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Author Topic: 2mg HRT Maximum Dose!!!!  (Read 5291 times)

Tina1957

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2mg HRT Maximum Dose!!!!
« on: June 26, 2012, 09:14:57 AM »

Hi

Am really struggling and things seem to be just getting worse!

After increasing to Elleste Duet 2mg from 1mg 6 months ago, all my debilitating symptoms disappeared and I had never felt so well , I couldn't believe how I felt (hadn't felt like that for over 2 years).  There was a slight hiccup though, in that 3 months in, when I was on the progesterone days I started to get anxiety and started bleeding 3 days into it.  Asked to try Femoston 2/10 after reading it was a much friendlier progesterone - stayed on this for 3 months, but immediately all my menopause symyptoms returned with a vengance, tiredness to the point of exhaustion, muscle aches, headache, constant fuzzy/disorientated head, ringing/pulsating in my ears, my hair has gone so thin and dry, sudden hot flashes leaving me pouring with sweat and feeling faint.  Strangely though, when on the progesterone days the symptoms were not as severe.

On speaking to my GP, she suggested going back onto the Elleste Duet 2mg  - now back on the Elleste, but still experiencing all the symptoms - for some reason the 2mg is no longer working for me.

My GP is on holiday at the moment, but I felt so desperate and went to see another GP a couple of days ago - she basically told me that 2mg of HRT was the maximum dose I could be prescribed in tablets and patches.  She said we could try an alternative route to see if it had a better effect, but when I mentioned that my symptoms were not so severe when on the progesterone days she said that maybe we should try a conti HRT and has prescribed Kilofem.  I can't start this for another couple of weeks until I have had my bleed.

Have read some info in the internet about low progesterone actually causing some of these symptoms if the oestrogen and progesterone levels are not balanced - could this possibly be the reason why my HRT is no longer working? 

Am also panicked by the thought that 2mg HRT is the maximum dose!

Any help or advice would really be appreciated.

Tinaxx

 
     
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meno lesley

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Re: 2mg HRT Maximum Dose!!!!
« Reply #1 on: June 26, 2012, 10:06:50 AM »

Hi Tina

I have been on various hrt's over the last 18 months. I am currently on Elleste Solo 2mg and Ultragest 100mg. This has taken away lots of symptoms but have awful joint and muscle problems. I have also read that balancing out the estrogen and progesterone can cause symptoms. So very confusing all this hrt business and i worry that 2mg estrogen is high as i am 54 and post meno.

Havent tried kilofem but someone maybe along soon who can give you some info. Hold on in there, and do hope you get some relief soon.

Lesley x

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Bette

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Re: 2mg HRT Maximum Dose!!!!
« Reply #2 on: June 26, 2012, 12:55:11 PM »

Hi Tina
Are you post-meno then i.e. were you a year period-free before you started HRT or over 54? If not, I'm not sure that you should have Kilofem.  :-\ Also, it contains the same prog. as Elleste, which was the one which didn't suit you.
It's not true that there are no higher HRT doses but to get higher you'd need to use an estrogen patch (listed here http://www.menopausematters.co.uk/treatafter.php ) and add a separate prog. I think that she was talking about combi HRT where you take the est. and prog. together.
I found that I felt better on the prog. part of my HRT (particularly anxiety) so my gp put me on the mini-pill too. That means that I have some prog. throughout the month but it still drops to stimulate a bleed which I need as I am 52 and still classed as "peri."
It can be a mine-field but there are lots of HRT options. If your gps aren't clued-up on it (I'm very lucky, as mine is) maybe ask to be referred to a meno clinic? They're listed under "Find a Specialist" in the top menu.
Bette x
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If you want a thing done well, get a couple of old broads to do it. Bette Davis.

Tina1957

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Re: 2mg HRT Maximum Dose!!!!
« Reply #3 on: June 26, 2012, 02:30:52 PM »

Hi

Thanks for the replies..
 
Although I have been on conti HRT, I am 54 so I think I would be classed as post-meno now. 

I am so relieved to know that there are higher HRT doses available, as this GP just dismissed the fact, saying that 2mg was the highest and to increase any more would jeopardise my health by increasing my chance of a heart attack!  (My quality of life is very low at the moment, so future health risks are something I'm willing to accept.) 

On checking I see that Kilofem does contain the same progesterone as Elleste -  so maybe it's not even worth trying this. 

My own GP is back off holiday middle of next week - think it might be best to go back and see her, although she is very sympathetic and  helpful to my suggestions, she herself does not seem that clued up on HRT.  What should I be asking for in relation to separate estrogen and progesterone?

If need be I will definitely ask to be referred to a Meno Clinic.

