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[GypsyRoseLee]

Have been seeing a gynaecologist because of my peri menopausal symptoms. PMS lasting much longer, very low mood at times, random anxiety, insomnia etc. She offered me HRT 2 months ago, but explained we would need to be careful with the progesterone because I reacted badly to the Mirena coil in the past.

I went back to see her today to finalise what HRT preparation, but unfortunately she was off ill.

I saw a locum gynaecologist who was very nice but initially tried to persuade me to take Prozac instead (no, thanks). Then tried to persuade me to take the Pill instead (no, thanks).

He finally agreed to let me try HRT and gave me a script for Evorel Conti patches. But he admitted he wasn't sure if I needed to wear a patch every day but he 'thought' I probably would? And he didn't know if I could start wearing one immediately, or wait for my next period. He seemed to know very little about the drug he was giving me 

But, I have just realised that Evorel Conti contains both oestrogen AND progesterone, and I am meant to wear a patch every day. But it doesn't make sense to me to wear a patch with progesterone in it every day, when my gynaecologist said we would need to be very careful about exposing me to progesterone.

I assumed I would just need to take progesterone for roughly just 10 days per month?

I am too worried to take this script for HRT as my mood has been so precarious recently (currently having a very good week though). The very last thing I need is too much progesterone causing even worse symptoms.

Any advice would be greatly appreciated.

[CLKD]

Doctors, if it wasn't so important we could laugh: however 

Do you live near to a Pharmacy? if so, make an appt. most have private rooms now, you can discuss your concerns with him/her.  The one near us at Lloyds is very good and knows his stuff! or give them a ring?

[Dancinggirl]

Oh GypsyRoseLee
He obviously didn't have a clue - really worrying. I wouldn't use the patches he has prescribed. You are right, you need something that just has progesterone for a few days each month.
For a start he has given you a continuous HRT which is only for women in post menopause - you are still peri meno.  As you rightly point out is has continuous progesterone which for you is a worry.
Can I suggest you go and see your GP and explain you think the locum gynae gave you the wrong type of HRT and ask for something different.
Can I suggest you try Femoston sequi 1/10 as the progesterone in it is kinder and it tends to suit many women who are sensitive to progesterone. Some women even report that they feel better on the progesterone in Femoston!!!!
An alternative would be to have oestrogen in patch or gel form and then Utrogestan for 10-12 days per month.  Perhaps try the Femoston first as it is easier to use.
Why not print off the info from this site and take it with you.
DG x

[peegeetip]

"He finally agreed to let me try HRT and gave me a script for Evorel Conti patches. But he admitted he wasn't sure if I needed to wear a patch every day but he 'thought' I probably would? And he didn't know if I could start wearing one immediately, or wait for my next period. He seemed to know very little about the drug he was giving me."

Takes my Breath away how bad this is to read. Are you in the UK?

Not sure what the "fear of prog" is either? 

Ultimately this patch has to be worn each day as others have said but why doc would think otherwise makes me suspect they have no clue. There will be instuctions of how long to wear each patch for.

In terms of the safety in using this patch till you get another option?
All is fine on that front, it won't make you unwell. Please don't worry!

The progesterone part is there to keep the estrogen in check.
Over the course of using this conti option longer term (6 months +) this will actually thin our womb lining and reduce the chance of endo related cancer. This is a good thing really

If you proceed with the patch as is, then there is a small chance your current cycle would stop completely.
But most people going onto conti options experience bleeding for some time as their bodies adjust.

Its up to you what you do but in the meantime you might still get some relief with this option till new option is prescribed.

Hope things improve soon

 

[GypsyRoseLee]

Dancinggirl I feel like bursting into tears 

Menopause clinic appointments are like gold dust. The only reason I got one today was because they'd had a cancellation. And I just feel I am worse off than before I went. My own consultant was very clear that I would need to wear an oestrogen patch all month, but then take separate progesterone for just a few days each month.

I was so worried I rang the clinic earlier and asked to speak to one of the nurses about my concerns. But the same locum rang me back, and assured me that I would be fine with the Evorel Conti and to try it for 4-6 weeks.

I made it very clear how concerned I was about taking continuous progesterone, and told him what my consultant had told me about taking separate oestrogen and progesterone. But all he said was, that if I didn't like it I can stop taking it and try and get an appointment again to see my regular consultant.

As it stands I don't have an appointment with her until mid May 

I just daren't start taking the Evorel Conti, I really daren't. My mood and anxiety have been so hit and miss these last few months. I can't risk taking an HRT that is well known for not being good for women who can't tolerate progesterone well. It's too much of a risk.

I think I will follow your advice and go back and see my GP. But I know she will just offer to write to my own consultant again and ask for advice - a process which could take weeks.

I am so, so, so fed up 

[bramble]

The good thing about the conti dose of progesterone is that it is a lot lower than the dose on the sequi regime. You may find that a lower dose even taking it every day is better for you than a higher dose taken for 14 days. May be worth a try to see?
bramble

Sorry - just checked the dosage and what I have written is wrong - dosage for conti is the same as dosage for sequi.

