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[Ana21]

Hello!

I've found it helpful to read about your journeys, so I thought I'd share mine.  I'm 57, postmeno, began combined continuous HRT in 2020, under the care of a meno specialist.  I started taking Estradot 50 and oral Prometrium/Utro 100 mg.  I experienced breakthrough bleeding, which is not uncommon when starting continuous combined HRT, but my bleeding persisted.  Transvaginal ultrasound, sonohysterogram, endometrial biopsy were negative of findings.  I had a thin endometrial echo of 1 mm.  I had read that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer, so I've tried not to worry about  being in the 1%. Unscheduled bleeding is so stressful.  My doctor wanted to reduce my estrogen to address the bleeding, but I asked him to keep me at my current dose for a little longer.  We waited and hoped the bleeding would stop.  It didn't.  We talked about the Mirena IUD as a future option to control the bleeding.

At the end of April 2021, I tried switching the progesterone from oral to vaginal admin which triggered a bleed, and then I had another bleed two weeks later.  My doctor thought the increased frequency of bleeding was likely due to the switch and asked me to monitor it.  I switched back to oral due to the increase in bleeds.  The bleeding became more erratic.  All my meno symptoms returned with a fury.  They were worse than before I'd started HRT.  And then there was the sudden hair loss. 

The hair loss was readily apparent to my doctor and he suspected low estrogen.  He ordered blood tests for thyroid (TSH) and estradiol.  My thyroid was normal, but my estradiol level was <40.  I'm at the bottom of the scale.  Confirmation that I'm not absorbing transdermal estrogen.  And it may explain the bleeding. Progesterone breakthrough bleeding occurs when the progesterone-to-estrogen ratio is high.  The endometrium can become atrophic and ulcerated due to a lack of estrogen and prone to frequent, irregular bleeding.

This morning, he prescribed an oral estrogen, Premarin 1.25, and Prometrium 200 mg.  His preferred oral estrogen is Estrace (estradiol) but it's on backorder.  The plan is to switch me to Estrace when it becomes available.  My pharmacy has ordered the Premarin and it should be available next week.  A new hormone adventure awaits.

My GP has referred me to a dermatologist for the hair loss and told me to start using minoxidil (Rogaine/Regaine) while waiting for my derm appointment, which could be months away, to preserve the hair that remains.  And so my minoxidil journey begins.  I've used it for the past two days. There are potential side effects.  I'm going to hope for the best and not dwell on them.

If anyone has any good things to say about Premarin, minoxidil or hair loss treatments in general, I'd love to hear it.  I was really hoping that transdermal estrogen would work for me, but I can accept the increased risk of oral estrogen.  It's got to be better than this.  It's such a relief to have confirmation that I'm not absorbing the patch and be able to move forward.  It's unfortunate it took so long to get here.

[LSmarty]

Hi
After trying many hrts years ago, I ended up using premarin and the mirena and as long as the mirena is changed frequently enough then it controlled all my symptoms very well.
I already had alopecia areata before starting on hrt which then went onto alopecia universalis, I had a few treatment 20 years ago but no one has addressed it since so I'm interested to see your progress with minoxidil
Take care
Les xox

[Ana21]

Hi Les!

I'll keep you posted on my adventures in hair loss treatments.  I've learned it's very difficult to take photos of your own head. The minoxidil can cause initial shedding, so it may get worse before it gets better.  Based on my pattern of thinning and past experience, I think my hair loss is due to androgenic alopecia.  When I was in my 30s, I developed adult acne with hyperpigmentation. I also noticed some hair shortening and thinning around the temples and front hairline, a mild version of what I'm now experiencing.  I was seeing a dermatologist for the skin issues and he referred me to an endocrinologist.  She suspected I had PCOS.  I had similar symptoms to her PCOS patients, but I didn't have a history of irregular periods.  Testing revealed normal cortisol, normal testosterone levels, etc.

I didn't have PCOS, but she thought I might be very sensitive to androgens and put me on spironolactone, a diuretic and androgen blocker. Spironolactone was life changing and I felt so much better on it.  I dropped 20 lbs (1.4 stone) during the first month.  I didn't realize I had been retaining so much water.  A small minority of women respond to spironolactone in that way.  I dropped another 10 lbs over the following 6 months.  It resolved the skin problems and my hair grew back.  I was on spironolactone for a few years and then tapered off.  I didn't have any further problems with my skin or hair until I started menopausal hormone therapy.

