Hi Kathleen
As has been said the hormones are not exclusive to Studd's regime!!! His progesterone dose is far less than the licensed dose and as we have seen on here other gynaes don't necessarily approve of doing this without supervision. I am absolutely fine on my HRT regime and my oestrogen and progesterone have only ever been obtained on the NHS through my local GP practice. We have arrived at my current cycle through mutual agreement and I have had various scans along the way so I know how my uterus behaves and does not over thicken.
We have had this discussion (about your situation) several times before and to me the only way you can sort out what you need is to go back to a cycle - because I think you were taking Evorel conti which is continuous synthetic progestogen every single day. The Tibolone is a different type altogether and sounds like it doesn't suit you. This (the progestogen component) could be contributing to anxiety, preventing the elimination of hot flushes and interfering with the beneficial effects of the oestrogen. Many women are fine with it but others are not. I know I wouldn't be!
I thought you had tried utrogestan before and didn't like it - but can't remember how you took it? If it were me the first thing I would do is to separate out the oestrogen and progestogen part of HRT and give yourself time on the oestrogen only to see how you feel. You might need a meno specialist to support you through this unless you have a small amount of funds for a scan after a year of perhaps trying a longer cycle? Of course it also depends on the state of your uterus - whether you have/had fibroids polyps etc.
By all means e-mail Dr Currie - but I do know she sees no need for bleeding and tends to be inclined to favour no-bleed regimes - and also due to the decreased risk of endometrial cancer. However if the 50 mcg regime did not work for you she may well suggest changing to separate patch or gel so that you could increase the amount of oestrogen relative to the progestogen - to see if this at least eliminated flushes. It would be best to get this right before thinking about testosterone but Studd's regime is pretty standard and usually includes the T from the start - the only thing that seems to vary is the number of pumps of gel!
How sympathetic or knowledgeable is your local GP?
So in summary:
I think you need to decide between bleed or no-bleed
If bleed - then cycle length?
You need to have separate oestrogen and progestogen so that you can increase oestrogen
Patch or gel - no reason necessarily to stop patches but just try an increased dose - your body is used to these after all?
Then finally which product? Utrogestan oral or vag, or Provera (oral only).
Oh - and I don't think you need to go and see John Studd to get this!!
You really have my sympathies - because my flushes and sweats stopped within days of starting 50 mcg oestrogen 10 years ago and only returned when I stopped HRT or reduced the dose. This surely has to be the first function of HRT and should be relatively easy to sort out.
Good luck and do let us know what you decide!
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Hurdity x