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[Rhiner]

Hi All just posted this in the wrong section - sorry!

Been on femoston conti 1/5mg since march after ovary removal. I am 55 and 3 yrs post period. I had severe meno symptoms after removal, faint, insomnia, jelly legs, distant so started this HRT.

Took a month to get normal again, the headaches started after 2 months on Femoston and slowly sleep was disrupted, waking at 1am - too much Oestrogen? So I halved the dose, but this obviously reduced too much as jelly legs etc started again.

Went to see Gynae last week and was changed to Estrodot 50ug/Utro 100mg daily, better hormone levels, bioidentical, less fluctuation and able to reduce patch by cutting if needed,  I started this on Monday. I am now feeling terrible, worse every day, jelly legs, poor sleep, feeling faint. I cut 20% off the patch on Thursday as headache had been present again.

Having to miss my sons birthday today as feeling so bad, I cannot see an end to this!
Any advice greatly appreciated.
Rhiner

[Rhiner]

Thanks Stella Jane, The gynae, who specialises in HRT said that the 1mg tablet was equivalent to the 50ug patch for estradiol. Good point about changing too much at once.
Rhiner

[Mary G]

Rhiner, I agree with everything that Stellajane has said but would add that I don't think taking Utrogestan everyday is a great idea.  It is a high level of progesterone and not only does it have a drag effect and bring down mood, it also undermines the effectiveness of the oestrogen meaning you do not get as much benefit from it as you should and 50mcg is not a very high dose of oestrogen anyway. 

To be blunt, I think if you cut anything off the 50mcg patch and continued to take 100mg Utrogestan everyday, it would be nothing short of a disaster.

How are you taking the Utrogestan, vaginally or orally?  This always makes a huge difference in terms of effectiveness and side effects.

My advice is the same as always, why not use the very flexible and highly effective Oestrogel as Stellajane suggested and then use Utrogestan (vaginally) for a few days each month.  It will mean having a period but it is a price worth paying for feeling normal for most of the time. 

[Rhiner]

Hi MaryG,

Thanks for the info. I will put on a full patch later today, as I am now starting to feel anxiety too.  I cannot see me needing more than this as it was only the 1mg Femoston tablet that I was taking and looking at it now it does seem as if the cumulative effect of oestrogen had built up over the two months, to give headaches and eventually waking early (1am) i.e. too much oestrogen.  I felt great between months 1 and 2.

I am taking the Utro orally, I will take vaginally this evening and see if any difference.  The gynaea did suggest this way of dosing if any side effects (and he suggested the back passage way too!!)

The gynae actually said that we can go a month without any prog, but wanted me to take daily from the start. Yes the bleed way - sequential? may be well worth it, to stop feeling this way. Can you still eventually cut down the dose on a sequential cycle easy enough, or do you have to go onto a conti route?
Rhiner

[Mary G]

Rhiner, I think your problem has been too much progesterone all along.  For a start, Femoston conti is a very low dose of oestrogen and from what you have said, the headaches and all the other symptoms you experienced were all to do with the cumulative effect of the progesterone over a period of two months.  I had exactly the same problem when using this type of continuous combined regime. 

I really do think that all the symptoms you are experiencing now are due to the Utrogestan building up in your system and if you take a reduced dose of oestrogen, you are making things worse.  If anything, I would have thought it would be better for you to have a good long stint on oestrogen only and then take the progesterone once you have raised your oestrogen levels and got the feelgood factor back - this is what Professor Studd usually does.

I would also recommend you switch from patches to gel because it is far easier to adjust the dose to suit your needs. 

One point which I have overlooked... you said you have had an ovary(ies) removed, have you been offered any testosterone?  I wonder if you could also benefit from that.

I am on the Professor Studd regime which is 2 pumps of Oestrogel everyday (some women use 3 or even 4 pumps), a small bead of testosterone everyday and 100mg Utrogestan (vaginally) for 7 days each month but I now stretch it to 5 weeks.  Why not have a look at Professor Studd's website.

I hope that helps.

[Rhiner]

Hi Stellajane and Mary G

Many thanks for your excellent comments.  I have just looked at the Prof Studd website and can see the 7 day x 100mg ultro starting each month, with one to 2 pumps of oestrogen. with a scant bleed around day 10.

Reassuring to know that you had the same probs re headaches with the conti regime at around 2 months, with the synthetic prog

I will miss the ultro dose tonight to see if this starts to make a difference. I have also put on a new full 50ug patch. Do you know what 50ug patch is equivalent to in pumps of the gel?

I have emailed my gynae, but its through his secretary so will not get a response until well into next week.

Many thanks indeed, Rhiner x

[Mary G]

Rhiner, if you stop the Utrogestan tonight and don't start again, you will get a bleed in a few days' time but don't worry about it, it is all completely normal.  I don't think you will be able to gauge much by stopping the Utrogestan for only one night because it hang around in your system for a long time after you take the last capsule. 

You will be interested to know that a lot of other MM members start to feel the effects of Utrogestan after about day 4 which is roughly where you are now. 

Re the 50mcg patch, in theory, it is roughly the equivalent to 1mg oral oestrogen and 2 pumps of gel but from my experience, it is nothing like the equivalent of 2 pumps of gel!  I didn't absorb patches well and could never get anything like the same level of oestrogen from them as I do from 2 pumps of gel - this was confirmed by blood tests and how I felt. 

Good luck and please let us know how you get on.

[Rhiner]

Thanks again for the comments. Took no Ultro last night, feeling a bit worse this morning for feeling faint, foggy, jelly legs. Maybe the 50ug patch is insufficient and like you MaryG I do not absorb the patch that well, or does it take time for the body to adjust to the different dosage form? How long should I give it before adding another half a patch, to 75ug?

