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[Greenwithenvy]

Hi all
Firstly want to thank all those who are involved in setting this site up what an amazing wealth of knowledge!
Also to all the women here who have shared their own stories so honestly.

I'm 45 and post menopause I started HRT last October was using fem seven conti 50 patches and  in terms of relief from symptoms great but I had difficulties with patches sticking properly and sore skin reaction so have now switched to evorel conti 50 early days but seems OK.
I feel a bit guilty having a moan as a lot of the women here are really struggling but although symptoms (all usual stuff) have improved by probably 75% I Am wondering if a larger dose maybe  75 might be better. I've had no side effects really apart from small irritations with the patch itself can anyone say whether switching to a larger dose would be a good idea or since I've only been on HRT since October I might still improve on the 50 dose?

Thanks

[CLKD]

   I can't help with the HRT query - sure someone will be along soon 

[Hurdity]

Hi Greenwithenvy

  from me too!

Don't feel guilty about asking anything....

At your age if you were post-menopausal by 45 that is still young ( how long were you without periods before starting HRT?) and you could easily benefit from a higher dose of oestrogen which is what your body would have been producing naturally. If you are still getting some symptoms  (ie flushes and sweats - I presume this is what you mean?) after starting in October I would say that a higher dose would definitely be worth a try

The best way to do this and still use transdermal HRT (if that is what you prefer) is to go for an oestrogen patch (or gel) with separate progesterone (Utrogestan). If you are OK with synthetic progestogens this may well suit you fine - although with a higher dose of oestrogen you might find that the standard 100 mg progesterone dose is insufficient to keep your womb lining thin and you might get spotting especially when taken orally. Obviously using it vaginally on a continuous basis is not desirable but you could consider re-starting a cycle - but then you would have to have a withdrawal bleed.

Alternatively you could have a Mirena coil fitted which delivers progestgoen to the womb where it is needed and then experiment with the right dose of oestrogen.

Hurdity x

[Greenwithenvy]

Thanks for the response
 I was suffering symptoms (flushes insomnia crying for no real reason and being generally out of sorts and irritable) for last 3 years or so but I had a mirena coil fitted so had had no bleeding for over 5 years. I didn't really consider menopause as the cause. My mum had an even earlier menopause and has suffered with bone density problems as she was warned off HRT so it should have occurred to me to think of it but it still feels too young.
I changed my gp and described my symptoms and was sent off for a range of tests which indicated I was post menopause.
The hot flushes and other symptoms I've had are much better after starting HRT so if there's no contraindications to a higher dose it's worth a try.
I'd rather not have any bleeding as I've got used to life without but will ask for the higher dose at my next appointment. I've had no side effects really from the patches(evorel) so if it's synthetic hormones in there they don't seem to cause me any difficulty.
Do you know if the higher dose of oestrogen will protect better against future bone density problems or if there is any indication a supplement would be better?
Thank you

[Dancinggirl]

Hi Greenwithenvy - If you found you were OK with the Mirena then you could have another fitted and then use oestrogen as gel or patch alongside.  AFter the first few weeks you probably wouldn't get any bleeds or spotting at all - just as you experienced before. The Mirena would allow you to use as little or as much oestrogen as you want - so you could adjust the dosage until you found the level that was right for you.
The Evorel patches are medium dose and I think this is enough to protect you bones.  It could be a good idea to have a DEXA scan to see how your bones are now and further treatment could be offered if needed. DG x

[Greenwithenvy]

Thanks for the advice dancing girl

I think I will try the higher dose patch with progesterone tablets and see how I go.  There seem to be quite a few women who are not very tolerant of the progesterone tabs if that's the case I'll definitely go back to a mirena although I had thought when the last one was taken out I was very glad not to go through having another put in - it's not the most comfortable experience.
Having said that I would not want to put anyone off having a mirena once it's in I had a really positive experience and went back for more 3 times!!

I'm scheduled to have a bone density scan in the next few weeks as family history isn't good hopefully will be better informed when I've had that.

[Hurdity]

Yes 50 mcg is considered sufficient to help protect against osteoporosis. Oestrogen works to prevent bone loss (and maybe also build bone?) in a dose dependent manner - so that although any extra oestrogen has some effect - only the doses above a certain amount are likely to have a significant effect and are licensed to treat and prevent osteoporosis. The licensed doses/products are listed here (the ones with asterisks): http://www.menopausematters.co.uk/treatafter.php as will be the equivalent combi HRT types.

Hurdity x