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[Kittyjay]

Hello ladies. I have my 6 monthly HRT review next week (age 44, estradot 50 and utrogestan 100 continuously) and I'm trying to work out what I need/want from the review....basically I've been on the above regime for over 6 months now and I know it needs a tweak but I don't know how.
Basically I do suffer a lot from anxiety (but have always been a worrier!) I find the utrogestan helps with lifting my mood but I do certainly feel like its kind of dulling my mood/personality if that makes sense? I worry that taking utrogestan continually at my age is harmful in some way as most people take it on a cycle. I tried this recently and crashed within a few days when stopping the utro. I bleed every month on the continuous progesterone which my gp says is unheard of (v helpful!) I also feel totally exhausted most of the time which is awful when I have a 5 year old.
I'm also wondering if my anxiety etc is due to low oestrogen and maybe at 44 I should be on a 75 patch, not a 50. I've never had oestrogen levels tested and presumably now can't as hrt will affect it...
Sorry for ramble- I can feel my panic rising bigtime as I write this because I just don't know what I need. Can anyone offer any advice? Thanks so much x

[Briony]

Hi Kiity

I am 43 and my doctor said the 50mcg wasn't strong enough for me at my age, so perhaps you do need more estrogen? At the time I was taking 200mg Utrogen for 12 days, but really hated the dip when I stopped, so decided to switch instead to Qlaira, which has more estogen, plus progesterone on a greater number of days than I did with the patch regime.

I would have loved to take 100mg continuously, like you do, but my GP would not let me as I still have periods.    I know some people take it for 26 days and have a two day rest, but I think that's only available off licence?     Regarding the tiredness - how to you take your Utrogestan? I took it vaginally which seems to have fewer side effects than if taken orally. Maybe you could try that, if you don't already? Alternatively, have you thought about a Mirena? (I see the logic with this method of progesterone, though have to confess I wasn't brave enough, especially as I've never given birth so it was likely to be harder to fit!).

Hope your review goes OK x

[Dancinggirl]

Kittyjay - I wouldn't worry about having Utrogestan continuously - it won't be harmful and if it keeps you calmer that must be a good thing.
I had a Mirena for 4 years and it was quite a good option for me at that time and might be good for you. AFter the first few weeks you shouldn't get any bleed at all and you can then use as much or as little oestrogen as you need.
An increase of oestrogen could be worth trying but this could result in more bleeding withe the Utrogestan.  Perhaps ask if you can have some Oestrogel alongside the patch - this has to applied daily but gives you the ability to adjust the dose ? You could just add one or even half a dose of gel per day for a couple of weeks to see how you feel and then increase if need be.
Anxiety is a tough one to treat and some women need a SSRI with HRT to keep this under control - although ADS/SSRIs are known to make one feel flat!!
The important thing for you is to protect your heart and bones withe HRT, get your energy levels up (perhaps look at your diet and lifestyle to help with this) and find the right balance of HRT for you. Ask if you can have  your Vitamin D and Iron levels checked as well as your current oestrogen level.  DG x

[Hurdity]

Hi Kittyjay

Sorry to hear you're still not feeling too good.

Just to clarify that progesterone is a sedative and so this will not be lifting your mood - it is oestrogen which does this. The fact that you are taking progesterone continuously as you say means that because it is a sedative it can also be depressive  especially over time as it builds up - and as you have noticed it is dulling your mood.

I agree with what you suggest and with Briony that it is more oestrogen that you will benefit from to lift your mood and help reduce anxiety! You are so very young to only have 50 mcg! I had this when I started HRT at nearly 54 and I was still late peri - properly post-menopause, so it was just topping me up then - and I was 10 years older. Still on this dose now (at 62).

I would definitely try to increase, but gradually to avoid side effects. The only problem with this and continuous prog is that the prog dose might not be high enough and so you have to take more and then feel even more dampened!

Are you definitely post-menopausal? A cycle would be better probably if you were going onto a higher dose - most of the conti HRTs tend to be medium or low dose, apart from some of the tablet HRTs with synthetic progestogens. I ask because you say you bleed every month - this does imply you might still have a cycle going on?

Re the crash when on a cycle - this is progesterone withdrawal and normal pmt and once the progesterone has cleared from the system the feel good factor from oestrogen only kicks in. Unfortunately on HRT this only last a few days before you have to start the prog again (unlike with a natural cycle when the progesterone phase is confined to two weeks including the withdrawal pmt phase).

