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[Dancinggirl]

Hi
Looking at options for low dose conti HRTs. I'm about to have my Mirena out (at the end of it's life now) - I've been using oestrogel alongside.
I know of one friend on Femoston 1/5 who likes it - I'd love to hear from anyone who is doing well with it. I understand the progesterone is more easily tolerated.
There is now the Ultra low Femoston 0.5/2.5  - anyone on that one?
DG x

[smudgesmum]

I am on Femoston Conti 1/5 and it suits me fine.  I started on Femoston 1/10 and moved up to 2/10 before being moved to conti as now 55 years old.

I did try several other brands before this one but the progesterone phase did not suit me, it is considered to be the 'kindest' progesterone.

Smudgesmum xx

[Dancinggirl]

Thanks smudgesmum
I've heard this one suits quite a lot of women because of the kinder progesterone.
I wonder if the even lower dose 0.50/2.5 would be ok?  I'm 57 and years beyond my menopause ( early peri in 30s and definitely post meno by early 40s) and would like to benefit from HRT fro as long as possible. Would you consider trying the ultra low dose in a few years?

[Dancinggirl]

I wish we could have a table showing the amounts of actual oestrogen & progesterone delivered in every treatment. Different types of oestrogen and progesterone require different dosage which is very confusing.  The Ultra low Femeston is 0.5/2.5 combination which is half the 1/5 I think you are talking about.  The studies I've read say the Ultra Low is very well tolerated and over time does reduce meno symptoms (maybe takes longer to kick in)!?
When will they just have separate pills/gels/patches in different amounts of both elements that can have a wide choice of combinations for women to try?
Maybe there are studies going on that are looking at this?

[Londongirl]

Hi there

I am on Femoston Conti. 

It was the first HRT I went on last year (am definitely post meno, 54, no periods for 4 years approx). 

Problem was that it was giving me monthly bleeds and alongside with that pmt symptoms.

So came off it and tried various others which either didn't work or just made me feel yuk so took a month's break, felt rubbish again and have gone back on Femoston Conti. 

Downside is I am getting bleeds but unlike last time, this time I am giving it six months to see if this subsides.

Along with that am getting depression but this is linked to pmt symptoms I now realise

However, am fairly keen to investigate and try the ultra low dose one myself! 

Good luck
Anna

[Taz2]

Dancinggirl - does this site help at all with the amounts delivered each day etc. http://www.medicines.org.uk/emc/medicine/2493/spc  My doc uses it instead of looking it all up in her big book 

Taz

[Dancinggirl]

Thanks everyone.
Taz - the info on the site was interesting but only covered sequential Femoston!
It's comparing different HRTs and their effects/tolerances that is needed.  It would be useful to know numbers of women on each type of HRT. Perhaps this would help less knowledgable GPs to choose right treatment from the outset - in other words better guidance for them.
REading many of the posts on this site, far too many women seem to be given totally inappropriate HRT treatments and possibly stop taking HRT and suffer in silence because of bad experiences.
I know we are all different but, by know, there must be some clearer indications of what type of HRT will suit a women depending on; stage of menopause, individual symptoms, preferences, health risks etc.
GPs need a graph table not a fat book, they flip through and randomly pick a drug from, that helps to guide them for a HRT prescription.
Perhaps a questionare to fill in should be compulsory to show reasons for choice of HRT prescribed ? Patient gets copy for reference.

Londongirl - I'd be interested how things go with you.  I get depressed whatever I am or am not taking - depends on what stresses I am under. I think we are often very quick to blame HRT but, of course PMT is a real horror .  I think the bleeding is normal for the first few months on conti.  I got spotting for the first 5-6 months on the Mirena and till about a year ago I think my regime (Mirena/oestrogel) has been good.  I don't want another Mirena so this is why i'm researching other options.  Let's keep posting
DG x

[Taz2]

Dancinggirl - I meant you could use the site to check up on all the different ones i.e. use the search facility at the top of their page http://www.medicines.org.uk/emc/searchresults.aspx'term=femoston+conti&searchtype=QuickSearch#EXCIPIENTS

Taz

[sweatybet]

Hi dancinggirll

I tried low dose femoston conti for two months earlier this year, advised to try by consultant for pain during sex, found it dampened down my interest in sex, so it solved that problem! Lol. Found I suffered from bloating, abdominal pain and complete lack of energy.  Could not continue with vagifem because of abdominal pain, headaches and disgusting smell.

I never tolerated bcp so I don't think I will try any more hormones.

Sweaty bet

[Dancinggirl]

Thanks Taz2  - Will check out site in more detail.

Sweatybet - my goodness you've had a rough time. I hope you are not suffering from too many meno symptoms. I find lots of lubricating gel helps in the bedroom 
DG x

[Taz2]

It is a good site to find out about most prescription drugs as it breaks it all down and gives lots of info. There is also a patient information leaflet for each one.

Taz

[Hurdity]

Dancing girl - the problem is any information re dosage of HRT delivered can only give a range of values because this will vary with each woman. The dosage is worked out using averages from trials involving a certain number of women. There will only be a few women who correspond to this average.  In addition each woman's own endocrine system and hormone balance is different and unique to her. This is of course why you cannot say that one dose is too high or too low - it is what works for you given your symptoms - taking into account general principles and guidelines etc.

Just to clarify, the progestogen in Femoston is not the "kindest" (a bit anthropomorphic!!) but of the synthetic progestogens (progestins) has the one closest to progesterone. In Femoston it is dydrogesterone. The "kindest" one of course is progesterone itself, even if the available formulation may not suit some women, and some women are completely progesterone intolerant.

There are flow charts available that can guide doctors through the decision eg e-guidelines, but I don't think they actually refer to brand types - more the general principles of the type of HRT. Menopause Matters has produced general professional guidelines   

http://www.eguidelines.co.uk/eguidelinesmain/guidelines/summaries/obstetrics_gynaecology_urology/mm_hrt.php

You might have to sign up to get these but it's free.

I agree separate oestro/prog would be helpful but remember that for many women the combi option is probably fine and it limits the amount of error therefore risks eg by women forgetting the progestogen for example or not taking it - and then getting endometrial hyperplasia through lack of understanding. Women on here have made it their business to find out about these things! It is still possible to have two (or three) different types of progestogen (inlcuding progesterone) and many types of oestrogen so there is a fair bit of choice. Unfortunately low doses of progesterone are not available which is a pity.

Hurdity x

[Dancinggirl]

Thanks Taz2 - site most helpful.
Thanks Hurdity
I knew you would give a balanced answer to my questions regarding guidelines for doctors and, of course, you are absolutely right.
Trying to remain positive about my break from HRT.  Down to about 2 thirds of a pump of  Oestrogel per day and no flushes etc yet - of course I've probably got plenty of oestrogen stored in my body for the time being. 
Day 7 of using Vagifem and it now seems to be making the burning urethra much worse than usual!!
Hey ho! the joys of being a women.
DG xxx

[Hurdity]

I just remembered this scientific paper about the pharmacology of estrogens and progestogens and the different modes of delivery, but it's very detailed and technical. I don't have time to read it although have glanced at bits of it in the past, and I don't suppose GPs would either!

http://www.cenegenicsfoundation.org/library/library_files/Pharmacology_of_estrogens_and_progestogens___influence_of_different_routes_of_administration.pdf

If Vagifem doesn't work then do try Orthgogynest pessaries, they are very gentle - but have you already tried the creams?

Hurdity x

[Dancinggirl]

Thanks Hurdity - you're brill.
Will try creams if vagifem doesn't help. I will persevere with vagifem in the hope that when I get to 2 times a wk it will be better.
DG x