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[Cblimey]

Kirsty Wark's TV programme gave me the kick up the a*** I needed to find out more about HRT and I've since been to see my doctor armed with information from this website. A big thank you! to the founders and contributors -- I'm so pleased to have found you!    I wish I'd discovered the site years ago.

I'd really appreciate your thoughts on the HRT I've chosen.  My female doctor is wonderful but unfortunately she knows very little about HRT, or the menopause.  I'm generally feeling happier since starting HRT 2 months ago (better mood, less joint pain, more empowered!), but I'm also feeling quite dizzy and have developed uncomfortable breast pain.

I'm on Evorel 75, 75mcg patches applied twice weekly and Utrogestan, 100mg capsules taken daily for 25 days on / 3 days off.

Is this a good balance?  I'm not sure why the Utrogestan is 25 days on / 3 off?  I'm not keen on taking the capsules; could I replace this with a patch or gel?  My doctor would love to know the answers to these too!


A bit of background:  I'm 49 and have been post menopausal for about 5 years -- my periods stopped during a stressful year in my life, came back for 6 months and then never returned.  I had very bad hot flushes and night sweats for the first 3/4 years and the (probably menopausal?) symptoms I still experience are aching joints, lower mood, reduced concentration and much less 'get-up-and-go'.  I feel that I'm making up for lost time and should have been getting the health benefits of HRT for the last 5 years.

Apologies for the long post but I would love your views.

[MicheleMaBelle]

Hi Cblimey- 

I'm glad you've found it useful but I'm more glad that you've got a decent GP who is prepared to listen and learn.

You're on a high dose patch for oestrogen. Not sure why she started you off on such a high dose ( maybe to bring your symptoms under control? ) I would ask her why this is. You maybe don't need as much?

Re utrogestan 100mg daily is prescribed dose for post menopausal women. if it's generally agreeing with you, you can take it vaginally ( yip you've just got to shove it up there by whatever means!) and there are generally fewer side effects if taken this way. Perhaps you could give it a try. You will see lots of comments on here about the progesterone part of HRT not agreeing with some women and schools of thought that the NHS guidelines are out of kilter and some women can take less.
However, if it's not causing too many issues with you, I'd just take it as prescribed. If it ain't broken, don't try and  fix it.

Let us know how you're getting on. You certainly sound as if you're on the right track! X

[Cblimey]

Thanks for the welcome Michelemabelle.   

My GP is lovely and very accommodating; we sat together and read through all the different types of Progesterone she was able to prescribe on her screen.  We also looked at the Evorel doses and I decided that I wanted to start on 75mcg as I didn't want to start on the lowest, 50mcg.  From your comments I could try reducing my dose.

Thanks for the tip on taking Progesterone vaginally.

[babyjane]

Hi there, glad you like the site, and you are very welcome.  We like it - a lot 

Browse round and join in, don't be shy, there is always something going on and it is not always serious but there is good advice and support and cyber friendship available whenever you need it 

[Cblimey]

Thanks babyjane.   

[Elizabethrose]

        from me too!

Have to say, your name made me smile: is that Cor blimey? x                                   

[MicheleMaBelle]

Hello again Cor- I think that's the highest dose. There's a 50mg ( medium ) and a 25mg low. X

[CLKD]

 

[Cassie]

Welcome its a great combo and if you dont fancy taking the Utrogestan daily, you could use it cyclically for say 12 days per mth which is how some ladies use it and as someone has mentioned, from the bottom up seems to do the trick for most... Good luck, hope you soon settle on the hrt.

[Cblimey]

Hi Elizabethrose, CLKD and Cassie.   

'Cor blimey' has seemed appropriate at many times during my menopause journey.  My surprise at starting menopause in my early 40s; my bewilderment / disappointment / outrage at there being such inadequate funding, understanding or training within general medicine for something that happens to 50% of the population; and in my excitement when finally discovering this website. 

Thanks, Michelemabelle, for the further Evorel info.

Cor
xx

[Hurdity]

Hi Cblimey

  from me too!

You have Heather Currie to thank for this website . This forum is the chat part of the site but nevertheless gives advice, help, information, support and friendship as appropriate, to hundreds of women on their menopause journey and beyond!

Just to add that - the licensed dose of 100 mg utrogestan for continuous use is 25 days out of 28 as you have been told. This is likely because it would enable a bleed to take place should the lining have built up during the time when both hormones are being taken. In practice many women take utrogestan continuously as a no-bleed type ( and many women would not bleed on the 3 days off anyway).

However as it is dose dependent - ie the more oestrogen you have the more progestogen you need to protect the womb lining ie keep it thin or enable it to be shed properly, and utrogestan only comes as one licensed dose each for cyclical use or continuous use - then it may well be that you do have a bleed when using 75 mcg oestrogen, and if taken orally you may bleed at the wrong time. Most women would not want to use it vaginally continuously for obvious reasons and also due to possible irritation but the other alternative is to take it cyclically - a higher dose vaginally for a shorter time each month. You would have to put up with a bleed though - so might be better to keep on with what you are doing for a few more months and see how you get on? Also you could cut a bit off the patch to give say 62.5 mcg ( which is what I take - a 50 mcg patch + a third of a 37.5 mcg one and I'm in my 60's).

