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[Dawncam]

Hello everyone and firstly, many thanks to all the ladies who post invaluable info on here. It's kept me on the straight and narrow for almost a year. Almost exactly a year ago after much tussling with various sequi then Conti pill regimes I decided to take a trip to London and see the Studd Man. Usual 3 pumps oestrogel/utro 7 days/blob of testim prescription.

Long story short, I think I don't absorb the gel properly and am now on estradot 75 patches/utro 7 days, every 4 weeks. Fingers crossed it seems to be ok as I was still having sleep disturbance/night sweats/joint pain on gel.

Still having usual prog intolerance probs with utro and am wondering about cyclogest used rectally. Anyone with any info on that?

[CLKD]

 

[Hurdity]

Hi Dawncam - I welcome you when you posted on the other thread and suggested you posted here - sorry you haven't had more responses but it is bank holiday weekend! I have barely been on the forum over the past week really.

However - it does so happen I am on almost the same combo! I use Estradot patches (Estradot 50) and utrogestan which I use vaginally on a long cycle varying from 5 - 8 weeks depending on my commitments and how I feel! I take it for 12 days x 200 mg. This is approved by my lovely female gynae GP (local, NHS). Actually because I now have testosterone (small pea-sized blob) every day - (I did have to go privately for this initially but did not cost much and nowhere near Studd's fees) - I increased my estrogen very slightly by 12.5 mcg so that I did not become too T dominant and get too many androgenic side effects - so probably now on 62.5 mcg (unofficially!). I will spill the beans to my doc when I start running out of patches too quickly!!!

I have always found Estradot patches to be brilliant and they have always kept flushes and sweats under control and I feel fine.

Re the Cyclogest - I am also probably one of the few women posting on here who have used this!

I have posted at various times about it including this thread:
http://www.menopausematters.co.uk/forum/index.php/topic,29259.msg465679.html#msg465679

I used these for the first  4 years of HRT (because utrogestan was not available - and my GP had been prescribing it for years - interestingly she studied under Studd maybe 35-40 years ago) - at 400 mg daily for 11 days per 4 weeks for a 50 mcg patch in late peri-menopause and it was fine for me.  At the time it came as 200 mg capsules so I used to put one up the front and one up the back (ie vaginally and rectally) each night.

I found that it was quite strong and used to make me foggy headed and sometimes give me migraines - but I also got these on withdrawal ie when I stopped the pessaries and went back to oestrogen only. I felt fine once it had cleared my system though. The dose prescribed for me for HRT is far too high for continuous use - and especially for a low dose of oestrogen and  it would only be given continuously at this dose to maintain a pregnancy. Unfortunately because it is not licensed for HRT there have been insufficient studies available as to the dose needed for this purpose (but presumably there have been studies re systemic absoprtion and pregnancy - although I've never looked these up) so I presume docs who prescribed it erred on the side of caution. It was double the amount of utrogestan because I presume less of it got into the system due to the preparation ie waxy capsules.

I used Cyclogest for several years  (4.5) before switching to utrogestan in 2011.

It is very interesting that you raised this - about rectal use - which I'd completely forgotten about as I'm happy on utrogestan - because this could be a way forward for taking progesterone for those who suffer the side effects from oral use, and bladder irritation from vaginal use. I think it is not prescribed much - but some gynaes still do so I gather - Nick Panay being one, and it is an option for badly progesterone intolerant women.

Used rectally it will be absorbed systemically before being transported to the uterus - but of course it avoids the metabolic by products of digestion that occur from oral use although I think it is still metabolised by the liver - I'm not clear about the relative amounts (in the system) compared to vaginal utrogestan, and vaginal vs rectal cyclogest - not even sure if this info is available.

There was this in the side effects table: "Diarrhoea and flatulence may occur with rectal administration". It did have an interesting effect the morning after rectal use..... but as always with all of this you have to weight up the advantages and disadvantages of each treatment.

Woah I've gone on a long time - but hopefully some of it is helpful!

