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[Lin]

Firstly, hello everyone.
I am 46 and have been menopausal for 2 years. My gp put me on Estelle Duet 2mg. All was fine until October last year when i started to get night sweats, hot flushes again like i had prior to taking HRT. At my review i mentioned this and was swapped to Premique 0.625mg/5mg, oh dear what a mess. I felt (without wanting to sound dramatic) practically suicidal. I went back and asked for my old ones back which they gave me, better the devil you know was my thought at the time. My question is this, i was asked for the first time about bleeds. I have had none since my last 2 year ago, no spotting, nothing. Is this normal? Should i have a bleed at the end/start of packets? Also i must mention, Gp also had me on prozac for first year of menopause as my brother was teminally ill, do you think this was reason HRT was so effective initially? If i was pre menopause i'd have half a chance at figuring this out. Rolls eyes. My head is a mess and scared to raise anything with gp in case they put me on something that made me feel the way Premique did. Can anyone advise?

[Dancinggirl]

Hi Lin and welcome to MM
OK - we need you to be a bit more specific about your menopause history.  Is it Elleste Duet (1mg estradiol with Norethisterone) you are on?
Am I right in thinking you were diagnosed as peri menopausal a couple of years ago?  In other words you were still having occasional periods or your periods had only recently stopped?
Your hormones will have dropped over this time and in fact the HRT you were given may have been too low all along and that is why you were not getting any breakthrough bleeds.  You should have been getting regular bleeds but maybe you were on such a low dose your uterus wasn't building up so there was nothing to shed?!!!  I'm not an expert but that may be the reason there was not bleed - others maybe be along to advice about this.
The reason your flushes are re emerging is probably because your own hormone levels have dropped and you need more oestrogen.
You may well just need a higher dose HRT.  Premique is a very old fashioned HRT (happens to be the cheapest) - this is also very low dose.  I'd ask for a higher dose HRT like Femiston 2mg - Femiston has a kinder progesterone and is better tolerated by many women.  There are so many options.  Do read up all the info under the headings to the left of this screen and particularly HRT Preparations.
You are too young to be without enough oestrogen to protect your heart and bones so it's important you get the right HRT for you.  Perhaps ask to be referred to a meno clinic or gynae?
DG x

[Lin]

Thank you for your reply. I am on 2mg. i am due another review next month so will have it out with them then. I've been under the local gynae for several years prior to my menopause for excessive bleeding, looming menopause was ruled out, lol. Gives me no faith whatsoever. So if i am on 2mg i really cant go any higher can i? My thoughts is maybe trying a different 2mg brand like Femiston. Once again thank you, its a minefield of info and my brain is a complete fuzzy puddle at the moment. 

[Dancinggirl]

Hi Lin
You may need to have them check your thyroid as this can start to play up around the meno and can cause sweats etc. Also, have they done an oestrogen level test recently to see where you are - even when on HRT this can be useful - knowing the amount of oestrogen you are taking should tally with the amount present in your body. It could be worth coming off everything for a month and then having a blood test to properly access things. I did this when I was 40 (i was peri from my mid 30s) and though I didn't feel too bad through this 4 week break the blood test showered I was well into peri meno.  If you are using a sequential HRT you should be getting a withdrawal bleed each month!!!
I would definitely try a different HRT - Femoston has a kinder progesterone and is well tolerated by many women.  There are other options - do read up under HRT preparations to the left of this screen. Another alternative is the bio identical route which involves using different oestrogen options(gel or patches) and a separate progesterone called Utrogestan.
I hope you have a good GP who will guide you through this - if not do ask to be referred to a gynae or meno clinic.
BTW many ladies on here are on ADs as well as HRT and I doubt in affects HRT that much.
 DG x

[Lin]

Still not getting anywhere. I've now been on femoston 2mg for 3 months. Still no bleeds, still getting night sweats and now facial hair. I went for a review with nurse (thats how it works at my gp surgery) I told her still getting sweats etc an she told me ..and i quote... " what i know about hrt i could write on a postage stamp, maybe you need anti-depressants. " I don't feel depressed, i only said i still had night sweats and now facial hair for gods sake!!!! Never even said it was getting me down etc ( which it is) So i left her room with another prescription for femoston and went straight to the counter to make appt with my gp.  There tomorrow now to see if they can sort this. Going to demand bloods etc coz i'm so so fed up of it tbh. Just thought i'd update you.

[Dancinggirl]

Maybe ask for a referral to a Meno clinic or gynae.   The nurse suggested ADs because some women find they help with sweats.  Do read all the info under the headings to the left of this screen - you can print stuff off if need be to show the GP. DG x

[Hurdity]

Hi Lin

Well fancy the nurse saying that!!! Surely she should not have issued a repeat prescrption in the circumstances and recommended for you to see a doctor?!

