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[bronwen]

I'm glad to find this page. I've been taking HRT (Ellestre Duet Conti) for just over a month and have had fantastic results physically, but mentally, not so good.  Experiencing dark thoughts and serious anger issues - almost psychotic episodes.

Was prescribed Ellestre by GP without a very meaningful conversation about my peri-meno symptoms or concerns. 

Went back to GP today (different male GP) to discuss side effects and he didn't seem to have a clue what he was talking about. After looking it up in his drug book, he's prescribed Evorel Conti patches - but I've looked these up and they appear to be more suited to women who are post meno.  I told both Dr's I was still bleeding and had mirena coil fitted four years ago to control heavy fibroid related bleeding (although I have read on this site that Mirena only licensed for HRT indications for four years).  I think putting me on a Conti drug is overdosing the progesterone in my system and causing the side effects I'm experiencing. 

I'm thinking of having a private consultation with a specialist but concerned that the therapies I get prescribed will be too expensive and not available on the NHS.  Any thoughts or advice welcomed

[Salad]

Just popped in to say 

I'm an oestrogen only user so not really experienced with your dilemma but I'm hopeful others will comment to help you out.
I would say seeing a specialist is a good idea, especially if you don't feel confident in your GP. There are NHS specialists  - hang in there, it does take a while to get HRT to suit.

[CLKD]

 

There is a search button here: maybe put the products into the box and see what threads come up, then make notes as to what others have done.

Browse round.  Make notes.  So many GPs really have no ideas about menopause other than thinking it means that ladies stop periods and have hot flushes!  Nope. 

Is there a Practice Nurse you could chat with or maybe talk to a Pharmacist at your local Chemist, most have private rooms though you may need to make an appt..  I have found the latter really useful when unable to get to my GP.  Or when I think of an issue when in town I pop in for a chat.

One really shouldn't have to pay for advice but many ladies find it quicker and more useful.  Also, some ladies struggle with the progesterone stage of HRT.

[MicheleMaBelle]

Hello Bronwen- sorry you're having these issues. Sad to say, it's not that unusual.
Firstly, you should NOT be offered continuous progesterone if you are still in peri menopause but I'm not sure if you've been offered this as you have fibroids and having a no bleed helps with these?

Secondly, both Elleste Duet and Everol contain an artificial progesterone norethisterone notorious for side effects and too much progesterone can cause low mood and depression.
So, you can go back to your GP after reading about the HRT preps on this site. Perhaps try Femeston- again another artificial progesterone but apparently a bit better tolerated. You might get on better with a separate oestrogen ( patch or gel) and progesterone.

are the GPs maybe there's another one in your practice that has more of an interest in menopause. If you go down the private route ( details of specialists are on this site but are a mix of NHS/ private) the costs will vary depending on where you are and who you go and see.
I paid £150 for my initial consultation and he wrote to my doctor who has prescribed on the NHS.

I hope you find something that suits you- unfortunately it takes time and trial and error but if you're feeling as bad as you are, you need to change PDQ.
 
Let us know how you get on x

[bronwen]

Thank you all for your welcome and helpful advice. As some of you have suggested, I've come to the conclusion I'm overdosing on progesterone with the Conti and the Mirena coil - hence the low mood.  I checked with my surgery and they don't have any GPs with a particular menopause interest. The best they could offer was a female doctor!  I've been mis-prescribed twice so have little faith in going back.

I will check this site for specialist advice / consultations and see how that goes.  Will keep you all informed on how it goes.  I'm reluctant to stop the Ellestre until I have an alternative because the physical benefits have been so good. In the meantime my husband is investing in body and head protection!!   

[dazned]

You could ask for elleste sequential hrt,so it's the same as what you are currently on but you only have the progesterone part for 14 days instead of every day. At the end of the lack you should have a withdrawal bleed if there is any lining build up to shed.

[CLKD]

It can take 3-4 months B4 HRT settles down.

[Freckles]

Hi there

My 12 year old GP was also crap and unfortunately I had to pay to see Prof. John Studd as I had no option.
So currently on his treatment regime of Estrogel (oestrogen gel) 3 pumps daily, tiny amount of Testim gel (testosterone gel) daily  and Utrogestan (progesterone) at 100 mg daily for seven days a month, plus Vit D as he found I had osteopenia (precursor to osteoporosis) in my left hip, hence the pains I had there.
I found it life changing within a couple of weeks (I had less oestrogen than the average male!)  and I get the necessary monthly bleed etc.
Cost for the consultation was about £300/£350, which for me was well worth it.  I had a three month follow up ( at lesser price) and then I have to go back once a year
I was given a private prescription for 3 months worth for all of the above. 
Cost me £70.00 in total  which I thought was about the same as the NHS.  This was a year ago.
Fortunately Studd wrote to my GP with his findings and I get ALL my prescriptions on the NHS.
Even if the NHS didn't prescribe it (although they would be hard pushed to justify that, given Studd's recommendations) it worked out at about £23 a month privately which was doable
I am progesterone sensitive and there is no way I could handle the NHS "guidelines" of 200 mgs for 14 days a month- just couldn't hack the low mood and adverse side effects.
No wonder so many women give up HRT due to the effects of too much unnecessary progesterone for too long.
Information is vital so would suggest getting your hormone levels checked via blood tests to see where you are now and read as much as possible re the HRT options.
Hope that info might be of some use?
Freckles x

[bronwen]

Thank you Freckles, that is very helpful. I am definitely considering the blood tests. 

