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[Sunnydays]

Hi Ladies,
I have just returned from an appt with a consultant gynae that I booked privately with self referral. I have an issue 'down below' and I wanted to speak to someone in the know with regard to hrt.
He is well regarded professionally in his work on women's health issues, specialising in the various gynae types cancers.

My first problem was such excruciating pain in intercourse and his feedback following examination was helpful. I'd rather not put the detail out on these pages but happy to PM back to anyone.

My other query was hrt which as some of you might know I'm in a constant dilemma over. I'm unsure over the conti regime (even though I'm on a low dose, only third of a patch) and as the weeks  have progressed I'm finding headaches are becoming more frequent. He was reassuring in terms of hrt, including that in view of my slight build I had the potential to suffer more harmful effects from lack of bone density (due to low oestrogen levels)  versus the risk of breast cancer. Also bearing in mind my gynae probs above, the lack of oestrogen i have stored has the potential to effect lots of areas for me. above He said there is no reason why i couldn't have constant oestrogen  then a progesterone for 12 days every 3 months. As an alternative he said about the mirena coil alongside constant oestrogen; not my preferred choice.

Like all professionals he has his preferred choice of hrt but I was a bit disappointed that he suggested one beginning with P for oestrogen which he said is from horse urine! The progesterone suggested was Provera. `it made me think, gosh is he uptodate with hrt??

I'm feeling liberated that I should be able to sort my problem out down below in time and excited that I can take oestrogen on its own, quite safely, for 90 days. My GP is lovely and will happily prescribe whatever is recommended but I would prefer a patch of a more natural oestrogen. I'm not so concerned about the progesterone as in theory it should be for just 12 days every 3 months. Can anyone add any cautions to this regime; does your tummy get bigger and bigger over 3 months leading up to a bleed. He also said to have a scan after the first bleed just to check womb lining and of course, to report any unusual bleeding, so whilst i'm excited I'm also a little scared. I consider that I have been lucky with the meno overall and the lifestyle I (try to) lead most of the time I feel has a positive impact but I can see that I need some (not a lot) of oestrogen for the more unseen things. Should I ask for a low dose patch? I know some ladies take gel but I have sensitive skin and I know that a patch works well for me (even though a pill to pop each day is easier).

I have rather rambled but I'd be grateful for thoughts.

[Dancinggirl]

Gosh Sunnydays - good to hear you had a positive experience with this consultant.
I can't remember what you are currently taking re HRT? Were you having trouble with erratic bleeding?
The headaches you have been getting may be more to do with the progesterone in the patches you have been using - you may find you feel great on oestrogen alone.

My slight concern about his suggestion to have a 3 month cycle would be in regards to erratic bleeding as I tried doing a long cycle and ended up having erratic spotting and a long withdrawal bleed - however you may well do well on this.
I have had a Mirena in the past and if you want to be bleed free this could be worth trying - you then just add as much oestrogen as you need.
Has he suggested using local oestrogen for your 'lady parts' to really help sort things out down there?
You mention about having a natural oestrogen - well most HRTs now have bio identical oestrogen anyway but he was probably talking about Premique which is the old fashioned type with equine oestrogen - I'm surprised he likes this type!!!!. There are oestrogen only patches (bio identical) which you could use with the Provera progesterone separately to be taken either every 3 months or continuously. I'm sure your GP will go along with what you want if it roughly coincides with the the gynaes recommendations.    It is often the progesterone that can be a problem.  Provera is one of the kinder progesteornes and I believe is Ok as quite a high dose when used on a long cycle.
If you are happy using patches then go for that.
I expect your gynae will write to you with his recommendations.
Keep us posted DG x

[Sunnydays]

Thanks DG. No,. I'm very lucky on Everol conti, no erratic bleeding or such like but I've found that as the weeks have gone on I'm getting slightly more headaches. I guess I could do with a bit more oestrogen, but of course on this regime, more oestrogen = more progesterone and possibly more headaches.

Yes I felt a bit discouraged by the Premique, but he's definitely a pill man rather than a patch man! I suppose I have confidence in his comment about the long cycle as he specialises in the gynae parts so must be aware of the impact of the oestrogen on it.

Yes to the local oestrogen down below! I need to keep using it.

Re the Mirena coil, this was actually his first recommendation and of course it should avoid the bleed, goes directly to the womb, and you can adjust the oestrogen to the level you need. I just feel this is quite permanent ( I know it has to be changed at some stage??) but supposing the type of progesterone didn't suit and you're stuck with it for a while. At least you can just reduce/stop patches.