Tina xx
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Hurdity

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Re: 2mg HRT Maximum Dose!!!!
« Reply #4 on: June 26, 2012, 02:59:00 PM »

Hi Tina

Women get different amounts of estradiol in their bloodstream from the same dose of tablet - so maybe not enough is getting through taking it orally - in your case.

If you are wanting to try a higher dose, I would definitely try an oestrogen ( or combi)  patch as others have suggested, especially at your age as the long term risks seem to be lower with patches than pills, aalthough you are a long way off 60 yet!

Personally I would start by going on a sequi product if you do though - because if you go straight onto a conti patch ( ie Femseven or Evorel) - you won't know whether the progesterone agrees with you or not.  Evorel sequi contains norethisterone anyway.

If you want to go for separate oestrogen and prog then go for a small patch like Estradot (I'm biased because this is what I use!). You only have 2 licensed options for seperate prog - Provera or Utrogestan. Utrogestan is the bio-identical one which several of us on here use.

Pity about your GP - you might have to be insistent -  as long as she is amenable to your suggestions!

Good luck

Hurdity x
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paisley

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Re: 2mg HRT Maximum Dose!!!!
« Reply #5 on: June 27, 2012, 03:41:43 PM »

Hi Tina,
        Don't know if it helps but I am on tablet hrt, oestrogen only cos of hyster last May. I take 2mg in mornimng and 1mg in evening. I am on progynova, still don't feel better on this amount. It is normally gynaes who will increase it more than a gp to a higher amount
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Tina1957

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Re: 2mg HRT Maximum Dose!!!!
« Reply #6 on: June 28, 2012, 09:57:23 AM »

Ladies, thank you so much for all the great info!!

I have written everything down and am now just trying to get my head around it all before I see my GP next week.

Am I likely to get a better affect from a Patch than the tablets? 

With the patches, what size patch would I need to be equivalent to 2mg tablet?

If I do need a higher dose in a patch (more than 2mg tablet as I seem to at the moment), would I need to then have a separate estrogen and separate progesterone?

Sorry for so many questions!

Tina
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Hurdity

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Re: 2mg HRT Maximum Dose!!!!
« Reply #7 on: June 28, 2012, 11:22:20 AM »

Hi Tina

Don't apologise - we're on here because we want to share our experiences ( or ask for support/advice)!

The thing is it is impossible to say what the equivalent would be for you re patch vs pill.

As I said before - how much estradiol gets into your blood is very variable and in your case perhaps more of it has been metabolised by the liver and less into your bloodstream?

However, the guidelines on the menu - under HRT preparation give broad categories for low, medium and high dose - and according to this you are on a medium dose tablet, so a medium dose patch would be 50 mcg. There would be no point starting higher than this because it might just be the right dose for you in patch form ie you can't say just because a medium tablet wasn't sufficient, that a medium patch would also be insufficient, if you see what I mean.

The point is about patches/gel is that the oestrogen goes straight into the bloodstream without having to go through the liver so should be consistent - provided it is applied correctly according to instructions, and if a patch - is stuck properly. Levels do not fluctuate as much with patches I understand.

Yes I would go for separates (patch or gel oestrogen) if you can just so that you can easily increase the oestrogen dose if necessary.

When you change to the transdermal method - if that's what you decide, then it will take your body a little while to settle into the new method of delivery so don't expect overnight improvments. I have always used patches and have always been happy with this method of delivery and the dose ( re symptom control).

In my previous post I made suggestions re patches and gave the progesterones available.

Also there are two gels:

b. Gels - are useful if transdermal treatment is the option preferred but skin irritation occurs with patches.

OESTROGEL    2* measures once daily (1.5mg estradiol) increased if necessary to max 4 daily (3.0mg estradiol)    £4.80 for 64-dose pump
SANDRENA    1 application daily 0.5mg or 1mg -dose range 0.5 to 1.5mg daily.    £5.18 & £5.96


That was from the menu on the left

Hope this helps

Hurdity x
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Tina1957

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Re: 2mg HRT Maximum Dose!!!!
« Reply #8 on: June 28, 2012, 01:05:24 PM »

Thanks Hurdity

Your explanation has made it a lot clearer, wish you were my GP!!!

Tina xx
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Sandra

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Re: 2mg HRT Maximum Dose!!!!
« Reply #9 on: June 28, 2012, 01:11:22 PM »

Hi Tina, hope you are feeling better today, Eestrogen dominance caused anxiety and depression in me for years, prior to menopause I used to have Cyclogest (progesterone) to balance the dominance. Now live in Spain, past the menopause but still having crap times although no longer on HRT, thinking I may go back on it but Doctor over here says that the sun combines with Vitamin D to produce extra Eostrogen so it could be that your symptoms are caused by the dominance.......don´t know if that helps.
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