Did you get your thyroid levels checked to rule this out as contributing to your problems?  Also some women do not absorb tablet HRT so well and you might find that transdermal oestrogen (patch or gel) along with micronised progesterone (Utrogestan) is better for you. As far as I know it doesn't cause hair growth (but I stand to be corrected here....) as it is the least androgenic of all the progestogens.(androgenic = male type effects eg hair loss on head, hair growth on face, spots etc)

Oh I've just noticed Dancinggirl has already recommended this back in April! Yes I agree with her about the meno clinic if your GP is not sufficiently knowledgeable.

Hurdity x

[dht240]

Hello Lin,
Good luck with your doctor's appointment today. I hope he/she is more understanding.
I am only at the very beginning of this journey, but have found in my doctor's surgery there are two doctors with a 'special interest' in gynae. Both have specific qualifications for this. Perhaps worth finding out if you have a local doctor who can help?

I am seeing one of these doctors today - and having blood tests too. I'm 44 and they've already mentioned HRT.

All the best for your appointment. I hope all goes well.
DHT
x

[Lin]

Thanks everyone for advice on this, i really appreciate it. x My Dr appt went along the lines of....maybe you are post menopausal and over the worse so maybe you dont need HRT. So off i went empty handed. Well that went down terribly. Night sweats were unbelievable, no sleep since. I feel like a zombie. So rang surgery last week and asked who was best equipped to handle my problems. I got told nobody specifically so probably best to see same gp as one that advised having a break. I have been put on Elleste duet conti 2mg. As i have explained b4 i was really exhausted and just grateful to have any hrt at this point. Now 5 days down the line & a couple of hours more sleep ( combinded with using some annual leave to rest) i have just realised i have been given a constant dose of the pills i originally said wasn't agreeing with me. I could scream. I have now made an appt with the head Dr at surgery for Thursday and if i'm being honest i dont know what to say to him re my progesterone intolerance? I'm sorry if this sounds like i'm not doing my homework but i really am not understanding the concept of hrt and hormones, i find it very confusing. Any advice?   So this is my plan and please feel free to tell me different. .... Ask dr why if i wasnt agreeing with the prog for half a month why having them for a whole month seems like a good option? Can i try patches? Can you please test my thyroid? And finally any chance of being referred to someone who knows about this if you dont? Does this sound right? Thanks in advance. P>S  Dear DHT i hope you coping better than i am, lol. x

[Millykin]

Hi Lin
I no expert 44 and peri, but I'm sure when you are classed as post meno you move onto conti which has prog in it every day but lower dose which doesn't cause a bleed but stops lining build up where as in peri you take it for 2 weeks at higher dose to cause a bleed. Maybe Otis the elleste prog you can't tolerate so maybe ask for Femoston conti as someone said it is more natural. I'm sure someone in the know will be along soon to put you right. Hope it gets sorted, hope I've helped a bit!
X

[Millykin]

Also if you look at HRT preparation you are on high dose so maybe a lower one would be better, it's says post meno you need a steady supply of oest/prog so that's why you take it every day, yours might be too high.
X

[Dancinggirl]

Hi Lin
When you see the GP again I would ask for Femoston sequi 2/10 - the progesterone in this HRt is kinder and closer to our natural hormones and is tolerated well by many women.  If you are post meno then you certainly can have conti HRT but many of us choose to stick with sequi regime to reduce any side effects the progesterone may bring.  Some women even report they feel better on the progesterone+oestrogen stage of Femoston!!!!!!
It is all very confusing - do read up all the info under the headings to the left of this screen as it helps you to be really clued up.  You can always print off the sections under 'HRT Preparations' to show the GP if need be.
Good luck   Dg x

[Millykin]

If it's any help I certainly feel better on oestrogen / prog stage.
M x

[Hurdity]

Hi lin

I agree with Dancinggirl.

It is far better to start any HRT regime on a cycle so that you can see whether you can tolerate the progestogen or not. In fact some docs even like to give women longer than 2 weeks on the oestrogen only when they first start to make absolutely sure.

If you turn out to be progesterone intolerant - or at least to that particular one then you will know what to change.  If as some find, they can tolerate the progesotgen without side effects (and just get normal pmt/pms during the last bit of the cycle (which is the first stage of the oestrogen only tablets before the bleed) - and you are post-menopausal, then you could try Femoston conti.

Looking back at your post also if you need a higher dose then this can be achieved easier through transdermal oestrogen ie patch or gel - along with separate progestogen or a combi patch. Some women do not manage to get high enough levels of estradiol into their system from tablet HRT - the amount lost to digestion/metabolism through the liver varies between women.

I agree that you should also get thyroid tested and in fact that should be done on any woman having blood tests around menopause.

Hurdity x

[peegeetip]

Hi Lin

do you have any sweats or flushes during the day? (when your on your 2mg HRT's)

If you don't have them during the day then its working.

If your getting them overnight only then it sounds like your running out of estrogen by evening / overnight.

You need an option to allow you to split your dose intake over the morning and then again in the evening.

If you have a 2mg tablet then you could try taking half in the morning and then half in the evening.

Alternatively take your HRT in the afternoon/evening and see if the overnight sweats and flushes disappear.

Hope that helps you.