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[Ordersvicci]

In peri meno. I’m feeling desperate as the extreme pms hormonal surges that I used to experience before HRT are back now in the utrogestran stage. GP tried switching me from 100mg patch to x3 pumpds gel to aid absorbtion but showed no signs of improvement and hated gel so switched back. Am meant to be upping to x3 utrogestran but no way could tolerate that. Am on long wait list back to chelsea and westminster (who these days discarged me last time they tweaked my hrt). Don’t know what to do or suggest to gp . I can’t function (family has various needs)

[joziel]

If it's happening in the utrogestan stage it seems related to your progesterone and not your estrogen, so not sure why the GP tried changing the estrogen...

It sounds like you need a different progesterone option. There are various synthetic progestins and also the Mirena coil, so lots of options...

[Ordersvicci]

Thanks, symptoms were also appearing in other weeks (utis, migraines, low mood, fatigue) and blood tests showed little oestrogen in spite of high dose . When they have increased dosage previously it has slightly improved the luteal phase but it is back to my extreme pmt levels this month and maybe coincidental that coincided with having switched to gel.
Anyway, yes I have been trying to get my utrogestran/luteal phase issues sorted for years , cannot tolerate coils (have never felt so depressed and suicidal) so what options are there?  No one has ever suggested anything else and said “well u have to take progestrone and if you can.’t tolerate coils utrogestran is the best vaginally” . Have made do with symptoms but this month is too much with suicidal thoughts and extreme mood swings.
Does anyone know any other progestrone options on NHS pleAse? Am Sure I read that some do lower dose continuous which because is more regular can help, rather than having sudden peaks of hormone but my gp siad why would you take it daily if intolerant?

[joziel]

You can read all the licenced (and some not yet licenced) options for progesterone/progestin on the BMS website: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

What estrogen dose are you getting? I still don't understand what your GP was hoping to achieve because 100mcg patch is equivalent to 4 pumps of gel - not 3. By switching you to 3 pumps of gel, she actually cut your estrogen, she didn't increase it.

You just need more estrogen, probably over the licenced amount. I'm currently on 12 pumps of gel (yes 12), but about to switch to Sandrena because I'm not absorbing it. It sounds like your GP can't really handle your situation and it might be best to consider a private menopause clinic. Sadly the NHS cannot manage to meet the needs of the 50% of the population who are or will be menopausal, it's too much to expect as more and more of us go on HRT - the system is going to collapse. It should be able to cope, of course. But it can't...  They can prescribe bog standard doses for the most average woman, but not deal with the complex situations so many of us end up in. You are better off with a menopause clinic IMO... I'm with Newson Health and really recommend.

[Ordersvicci]

Thank you, that’s a very helpful link. The GP switched me to 3 pumps to see if I absorbed the gel better and so not to have to increase progestrone (as new guidelines say x3 for 100mg/4 pumps). Unfortunately the really knowledgeable GP retired  and they are trying to recruit a new one so it isn’t her speciality.
We can’t afford private unfortunately. Could maybe borrow for one consultation but not all the tests etc, must cost so much and we are low earners. Do feel for the NHS and it is awful for women like us  especially as  many of us are in caring roles both for work and unpaid.

[joziel]

You don't need to do all the tests privately if you have recent NHS results, they will accept those. You can also get the meds on the NHS because the doctor will write to your GP and tell them what to prescribe. It's just the £230 for the consult.... and then annually if you want to remain a patient. (But if you get stable on a dose your NHS GP can take over.)

It's not really a good idea to try to fix progesterone problems by limiting the estrogen you're on, as you'll just get symptoms back. Why don't you look through that list of approved progestins from the BMS and decide what you'd like to try and then go back to your GP and ask to go on that and also to increase your estrogen...?

[Ordersvicci]

Thank you, that’s exactly what I did earlier and have a GP appointment tomorrow to suggest and discuss
Also useful info re how it works having a private consultation
My GP has agreed to prescribe testosterone too but wanted to do one thing at a time
Thanks so much

[joziel]

Well that's excellent, my GP won't prescribe me testosterone  I have to get it privately from Newson!

[Hurdity]

Hi ordersvicci

 

Sorry to hear about your problems with HRT.

Can you tell us a bit more about yourself for context ie how old you are, where you are in menopause (in terms of what your cycle was doing before you started hRT), and whether you are on cyclical or continuous HRT?

You talk about the luteal phase so I imagine you are on cyclical HRT/ Depending on whether you are early or late peri-menopause your symptoms could either be due to the Utrogestan, or your underlying cycle (or both!).

A single blood test is just a spot check so to speak and doesn't give a picture of what is happening in your body, especially if you are still having a cycle of your own, though should give an indication of the baseline level - ie minimum level of oestrogen you are getting. The result depends where in your cycle the blood was taken, and if on patches when the blood test was taken re patch change, though sounds like it was after changing to gel?

What was the level of oestrogen?

Fatigue and migraines can be due to progesterone, other things being equal, though sudden increases in oestrogen can also cause this - but in the latter case should settle.

UTIs - sounds like you need vaginal oestrogen if not already using it. Please go to your doc and either get some estriol cream or Vagifem/Vagirux, or one of the other options all losted here: https://www.menopausematters.co.uk/local.php This is often needed as well as systemic HRT and don't let any doc tell you otherwise. It puts extra oestrogen where it is needed - the vagina!

You should not need to go private and certainly not to go into debt in order to do so and sounds also like you have a sympathetic GP re testosterone. The latter is the main reason why some women need to go privtae for one consultation (I had to once in 2015 but thereafter get it from regular GP) so with supportive GP, all other treatments are licensed on NHS. It also sounds like your GP is working with you to find the right treatment which is great!

Hope you see this re vaginal treatment, before your appointment!

Hope this helps and keep us updated in this thread.

Hurdity x

[notreallyhere]

OP, have you heard of PMDD? What you describe sounds a lot like it. I have it and it means extreme sensitivity, including mood swings way worse than PMS, to hormone fluctuations. It gets worse when in peri and when trying to adjust HRT. Just a thought…