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[Jane 70]

So confused!  I'm 2 years post periods and have been started on everol conti which I know is fine but I'm 44 and wonder if sequi would be better.  I think I am correct in thinking that if you have an oestrogen only patch you are less likely to get breast cancer but seeing as I've still got a uterus I need to have both hormones. From what I have read it seems to be the combination that increases the chances of getting breast cancer. That is why I'm wondering if the sequi would be better as I will only have progesterone for 2 weeks as opposed to 4.  Would be very grateful to hear from anyone who may have seen a specialist and knows the answer or am I worrying unnecessarily.
Thanks x

[Dancinggirl]

Hi and welcome Jane 70
You obviously have a good understanding already having done some research. It's worth reading all the info under the headings to the left of this screen - this site gives fab info.
Firstly, your breast cancer risk when using HRT is extremely tiny up to the age of 60.  Up to the age of 53-54, when you would normally have your menopause, it is actually very important to have HRT to protect your heart and bones.
As you have been diagnosed as post meno because you haven't had a period for over 2 years, conti HRT is absolutely fine.
There are many HRT preparations on the market and it's a matter of finding the right one for you.
It tends to be the progesterone that causes side effects and norethisterone(Everol has this) can give PMT type symptoms.  In patch form some find side effects are generally less but every one is different. However, many women like to use sequi HRT, even when post meno, because it reduces the effects of the progesterone but, of cause, you have to put up with a withdrawal bleed!
Perhaps give the Evorel a go for 3 months and see how you feel - do be prepared for a bit of bleeding in the first few weeks.  Then get back to us for advice about other options if you are not happy.
I tend to suggest Femoston as it has a kinder progesterone and is well tolerated by many women.
Keep posting  Dg x

[Jane 70]

Thanks Dg 
That was very helpful and reassuring. I've delayed starting HRT for many years due to risk of breast cancer, my symptoms started when I was 35! Having finally given in, I feel much better. The reason I wanted the patches was to reduce the side effects, do you know if patches can be cut?  I want to keep HRT to a minimum whilst still keeping my symptoms under control. I can't seem to find any information on this.... I'm still learning, and although my GP is lovely she doesn't have these answers.
Thanks x

[Dancinggirl]

Jane 70
I do feel you are worrying unnecessarily about the breast cancer risk - did your doctor not explain that with using HRT there wasn't any additional risk of breast cancer till your late 50s -60? Even beyond 60 the benefits of HRT can often far out way the risks. You doctor should have explained the importance of using HRT to protect you and reassure you that additional breast cancer risk was nil.  In fact you may have done more damage to your body by not using HRT up till now because oestrogen deficiency can cause long term problems with bone density and heart disease. I think a DEXA scan would be a good idea to check how your bones are. You are totally doing the right thing by using HRT.  As you are post meno and your oestrogen levels will probably be very low, the medium dose you have been given is probably very appropriate. You may find you feel a little strange while your body adjusts and welcomes the oestrogen but I wouldn't start mucking around with cutting the patches up at the moment.  It is good to keep to a fairly low dose but every women is different so getting the right level of oestrogen can be trial and error. 
I had a premature menopause - it started in my mid 30s and my GP actually insisted I take HRT.  I had to try a number of different preparations but eventually used Oestrogel with separate progesterone pills on a sequi basis for many years. In my 50s I had a Mirena fitted and used Oestrogel as this gave fewer side effects. Oestrogel gives you more control over dosage - you can start very low with one squirt per day and go up to 4 squirts if necessary - I only ever went up to 2 squirts per day.
Look under HRT preparations for more info.  http://www.menopausematters.co.uk/treatment.php
If I were you I'd try the patches for 3 months. If you are not feeling they are right for you then try Femoston sequi - either 1/10 or 2/10 - the oestrogen is bio-identical like most preparations now but the progesterone is very similar to our own so quite kind and well tolerated. It is very important you find the right HRt for you, as you are young and need to use HRT for at least 6 years. You won't believe how much better you feel once your hormones are back on track - your poor body has been starved of oestrogen for too long.
See how you go with the patches and keep us posted.  DG x

[Jane 70]

Hi Dg
Unfortunately my GP explained very little, she remained completely impartial and said the decision was up to me. It's only recently that I have realised the importance of HRT in protecting against CVD hence finally starting on it. Thanks for all the advice, I really appreciate it, I will see how I get on over next few months but it's good to know there are other options. Xxx

[Dancinggirl]

Good luck.    DG x

[Jane 70]

Oops,  Just realised I posted my question in the wrong section....... Looks like the HRT isn't helping with the brain fog yet...... !!

[Hurdity]

Hi Jane70

 

Dancinggirl has helpfully given you most of the information you need. I just want to add have you read the information on this site? The menu on the left - summarises a lot about risk and cancer, age etc The sub-tabs - especially under HRT (second heading down on the green menu) are very helpful eg balancing risks and benefits here:
http://www.menopausematters.co.uk/balance.php

If you look at the scales for age under 50 you will see that the official view is that the benefits exceed the risks. I agree that you really need HRT! I wouldn't cut the patch - you are incredibly young to be having HRT and I would want at least a medium dose of 50 mcg (patch) which is what you have at the moment.

Personally I would definitely stay on patches in the long term, but as Dancinggirl says you may need to change if the progestogen disagrees with you.

Firstly it is usually better in my opinion to start with cyclical HRT wherever you are in menopause because then you can determine whether the progestogen is causing the problem - but of course the disadvantage is having a cycle and the hormonal fluctuations ( in progesterone) - and therefore pmt - that comes with that.

So if you stay with patches you would be better off eventually with a separate oestrogen and progesterone ( micronised progesterone - Utrogestan) because the combi patches have synthetic progestogens that can cause side effects.

Incidentally it is increasingly being thought that the effect on the breast differs according to whether synthetic or "natural" (ie bio-identical) progesterone is taken. I don't have the research info to hand. All the risk statistics quoted are from studies using synthetic oral progestogens and equine oestrogens.

In your case, as you are young, and had an early menopause http://www.menopausematters.co.uk/menopause.php I would go for as higher dose as I can cope with - re progestogens - because higher oestrogen doses require higher progesterone doses to shed (or protect) the womb lining.

I am 61 and use Estradot 50 mcg patch with Utrogestan 200 mg for 12 days every 6-8 weeks ie still have a cycle and bleed and I have been using HRT for over 7 years now.

I hope this isn't too rambling!

Hurdity x

[Jane 70]

Hi hurdity

Thank you so much for all the info, I have been doing some more reading and I quite like the idea of natural progesterone. I've just started the sequi having had the conti for 3 months, i feel happier only having progesterone for 2 weeks instead of 4 so will see how that goes.

Jane xxx

[Hurdity]

The "natural" progesterone is the one I mentioned - available as micronised progesterone and marketed as Utrogestan. Here is the info:
http://www.menopausematters.co.uk/to_progestogens.php

Hurdity x