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[SilverFairy]

Briefly, I have Graves disease and going through the menopause.
I have tried Femeston Conti, Kliovance and now on Femseven Conti. The first two gave me daily headaches after I had taken them for 3 months. The Femseven causes me headaches but not the 24/7 variety and seeing as Im not sure where to go from here I need to stay on them.
A few weeks ago I went on Gynest which seemed to work for -problems down there-    But it has affected my thyroid levels and caused me to go slightly hypo. I'm upset as my levels were doing well and I was feeling better than I have for a long time     I am now adjusting my Carbimazole dose but if/when I change my HRT I might have to adjust it again.
I presume I need a top up of progesterone and if I come off the Femseven Conti what would you advise. I have done so much 'googling' I've confused myself!!
The symptoms I want to sort out are hot flushes at night, vaginal dryness and really bad mood swings.

[CLKD]

The Orthogynest is such a small amount after the initial 2 week load that maybe your other symptoms will settle?

   browse round, join in - have you read the menus, left of screen?

[Hurdity]

Hi Silverfairy

I've answered some of this on your other thread and asked some questions which are answered here! (I always look through unread posts and it puts them most recent first!)

You don't need extra progesterone with any of the vaginal oestrogens.

Also if you have always had problems with the conti HRT it could well be the progestogens which are taken continuously, which give you the headaches. How far into menopause are you eg what were your periods like when you started HRT (have probably asked that on your other thread!)?

If you are still peri - or even if not, have you thought of trying a cycle? You would then know if it was the progestogen disagreeing with you. Otherwise you could try separate oestrogen and the bioidentical prgoesterone Utrogestan, which is prescibed as micronised progesterone, which should have the least side effects and does not normally give daily headaches. Some women find that progestogens of any sort give a headache at some point though.

Mood swings indicate you are still peri as these normally stop when you are post-meno as hormones are stable - although I'm not sure how they fluctuate with thyroid meds.

Sorry this is a bit garbled!

Hurdity  x

[SilverFairy]

It's a bit muddled really because as I was diagnosed with Graves at some point after I started the menopause. I havent't had a periiod for about two years.

Maybe the menopause starting tipped my levels over so I suffered Graves symptoms but I rather think it was the other way round as Oestrogen 'works' as an antithyroid. I was put on a high dosage of Carbimazole (anti thyroid medication) which made me go hypo and I had really, awful symptoms and felt like I didnt want to go on with life.
As the Carb was lowered (I am now only on 2.5mg which was keeping me only very, very slightly hypo) I started to feel a lot better but I was left with night sweats and really bad mood swings (which I had suffered premenstrually most of my life, I also had PCOS) which at first I lumped in to the Graves symptoms (you wouldn't believe how similar thyroid, both hyper & hypo symptoms are to menopause ones) but when I started HRT both of those went after 2 weeks.
The only problem I then had was vaginal dryness.
 So GP gave me Gynest and within a short while I had hypo symptoms again. My Carb dose has been low for at least 5 months and Graves isn't cyclical to my knowledge so the only thing that could have tipped me hypo is the Gynest.

[Sarah2]

The type of vaginal oestrogen you are using is very very weak- it's one tenth the strength of Ovestin ( another cream) which is itself weaker than Vagifem which many women use.

Are you able to see an endocrinologist because it sounds as if the usual GP line won't be enough for you because you have two issues- thyroid and menopause.

It's easy I suppose to blame the hormone cream but it could also be a pure coincidence. You will not really be absorbing more than a tiny tiny bit more oestrogen- if any at all. There are studies which show how much oestrogen is absorbed though vaginal creams and it's practically zero especially after the initial 2 weeks.

Why don't you increase your thyroid meds again ( you say you are on a low dose?) and see how that feels? Are you able to do that?

Alternatively, you may well get on better with HRT that does not have daily progestogens- these can affect some people badly. You could try 2 separate hormones and see if it's the progesotogens that affect you.

[SilverFairy]

I'm sorry, but I have Graves, a hypEr thyroid condition, so to raise my medication would just make me more hypO. I am under an Endo and have been since I was diagnosed, she is allowing (humouring) me to titrate my dose of antithyroid (Carbiamazole) because I neither want surgery (I have heart issues) or RAI (which will affect my Thyroid Eye Disease) to remove my thyroid (as that wouldn't make any difference to me having Graves!) and this is the only other 'choice' I have left :s
There is no menopause clinic at our surgery or local 'cottage' hospital and the large hospital is over an hours drive away!
Ive been left confused and a tad upset by this recent change. I have felt really unwell and I'm the type of person that needs a reason for things happening, I certainly don't believe in coincidence.
It took me so long, with no real help from the medical profession, to reach a point where I felt relatively well and now I seem to be going backwards 

[Sarah2]

sorry- I don't know much about thyroid illnesses.

