Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Tribbins]

I started HRT 7 months ago, being post menopausal by about 7 years. I had weekly migraines, fatigue, lack of motivation, some skin issues, still struggling to sleep due to waking up too hot. I did a slow start onto Evorel 25 for a few months then tried Utrogestan (awful) then Cyclogest (cumulative effect got worse). Can't afford to go private so had to rely on NHS support which I can only describe as non-existant. Due to lack of choice with regard to progesterone (Mirena or nothing) I decided I would have to stop HRT as I really wasn't feeling great anyway, I was at this point on 37mcg oestrogen. Although the migraines had reduced drastically, I was getting aura, low mood, sore breasts, felt groggy, developed awful thrush and bowel changes, waking at 3 - 4am and not being able to get back to sleep, dry, blurry eyes and diffuse hair loss.

I started cutting down the patches until I got to a quarter of a patch (6mcg) and weekly migraines returned. However, they aren't as bad as they were previously. I feel mentally so much better, sleeping well and more energised. I don't think I need much in the way of hormones to feel better, I just need a very low consistent dose. Now someone might say '6mcg is pointless, you might as well not take any, as that amount won't have any effect'. All I can say is that I started slow (on 6mcg, quarter of a 25 patch) and it affected me immediately from that low dosage.

I'm not taking any progesterone and I don't know if I need to for 6mcg oestrogen (unfortunately I can't get any response from the 'menopause team' at my practice, not really sure what they do, I've phoned around 5 times over the past couple of months but no response) - but I do know that I feel quite well on this very low dose for this time of my life, although it may change. Do I still need to take progesterone for such a low dose of oestrogen?

[Nas]

HI Tribbins,
That is a really low dose of oestrogen, but glad you feel well on it.
I am not sure re: the progesterone to be honest. I guess even with a tiny dose such as yours, there is still a chance that the lining could build up over time, but I would imagine that it would take some time for that to happen?

You could try and see I guess. The proof might be if you bleed or not. If you start bleeding, that could suggest that your lining is building up.

Hurdity, what do you think? 

[sheila99]

If you ask the nhs I'm fairly sure they'll say yes. Off licence so this isn't advice but you could try either a progesterone cream which has a lower dose that you might tolerate, or you get a womb scan done privately (I think around £100) every few months to check your lining isn't thickening. Given the cancer risk from a thickened lining I'm not sure it's safe to leave it til you bleed. There's a long thread on compounded progesterone if you're interested.

[Mary G]

Tribbins, read up on the ultra low dose Menostar patch.  I think you need regular scans and twice yearly progesterone but definitely not progesterone every day on such a low dose.

[Tribbins]

Thanks for your replies Nas, Sheila99 and Mary G -

I'm going to have a good look at Menostar (is it available in UK?) and compounded progesterone. Otherwise, If I can get away with taking progesterone a couple of times a year and having scans, then that is what might have to happen. I checked out the local scan clinic, it is £150 so not going to break the bank twice a year. It's good to know there are options, as the idea of a Mirena scares me x

[joziel]

Have you tried desogestrel? It's not licensed as a HRT progestin but there are studies showing it works well, they just didn't use enough women in them to reach the point of it getting licenced for this use. It is of course a POP... and it can be taken along with HRT as a contraceptive in younger women. It is a powerful progestin. Just another idea...

[Tribbins]

Hi Joziel

I took Cerazette for a short while about 15 years ago, (I just googled desogestrel and that came up) I haven't tried it recently. Do you have to take more than one a day as HRT?  Last review I had, I was told that only option for me is Mirena due to my 'risk profile' - guessing that to be age, and migraine history, can't think what else.

[joziel]

Yes that's right, the brand name is Cerazette. There is definite evidence that double the amount (150) is adequate but a lack of evidence that just one is - but nothing to show it isn't, they just didn't run that study. For some reason. If you look here and search the page for 'desogestrel', you'll see where it's mentioned: https://thebms.org.uk/wp-content/uploads/2022/12/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-NOV2022-A.pdf

Definitely if you are really stuck and want to try something, you could try desogestrel along with scans at first to make sure your lining isn't building up.

By the way, there are some other options there as well. There is norethisterone, which you could take multiple POPs of to equal the amount recommended. You'd need to have a doctor on your side through all this as it's slightly left field, but if you have that, there are definite options.

[joziel]

PS Just in time… https://www.theguardian.com/uk-news/2023/nov/16/contraceptive-pill-to-be-available-on-high-street-without-need-for-gp-visit?CMP=Share_iOSApp_Other

[Tribbins]

Ha ha I just saw that too! Do you think they'll sell it to a 59 year old?

[Hurdity]

Hi Tribbins, Nas

As per Mary G, that preparations such as Menostar (14 mcg) - which is not available in UK, but in USA - do require progestogen on an occasional basis to clear any built up lining.

Here is a post I made on the subject a while ago (10 years!):

https://www.menopausematters.co.uk/forum/index.php/topic,22215.msg336409.html#msg336409

In that I quoted the Menostar leaflet and made a comment on what I read so will quote from my own post here:

"In fact even in America where Menostar is available it still recommends the use of a progestogen every 6 - 12 months together with a scan/biopsy at the slightest sign of any untoward bleeding - to prevent the possibility of endometrial cancer.

This is what is says in the prescribing leaflet for Menostar:

It is recommended that women who have a uterus and are treated with Menostar receive a progestin for 14 days every 6 to 12 months and undergo an endometrial biopsy at yearly intervals or as clinically indicated."

That being the case I would try to get your GP practice or whoever you are under, to sanction this so that they can order a scan for you and/or allow you to take progestogen annually or 6 monthly initially, on this basis?

Amazing that you can actually notice the difference on 6 mcg and you are obviously a good absorber, and I imagine post-menopause, otherwise that small amount would get drowned out by your own cycle?

Hurdity x