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[Sassyt]

Hello all,

I had to have a total abdominal hysterectomy in March 2012 aged 35 due to severe endometriosis (my surgeon said it was the worst case he'd ever seen!) ovaries and even my appendix were removed.
I was prescribed Evorel 50 as soon as I was released from hospital and have been on them ever since.

Without going into too much detail and making this post a novel I suffered a nervous breakdown in February of this year after my partner left me for someone else. I was already on Fluoxetine for depression but the breakdown has also introduced severe anxiety. I became too scared to leave the house, to answer the phone, or indeed to use the phone and completely hid away and shut down.

Although I am slowly recovering now a lot of these symptoms still remain, because of those symptoms I made a mistake and forgot to re-order my patches and have been too scared to get to the doctors to get a prescription so have been without for 2 weeks now.

The thing is, since I haven't been using them my anxiety symptoms have lessened, my energy levels have increased a little (I suffer from ME so this is a big deal!) and I've felt more motivation and got some jobs in the house done that I have been too overwhelmed to even start since my breakdown. So now I'm in limbo as to whether Evorel are suited to me and I should maybe ask my GP for something else but I don't know if brands make a difference, or it could be a dosage issue?
I do have to be on the smallest dose as possible though as I have had a DVT previously so wary of an increase in dosage and my GP was reluctant when I discussed it before as I was still suffering from severe hot flushes.

Just wondering if anyone has had similar and what happened? I do feel well enough to get to my GP this week but I wanted to ask for your opinions and experiences on here first to help me decide whether to just get a repeat prescription or ask for an alternative.

Would love your thoughts, thank you

[Hurdity]

Hi SassyT

Sorry to hear about your health issues.

I am wondering if the endometriosis was just confined to your uterus & ovaries, which is why you haven't been given a progestogen to restrict its growth elsewhere in the body?

This is what it says on this site:
There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.
http://www.menopausematters.co.uk/atoz.php#GlossE

Regarding the increase in energy after stopping the patch - this does puzzle me! Evorel 50 is quite a low dose of oestrogen for someone of your age and especially if you were still suffering from flushes. Usually oestrogen should help with low mood and anxiety - but you need to have sufficient. Maybe it interacts with the other medication you are on?

Also if you had a total hysterectomy then your testosterone levels will also have dropped dramatically and this can affect mood and energy. There is some information about this on this site here:
http://www.menopausematters.co.uk/testosterone.php
http://www.menopausematters.co.uk/aftermeno.php (scroll down for the bit about testosterone)

DVT is mentioned here and you will see you are using the transdermal mode of delivery as recommended.

Since HRT is associated with a small increased risk of venous thrombosis, care must be taken when considering HRT use in women with a past or family history of thrombosis. Depending on the indication for HRT and on the cause of the thrombosis, risks and benefits should be assessed. If HRT is to be used, preference would usually be given to the transdermal route (patch or gel) [ref 22]. Specialist advice should be requested. Vaginal estrogen may be used for treatment of vaginal and bladder symptoms.
http://www.menopausematters.co.uk/atoz.php#GlossT

I wonder if you could ask to be referred to a menopause clinic especially in view of your age and medical history - so that you could have access to more specialist advice and treatment than your GP can give? There may be one near you. This is where you look:
http://www.menopausematters.co.uk/clinicfinder.php

I use Estradot which suits me fine - the patches are very small and stick well - however the oestrogen is the same as in Evorel.

I hope this helps and good luck with your doctor.

Hurdity x