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[Macjac]

Hi

I am not quite new - been using the site and posting some questions over the last few weeks but didn't introduce myself as a new member so am doing this now.

Firstly this site is brilliant and you are all so helpful.  This has already helped me masses and made me feel more confident to challenge convention and experiment. However I am finding it all a bit overwhelming as there are so many different variations of how to take HRT.

I naively knew nothing about menopause until last year and thought it was something that lasted a year or two and then was done with.  How wrong I was!

So bit about me.  I am 51, fairly fit and very slight.  I work full time and commute into London 4 days a week. I work for a dot.com in a fairly senior role that is predominantly male and much younger than me (so having menopausal moments is not really on any of their radars - currently leaving meetings to "take a call" to get though bad flushes!)     

Periods fluctuated between none and super heavy for about a year but no adverse symptoms then periods stopped and hot flushes kicked in middle of last year.  Got to the point where I was sleeping (barely) on a towel with a cold flannel by the bed and decided I couldn't go on like that! Went to the GP knowing nothing about HRT and after a short and uninformative appt got prescribed Ellest duet.

Then did loads more research on different types of progesterone and decided this didn't seem like the way I wanted to go.

So had a private appt in Oct last year.  Consultant said as I had been period free for 10 month I might as well start continuous HRT and gave me Utrogestan and Sandrena.Ironically a week later (before taking tablets) I had another period so put the tabs and gel in the cupboard.  Next 4 months ticked along fine and symptoms all disappeared.

Anyway in the last few months the flushes and sweats have returned along with many of the other usual symptoms.  Dryness, loss of libido etc and dry eyes making wearing contacts difficult.

Went back to my GP and she said as periods were still fluctuating then I should probably start taking progesterone sequentially but she wasn't at all familiar with Utrogestan and didn't really know quite how to suggest taking it other than what it said on the packet. She also gave me a prescription for Vagifem

After more research on this site ( thank you all again) I decided I would use the prescription the consultant gave me but try taking the utrogestan vaginally 100mg per day on days 15 - 26 and use sandrena gel 1 mg each day plus the vagifem.  I wanted to start on a low dose of the progeste

Vagifem has worked a treat and that all seems much better in that department.

Started taking the sandrena with high hopes (1mg) but sadly I have noticed absolutely no change good or bad.  (3 weeks in).

I have started the progesterone too now - as yet no side effects (good news) although only been using for 5 days!

I am now unsure what to do next.  The gel doesn't really seem to be doing anything.  I have experimented with arms and thighs, and given lots of drying time etc.  I guess either the dose is not high enough or I am not absorbing it.

I can't get another appt until at least Sept with the consultant and also this is seems an expensive route  if one needs to keep experimenting.

Thinking I will experiment myself and try upping sandrena to 1.5mg and see if that improves flushes.  If that fails then maybe see if I can get a  prescription from my GP for estradiol and try that instead.  Then I guess get a follow up appt with the consultant to tell her what I am doing and see what she thinks. 

 I also hadn't really thought through how I get my prescription renewed.

Sorry long intro....

So now a few questions.....

I understand the progesterone part thins the lining.  As I am only taking half the official dose how do I know if this is enough?  Is this where scans come in or does this need blood tests or both?  Presumably these need to be done privately?

Or do I just wait to see if I get a bleed and if not assume the dose is too low?

Does the progestrone actually trigger the bleed and when should this happen - when you finish the tablets or during it?

If I increase the gel dose do I need to increase progesterone?

Do people typically just experiment themselves with this and then basically tell the GP what they want?

How are people managing to flick between a private consultation and getting prescriptions renewed when it all seems so trial and error?

Sorry for all the questions but I feel like I am making it up a bit as I go along.

Any advice would be most welcome and I will continue to read through the posts here.  I have just found the gel and utrogestan support thread which I am ploughing through.

Thanks all!

Macjac



 

[Hurdity]

Just a quick reply Macjac - did you get any answers to your questions from other members elsewhere? If not I will try to answer them later!

Hurdity x

[Wilks]

Hello, I can't answer all of your questions but I've seen a private menopause specialist who recommended a prescription and wrote to my GP, so I get my prescriptions on repeat from my NHS GP surgery.
I'm using an Estradot patch and utrogestan (12 days a month). The utrogestan triggers a bleed towards the end or just after the 12 days.

I would only ever use the doses advised by a doctor unless the doctor has said they're ok with you experimenting.

Hope that helps a little?

[Dancinggirl]

Hi and welcome to mm Machiavelli

It can take time for the oestrigen to work it's magic but you may need to try Oestrogel instead of Sandrena as I found this better. You might also do better with estrodot patches as many women prefer these to the gels.

Using the half dose of Utrogestan vaginally is fine. Taking Utrogestan orally means a lot is lost as it goes through the liver and digestive system and using it vaginally means it delivers the progesterone more directly to where it is needed. Do use at least 10 days of Utrogestan each month as this will ensure your uterus sheds properly. Using for fewer days each month is for those who react badly to progesterone and then regular scans are needed to check the womb lining.

Any deviations in regime must be done under the guidance of your specialist. If you want a bleed free hrt regime then having a Mirena fitted can be a good option. The Mirena is a very effective way of delivering progesterone to where it is needed with minimal systemic absorption and around 60% of women get no bleeding at all and most women get fewer side effects. The other plus of the Mirena is that you can use higher doses of oestrogen safely if needed.

Give your current regime 3 months to allow the body to adjust and settle.

Have you had your thyroid function checked? 
DG x

[Macjac]

Thank all.

How would a thyroid issue manifest itself? Does that cause symptoms like  with the menopause?

Is a mirena coil progesterone only?  And can they be fitted if you haven't had a natural delivery?

Thanks.

[Dancinggirl]

Hi Macjac - thyroid problems can have very similar symptoms to the menopause and doctors usually test this alongside other things when flushes, poor sleep etc emerge.  Thyroid issues can also arrive at the same time as menopause adn if HRt isn't working it may be worth checking whether you symptoms are thyroid related.

Yes, the Mirena can be fitted if you haven't had a natural delivery - it can be a bit more tricky though adn could require some pain relief.
Yes the Mirena s progesterone only and requires oestrogen as gel, patch or pills alongside.

Here are the details about the Mirena:
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.

DG x

[Macjac]

Thank DG for all your helpful advice. Lots of things to consider.

I have upped my Sandrena gel to 1 1/2 sachets a day which I gather is equivalent to 2 pumps and I think this is helping. Flushes are less frequent and less extreme and am getting more sleep.
 
I have just got to day 26 on the Utrogestan so am hoping to get a bleed in the next few days and have managed to get a follow up  with the consultant now in August so feeling more hopeful!

Thanks all

Macjac x