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[Hurdity]

Hi there all

I just wanted to report on my visit to a consultant today in case it is helpful to anyone.

By the way I am a lifelong supporter of the NHS and so feel a bit like a traitor having made a private appointment but it is a one-off (I hope) and the libido issue is not dealt with on NHS (not where I live) and I was also getting really fed up with the commnets from my GP (I mentioned these a while back) about HRT and cancer and how we weren't designed to have oestrogen this long etc. Anyway I went to see Annie Evans in Bristol - as others have on here and she was lovely and really helpful.

Staying on HRT over 60: she showed me the paragraph in the paper from the International Menopause Society (2013):
http://www.imsociety.org/pdf_files/ims_recommendations/updated_2013_ims_recommendations_on_menopausal_hormone_therapy_and_preventive_strategies_for_midlife_health.pdf

"There are no reasons to place arbitrary limitations on the duration of MHT. Data from the WHI trial and other studies generally support safe use for at least 5 years in healthy women initiating treatment before age 60. Continued use beyond the 5-year window may be appropriate, based on a womans individual risk profile.

Whether or not to continue therapy should be at the discretion of the well-informed woman and her health professional, dependent upon the specific goals and an objective estimation of ongoing individual benefits and risks."

This same recommendation is also in the British Menopause Society Paper.

HRT post 60 She said I could stay on it as long as I wanted - obviously provided I have no health problems preventing it. Also she said that all gynaecologists she knew (of a certain age) were on it and didn't intend to come off it! The starting age of HRT relative to menopause was the crucial thing regarding risks, rather than age per se.

Length of cycle: She was happy with my self-designed cycle of 5-8 weeks with the current dose of progesterone I take (ie 200 mg Utrogestan vaginally for 12 days per cycle), especially as I have never had any bleeding at any time other than after withdrawal of progesterone.

Scan of uterus: I asked her if she thought I should have an annual scan of my uterus (for peace of mind due to my age and long cycle and because I have a small fibroid) but she says there was no reason to do this in my case as I do not have any bleeding problems. If I did (have untoward bleeding), then I would be properly investigated through the NHS.

Dose of oestrogen: I said I thought it would be great to have a higher dose of oestrogen (than 50 mcg) to feel generally better rather than just not having symptoms of flushes and sweats ( although this is good!) and she did suggest I could have a 75 mcg patch if I wanted!!! However after discussion of libido I decided to leave this for the moment and deal with one thing at a time as she suggested.

Type of HRT: she confirmed that I was on the least risky formulation of HRT ie transdermal estradiol and "natural" progesterone - which she described as "breast friendly". Also that being on a cycle was better for the breasts than continuous combined HRT - although slightly more risky for the endometrium (womb lining).

Libido -  the big one! After hearing about my symptoms (total lack of libido which started decreasing some time ago, coupled with tiredness etc) she thought this would be worth a try. Eeeeeeek - scary!! So - I have now come away with a box of testogel sachets which will apparently last me 10 months!!! (if I go on with it that long). She said that it would take several months for the testosterone receptors to be re-activated (they've "gone to sleep"  - my words!) - also that if I didn't suffer acne/hairiness in my younger days then I shouldn't have these side effects if I stuck to the tiny (petit-pois size) amount of gel. Well I'm now very nervous of trying it especially as I'm 5 days into utrogestan and woke with a neck/headache and foggy head - but seems to have abated at the moment. I'll start another thread on the T stuff.

The most interesting thing she said - which I didn't know, was that when women find that their flushes return after taking oestrogen for some time, it is not always increased oestrogen that is needed, but a little testosterone. She said that it played a small part in the control of flushes and sweats (I know metabolism of these two hormones is linked). I can see why this makes it difficult for most women because testosterone just isn't available on NHS except as implants and only sparingly to some women with total hysterectomy/ovary removal.

Follow-up: She's going to write to my GP so the letter will go on file and I can refer to it if she (GP) starts to make comments about my being on HRT when I go to see her about various symptoms (this is when I can't get an appointment with my lovely gynae GP who is only part-time and you have to wait weeks for). I don't have to go back to the consultant for a review and if I want another prescription for the T, I just phone up and they can send one - I don't have to pay for the service again (except of course for the prescription) unless I want her to review my HRT.

Anyway I realise that this was tailored to me and wouldn't suit everyone but hope it gives confidence to some of you out there who are having trouble with GPs about HRT anyway.

When I get around to it and after a few months ( if I take it that long) I will report on the libido effect  - my husband sounded very pleased at the prospect  (he doesn't know this was a private appointment though - I didn't really need to tell him and he didn't ask!!)

Hurdity x

[Taz2]

That sounds like a very positive experience Hurdity - thanks for sharing and explaining it all - especially about the testosterone. Makes you wonder how many of us who try to come off HRT but fail due to the horrible sweats need that instead of oestrogen!

I'm sure if the testogel works then your husband wont mind at all that you paid for a consultation so, one day, you may tell him 

Taz x 

[Winterose]

Thank you for sharing that, excellent post , will await the testogel reports, 

[dazned]

Thanks for your report glad you got to see a good,knowledgeable Dr,watched her give a talk on you tube she seemed like a person one could talk to.