Hurdity x

[Dawncam]

Thank you for the lovely welcome.


I've been stalking this site for a few years but A LOT over the past year as oestrogel obviously not working for me but seems to for everyone else (was up to 6 pumps a day at one point!) and consequently thought I was going mad, but I suspect we've all thought that at some point!

So far, patches are good. Hurdity, your posts are always so informative and thank you for such detail. A couple of things; once I'm settled on 75 patch, would it be obvious of T androgenic effects? I've already got tiny bit of hair thinning, really not noticeable as I have a lot of hair, but I can see it and don't want it to get progressively worse. Have you considered alt day T? I love using T for all the benefits it gives but just want to monitor any side effects. I think I may also need to push slightly higher than 75 but not 100 as still got aching joints. Will wait and see. Do you increase E on utro days as I know it works on E receptors and reduces impact? I've used utro rectally and, it seemed fine although it did work like a laxative that's why I wondered about cyclogest - suspect they're both the same. I just find utro a bit 'drying' if used V route. Maybe just have to put up with it. Also, do you think more is absorbed systemically rectally than V route. I'd like to prevent that if possible. Sorry for all the Q's just glad to have relevant info from someone who's 'been there' so to speak. Dxx

[Hurdity]

Gosh 6 pumps is a lot!!! Presumably the idea was to suppress your cycle, prevent ovulation and therefore reduce the mood swings - did this not happen with you then?

How long have you been on the T gel? When I went to see a gynae to get this she said the effects could take 4-5 months to fully take effect ie the positive ones, as my T levels were probably quite low (I didn't have them tested).

In terms of negative side effects - I really only get the hair growth on my inner thigh and around there - where I apply the gel. My hair is thinner - but like you it's pretty thick anyway so hopefully this will be OK. I don't know if it would be getting thinner in my case because my oestrogen levels will be much lower now I am well post-meno and I am only on a medium dose. Also my thyroid function is not the same as it was so that could be contributing (TSH not high enough to be treatable!). I haven't noticed anything else negative. I must say I hadn't thought of taking it every other day but feel reluctant to reduce it now because the effect on muscle fatigue and pain after exercise is enormous (positive!). I just use a pea-sized blob so one tube lasts ages! I might do so when/if I start reducing hRT when I get fed up of having a bleed in my 60's!!!!!

I don't increase oestrogen on utro days no - and never have done. It has never reduced impact for me - perhaps that's with gel only or only some women, or perhaps only with synthetic progestogens, or only with higher oestrogen doses? I get some side effects from the utro but not low oestrogen symptoms.

I've never used utro rectally - but sorry have no info on whether more is absorbed systemically rectally vs vaginally. I would have said yes but before I had looked into systemic absorption of vaginal Utro which is actually higher than oral at any given dose ( but doesn't go through digestion obvs)!

The laxative effect was just the next morning - won't go into the details  .

re drying effect - I have always found the reverse with vag utro - ie it has a lubricating effect because the goo oozes out ( sorry TMI!). The other thing is I always "load up" with Vagifem before starting the Utro to try to minimise systemic absoprtion - but I have absolutely no info as to whether this should work or not!!!

Btw did you say how old you are and where in menopause - because it does have a bearing on how you react to all this - I am 63  and well post meno so will be very different situation to you.

Anyway hope this helps

Hurdity x

[Dawncam]

Hi Hurdity- yes, 6 pumps was a lot and no, it wasn't prescribed I just kept upping the dose in an attempt to deal with the ever increasing symptoms. Eventually, I realised I mustn't be absorbing it properly (not helped by any medics may I add!). A few ladies on here have the same issues with gel so it made me consider that may be my prob. So far, patches seem good.

