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[Kathleen]

Hello ladies. I haven't posted for a while although I've been looking at the forum most days.

After a horrible weekend of palpitations and anxiety I've decided to try HRT again. I am 57 and haven't had a period for three years. I tried Climesse last year but it didn't suit me so the GP gave me Evorel 25 patches and Utrogestan 100. I put on my first patch yesterday and took a Utrogestan capsule last night. My question is, does the ratio of hormones seem right to you? I can't understand why the Evorel is 25 and the Utrogestan is 100, does that mean I'm getting four times more progesterone than oestrogen or am I missing something. Also I've been told to take the Utrogestan for twenty five days and then expect a bleed, again is this right do you think as I'm post meno. I tried to talk to my GP but he has left the surgery and the earliest Drs appointment they could give me is in a month's time.

I'm feeling a bit lost and quivery at the moment, I seem to feel better for a short while then crash and feel terrible again, just sick of this whole business really.  I'm hoping someone can advise me on this HRT combination, I would like to feel confident that I'm doing the right thing.

Thank you so much for reading and best wishes to meno ladies everywhere!

K.

P.S I haven't seen any posts from Mags or Bev lately, does anyone know how they are doing? Perhaps they are in touch by PM now.

[Dancinggirl]

Hi Kathleen
This is a good HRT regime you have been given.  You've been given low dose of both and as Stellajane has said you can probably take the Utrogestan continually if you wish - you would probably have to check with the doc about that. This low dose regime may take a little longer to kick in and give benefits as you are very post meno and your base line hormones will be starting at a very low level - it takes time for the body to build things up.
Hurdity, who uses this HRT combo but in a sightly different way, may be along with some advice - she's great on this one.
Keep us posted about your progress. Good luck.  DG x

[Diamonds and pearls 53]

Hi Kathleen, I have recently been put on the same dose as you except I'm on Estrodot 25 mcg and  Utrogeston100 mg..I have just restarted hrt too after a reluctant break whilst some bleeding was investigated ( all normal,thankfully) and  this  is my first try at patches and separate progesterone.I am post meno at 60, so wasn't sure what to expect during the 3 day break(G.P didn't know) and this is only my first month of taking it -but no bleed has occurred. I am not sure how the ratio of hormones works out to be honest, but this appears to be the standard dose for conti hrt on this regime. I am feeling better already, though not sure whether I may need a little more oestrogen as am still getting some flushes but the emotional turbulence I was struggling with is definitely better.
Do hope you feel the benefits soon..good luck!

Diamonds and pearls x 

[Sarah2]

You won't be able to take less utrogestan unless you take it just every 7-10 days. There are some specialists who are happy for women to take 200mgs just 7-10 days either monthly or every 2 months. This will usually result in a bleed.

You can't compare Utrogestan with other progestogens because it's harder to absorb and is bio identical, so you need more if it to do the job!

You need to see how you feel on your new regime. You might need a higher dose of patch, or with your dr's agreement, reduce the Utrogestan- though I have the impression that GPs are very conservative with this whereas consultants are happier and more confident in adjusting dosage per patient.

I use gel rather than a patch and one of the bonuses is that you can alter the dose very easily either daily or weekly until you find the right dose to keep your symptoms at bay. You can use anything from 1 pump- which is 0.75mgs to 4 pumps which is 3 mgs and would be a patch of 50mcgms i think.

[Hurdity]

Hi Kathleen

I don't have much to add to what has already been said except just to say the numbers mean nothing when compared - you can't compare the oestrogen to the progesterone just from that!

Oestrogen patches are measured in the daily dose so Evorel 25 delivers (on average) 25 mcg of estradiol per day into your system.

As has been pointed out Utrogestan only comes in two doses - 100 mg or 200 mg (1 mg = 1000 mcg) and is designed to give enough to oppose any thickening of the womb lining stimulated by the additional oestrogen. Yes it is unfortunate that it is one size fits all, and I would say that 100 mg on average - is too much for 25 mcg oestrogen. It won't do you any harm - I just don't think it's needed and may give rise to a few pms symptoms.

I agree with Stellajane I very much doubt whether you will get a bleed after the 25 days so whoever gave you that information is wrong. It is designed to be a continuous dose but I think the 25 days/28 has been given just in case there is any thickening, which would be shed on or after the "days off".

It is common to experience some spotting when re-starting HRT after some time off it as your body settles.

If after 3 months you have no problems, you might like to try every other day - but it may a question of try it and see - and this might not be sufficient to maintain progesterone levels to prevent thickening. Each woman is different, and especially in how much of the progesterone gets into the system after taking it orally. I do know women who do this vaginally (every other day), but not orally.

Sarah2 - it's quite difficult to compare gel and patch dose due to how the data are presented but I understand that the standard post-meno dose of gel (medium) is 2 pumps Oestrogel and this is approx equivalent to a 50 mcg patch, or slightly more maybe? Happy to be corrected on this one if you have further info.