I will now be asking my private gynecologist ,who by the way is also easy to talk to and highly thought of in this region, again about testagel as before he said no ,he said he would give the implants but not testagel. So will try him again 
I know he is happy to prescribe off licence as he gives me the utrogeston pessarys so will try to persaude him. I wouldn't have a problem having an implant once I knew testosterone suited me ,although I know one is derived from male T and one female T as I understand it, well thats how I interpreted what he said,please let us know how you go with it.

[Annie0710]

I'm glad you had a good consultation Hurdity, and you've explained it do well

I can't wait to read your reviews on the testosterone, it gives me hope :-)

Plus very good news that can continue your hrt

Annie

[meno lesley]

Hi Hurdity

Interested to read your post. I have been seeing Nick Panay and after blood results showing very low testosterone prescribed testigel which I am worried about adding to the mix as have been struggling for a while now.

Lesley x

[CLKD]

   …….   my GP told me many years ago that testosterone would lower my voice (I wanted to try it to encourage libedo) 

Let us know how you get on!

[warwick01]

Hi Hurdity

Really informative post!

It makes me wonder if my return of symptoms may be due to lack of T and not that the Oestrogel was not being absorbed......Mmm

I had Testosterone implants in my mid late 30's for PMT symptoms. The only side effects I had was increase in libido, so much so I had to nip home at lunch time for a bit of nookie...... my then DH couldn't keep up with me. Found out later he had another women on the go....... As you can imagine it ended in divorce.

I never had any further implants

[CLKD]

If it worked Warwick, wonder why my GP didn't prescribe it .......... B..ger !

[marras]

Hi Hurdity, thank you for such an interesting and informative post. It's especially interesting for me as I'm 65 and only been on HRT for six months! Interesting to know that many female gynaes are on it and intend to stay on. Fortunately, I don't have a problem with low libido but my DH does....shame!! How great that you can have a higher dose patch too. I'm on 25mcg Estradot (twice a week) with 1mg Climaval daily. I have wondered if I could switch to a higher dose patch and do away with the Climaval tablet.

[pepperminty]

Hi Hurdity,

Very interesting. I think from what I have read as long as you only use a pea size dose you are fine. I hope it works for you. Good luck !!

pepperminty xx

[lancashirelass]

Gps will generally not prescribe off licence meds without instruction from a consultant

[Ju Ju]

Interesting post. I'm glad your appointment so worthwhile. I was fortunate that my GP fully supported my seeing a private gynaecologist. In fact she suggested I see my gynaecologist, who she had worked with as a registrar a few years ago. I, too, would rather go through the NHS, but testosterone is no longer available on the NHS as it is no longer licensed for women in this country for commercial reasons. It is only licensed for men. I had to sign a disclaimer.

I wanted to try testosterone, which I did for a few months, as I have very low levels. I was prescribed Tostran, which is gel in a pump can, which is easier to apply than gel from sachets and more accurate in dosage. Implants are available at the clinic, but not considered suitable. I used testosterone for several months, with no noticeable benefit. However, I did have facial acne like blemishes quite badly and more hairs on my chin than before. I didn't have acne as a teenager, but did have 2 long periods of acne during the peri menopause period, though not as horrid as this. The acne is only calming down several months on after stopping testosterone.

In order to take testosterone, I had to start oestrogen and of course progesterone to protect my womb. The benefits of oestrogen have been wonderful, though not everything is hunky dory, but now I have a life! But I am very sensitive to progesterone. I currently take Provera for 12 days every 3 months, but dread those cycles a bit, but unlike periods I know what to expect and when and how long, so I can plan accordingly or postpone if say I go on holiday. She has suggested different progesterone preparations to try in her follow up letter to discuss with my GP after my yearly review appointment last week. (At my initial appointment, she did say I could have just 2 cycles a year, but I would have to have a scan every year.)

She also diagnosed a prolapse that needs repair. Having read up on symptoms, it seems I have been having problems for some time and I have been blaming it on IBS. Now I have to wait 2 weeks to see my GP as she works part time. I don't want to discuss HRT with any other doctor in case the age issue comes up. I'm 61.

[Dancinggirl]

Thank you for sharing everything Hurdity - really informative and helpful.  There are a number of us posting on this site who are 'a little more mature' and facing the prospect of HRT being taken away from us in the not too distant future. 
I am still experimenting with the best cycle using Oestrogel and Utrogestan - the longer cycle gave me heavy and painful bleeds so I am now on my fourth phase of Utrogestan after 3 weeks of Oestrogel only and it'll be interesting to see what type of withdrawal bleed I get this time.  I have also reduced the amount of Oestrogel I use to one pump per day - which is quite a low dose but my flushes are still under control!!!!
The other thing that I have noticed is a slight return in libido .  Now my urethra is not so painful this must also be helping.
I will be really interested to know how you get on with the Testosterone.  Personally I'm not convinced that more oestrogen will result in more energy but if you don't try, you don't find out.   DG xxx

[evey]

Thank you for sharing it was so interesting, you have helped me along with others with advice regarding HRT.  Hurdity as you know I have chopped and changed regimes with utrogestan just trying to get the system that I can cope with side effects etc.  Do you mind if I ask you, I know you take 200 mg Utrogestan and 5-8 week system, how does that work?  Also do you get side effects from this dose age? Good luck with the Testo, also to you dancing girl as I'm sure you have tried to advise me too, I do feel bad repeating myself about the utrogestan, hope you have a good result too D/Girl with your utro usage.