I'm looking forward to my appointment with the dermatologist.  I wonder if I'll need an anti-androgen to deal with my current hair loss.  There are more treatments available now.  I'm going to ask the derm about the effectiveness of red light therapy.  Curious about that.

With the hair loss, I may not be a good candidate for the Mirena or other androgenic progestin.  Another question to ask.  I think the problem in my 30s was triggered from going on and then off birth control pills containing a testosterone derived progestin.  Perhaps if I can get my estrogen level high enough, the Mirena will be an option.

I forgot to mention in my first post that HRT triggered melasma and I'm seeing a derm for that.  I had noticed hyperpigmentation, the sudden appearance of freckles.  At my age, freckles look like age spots.  I was surprised when the derm said it was melasma, which I associate with pregnancy.  If I had read the package insert more carefully, I would have noticed that "chloasma" is listed as a potential side effect of Prometrium/Utro.  Treatment is working well.

Looking at head covering options in case the situation worsens and I feel self-conscious.  I'm sure you've been through this process.  For now, a side part works well enough.  Perhaps I should make some wide headbands in readiness for the next phase.

[Bumblebeer7]

Hi, just wondering if you ended up taking spiro, and how it has worked for you?  Just started it myself

[Floo36]

I’m baffled why you couldn’t have oral estradiol as it’s readily available, I know I’m on it.  It’s body identical.  I have absorption problems even with oral.  There are still lots of things to try as well, gel, spray, other patches.  Have you tried anything else?

[Floo36]

Hi just wondered how you got on with the Premarin? I have now asked to try this after trying everything without success. 

[Ana21]

Hello Bumblebeer7 and Floo36!

Bumblebeer7, my derm appointment isn't until the second week of March, almost 6 months from date of referral.  Waiting patiently while continuing to use topical minoxidil and Nizoral 2% shampoo.  I hope the spiro works for you.  Are you using the spiro on its own or in combination with topical minox or anything else?  Any side effects so far?  I recall an adjustment period. 

Floo36, I couldn't have the oral estradiol because of supply issues at the time and the priority was to get my estrogen level up and stabilised, rather than experiment with other transdermal methods.  That's how I ended up on CEE.  I'm still on the oral Premarin and I've made it through the first few months of temp side effects and feeling really good.  Curious as to how it compares to oral estradiol.  I'm sleeping well, no hot flashes, increased libido and sexual function (not something I expected from CEE), so it's working well for me. 

[Floo36]

I’m so pleased that it is working for you, long may it continue. What were the side effects that you had for the first few months?

[Ana21]

Hi Floo36!

My temp side effects were stomach discomfort, nausea and mild headache that lasted for about 7 weeks, diminishing in intensity over time.  It wasn't debilitating and didn't prevent me from doing anything I would normally do.  I also had some slight dizziness that resolved within the first 2 weeks or so.  My doctor warned me about the stomach upset and suggested I take the tablets at bedtime to limit discomfort.  That didn't work for me.  I had to take them with food.  I had experienced temporary stomach discomfort when taking oral birth control, so it wasn't a surprise.  My body has adapted and I can now take estrogen on an empty stomach.  The early gastro side effects were also a sign that my gut was responsive to estrogen and after about 3 months, I now have pre-meno bowel function.  Yay!  So happy.

I developed a temporary sensitivity to smells, very similar to what I experienced during pregnancy.  Before I realised the problem was hormonal, I purchased and binned three bottles of hair conditioner because the fragrance was unbearably strong and nauseating. 

I also had inflammation, joint and muscle pain.  It lasted about a month, diminishing over time.  Mild, no treatment required.

I'm still spotting, but it's light.

I hope you're able to find something that works for you.  If you decide to try Premarin, let me know how it goes.  It seems like everyone's last choice in estrogen and I rarely read anything positive about it.  It's allowed me to elevate my estrogen level and see how my body responds.  Interesting experiment.  Now I know what estrogen can do for me. 

[Floo36]

Hi Ana21,  thank you for sharing the side affects that you experienced it really helps.  I’ve only been on it 16 days so too early to report improvements.  Fingers crossed.

[Kat17060]

I’ve also switched from gel/patches to Premarin.
So far so good all my neck pain and sinus pain has reduced.
The only thing is that my eyes are dryer.
It was last resort I’ve tried so many in the last 3 years after my full hysterectomy.
Im also supposed to be on progesterone but it doesn’t suit me.