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[Kwebst]

Hi Guys
Need some opinions please. Quick history. I am a 50 year old perimenopause woman with a history of raging PMT, which was mostly helped by citalopram. Had an endometrial ablation ( worked brilliantly - cut down to half a day bleed amonth). Hit peri with night sweats, anxiety, dry skin, periods every other month, poor sleep, low libido, you get the drift. SO, onto HRT. Tried elleste and was ok but not brilliant so doc suggested I go onto kliovance as my periods are next to nothing. BIG mistake. Big tears and raging hormones after 2 weeks. Definitely think I don't agree with the norethisterone in the kliovance and elleste. So onward and onto femseven patches. Whoop whoop worked best so far by far, (horrendous sore boobs at the beginning) but have had a bad month with heaps of peri symptoms back. Hoping it was just a blip cos I was soo much better. BUT, the last time I was back at the dr she suggested a 3 month oestrogen , couple week progesterone cycle since most of my endometrium has been cooked! So, am back at the dr this week for more prescription. So you clever ladies, I see tridestra is the 3 month tablet, my question is how does the dose compare for the patch to the tridestra? I know the dose is comparable but will the trdestra be an equivalent or a higher dose of oestrogen than I have been getting? or should I press for a gel instead? My doctor I brilliant and listens to my opinions. would appreciate your thoughts. PS the last time I had a period was nearly 4 months ago.
thanks

[Salad]

I didn't want to pass by and not leave a reply 

However, as an Oestrogen only user I'm really not very knowledgeable of your HRT. I'm glad you have a helpful GP, hopefully you'll sort a regime that works for you.

[Dancinggirl]

Hi kwebst
You are clearly sensitive to certain progesterones.
The longer cycle regimes might work well for you. Tridestra is possibly an option to try first.
Oestrogel is good for adjusting dosage - so use between 2-4 squirts per day, starting low and over several weeks gradually increasing till you find the right amount to control the flushes. You would then have two options for progesterone, Provera or Utrogestan and would probably need 12-14 days of a reasonably high dose to ensure the womb lining shed properly.
Some women do a 6 week cycle with the Utrogestan successfully. Hopefully ladies who do long cycle will be along to advice soon. Unfortunately I got erratic bleeding using a long cycle regime and found Utrogestan gave me too may side effects.

[Mary G]

Kwebst, Tridestra sounds like an interesting product and taking oestrogen only for three months sounds like sheer bliss.  It's great that you have had an ablation because you shouldn't get any breakthrough bleeding on this regime and you probably won't bleed at the end of the progesterone phase either so it does make the whole thing more tolerable.  I have tried a long cycle but always get breakthrough bleeding between 5-6 weeks so it is not an option for me but I am considering having an ablation.

I would think that the oestrogen in Tridesta is about the equivalent of 2 pumps of Oestrogel or a 50mcg patch.  If you decide to go for the Oestrogel/Utrogestan option, there is no reason why you can't do the same regime as the doctor suggested i.e. 3 months of Oestrogel only and then a course of Utrogestan used vaginally which should be very effective on an ablated womb. 

Please tell us more about your ablation!

[Kwebst]

Thanks ladies-still going round in circles as what option to do next🙄😂 Too many choices of HRT, only thing I know I'm def going to ask for more oestrogen.
As for the ablation - best thing I ever did. Always had problems with heavy periods since the day I started. Went on the pill at 17 because I couldn't cope at that age with the heavy flow. Then I had to change my pill because my PMT / headaches got bad. Tried the coil which was good then migraines so an ablation was suggested. A very easy procedure and for first 6 months no periods at all. I would ovulate but no period. After 6 months it was if my body had “healed” a bit and I started having periods again. BUT I went from 5 days of very heavy, with the odd “flood” to, at most half a day, sometimes nothing. This was years
before peri kicked in. Best thing I ever did and I heartily recommend it!

[Mary G]

Kwebst, thanks for sharing your very positive ablation experience with us, it sounds like a really good option and I am seriously considering it.  I also had migraines with a Mirena coil (I assume you had a Mirena) once my oestrogen levels dropped.  Even though you still need progesterone after an ablation, you can probably get away with using slightly less of it and at least you don't have the ensuing bleed which for many of us can be very heavy and debilitating.  It also enables you to do a long cycle with the confidence that it will actually work. 

We have had many women on here who are not necessarily progesterone intolerant but end up ditching HRT because they get fed up with having periods into their 60s so they will be encouraged by your experience.

One thought, if you suffer with migraines, the progesterone in the Tridestra might be strong (20mg) so you may want to ask for Oestrogel (very flexible and easy to adjust the dose) and vaginal Utrogestan which should work very effectively on an ablated womb because it is localised.  Your doctor sounds very receptive so it might be worth getting her opinion on that and it could help you decide which option to take.  Either way, it sounds like you are off to a good start.   

[Hurdity]

Hi Kwebst

Tridestra is slightly higher dose than you are currently on with the Femseven - but as always it depends on how well you absorb the oestrogen from each delivery method as women vary so much. There haven't been that many women who are on Tridestra - usually because unless you are pretty late peri-menopause - there can be breakthrough bleeding before the 3 months has elapsed which rather defeats the object.

Brilliant that the ablation has worked for you in your position and sorted out your periods! There have been women on here also who have had an ablation - but as an aside (to other over 60's like me!) - re Mary G's comment - it is not suitable for women post-menopause ( according to the info on the web) and I can't imagine why one would choose to have such a procedure unless like you, one suffered from very heavy periods - since it is an invasive surgical procedure, with associated risks.

Kwebst - I would go with Dancinggirl's original suggestion probably - of gel rather than taking the Tridestra - especially as you didn't get on with the HRTs containing norethisterone, although you might be better with the MPA? I am one of the long cycle women she refers to - I have a normal womb and in my 60's taking utrogestan vaginally on a long cycle of 6-8 weeks (with medium dose oestrogen patch), but you may not need to take it that often with your ablation. I presume your doc will supervise if you go on long cycle HRT just to make sure the reduced lining doesn't thicken? Not sure how it works really!

Let us know what you decide and how you get on

Hurdity x