Hurdity x

[Kathleen]

Thank you so much ladies for your helpful replies. I feel reassured that I'm doing the right thing.Unfortunately my computer has packed up so I'm typing this on my phone which I find a bit tricky and that's why it's a short message. Just wanted to say how much I appreciate you taking the time to reply. Wishing you all well.K.

[Sarah2]

I don't know how 1.5 mgs Oestrogel compares with patches myself, other than another member said here on another thread that her dr told her that 2 pumps ( 1.5mgs) equated to a patch of 37mcgs.

2 pumps is not a high dose because the lowest oestrogen-only  pills start at 1mg and the next 'medium dose' is 2mgs, rising to 3mgs being classed as 'high'. I'd always considered 2 pumps to be in between low-medium from the menu on the left.

[Lilyloos]

Hi there
Was comforted to read your post re. being post menopause but still have periods where you have palpitations which cause anxiety.  I too have been period free for 3 years, and I am again suffering with palpitations and anxiety.  These always happen in the early hours but recently they happen through the day at odd times.  I came off hrt Climagest 2mg and then down to 1mg.  When palpitations started I went back onto hrt but GP put me on Premique low dose which is only .35mg oestrogen and higher progestogen (combined).  I have been on this for about 6 mo this now, but not sure if there's enough oestrogen in there for me.  This is my first post on this site, so if I've posted in the wrong forum topic apologies!
Would welcome any suggestions from anyone out there who has/is experiencing the same, it's so isolating ...... X

[Dancinggirl]

Hi Lilyloos and welcome
Can I suggest you start your own Thread so more people will read your posts.
Premique is very low dose and one of the older style of HRTs.  Maybe try Femoston Conti - there is a 1mg or 2mg version - which has a progesterone that is very well tolerated.
What makes you think you need a higher dose? If you are very post meno it could take some time for the oestrogen level to build up in your body.
It could also be good to try Oestrogel with a separate progesterone like Utrogestan which means you can adjust the dose according to your requirements.  Many GPs are not up to speed with the different tyres of HRT so you may need to print off the info from the section to the left of this screen - under HRT Preparations. They would need to give you the Oestrogel and progesterone separately.
Do you have a menopause clinic in your area or could you get a referral to a gynae?
Do start your own thread then others will be along with advice.  DG x

[Lilyloos]

Thank you Dancinggirl! 
I will start my own thread, wasn't sure how to lol!  I just wondered if increasing the hrt would help reduce the palpitations, they are the most frightening thing of all at the moment.  X

[Dancinggirl]

Hi Lilyloos
If you look at the list to the left of this screen - click on Forum - then choose 'All things menopause' - to the right top hand corner above 'Last Post' there is 'New Topic' - click on 'New Topic' and fill in the fields.

I had a break from HRT post meno and when I went back on HRT it took a few months for the palpitations to settle. Some ladies need a beta blocker to help with palps so that could be worth discussing with your GP?  They can be scary but are very common in post meno.
Do your post and see what others recommend.
DG x

[Lilyloos]

Hi dancing girl,
Thanks for your reply I was prescribed beta blockers, just a small dose, but didn't want to take them incase I was on them forever.  My GP doesn't seem that knowledgeable about menopause, or to be honest that interested, he thinks most of my symptoms are anxiety.  I am anxious because I know what I am feeling is not 'normal' for me, and worry GP is missing something.  I ended up going to a and e early hours one morning as my heart rate was so fast..... I think if GP had said it's all very normal and very common in menopause I wouldn't feel so bad about them.  I have started taking beta blockers at night for the last few nights, and so far so good so if it keeps them at bay for a while it might break the cycle.  So far no other replies to my new topic, but huge thank you to you for reassuring reply! LL x

[Dancinggirl]

Lilyloos
Palpitations are very normal for menopausal women and beta blockers can help so I think you are wise to take them.
I would try a different HRT as Premique has a progesterone that often gives PMT type symptoms which probably won't help the anxiety.  Perhaps try Femoston 1mg as the progesterone is kinder and well tolerated by many women - just ask the GP to change to this and print off the info from the HRT Preparations section so show him if need be.  You could explain you were advised to change by friends because you had heard that Femoston has a better progesterone?!
If you aren't getting hot flushes and night sweats you shouldn't need a higher dose.  As you get older you should try to keep to a lower dose anyway.  DG x

[Hurdity]

Hi Lilyloos

What a pity that your doctor is not well informed and that he is giving you medication (beta blockers) to treat one symptom (palpitations) when changing HRT might help with this and more including anxiety - another well known menopausal symptom.

I agree with Dancinggirl that you would be better off trying a different HRT and Femoston would be a good one ( for tablet HRT).

You haven't said how old you are - and this will make a difference in terms of dosage - the younger you are the higher dose of oestrogen is generally taken, and especially if you are under 51/2 - the average age of natural menopause in UK.

Hurdity x

[Lilyloos]

Hi Hurdity
Thanks for the reply.  Am coming up to 54 so would expect low dose Femoston may be ok for me?  Am seeing GP on Thursday so will see how I get on, just want to feel more normal than I have done for a long long time.
Really appreciate your reply LL x