But I do think you could try changing your HRT as suggested by other people here...

if you are taking HRT (combined) then it is quite likely that it's the progestogen you are getting every day that is causing you to feel terrible.

Why not see if you can go back to sequential HRT so you only take a progestogens for a few days each month? For women who are very affected by progestogens, some gynaes say it's fine to take only 7 days per month. You could swap to a bioidentical one such as Utrogestan.

[SilverFairy]

I am just reading the (long!) thread on Utrogestan and remember noting down somewhere quite a while back, about maybe trying that.
Trouble was my usual GP is very anti HRT and 'took advice' from a colleague who he said knew more about HRT matters. I ended up on Kliovance! even after suggesting bio identical hormones.
After the second change of HRT, and after mentioning that women who had suffered PMT are often affected by the prog in HRT, I was just prescribed a different one. I have now changed to a female GP for the menopause problems and hope that if I suggest certain things she will be more willing to listen.
I haven't had periods for about 2 years and still have my womb, wont that affect how I have the progesterone?
I seem to have read so much and still know so little!!

 

[Sarah2]

Are you in a position where you can see a gynaecologist and not just a GP?
Yours seems such a complicated situation because your thyroid issues overlap symptom-wise with menopause.
Could you afford to see a menopause specialist privately or would your GP refer you to one on the NHS given the complications?

Not having had periods for 2 years makes no difference at all to how you have progestogens- is that what you mean by 'how you have' it?
If you have a uterus you need progestogens to stop the lining overgrowing- so you can either have them all the time as in a continuous/combined product, in which case the daily progesterone means the lining doesn't grow at all so you don't need a bleed,  or sequentially ( taking progestogens anywhere between 7-14 days a month)- giving you a bleed every month or two months.

Utrogestan is bioidentical  and some women have far fewer side effects.

You take it orally although some women use it vaginally like a pessary although few GPs will mention this option- it's mainly consultants who suggest this as an option.

The other option would be the Mirena coil which contains a progestogen and needs replacing every 4 years- this would give you a bleed-free continuous type of HRT, and you'd need to use a separate oestrogen.

[SilverFairy]

Can't afford to go privately and the nearest hospital is about an hours drive away and I already have to attend to see the Endo. As I dont like driving that distance my partner takes the day off so would rather keep appointments to a minimum.
What difference does it make taking Utrogestan orally or vaginally please? I dont fancy the coil to be honest!
When I was on the Femseven patches alone, I still needed something extra for dryness.
 

[Sarah2]

It's quite common to have to use vaginal oestrogen as well as systemic oestrogen.

Is this what you are asking?

This is not connected in any way with using a progestogen vaginally as the other route for Utrogestan.

Some people find that they absorb Utrogestan better vaginally rather than taking it orally. In the UK from my understanding, Utrogestan is licensed for vaginal use only if it's for fertility treatment- but consultants allow you to use it vaginally for HRT and so do some drs who are more open minded.

[SilverFairy]

So, I may have to take oestrogen orally, vaginally and progesterone orally/vaginally? How would you use both the progesterone and oestrogen vaginally? Sorry for all the q's!

[Sarah2]

Many of us- me included- use oestrogen and a separate progestogen, and oestrogen cream vaginally.

You don't have to have oestrogen in oral form- transdermal either as patches or gels is safer, especially as you get older- how old are you?

You don't have to use Utrogestan vaginally. You can swallow it which is how it's meant to be taken as HRT.

I don't know the answer to using Utrogestan vaginally at the same time as using a vaginal oestrogen cream. There are people here who do that so maybe they will add something helpful.

But if you are using an oestrogen cream vaginally then you only need to do this twice a week, and you won't be using Utrogestan every day anyway.  It ought to be possible to use both - this and the Utrogestan- at the same time, but an alternative would be to space out when you use them in the day. Both are supposed to be used at bedtime, but I suppose there is nothing to stop you staggering this and leaving a couple of hours between the two - I think Utrogestan is supposed to be absorbed within an hour, so in theory you could insert it at 10pm and use the cream or oestrogen pessary an hour later.

But in any case, even if you did change to Utrogestan you might prefer to use it orally first to see how you get on.

[SilverFairy]

I'm 56.
I have just found the products I noted down when I first read through one of the threads and it was what I asked to be put on by my GP who then didnt!  Oestradiol valerate, low dose with Utrogestan. I have also written down Climaval and Progynova both with question marks, no idea about them?!  Between thyroid problems and menopause my memory is shot   

[Sarah2]

You'd be better swapping the oestrogen tablets for patches or gel - gel is brilliant because you can titrate the does easily so you use as little or as much as you need to control your symptoms- and no need to cut a tablet or patch in half.