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[Kathleen]

Hello Ladies, can you help me please?

I have a GPs appointment tomorrow to review my HRT but I would appreciate your advice beforehand.

I am 57 and haven't had a period for over three years, I tried Climesse tablets last year but they didn't suit me so in January I began using Evorel patches and Utrogestan. I continue to  struggle mood wise and I still have flushes, especially in the morning though not a night. I started with 25mg patch then increased to 50mg but when I had nausea I went back to 25mg. I also took the Utrogestan orally but have been experimenting with using it vaginally.

I guess part of my problem is that I've fiddled around with dosage over this last 6 months and sometimes I think that is just adding to my confusion about what is and isn't working.

My question for you ladies is should I have seen more of an improvement by now especially as far as the flushing goes? A lot of women say they noticed a reduction in these very early on but moods took longer to improve. In my case things may be taking longer as I am post meno or it may be I need a higher dose patch and should try using 50mg again.

Sorry to go on but I value your opinions and like everyone I'm just trying to find the right mix of hormones in order to feel normal again.

Wishing you all well and thanks for reading.

Take care.

K.

[Limpy]

Hi Kathleen, If you are changing doses that may be why it is taking time to settle down, but I would have thought the flushes would have improved by now.
Have you considered the conti patches which combine oestrogen with progesterone?

[Taz2]

Hi Kathleen - I need a 50 patch to keep hot flushes/sweats at bay. Any attempt at less brings back all the symptoms.  My flushes disappear within forty eight hours of using the 50 patch. I would say that 25 is not enough for you.

Taz x 

[Suzyq]

I agree with taz - sounds like you need 50 - it will take a few days to get over the side effects of an increase but maybe give it a go

[Joyce]

Sounds like you need higher dose. Assuming you get higher dose, stick with it, rather than changing doses. It takes a wee while to find the optimum level sometimes. 

[Shazzie]

Hi Kathleen

I too am on Evorel 25mcgm as I cut the 50mcgm patches in half.  I, like you, still get the odd flush and palpitations and sometimes wonder if I should up it again to 50mcgm.  I am much much better on half a patch then no HRT at all.

It is really tricky isn't it getting the dose right.

Hope you get an answer soon.

Shazzie xx

[honeybun]

I am on Evoril conti and cut the patch in half. I manage ok on this but a couple of months ago I changed back up to a full patch. I felt really weird, jitterery, ill at ease and sick. I'm sure if I had persevered it would have settled but I don't think my body needs the full amount.
My flushes are controlled but poor sleep and night sweats are still a bit of an issue.
My anxiety is rubbish at the moment but HRT has had no affect on that anyway.

I would say you need to pick a regime and then stick to it no matter how tempted to fiddle and tweak things. You need to give a new regime time to settle because if you keep on changing you loose sense of what works best.


Honeyb
x

[Hurdity]

Hi

I agree with the others re the dosage

I went onto HRT at just under 54, during peri-menopause but very infrequent periods, and started straight away on the 50 mcg. Apart from a few brief times I have been on 50 mcg ever since and is the only dose which keeps my flushes totally at bay.

I came off it for 3 months in 2011, but flushes came back. I then went back onto 25 mcg which dealt with the flushes for a short while but then they crept back so wwnt back up to 50 mcg. Last year I went down to 37.5 mcg for a couple of months and again the flushes came back so I am on 50 mcg again and absolutely fine (age 61). (I am on a long cycle  - 12 days utrogestan every 6-8 weeks followed by bleed).

Yes I agree you should stick to one dose - any nausea due to increase in oestrogen should dissipate very quickly. If the nausea is due to the Utrogestan then vaginal use is supposed to minimise this. I presume you were taking it at night before bed? Also that you are on a continuous regime?

Any changes on dosage of either oestrogen or progesterone can cause mood changes. Once your bosy has acclimatised to the dose and regime you are on you should no longer get mood swings. However continued low mood could be due to either:  too low an oestrogen dose; taking progesterone continuously (it has a sedative and sometimes depressive effect in some women, especially at high doses); or low tesosterone - although this is not generally recognised and rarely tested on NHS.

