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[Briony]

Hello, desperate newbie here!

After two years of hell, I am so relieved to find this site (recommended by a friend). I'd really appreciate your advice with the following dilemma I have regarding which HRT route to follow.

I'm 42 and following years of irregular periods, at 40 I suddenly developed terrible pains in my arm, mid back and ankle along with tingling in my fingers and some numbness. MRIs and visit to spine and neurological specialists found nothing. My GP was convinced it was anxiety and put me on Cymbalta (which was hell in itself).
 
Over the next 12 months, the pain eased and my periods came back more regularly (probably because I didn't feel well enough to exercise as much as I used to). At the same time, I noticed I was becoming more withdrawn and kind of lost confidence in myself - very out of character. Worse, my every 35-49 day periods seemed to coincide with days (weeks even) of horrible nausea, burping, sore boobs (sorry tmi!) and debilitating fatigue. I also get weird 'cold moments' and a crawling feeling across my shoulder, like it has ants on it at random moments! It always gets noticeably better a few days after my period ends.

More recently, my hair has started to fall out in handfuls and I just feel 'weird' most of the time - sort of spaced out, dizzy and tired. I don't recognise the person I have become and it's really begun to get me down, especially as I'm sure people think I am imaging things - only my partner sees  what I am going through.

I was convinced I had an under active thyroid but blood tests have only revealed nothing but lowish  estrogen (41), so my GP has said I need to try HRT (even though he seems sure hormonal issues could not cause my symptoms!) My worries are this:

- aren't my symptoms caused by excess of hormones/fluctuations rather than peri meno? (The blood tests suggested I wasn't peri yet). In which case, could more hormones make things worse? Or will they smooth it out? (I so wish I had listened more to my biology teacher!)

- he wants me to have the Mirena with Evorel 50 patches. I was already concerned with Mirena as I have not had children (met Mr Right a bit late) and although we're really happy to adopt, this makes it all very final. Moreover, surely the nausea, fatigue, spots and bloating are caused by progesterone, so having more of this 24/7 will make it worse? I stupidly googled the side effects of Mirena and have really frightened myself! Weight gain is another thing I am worried about as I have already gone up a dress size since all this happened 

- reading through this forum, it seems that patches would suit me better than tablets (for some reason I seem to get side effects with most things I take). Would people recommend Evorel Sequi or Femseven? Again, Femseven seems to be the preferred one but I am scared my GP will refuse as it's more expensive?

I am so sorry to waffle on - I've asked far too many questions in one go. He's booked in the Mirena fitting for later this week (went to see him today to say I had changed my mind, but he talked me into going through with it); the more I think about it, the more I feel the Mirena could make things a lot worse, not better.

Any advice from you lovely ladies much appreciated!

[babyjane]

Hello and welcome to the forum.  Of course you have a lot of questions and you will get replies from ladies who know about HRT.  I have never used it so I am not qualified to comment but I just wanted to welcome you and say 'Hi' 

[Hurdity]

Hi Briony

 

Sorry to hear about your difficulties.

What were the units of measurement for the oestrogen and what stage of the cycle were you at? One blood test by itself doesn't mean a lot as oestrogen varies hugely throughout the cycle. Usually it is FSH which is measured to determine whether you are becoming peri-menopausal but even so this will vary too. Here is some info about blood tests and the diagnosis of menopause:http://www.menopausematters.co.uk/diagnose.php

... and an article about peri-menopause:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

Also can you ask the doc what your actual reading of the thyroid test was? There are still some docs who use the old reference range though I would hope most were on the ball now.

I can't see how the doctor could possibly suggest you have a Mirena coil if you are hoping to conceive. It is perfectly possible to conceive at 42 if you haven't reached menopause although you may not be ovulating in every cycle.

If I were you I would either go for one of the patches you suggest (Femseven) or separate oestrogen (patches) and progesterone which is the most "natural" at your stage. Progesterone is given as "micronised progesterone" and marketed under the brand name Utrogestan. Cost should not be an issue and especially in your circumstances. Progesterone itself does not have an androgenic effect (the spots and hair) but the type in Femseven might have this effect. Here is some info about the different progestogens:
http://www.menopausematters.co.uk/perimeno.php

The difficulty I would envisage is having to take HRT according to a 28 day cycle which is the norm, and your cycle seems to be longer than this - perhaps this is why the doc suggested Mirena?

This doesn't give you a complete answer but hopefully some of it is helpful 

Hurdity x

[CLKD]

 

[Briony]

Thanks so much to all three of you. You can't imagine how much I appreciate your support and brilliant advice. Hurdity, the links are great and I'll certainly try to get the progesterone format you recommend. Really, really appreciated x

[libby1]

Hi Briony

Did you have a mirena fitted? How are you getting on? I've had mine about 1 year now

Libby
x

[Briony]

In the end, I decided to go for Utrogestan initially and not the Mirena. I know my GP wasn't too pleased (think she thought I was anticipating problems before they arrived!) but I didn't want to risk feeling any worse than I already do. I have been on Evorel 50 for nearly a week now, but no improvement yet. I have to learn to be patient!! x

[Briony]

PS Hurdity, I forgot to mention it was 40 nmol (day 5 of period). Still not sure of its significance as GP was very non-plussed by it. Is this low enough to indicate low estrogen, despite the LH and FSH being within normal limits for my age (Not raised). I am 42.

[peegeetip]

Good that the doctor is considering this. So many times they ignore peri.
The blood tests on hormones can change from day to day.

More worryingly the numbness or tingling can be brought on by vitamin deficiency.

Has your doc checked your b12 levels? as they don't do that as part of a normal blood test.

If you've been trying to cut down or on a diet, then this could make your problems worse.

Sooner you get that checked the less damage done and no lasting issues.

Its an extra blood vial bottle that they take off you for the b12+foliate blood test

 

[Hurdity]

Hi Briony

That reading can't be right! it would be far too high!!!

Most estradiol levels arer given in pmol/litre  (eg in UK) or pg/ml (eg in US) - think I've got this right re the countries. Nmol/litre are 1000 times those of pmol/litre ie 1 nmol = 100 pmol. This would give your estradiol levels as 40,000 so this is a mistake!

It's too late really to ask for a re-test as you are have started HRT but if you are in UK it sounds as though it was probably 40 pmol/l which is low. Not sure why the other levels weren't raised but as has been said blood tests are unreliable as diagnosis for menopause http://www.menopausematters.co.uk/diagnose.php

Anyway I do hope you begin to feel better soon! 

Hurdity x