Are you with a menopause specialist gynae? If so perhpas you could try a cycle again but with a shorter duration of progesterone - if you are progesterone intolerant to some extent - and perhaps your lining can then be monitored? This is a tall order on NHS but it should be available to prog sensitive women and especially someone as young as you who should be on a higher oestrogen dose ideally.

Hurdity x

[Kittyjay]

Thank you all for your amazing advice. I think I'm going to ask to up the oestrogen to a 75 patch and try a cycle once again. I have kind of persuaded myself over the last few months that I feel so much better with the utrogestan continuously but actually I think it's just masking the issue by dulling the senses. I honestly don't know what stage on meno I'm in. I didn't have a period for 5 months aged 41 and after blood tests my gp said I was post menopausal - I didn't question it because I didn't understand it all to be honest and was a bit of a shock at 41. I haven't seen any gynae at all but my gp did some kind of gynae training he said ... And has always let me try what I want when I have gone in with research ( usually from here!) . I've been on hrt since. Should I ask to see a gynae do you think?
Briony- I take the utro vaginally too apart from when I bleed when I take it orally as I'm a bit squeamish..I just don't feel like I ever get the feel good factor from oestrogen that I expect to have? DG- that's v interesting what u said about the gel ... Food for thought.
Ideally I'd like a longer cycle with maybe a bleed every other month- I think that's what you do Hurdity from reading your posts before. I just don't understand why I now have massive monthly bleeds accompanied by awful mood and pain. Just want it to stop and get some energy back. I don't want to take AD's if I can help it as have taken them before and struggled when I stopped. Hopefully a stronger dose of oestrogen will help.
Thanks again you lovely ladies, Kitty xx

[Dancinggirl]

Kittyjay - sometimes when a blood test is done it shows a very low oestrogen level and GPs just assume one is post menopausal but unless they do a series of tests over a few weeks that show the oestrogen levels continuously low then there is a good chance you are still peri menopausal and your hormones are fluctuating and this would cause the extra bleeding.  You may well be better on a sequi regime even if it gives some ups and downs - I'm 59 so very post meno and still use HRt sequentially so I get the full benefit from the oestrogen.
Upping your oestrogen is worth trying  - I still think you should ask for some oestrogel which would allow you a chance to experiment alongside the patch. You could then go to the 75mg patch if you find you feel better using one pump of gel each day alongside the patch.   I don't think you really need to see a gynae but if your bleeds are very heavy a scan might be a good idea to check your womb lining.
I had an early meno and at your age my hormones were still fluctuating.  Even if you are actually post meno, the hormones continue to drop and then bottom out for around 2 years after the final period.
Let us know how you get on.  DG x

[Briony]

Kittyjay - sometimes when a blood test is done it shows a very low oestrogen level and GPs just assume one is post menopausal but unless they do a series of tests over a few weeks that show the oestrogen levels continuously low then there is a good chance you are still peri menopausal and your hormones are fluctuating and this would cause the extra bleeding. 

What DG describes is exactly what happened to me. An incredibly low oestrogen reading was enough for my original GP to say 'menopause - take 50mcg patches - end of story'. In fact, my levels were fluctuating all over the place so  the HRT, at times, resulted in too much 'topping up'. Now I am on an HRT style contraceptive pill which provides a stronger dose of oestrogen (though it's still bio identical) and I feel much better and more in control. Will swap back to patches at a later date as I feel they are safer - but for the time being, in my early 40s, I feel this  (Qlaira) is what my body needs.

[Hurdity]

Hi Kittyjay

Well that explains it then - as the others have said - yet another doc (who says he has had gyane training) diagnosing a woman as post-meno on the basis of one blood test. How can monthly bleeding on continuous progesterone be unheard of! if you are not post-meno then may well be expected! In the circumstances - you may still be having quite a strong cycle I would say. Since you had not been without a period for 12 months when you started HRT it may well be that your cycle started up again - although 5 months is quite a long time to go without a period and it was 3 years ago - but still!

I agree that you don't need to see a gynae but slightly concerned that your GP isn't as clued up as he thinks he is! By all means ask for an increase if he is amenable - but a longer cycle might be difficult if your cycle has come back quite strongly as you may well still get breakthrough bleeding until your cycle weakens again. I was well post-meno when I started on a long cycle.

Hurdity x

[Kittyjay]

Thank you ladies- you are all so great taking  your time to reply - I hugely appreciate it xxx
I'm going to discuss all the above things with him next week and hopefully find a good way forward. I don't think I'm post meno...and I think returning to a cycle is the definite way forward. thanks again x