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[Amandajane46]

Hi ladies should I still be getting symptoms of peri menopause on HRT evorel 50 I thought the HRT ment to get rid of symptoms?

[Dancinggirl]

What symptoms are you still getting and how long have you been taking the HRT?  DG x

[Amandajane46]

Been on HRT for about 6 months but still having symptoms around my cycle : morning anxiety headache lower back pain sickness fatigue and more not as bad as before HRT but still there

[dazned]

If this the first hrt you have tried you might need to try a different one ,unfortunately it's not an exact science a lot is trial and error! 

[Dancinggirl]

Amandajane46
Unfortunately when you are in peri meno your own hormones will be fluctuating and this can give rise to a variety of symptoms. HRT can only help to a certain degree - it won't solve everything.  If it controls flushes and night sweats then that is good - the symptoms you describe may take more time to settle and may not be entirely menopause related.
Which HRT are you on and what dosage? The symptoms you describe are typical of PMT and it may worth trying a different HRT preparation - Femoston is popular because the progesterone is kinder but any sequential HRT may give some PMT symptoms with the withdrawal bleed.   DG x

[Amandajane46]

Hi I'm on evorel 50 which has releaved a lot of my symptoms some I no longer get but some I still get at a lesser degree

[Dancinggirl]

Amandajane46
Is this HRT oestrogen only? If so, I assume you have had a hysterectomy? If you are still in your 40s and had a hysterectomy then you may need a higher dose of oestrogen.  Also, if you are taking pills at the moment you may benefit from using a transdermal form of oestrogen e.g. patch or gel, as this can deliver the hormones more effectively. Perhaps ask to have your oestrogen levels tested -  you may need your levels to be 500 or above at your age.  DG x

[Amandajane46]

Hi I am on oestrogen only as I have marina coil and evorel 50 is patches but I think yes I my need my levels checked

[Dancinggirl]

Sometimes the Mirena coil can give an initial surge of progesterone in the first few months that can make one feel fatigued and give a headache.  This usually settles after a time. If it does continue then you may be very progesterone sensitive and may need to try something like Utrogestan on a sequential basis. However, if you are still peri meno then some PMT type symptoms will emerge as your hormone will be fluctuating.  DG x

[dogdoc]

Dancing girl you say a level of 500 is good for younger women but do you know where in the cycle that is?  I have a level of 500 on estrogen but only at my 'peak'- which is when I feel my best. On day three it's at 100. Hard time knowing what level to aim for.
Tara

[Dancinggirl]

I am certainly no expert about hormone levels but my gynae wanted my levels to be between 500-600 to get the best relief from symptoms - I am 59 and very post meno so won't have any oestrogen of my own.  If you are in peri meno then there will be peeks and troughs because your own hormones will be influencing things and HRT will help to control those fluctuations. Finding the right level to control symptoms will change as you get deeper into the peri stage and approach post meno - once your periods stop completely apparently it can take up to 2 years for the hormones levels to bottom out.
MAny women want to try to control their cycle and hormone fluctuations through peri meno but in my view this is virtually impossible because of the fluctuations - inevitably symptoms will kick in and out even with HRT.  I have used Oestrogel for most of my peri and post meno stages and this enables you to adjust the dosage and use the lowest amount to keep symptoms under control.
HRT can't sort everything but it can make things better to a manage.  DG x

[Hurdity]

Interesting and surprising that the gynae is suggesting you try to achieve levels that are that high Dancinggirl, especially in late 50's? If you look at the table on Wikipedia this is the upper limit of the 95% range for the luteal and follicular phase and is only surpassed briefly by the pre-ovulatory peak.

Many women do not ever have these levels (except at the peak!). I would love to have higher levels so that I felt more lively than I do, but I would not like to have to take the associated higher progesterone levels that would be necessary, or shorten my cycle in order to keep the lining thin. I would also be worried about having levels this high throughout my 60's and into the indefinite future. Mine are way lower than that and in post-menopause have been just over 200 - which is also within the range for the cycle (except the peak).
http://en.wikipedia.org/wiki/Estradiol
http://www.gpnotebook.co.uk/simplepage.cfm?ID=570818627&linkID=24801&cook=yes

Amandajane - if your symptoms are cyclical then as Dancinggirl says it is due to your own hormones - as she says HRT does not eliminate your cycle.

If you feel better the rest of the time then that's great! As you get further towards menopause the fluctuations will fade and you should feel more on an even keel.  As Dancinggirl says if you are in your 40's then why not try a bit higher dose eg a 75 mcg patch and see how you feel?

Hurdity x

[Dancinggirl]

Hi Hurdity - though the gynae said he wanted 500-600 I am not personally happy to have the oestrogen level that high.  I had a blood test done after 4 weeks back on HRT and the level was 475 on 2 pumps per day( he actually suggested I could increase to 3 pumps per day to get the level up a bit more!!)  - I have actually reduced my dosage to about 1.5 pumps per day and this seems to be keeping the flushes etc at bay. I would hope my oestrogen would be around 300-350 now and I may try reducing down to one pump per day to see if things are OK at that amount - if I'm to continue using HRT for the longer term this should be better.  DG x