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[bella mama]

Hello to anyone who can give me some help on what I can do.  I am feeling a bit low this morning because I have had months of worsening joint pains in shoulder and elbows..shooting down to my wrists. It's mostly on my right arm.  My low back has been so stiff and sore for the past 6 weeks and finding it hard to bend down. It feels like the same pain in my shoulder which is like a burning pain and then a shooting pain. I have awful tiredness and can sleep in the afternoons if I sit down..
I am only 44 and feel like 104 again!!!!
I take elleste duet 1mg and citalopram 20mg.
My periods are not regular and can miss some months at times only to have a flooding period when it does come.  I have not had one for 2 months.
I am reluctant to up my dose of elleste duet to 2mg as I am concerned it will get more hairy! Have noticed my chin is getting a bit hairier than it used to be.  :oWould this happen with a higher dose?? The thing is my flushes are no worse it just this worsening burning stiff pain and feeling fed up. The other thing is I having problems with my bowels....could be because I am taking so much ibrufen and paracetamol though.
Is there anything else I could try before upping my dose of elleste duet???

[CLKD]

I am not on HRT and have hairy chin (see my thread  ).  As oestrogen levels drop apparently muscles become lax = aches and pains.   

A change of bowels can come with The Change but if you are worried symptoms need to be discuss with your GP.

[bella mama]

Hi there thank you for replying to my message. Thinking I might have to go to see my GP but it is daunting going into see them. Probably because it feels like I have loads of moans about aches and pains. 

[CLKD]

So make an appt with your Practice Nurse who may be less busy?  A double appt. with a list of your symptoms.  The GPs are there to help ……..

[Hurdity]

Hi bella mama

You raise several issues in your post!

First as CLKD says the hairiness is not necessarily related to HRT - it's due to the relative balance between oestrogen and testosterone as we near and reach menopause. As oestrogen falls dramatically -  (which it does overall at menopause) the the ratio of T to O increases, even though T itself is falling and can also lead to symptoms.

Also some progestogens in HRT are more androgenic and more likely to lead to these male type symptoms eg hair loss on head and increased hairiness elsewhere eg chin and lip! The one you are on contains norethisterone which is one such. Here are the different types listed and how androgenic (testosterone related) they are:

Progestogens which can be used cyclically are of 3 main types:

    Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
    Less testosterone related - Medroxyprogesterone acetate(MPA).
    Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

Side effects are often experienced during the progestogen phase of treatment and can be reduced by using a product containing a different type or route of progestogen.
http://www.menopausematters.co.uk/perimeno.php

Also you say you are still having hot flushes despite taking Elleste Duet? You mention also stomach problems. It could be that you are not absorbing the oestrogen well from the tablet HRT due to your bowel problems.

You have alternatives - you can either try Femoston (starting with 1/10) - which has the least androgenic progestogen (known as dydrogesterone) and see if you have fewer side effects - but you still might have an absorption problem, or you could try a transdermal HRT which means the hormones get into your system without having to be digested or go through the liver - so won't be affected if you have bowel issues.

Unfortunately both the HRT combi patches contain the most androgenic of the progestogens so you might not want this. Alternatively you could try separate oestrogen (patches or gel) and progesterone (= micronised progesterone marketed as Utrogestan). You might find this a bit of a faff but could be worth it and help you feel better. Also you would then be able to increase the oestrogen by itself until your symptoms went.

The final alternative is to have a Mirena coil fitted which although it contains levonorgestrel - (one of the tesosterone related progestogens) - delivers the progestogen straight to the womb lining rather than into the system so side effects are usually minimal. Then you could have patch or gel oestrogen again as above, to suit.

One last thing if you are so tired and have joint pain, I presume you have had blood tests to rule out other possibilities re vitamin deficiencies and especially thyroid function - it sounds like a good idea to have more tests at this point if you haven't had any recently? Make sure you ask for a print-out of your results too.

Hope this helps and keep us posted! 

Hurdity x

[CLKD]

   Both!

[Briony]

Hi
I am similar age to you  and suffered very similar initial symptoms. I was very, very fit / sporty so I was worried stiff about the cause of my pains, stiffness, tingling and fatigue. To cut a long story short, diagnosed with low estrogen and tried low dose hrt. Helped, but not a lot so I moved to something stronger. Now  take Qlaira, which is a BCP similar to 2 mg estrogen. It has helped greatly ( am no more hairy than I was before, but a lot more flexible!). X