recommendation for a menopause clinic, so I’m hoping I’ll be able to do that, and also been looking at doctors to move to. It’s very strong the feeling though that your ‘ menopause specialist’ doctor ( the only one in the area and she also is part of an online private menopause clinic) must know what she’s doing!! So my brain is even more confused! It doesn’t help that others think that it’s a ‘trust now gone’  issue  so she won’t help, and that she’s actually been doing all the right things, getting me investigations, not upping anything etc. because of concerns about the bleeding, when in more clear moments I see it as trust and competence!
So to have others views has been incredibly helpful, Thankyou xx💐