Hi trac896
Sorry to hear about how you are feeling and also about how it is affecting your relationship with your husband.
Do not despair - re the hormones. What you need to do is change your HRT! You are on a very low dose of oestrogen especially for your age and you would have been on amuch higher dose when you were on the pill. Are you getting hot flushes or sweats?
The average age of menopause is 51 or 52 so you are nowhere near that yet and even the average oestrogen levels through the cycle would be higher than what I imagine you are getting from 1 mg oral oestrogen.
Also you presumably changed from being on a cycle (on the pill - I presume it was the combined pill?) to being on what is known as continuous combined HRT which means you are getting a continuous dose of progestogen. IN your case it is a synthetic one (which is also the case for the CP but at least you were also getting high oestrogen doses too). Continuous progestogens can give rise to low grade side effects and can attenuate - lessen - the positive effects of the oestrogen. Added to that Kliovance contains norethisterone which is a synethic progestogen known for giving rise to side effects on some women (pmt type effects - irritability etc)
Also oral HRT (tablets) is more responsible for reduction in libido than transdermal HRT (patches or gel) because (as I understand and if I am remembering correctly) it reduces the amount of free testosterone circulating in the blood stream - and this is what contributes to libido (ie free T).
So - I would suggest you go back to having a cycle and a bleed. Since you only stopped having a cycle ( nad presumably a bleed) 3 months ago I'm sure you won't mind going back onto it again if your bleeds weren't too bad, and especially as you are almost 10 years away from the average menopause age?
Personally I would choose a transdermal HRT (patch or gel) but both types of combi patch have synthetic progestogens. Femseven is generally better tolerated but because you keep the same patch on for a week some report sticking problems.
Of the tablet HRT types Femoston is the best tolerated so I would suggest you try a change to Femoston 2/10? This would double the oestrogen dose (you really would benefit from more at your age) and the progestogen although synthetic, is closer to natural progesterone than the others. You would then get a withdrawal bleed every 4 weeks, and hopefully your libido might improve. They are listed here
http://www.menopausematters.co.uk/perimeno.phpUsing oestrogel (
http://www.menopausematters.co.uk/treatafter.php scroll down for gel) gives the most flexibility because you can adjust the dose until you get to the level at which you feel well, but you would then need to take a seperate progestogen and there are only two types - one natural (Utrogestan) and the other synthetic (Provera). You might not want to fiddle with separate preparations at your stage.
http://www.menopausematters.co.uk/to_progestogens.phpPerhaps you can ask to be referred to a menopause clinic but hopefully your GP will respond favourably to your request to change? Oh - I see you under a specialist?
Did you go through menopause naturally ie do you still have womb and ovaries?
Tesosterone levels decline with age but replacement is not usually precribed on NHS except sometimes where women go into surgical menopause younger than menopause age.
Palpitations could be due to reduction in oestrogen - as the dose in Kliovance is much lower than CCP ( if that's what you were on).
As for your husband - yes do sit down with him and talk about your hormones and especially if you sense things have changed ( hormonally and therefore your mood) since coming off the pill and onto Kliovance.
Incidentally why did you come off the pill? There is a pill Qlara which contains bio-identical oestrogen and only has 2 pill fre days so is supposed not to have the same mood swings as the usual CCP - but of course it still has a synthetic progestogen - which you may be sensitive to.
I hope I've given you some alternatives to think about - all listed on here. Do read up about them and ask anything else you need to - but make another appointment as soon as you can!
Hurdity x