I think the first thing to do is get the oestrogen dose right - which should be at the very least, the minimum needed to prevent flushes. I would say this is 50 mcg! if the progesterone continues to cause problems then you might be better off on a cycle (which would give you a bleed) but not many women like the idea of this, and doctors are less happy with a longer cycle - which would be beneficial if you have problems with progesterone.

A bit long-winded answer but hopefully helpful!

Hurdity  x

[Kathleen]

Hello ladies and many thanks to you all for taking the time to reply.

I keep thinking that I really need a 50mg patch but when I used this dosage I felt nauseas so stopped, maybe I should have persevered. I am also mindful of the fact that at 57 I am closer to the age when women are pressured to give up HRT altogether so I hoped the 25mg patch would be enough to help me and, as it is the lowest dose, I would be allowed to take it beyond 60. Ho hum.

I am using Utrogestan vaginally at bedtime for 25 days and then leaving a gap of a few days before resuming. I am not having a bleed though. I read on the forum that vaginal use is not licensed in the UK so is everyone using the oral tablets or have you managed to get hold of some suppositories?
I will ask my GP tomorrow and will let you know he says.

Once again thank you ladies for all your comments, they have helped me so much, especially as I'm struggling today ( it was murderous irritability yesterday replaced by anxious jitters today, jeez, this is annoying).

Wishing you all well and take care.

K.
   

[honeybun]

You won't get a bleed using utrogestan 25 days a month. That's considered a conti regime so no bleed is necessary. I take it is the 100 utrogestan that you are using ?.

If you wanted a bleed then you would only use the utrogestan for a week a month but double the strength. That would trigger a bleed.


Honeyb
x

[Hurdity]

Hi Kathleen

It;s the same product but just used vaginally. It is licensed for use vaginally for fertility (same product), and elsewhere eg France - for HRT. There has been lots of research on it and many gynaes and docs who are clued up are perefectly happy for vaginal use.

Some research has shown that a lower dose is needed when used vaginally. The monthly dose is actually 12 days for oral use, not a week, but as I use it vaginally I use the 200 mg for 12 days every 7-8 weeks and I think this is OK (supported by GP).

There are progesterone pessaries/suppositories - Cyclogest - also used mainly for fertility treatment - and not licensed for HRT. I used to use these ( doc prescribed them) but I found the dose too high and gave me migraines (more often than I get them now).

It's a pity that Utrogestan is not also made in 50 mg doses since I am sure daily vaginal use at this level might be sufficient. Some women have used the 100 mg vaginally every alternate day with low/medium doses of utrogestan and I seem to remember a preliminary trial showing that this did not lead to endometrial build up.

As always there should be far more work going on in this area but I doubt it will happen due to big pharmas and all the synthetic stuff that is on the market.

Hurdity x

[Kathleen]

Hello Hurdity and thank you for your very informative post.

Can I just ask you to clarify something? When you say that it's the same product just used vaginally are you referring to the little circular capsules that are in a blister pack? This is what I've been using even though it says on the packaging that they are for oral use only. I just want to be clear on all this before I see the doc tomorrow.

Thank you so much for your help, truly appreciated.

Take care.

K.

[Kathleen]

Hello ladies.

I just want to update this thread by saying that I saw my GP today and decided to  persevere with using Evoral 50mg patches and Utrogestan 100mg orally. We agreed to review in three months.

My doctor is a delightful young man and  very helpful.  He mentioned that menopause is difficult to treat and also to study as the effects are so varied. We also spoke about using Utogestan vaginally and I will post separately on that issue.

Thanks again ladies for your comments, they really helped prepare me for my appointment.

Wishing everyone well.

K.

[Hurdity]

Hi Kathleen

Sorry not to reply - I wasn't on the forum after that. if you want to ask something specific to me do just send a pm as this will come through on my phone which I check more than logging onto the forum!

I see you've been to the doc - but yes it's the same stuff - blister pack - slightly oval capsules cream coloured - just standard utrogestan. I don't get anything from any other source than NHS precriptions! If I lived in Aus I would send away for it as it's not available there.

Hope things improve for you

Hurdity x