[Hurdity]

GypsyRoseLee - I am appalled that you have been treated like this and by a specialist who should know his stuff!!!! I can't believe that a gynaecologist would not know how HRT works and at least the basics of the different types. We all on here know more than he does on that front, it seems 

Aside from the fact that he should know that HRT is taken all month unlike many preparations of the pill - he could (but shouldn't) have been confused by Evorel conti: Evorel patches come as two types, Evorel 50 mcg ( oestrogen only), and Evorel conti (Evorel 50 mcg + the progestogen - norethisterone). For the continuous combined version, you just take the Evorel conti patches, and for the cyclical HRT known as Evorel sequi, you take two weeks of Evorel 50 mcg followed by 2 weeks of Evorel conti - which provides the progestogen.

As peegeetip says it isn't going to do you any harm but as you are still peri and having fairly regular periods it is unlikely to stop your periods completely - not in the short term anyway and you could end up having irregular bleeding and spotting. Added to that of course is the problem of taking a synthetic progestogen all the time - which in your case, if you reacted badly to the Mirena - is probably not the best option. Yes you would stop the dips in oestrogen you will be getting at the moment - but you might end up cancelling that with undesirable progestogenic side effects.

The decision whether to take it knowing all this is yours - but as you say your usual consultant probably would not have prescribed this formulation for you.

As Dancinggirl says of the tablet HRTs Femoston has a progestogen closest to our own progesterone, but Utrogestan has micronised progesterone which is biologically identical.

I don't know why your GP needs to write to your consultant.  She can prescribe HRT herself. Can you not just take the plunge and decide which one you want to try and then ask for it? You could e-mail Dr Currie with your concerns and ask her a question (costs £25 per question) - and we can help you if you need to think what to say to her, and take it to your GP as added weight. She usually replies within a few days so you could make that appointment with your GP and then print out your response from Dr Currie.

Don't despair GypsyRoseLee, things will get better! 

Hurdity x

[GypsyRoseLee]

Thank you for such a considered response Hurdity - I really don't know what I would have done without all the experience and help from everyone on here.

I am still reeling that the locum (and he was a gynaecologist) just seemed so unsure about what HRT preparation, or how to take it. He spent a long time looking through a book reading about different preparations. Very un nerving. He didn't even tell me the Evorel Conti could stop my periods.

Unfortunately my GP is very diffident, and seems very happy to just pass me off. I assume she must prescribe HRT all the time but because I have been seen by a consultant it's like she doesn't want to get involved?

When I saw my usual consultant I explained that I just wanted to feel 'normal' like I do in the first half of my cycle, but all through the month. She said the best way of achieving that was through an oestrogen patch and then separate progesterone. I can't see how I can achieve that 'normal' feeling all through the month when I am taking progesterone every day? It doesn't seem sensible or logical?

But I think I will take your advice and go back and see my GP and see if I can persuade her to prescribe me something much more suitable.

Even if she refuses at least she can set the wheels in motion and write to my consultant. I guess a few more weeks of this rollercoaster won't do much more damage, when I have been fighting this for a year already.

[CLKD]

Oh >sigh< - GPs are that - practitioners who if they don't know the answers, should refer their patients to the appropriate Consultant: who should, following examination and tests, ought to write back to the GP with their findings, suggestions for treatment and if they need to see the patient in the future: at least that's what I spent my time as a Med Sec. doing  …… so once your GP receives the recommendations from the Consultant, there should be no excuses for not prescribing what is suggested!

Despite budgets: despite personal preferences: despite ……. it is why they referred the patient!!!!

[GypsyRoseLee]

Yes, that would sound like a logical approach CLKD 

I will go back and see my GP this week, and at least explain what has happened and see if she can help or at least write to my consultant for their recommendation. I suppose another few weeks can't hurt? It will just give me another month where I can chart my symptoms and see how they tie in with my cycle again. Not that I really need any further proof that this is all hormonal.

I saw my GP only last week, and she sent me off saying she would write to my consultant. But then I got the appointment at the Menopause Clinic today, as it was a cancellation. She probably hasn't even written that first letter yet!

[CLKD]

so give your GP a ring in the morning so that you don't have too many consults going on at once?  that keeps the GP in the picture ………

[GypsyRoseLee]

Yes, I am going to pop and see my GP this Thursday and explain where I'm at with all this. I'm sure she'll be delighted to hear of this new complication 

[Hurdity]

Don't forget that you don't have to wait until you have another specialist appointment. Decide what HRT you want to try and ask for it - nay - insist - if you can!

Good luck!

Hurdity x

[peegeetip]

There is little harm in trying these patches for the short time while you wait.

If your getting a constant amount each day then you could find that the symptoms your having reduce.
 
If your given a sequential option later then you could start that at anytime in the conti cycle of patches.

 

[carrs]

I had a recent experience where the gynaecologist I saw for irregular bleeding was happy to check me for that but did not want to discuss any changes to HRT. which I was wondering about because of the bleeding. He said it was not his area.

It seems they are specialists in certain areas only.
 
As you say, you saw a locum doctor who told you he did not know much about which HRT to prescribe; probably does not normally do a menopause clinic. It's a shame he tried to dig his heels in afterwards and resist changing the prescription. He should have offered a follow-up appt if he thought you were not happy with what he said.

It's pot luck, really, who you get to see for prescriptions. But at least you know, yourself, the issues that will affect you.