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[Tak]

Hi I am new here, and the title of this thread is what I have recently been told.
 My journey so far-
  I am 3 .5 years post meno and have been on hrt since July 21. I have been on the same dose of 75 patch/ 1mg satchel gel/ 100mg prog combo since Nov 21. In Jan 22 estrogen pressaries we’re added, I then had some very light spotting & bloating about 3 weeks after starting the pessaries. I was sent for bloods and an ultrasound, bloods were ok & ultrasound found fibroid and so they couldn’t measure womb thickness as this was distorting the image.
 So I then had to go and have a hysteroscopy, which couldn’t find any problem or disease. The consultant didn’t have a problem with what I was on dose wise, and I even asked if 100mg of prog was enough, she said yes.
  I had my yearly review & gp didn’t see that I needed to change anything, late 22 I had some more bloating and had bloods done again to rule out ovarian cancer, the test was clear. I have carried on with same regime until this years review, which was with a new member of staff at surgery. I know she isn’t a gp, and I don’t think she is a nurse either, I said all was going ok but I was getting a bit of night heat & I still got the bloating/ pelvic ache occasionally.She said she would refer me for another ultrasound & bloods to check absorption & consult with my gp who is the female health go to at the practice. Bloods came back 414pmol/L and I got a call “ we need to change your hrt, you are on a dangerous amount” and “it is a top heavy dose” (to much estrogen to prog ). Even though ultrasound was fine & within limits( fibroid still there ).Instant swap to Bijuve, “you will absorb this better”, I have now been on this for 9 weeks, needless to say cutting the dose by more than half hasn’t gone well. . I have made an appointment for next week with gp, was 414 a high blood result?  I am going to try and get my dose increased by either adding gel or patch or changing back to separate estrogen / prog again? 

[Nik2502]

Hi

414 isn’t high. 350 is usually the level aimed for. Some women need much higher levels to feel better.

Nik x

[Kathleen]

Hello Tak and welcome to the forum.


I am with Newson Health which is a private menopause clinic and they certainly wouldn't consider your levels to be high. When I was using three sachets of Sandrena gel my levels reached 600 and they thought that was fine.

It does seem that we need different levels to feel well and I was told to be guided by symptoms rather than numbers.

I hope this is helpful and I wish you well.

K.

[CLKD]

It's a shock tactic, but no practitioner should tell a patient that they are on 'too high a dose' without referring them to a GP.  Certainly your treatment should not have been altered without further discussion.

Now that you have had time to recap, I would be contacting your Practice Manager at the Surgery to find out who exactly has permission to alter your HRT without further discussion with a GP.  At the next appt take a list of your symptoms with you to discuss and ask to go back onto the regime you found helpful.


dangerous dose my foot .......... I don't know where these people read all this information and why when others haven't considered your regime to be dangourous 

Welcome to the wonderful world of menopause ignorance and mis information.  Sorry that you have caught the tail end of someone with little HRT knowledge.  If it were dangerous who ever that was should have asked a GP or Nurse Practitioner into the room that day.  There doesn't seem to be any joined up thinking in the NHS anymore.

Fortunately you have landed in the right place for support. 

Let us know how you get on.  Many have to use regimes 'outside' what is expected in order to maintain a quality of life. 

[Tak]

Hi everyone
  Thanks for the replies   
The person I had the f2f appointment and follow up phone call with was reporting /consulting with a gp. Also in the f2f app she did mention being me being referred but it would be a long wait, so instead maybe they could write to meno clinic for advice. That could not have come back in the 7 days between apps, so I will be asking gp who took the decision.
   Many pre hrt symptoms have re-surfaced, so obviously 1 Bijuve does not contain enough estrogen for me, can anyone tell me is it equal to 1 or 2 pumps of gel, as I have read differing opinions on this. Some say as it goes via stomach & liver it is absorbed better, others say that route means it does not all stay as the same type of estrogen so can be lower dose  .

[CLKD]

I believe that a patch bypass the gut.

[Tak]

Just had phone app with gp this time, apparently the reason for the change to Bijuve from my previous regime was because I was on an unlicensed dose of estrogen because of the 75 patch /1 mg Sandrena combo which I was on = to 5 pumps gel, have now been put on oestrogel 2 -3 pumps ( max 4) and separate prog. Still think this is low but will give it a try. I did say I still had a full box of 1mg Sandrena so could use 2 sachets of that ( which I thought = 4 pumps), but  gp said only 1.5mg was enough of that. But then contradicted herself by saying I could go up to 4 pumps of oestrogel if needed as this was the max licensed dose. She also commented that 414 pmol/ L bloods wasn’t excessively high as 200 was the min for bone health, and it looked like I absorbed it well. Don’t know what I will do if this doesn’t sort it. Have to raid the piggy 🐷 bank and get a private consult.

[CLKD]

Keeping a diary will help chart progress.  What I would suggest is not to increase too much too soon, as the body rarely gets where it is suddenly.  U don't want to cause more symptoms so little steps.  This allows the body to adjust.

Let us know how you get on. Do U feel supported by the conversation earlier, it can take a while to find a regime that might work. 

U shouldn't need a private consult, however, it it gets you time to discuss your symptoms as well as advice on various HRT regimes, it might be worth while.  Perhaps ring round to find out what private consults actually cost and how long waiting lists might be. 

[Tak]

I had a regime that worked but gp has changed it  so back to the bottom of the slope I go and here comes the slog back to the top again. 

[CLKD]

GP changed without knowing much by the sounds of it!   

Let us know how you get on.