Does anyone here have experience of being prescribed bio-meds?  They are supposed to be more like natural hormones but there is an issue about them not being approved or regulated in the UK.

[MicheleMaBelle]

Hi Bronwen- there is quite a bit of debate about this and if you search you'll find a blog article on the site from Dr Currie about this very same subject.
Hormone levels fluctuate and the preparations that are " individually tweaked" are not made under controlled conditions or regulated in the same way. If you do decide to go down this route all I can suggest is that you proceed with caution.
There are bio identical preparations available under the NHS. A lot of the oestrogen are bio identical and so is utrogestan ( micronised progesterone) .

[CLKD]

Professor Studd has some good results, worth paying for - some GPs won't prescribe though if a patient 'goes' Privately.

[Hurdity]

Hi bronwen

  from me too.

I agree with much of what's been said and including your own analysis!

You have definitely been given too much progestogen (and two different synthetic types!) which could account for side effects, because even after 4 years the Mirena coil is still giving out some progestogen (it is licensed for contraception for 5 years - well used to be anyway), some of which will be absorbed systemically. Maybe the doctor thought it had run out and therefore gave you more - but as said if you are peri-menopausal then you should be on a cyclical HRT unless you have a Mirena fitted. Alternatively as Michelemabelle said it could be because of the fibroids?

Here is what it says on this site about fibroids:

Fibroids are benign smooth muscle tumours of the uterine (womb) wall and are dependant on estrogen. They tend to shrink after the menopause but shrinkage may not occur, or they may even increase in size with HRT use. Increase is thought to occur in 25% of HRT users and mainly occurs in the first six months of therapy. There is some evidence that transdermal (patch or gel) but not tablet HRT nor tibolone may promote fibroid growth. [ref 24] Fibroid size can be monitored by regular examinations and sometimes by ultrasound scans. There is some evidence that the use of the progestogen releasing intra-uterine system, Mirena may cause fibroids to reduce in size. Mirena is often used in the perimenopause by women who have heavy periods and/or require contraception and can provide the progestogen part of their HRT

In your position, if you got on well with the Mirena, then why not have another one fitted, and then you can add oestrogen as a patch tablet or gel  at the dose required. Not sure what you mean by bio-meds but as Michelemabelle said these are available on NHS. The oestrogen patches/gel I was referring to contain the biologically identical estradiol. The only problem could be additional bleeding from your fibroid. In view of the fact you are approaching menopause, is there any chance of getting a referral for a scan (to check on your fibroids) at the same time as removing/replacing the Mirena (if you decide to go down this route)? You might be able to ask for a specialist referral re hRT in view of your fibroids too?

There is no point in having blood tests while taking HRT as you won't get a true reading of your menopausal status and in any case these are not necessary in women experiencing symptoms over the age of 45 and who have cyclical changes. You haven't said how old you are?

Re private consultation - as said - you do not have to go privately provided you do your homework, decide what you want to try and the reasons for it, and are not medically contra-indicated. Most women cannot afford these sorts of fees. However as stated also there are specialists and clinics listed on this website although some of the information is out of date:
https://www.menopausematters.co.uk/clinicfinder.php

In addition there is the facility to have an e-mail consultation with Dr Currie for £25 which you could then print off and take to your GP if necessary, if you are unable to obtain a referral to a specialist(go to home page of website and scroll down).

The only treatment that may not be available on NHS - because it is not licensed - is testosterone - but first, it is important to find the right oestrogen and progesterone combo that makes you feel good, without adverse side effects.

Hope this helps

Hurdity x

[Freckles]

Hi Bronwen

Just to clarify Testim (the transdermal, i.e. gel version of testosterone) is clinically proved to improve energy, low mood (depression) and libido in women, used with transdermal (i.e. patches or gel) of oestrogen  and clinical realistic and necessary use of progesterone.
I am (like many women) are prescribed a tiny drop of Testim gel (half the size of pea, so 4 small tubes a month) and I get ALL my HRT meds on the NHS.
For me it was life changing and well worth £300 to be assessed privately.
Not super cheap granted,  but about the cost of a weekend away. For me it was worth it to sort out the last third of my life.

Primarily I think because Prof Studd, given his extensive reputation clinically, wrote to my GP advising my prescription.
Testosterone WAS licensed for women in the UK until 10 years ago and it was withdrawn by the manufacturer for financial, and not clinical reasons.  It's still licensed for men in the UK.

I think many GP's may struggle to disagree with a Consultant's  recommendations, but obviously GP's vary considerably, to say the least, regarding their knowledge and attitudes  to HRT .
I'd still buy Testim if I wasn't prescribed it on the NHS- the private cost is the about the same as a NHS prescription cost.

I personally think the "recommended" NICE guidelines on using 200mg of progesterone daily for 14 days each month is excessive and unnecessary, based on the clinical research papers I have read. There is no overwhelming conclusive clinical evidence or utility in having such a NHS regime.
I think it's most likely a cheaper NHS option rather regular and more reliable diagnostic  "well women" check ups (MRI/digital scans rather than old fashioned x-rays of breasts, womb, etc). 
Basically I don't think that hormonal problems/menopause is accepted by the NHS as having such a significant impact on women and is generally dismissed and inappropriate treatment is often given.

Read around and get as information as you can to inform you.

There are a range of diverse and sometimes misinformed opinions out there, so as much information you can get the better.

Good luck!
Freckles xx