I'm 54, prob 3/4 years post meno. Several sequi then Conti pill regimes, dreadful prog intolerance symptoms and lack of info from meno clinic sent me to Studd. Not getting into the rights and wrongs of private vs nhs, I'd tried Nhs everal times and was desperate. I found Studd's details on here and he changed everything. I can't afford return visits every 3/6 months as I live in Scotland and even he said I shouldn't have to and that the clinic here should carry on with his prescription. That was almost exactly a year ago and it's not been plain sailing as I wasn't absorbing the gel and only now realise that!

Anyway, been on T for a year and very happy with it. I also get hair at top of thighs, in fact more hair generally where I don't want it! Except on head but I suspect that was because the E wasn't being absorbed properly.

I'll keep going with utro v route. I was prescribed ovestin a while ago but don't get on with it and don't really need it continuously. I'll ask for vagifem and see if that helps with pre v route utro.

Thank you so much for all your detailed replies. Just want to get this sorted. Fed up being obsessed with it and have a very busy life with little time to keep worrying about this! I must say, patches are so much easier so I really hope they work.

Thanks again.

Dxx

[Hurdity]

The problem with very high doses of oestrogen (higher than occur physiologically) is you can get something called tachyphylaxis which maybe Studd mentioned to you before you changed to patches, but usually only occurs with implants:

Tachyphylaxis

Too frequent implantation or too high doses of oestrogen leads to supra-physiological oestradiol levels and the recurrence of symptoms even at these high levels.(4) It is not easy to treat and it must be said that the secret is to avoid it happening by using the correct dose of hormones in the first place. The normal range of plasma oestradiol during the ovarian cycle is between 100-1500 pmol/l but plasma oestradiol levels greatly exceeding these values can be found in patients with tachyphylaxis.

"The symptoms that these women suffer are real, not imaginary although they are not always typical menopausal symptoms.(5) In fact many of these women have a history of psychological disorders.(6) Because of this potential problem, the implants should be used with caution in women with a known history of chronic anxiety or stress disorders. The recurrence of apparently oestrogen deficiency symptoms at these levels are no doubt due to the change of oestradiol levels from "very high" to "high" and they become accustomed to a higher threshold. These high levels may be unnecessary and avoidable but sometimes women with convincing oestrogen responsive depression need even higher oestradiol levels but there is little or no evidence that they are harmful.

There would rarely be an indication for repeat implant if the oestradiol levels are above 1000 pmol but sometimes women with convincing oestrogen responsive depression need even higher oestradiol levels and a repeat implant should not, after very careful consideration, be prohibited.(3) It is wrong to deny women further oestrogen therapy thus making them suffer many months or years of symptoms, particularly depression, anxiety and loss of energy. They can be given a low dose oestradiol implant of 25 mg usually with testosterone 100 mg, with explanation that this must last for six months. Alternatively this period can be covered by patches, gel or oral therapy. The oestradiol levels will fall to more acceptable levels within one or two years without the patient suffering greatly from oestrogen deficiency symptoms.(7) The "cold turkey" treatment is not acceptable as profound depression is very common in these patients denied further oestrogen therapy."

http://www.studd.co.uk/implants.php

I've posted about this before - but you wouldn't be able to tell without blood tests. However glad patches seem to be doing the job for you - it is so much a matter both of preference and how well you absorb the different preparations - the latter is more important than the former!

Re vag oestrogen - I used to use the Orthogynest pessaries but they were discontinued so now use Vagifem together with Estriol cream for outer areas from time to time. I find the Vagifem tends to irritate my bladder on the day of use but not too bad. Also because of vag utro at night I do the Vagifem approx 12 hours later in the day - it sticks to vag walls so no problem with it falling out!

Hurdity x

[Dawncam]

Thanks Hurdity - I was aware of that condition and ever vigilant although I don't think I was using 6 pumps enough - only 2/3 times - to warrant that, and, as Studd mentions, the symptoms of super high E tend not to be typical Meno, more phsycological in nature. I don't think that was my problem, it seemed to be declining absorption as I had the full range of meno symptoms returning. I knew from being on tablet E that and it working, that my E was declining. Seems to be rising  again so that's good.

Thank you for VA treatment info.

Dx