Given your young age and the fact that you have been post-menopausal for some time I can see why you have been given this dose - but your body will be less acclimatised to it after so long without so maybe the side effects ( notably breast pain) are due to this. Hopefully they will settle? It is usual to start lower - and use the lowest dose which both deals with symptoms and makes you feel good (there is sometimes a discrepancy!) - and build up as necessary. I can't see a problem with the higher dose - except if you continue to experience side effects.

Incidentally patches come in a range of doses from 25 mcg right up to 100 mcg - and some women even have to use more - those in surgical menopause for example.

Hope this helps and let us know what you decide and how you feel as time goes on

Hurdity x

[Freckles]

Hi there and welcome to the site.
But 100mg daily of  Utrogestan for 25 days each month- blimey! Why?
That's a hell of progesterone to take each month and for so long.
I am sure someone on here will beg to differ in their opinion   and will correct me (!) in their lay opinion,  but my last understanding of current clinical research is that NICE guidelines *suggest* 200mg  daily for 14 days or so.
Did your GP indicate why so much and for so long? 
I am prescribed 100mg of Utrogestan  (which I take vaginally with a pessary dispenser as using fingers didn't /or et it high enough).
Too much progesterone when it's not unnecessary clinically can cause horrible side effects, either physically and/orpsychologically.
 
Also I disagree with Hurdity's opinion that " ie the more oestrogen you have the more progestogen  [sic] you need to protect the womb lining".

There is no reliable and  consistent clinical evidence to support that claim.
I have sadly wasted hours (scientist nerd that I am!) looking at this re clinical reteach papers and this is not the case at at6 all

Indeed I am on 3 pumps of gel Estrogel daily, a very tiny bit of  gel Testim and 100 mgs of Ulstragestan  for 7 days a month which works very well for me.  Seems to be a generally standard dose  as to HRT as prescribed by Prof. Studd  (and please note- many others on the NHS and privately).
I am NOT medically qualified and also unsure of other's opinions, including Hurdity's or indeed others on MM  regarding their validity  and reliability of their offered opinions.
It's just a chat forum after all!
But I would suggest a sensible attitude would be to read around on MM  and other forums to get an informed opinion  on HRT options, the necessity (or otherwise) of such dose of progesterone  for so long.
Then you can make an informed decision- which it what it's all about after all. surely?
 Good luck! xx

[Salad]

Morning Cblimey

It sounds like you are on the right track with maybe some dose tweaking, which seems to be par for the HRT course 
Having a supportive GP is so reassuring and will help you along the way.

My GP started me off on tablets which I was allergic to  , so I used gel instead. Although I initially used 50 mcg I was up to 75 mcg after the first two weeks, in order to get symptom control.

Is your breast pain accompanied by increased size too? For me that indicates my oestrogen is too high.

I'm Oestrogen only so no idea about the progesterone part!

[Hurdity]

I think we would all be interested to see any research/evidence which demonstrates that the same dose of progestogen could be given to protect the endometrium as part of HRT regimes, irrespective of the oestrogen dose ie that this is not dose dependent. My understanding from reading widely is that the degree to which progestogens protect the endometrium (from endometrial hyperplasia as a result of oestrogen stimulation when used for HRT) is dose and duration dependent and also dependent on the dose of oestrogen such that lower doses of oestrogen will require correspondingly lower doses of progesterone and conversely the highest doses of oestrogen may require higher (and/or longer duration) doses of progestogens.

This is borne out by the information on this website showing the dosage of progestogens at different oestrogen doses when used in continuous combined HRT. https://www.menopausematters.co.uk/postmeno.php

It's not really an opinion as such but my understanding from everything I have read - however if this is incorrect then please let us have further information, as we would all be interested.

Many of us agree (with the established view from the medical profession)  that the licensed doses of progestogens are too much for some women and that a reduction may be preferable to minimise side effects – and reducing this to 7-10 days will minimise these – but such regimes “may be associated with an increased risk of endometrial hyperplasia, so there should be a lower threshold for ultrasound scanning and endometrial sampling”. (from  BMS & Women's Health Concern recs on HRT 2016).

Dr Currie herself recently posted about this here:

Just to confirm, while Professor Studd is very experienced and extremely knowledgeable, his regimens are not always in line with current recommendations, particularly around use of progesterone.
As always with providing menopause advice, this should be individualised and flexibility should be applied, as long as there is a clear understanding of national and international recommendations. Some women are intolerant of progestogen and progesterone and so it is appropriate to adjust the regimens, as long as it has been fully explained and discussed.
Best wishes
Heather

Cblimey - I do hope you are not confused now and are clear about your treatment and the possible options? The most important thing is that variation from the licensed progesterone doses should be carried out under medical supervision.

Hurdity x

[Cblimey]

Hi Hurdity, Freckles and Salad. 

Thank you for taking the time to give such detailed responses. I really appreciate all the info.

For now I've decided to lower my oestrogen by cutting up the patches so I'll get approx. 50mcg. I'll see how this affects my breast pain.  Salad you mentioned breast size - I'm not sure if mine are bigger but they certainly feel heavier.  When I roll over at night the pain wakes me up. I already sleep wearing a bra but I'm now on the hunt for a more supportive design.  I didn't mention before but I had a breast tumour removed in my 20s that thankfully turned out to be benign, so I'm particularly sensitive to changes in that area.

As for the Utrogestan I'm going to keep reading and researching before I change from the 100mg capsules.  I don't like processing those hormones through my gut (I've also had a number of tumours removed from my large intestine) so I'm definitely looking for an alternative.

Should my GP be checking the health of my womb now that I'm on HRT?  Do you have regular monitoring?