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[Fruitcake]

Would appreciate your assessment of my HRT journey so far and what to do next.

I'll try to be as brief as possible.  54 years old suffering symptoms for 12-18 months and periods were every 6-8 months, very light.
Started on Evorel Conti in June after blood tests and smear tests all clear. Was already having a light bleed when I started the first
patch but Doctor said that shouldn't matter.  Well, the bleeding never stopped really and got heavier than a 'regular' period.  The flushes
and night sweats eased but didn't go altogether.  Even though I felt really tired physically, I felt better mentally but think this was relief that I'd finally got the HRT. I thought things would improve but was prepared for some side effects in the early days.  As the bleeding wasn't stopping and was heavier than my normal period, after the first month I halved the patch (I know not strictly correct on the conti patch but wasn't intending it to be long term). I thought I may benefit from a slow increase of hormones rather than all at once. I know I have a sensitive system from previous medications. Anyway the bleeding did stop on the half patch within the week. 

The flushes were still there but no worse on the half patch but I developed really painful knees and shoulders (a new symptom).
After a couple of weeks I decided to try a three quarter patch, the idea to increase to the full patch more slowly. The knee and shoulder
pains were still there and they seem to alternate, if my shoulders were aching then the knees were okay, if the knees were bad then the
shoulders were better...* just weird I know *  Within four days of the three-quarter patch I was bleeding again. I have now gone back to a half patch. One week in and the bleeding has stopped but shoulders are still painful. They actually burn inside the joint and feel like something heavy is pressing on the top between the neck and shoulder.

The flushes have turned into sweats.  I'm not getting the same feeling of heat and face/neck flushing, it is full on sweat everywhere.
My whole body is running hot, it is hot to the touch (not normal for me) so with the heatwave over the last week, just moving about is
causing me to sweat.  I'm getting sweat rashes under my boobs and the back of the neck, even on my scalp little itchy sore spots.
It is uncomfortable and physically draining as well as embarrassing. 

Thanks for reading to the end, what do you think should be my next step. Am I expecting to much to soon?
I should have a three month check-up with the GP soon so would like to tell her what I want rather than have her decide.

[Dotty]

Hi if you are still having periods then you’d be better off on a Sequi regime, so Evorel Sequi instead of Evorel Conti. x

[joziel]

I'm not sure why you're reducing your patch? To deal with bleeding, it's not going to work to cut down a combination progesterone and estrogen patch.

Even if you just had an estrogen patch, it wouldn't be the estrogen you would usually adjust to try to deal with bleeding - it would be the progesterone....

From your symptoms, you need more estrogen, not less. If you still had flushes on the full patch - which is 50mcg - you probably need higher than a 50 patch.

To get higher than 50, you will need to use separate estrogen and progesterone since all the combination patches are 50mcg. Ie - you would need a 75mcg estrogen only patch and then utrogestan for progesterone.

And as Dotty says, if you are still bleeding at all before HRT, you should be on a sequential regime - not on a continuous. You will get problematic bleeding if you try a continuous regime when you are peri-menopausal. (Although there are some specific situations which call for it, like endo sufferers.)

[Fruitcake]

Thank you for your replies.

At first I also thought that the continuous therapy wasn't correct as I'm not post menopause but having read more information regarding this including on this site about treatments available, for someone my age not having regular bleeds it is prescribed and reduces the risk of thickening the womb lining.  So I don't have a problem with it, after all we all want to be bleed free with no symptoms.

I'm not sure why you're reducing your patch? To deal with bleeding, it's not going to work to cut down a combination progesterone and estrogen patch.

Even if you just had an estrogen patch, it wouldn't be the estrogen you would usually adjust to try to deal with bleeding - it would be the progesterone....

Sorry, I don't understand what you mean here.  I did cut down the patch to stop the bleeding and it worked because it reduced the progesterone (as well as the estrogen) in the patch.  I checked Evorel Conti is a matrix patch, so technically the two hormones are distributed across the patch equally (but not equal in 'mg' strength). 

I wonder now if a 'long cycle' therapy maybe the way to go.  Presumably my own hormones are still active in a random way but can't be relied upon and this caused the endless bleed for the first month until I halved the patch. 

Really odd about the excessive sweating not flushes I'm suffering, then I look and another two posts about the same thing on the same day!

[joziel]

Fruitcake....

You are peri-menopausal. Therefore you should be on a sequential regime. That is 2 weeks of a progesterone/progestin - and then 2 weeks with no progesterone/progestin - when your bleed will occur. That way you will have scheduled bleeds.

If you try to do anything else, you will just have continuous problematic breakthrough bleeding at random times. As you are experiencing.

If this continues, your GP will refer you for scans and tests to investigate the bleeding - some of which can be unpleasant and painful.

You should go back to your doctor and request a sequential regime.

You don't want to 'reduce the estrogen in the patch' because the whole point of HRT is to replace your estrogen levels to the point where you don't have symptoms and have enough estrogen. Your night sweats didn't stop when you were on the 50 patch. Night sweats are a classic sign of low estrogen, so you needed more estrogen than 50mcg. Instead of giving your body more estrogen, you reduced it when you cut the patch down.

You can't adjust one patch when it contains both progestins and estrogen because you are adjusting both things in the same direction when you might need more estrogen (as you probably do).

Again - go back to your doctor and request a sequential regime which enables you to adjust progesterone and estrogen separately. That will probably be a patch, gel or spray and utrogestan. With utrogestan for 200mg for 14 days and then stopping for 14 days to schedule a bleed.