For the Studd regime, is it based on a 28 day cycle, i.e. 7 days of prog and oestrogen then 3 weeks of oestrogen only?

Thanks again, Rhiner x

[Mary G]

Rhiner, it is very likely that you are not absorbing the patch well so it would be worth upping the dose.  I ended up on the 100mcg patch before I switched to the Oestrogel. 

The Professor Studd regime is based on a cycle as you describe.  This is his preferred method (he nearly always works with Oestrogel) and it has been tried and tested over a number of years.  It is a hugely successful HRT regime and was created on the back of years of his own research and studies.  It is the best HRT regime I have been on by a very long way and it was only when I made the switch that I finally got breakthrough - it's been a real life changer for me.  Part of its success is due to its flexibility which I think is hugely important in any HRT regime. 

The downside is having to have periods again but it is a small price to pay for feeling normal again aged 55!

[Rhiner]

Hi MaryG,
Thanks for the advice, will up the dose either tonight or tomorrow, if needs be, if I am still feeling low on oestrogen.I will stay 'as is' for now, just to see if there is any improvement as its acting on my body in a different way to tablets.

The Prof Studd regime sounds like a no brainer to me. Does he recommend to have any scans, with just 7 days on progesterone, to ensure no lining thickening is happening, or does the research conclude that this is not necessary?

Thanks again,
Rhiner x

[Mary G]

Rhiner, no Professor Studd does not make uterine scans a condition of using his regime.  He has carried out years of his own studies and research so clearly he cannot think it is necessary otherwise he would very clearly stipulate that all women must have a yearly scan in order to use this regime.

However, it is a good idea to have a scan from time to time anyway because there is much more that needs to be checked than simply the lining - ovaries, bladder, vaginal wall thickness etc. 

Others may disagree with me but I think the NHS over-prescribe the progesterone part of HRT because they do not routinely offer uterine scans.  They have probably worked on worst case scenario and doubled it but this is way too much for the majority of women and I wouldn't go anywhere near the NHS recommended dose and I think they need to review it.

For some reason that nobody has ever been able to explain satisfactorily, the NHS does not licence Utrogestan to be used vaginally which it should because it is much more effective when used in that way and also carries fewer side effects.  Again, the NHS need to review it. 

If you are on HRT for the long term and don't want to take too much progesterone, the best thing to do is to find your own personal threshold and the only way to do that it is use the Studd regime for a few months and then have a scan to see how well it is working and how thick your womb lining is.  Everyone is very different and you can't really guess how much progesterone you need but most women don't need anything like the NHS recommended dose which, in my opinion, is ruining what is otherwise a fantastic, life changing HRT regime and the tragedy is that some women really can't tolerate the side effects of the progesterone component and stop using HRT altogether. 

[Rhiner]

Thanks MaryG for the comments,  yes it does feel like NHS cost cuts/play it safe by giving a large dose and no scan needed.

Rhiner

[Hurdity]

Hi Rhiner

Sorry to hear about your problems - and I agree with what Stellajane said that by changing two things at once you have no way of knowing what is due to what. Stopping and starting the Utrogestan will itself give rise to side effects.

I also agree with Mary G that your symptoms may well be due to the cumulative effect of taking progesterone all the time and not oestrogen - because the side effects from sudden increases in the latter tend to settle fairly quickly. Also that having a cycle may well be the way to go to avoid the continuous low grade progestogenic side effects.

So what you have done is swap one conti HRT for another.

Personally I would go for taking the Utrogestan cyclically as suggested but to start with the licensed dose - that is 200 mg for 12 days initially. Prof Studd does prescribe the 7 days regime for his own patients but this is not licensed on NHS, because his own research actually shows that there is a higher risk of endometrial hyperplasia ( a particular type of thickened lining that can lead to cancer) than  a 10 day regime, which is higher risk than a 12 day regime. He used to say on his website - and maybe it still does somewhere, that patients on a 7 days progesterone regime should have a lower threshold for endometrial sampling - because of the increased risks. Also it is important to distinguish between progesterone and synthetic progestogens such as norethisterone - the latter which is  approx 8 times more effective in thinning the womb lining than progesterone (if I'm remembering correctly).

All in all I would not adopt this regime without medical supervision.

If you do want to have a cycle as said earlier then please start with the licensed dose and see how you get on. As Mary G says also if you can get approval to take oestrogen only patch for say 6 weeks before starting the first course of progesterone then you will at least have a chance of seeing if this suits you.

I have almost only ever been on a 50 mcg Estradot patch since being in late peri-menopause at age approx 54 (although I still have my ovaries) and this has worked fine for me. It may well be that you do eventually need a higher dose without ovaries even if you are post-menopausal but I would really try this dose first.

As for equivalence - these are based on average serum oestradiol levels using the different methods and actual levels vary widely between different women - so some may absorb patches very well, others tablets, and others gel.

Hurdity x

[Rhiner]

Dear Hurdity, thank you so much for the response.

I did increase to 75ug from 50 last night for the oestrodot patch and I can feel a little normality returning, jelly legs have gone, not so dazed.  I may go back down to a 50ug dose at next change on wednesday, as I perhaps did not give sufficient time for the change in dosage form, i.e. tablets to patches, to kick in. I guess this can take a while for the body to acclimatise to the different mode of delivery, do you have any idea how long this can be, I guess it varies?  The patches themselves though are brilliant, small and stick really well, with the ability to cut them down for smaller doses if required

The dosage advice re Utro sounds sensible. I may try the conti, daily dosage of 100mg initially, as requested by my gynae, once I have completely sorted the oestrogen dosage.

Many thanks, Rhiner xx