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[Dediva Ann]

Hello lovely ladies - me again 

As you may remember from a previous post the lady GP had advised me that switching was entirely up to me but that she wouldn't want to put her name clinically to the Estrogel and Utrogestan regime as she has no experience of it and was concerned about the risks.  She did however say she would do some more research but urged me to stick with Femoston 2/10 for now and to consider switching to Estrogel and the Mirena coil.  (I did seriously think about the Mirena but that's Northisterone again which I hated in Elleste Duet, plus I dread having a coil fitted.)

I have stuck with the Femoston but still feel utterly lousy: am hot flushing; too tired to do a thing; struggling to think and focus; my breasts are so painful (never had any breast issues prior to HRT); I have no energy, feel weak and pathetic; I ache all over; and I keep getting sudden pains in my head and sometimes it's hard to make my eyes focus. My mood is rock bottom (suicidal at times); my libido is seemingly gone forever and am experiencing horrible dryness (recent sex even with lots of lube was painful and so I am now terrified of trying again!) I know it's hard to differentiate what's perimenopausal and what's caused by the Femoston but all I know is that this is very, very grim. 

On Monday I saw the male GP about something else entirely.  Because my mood was so low I mentioned that I hoped the lady GP would consider switching me to Estrogel / Utrogestan and maybe even Testosterone at my next HRT review which I hoped to bring forward.  He was so concerned about my mood and asked me to explain what I wanted and then looked it up in the BNF. (He has no experience of prescribing it previously.)  I feel incredibly lucky to have come away with a prescription for Estrogel 2 pumps daily; Utrogestan 200mg to be used vaginally on Days 15 - 26 plus a tiny amount of Testogel daily (He first ordered Tostran but has kindly switched it to Testogel after I sought advice on here.)

I am 49 and have been peri for about a year.  I was occasionally skipping periods but they have been regular and reasonably light since I started HRT in March (Elleste Duet and then Femoston 1/10 and now 2/10.)

Finally my questions!  Does all of the above sound about right?  I had to tell my GP what I wanted based on what I have read on here for someone in my situation.  He said I could start the Testogel immediately (before I switched to the Estrogel / Utogestan regime in two weeks.)  Of course I am keen to start feeling better ASAP but am just concerned that by introducing everything at once I won't know what is helping?  Should I hang fire on the Testogel and see if I improve before starting it? Or should I go for it all ASAP?  Am I likely to experience anything horrible as I switch while the new regime gets into my system?  Also, I am already someone who goes for a wee once an hour all through the night, is there anyway to avoid making this worse with Utrogestan?  ( i hear it can irritate the bladder?)

All support, wisdom and advice gratefully received and I sincerely hope that with perseverance more ladies can start getting what they need from their GPs.  I felt utterly doomed prior to this appointment but very lucky now and just being listened to made a big difference too.  Thank you.

[dazned]

Great to see that you were finally listened to,validation really helps doesnt it !

If it were me I would just start with the estrogen and utrogeston first else as you say how will you differentiate between whats doing/causing what ! Give your body time to settle to new regime ,if you feel settled on it then introduce the testosterone. When I used utrogeston vaginally it irritated my urethra but you might be fine. Good luck.

[Dancinggirl]

Your GP has given you the right things for the Oestrogel/Utro regime. Here is the link that supports what you have been given: http://www.menopausematters.co.uk/to_progestogens.php
I would start the Gel once you have finished the last pill in the pack of Femoston. Start the testosterone as your GP has suggested.

If you have bladder issues then you will need to avoid using Utrogestan vaginally .  You need to take Utro before bed on an empty stomach. It will make you feel drowsy/sedated but this will hopefully wear off by morning. I found it did make me want to pee a bit more often for the first 2-3 nights but if it helps you sleep you may find you don't wake needing to pee!!!

Hopefully this regime will work for you. DG x

[Hurdity]

Hi Dediva Ann

Well done . Great that you have a sympathetic GP that is prepared to look things up there and then!!!

I agree I would wait to start the testosterone until after you have got used to the new regime - it is a lot to get used to all at once. You will undoubtedly register the difference using transdermal than oral HRT - so you need to get used to that. Then trying the utrogestan - so I would give it 3 months to stabilise before trying the T personally. The gynae I went to said it can take up to 4-5 months to fully reap the benefits of using T, but you might find that things improve once you start using transdermal HRT anyway.

You haven't mentioned vaginal oestrogen - if you are suffering dryness while being on HRT you really should be using this too, so I would get some estriol cream or Vagifem if you haven't already got some. If you sort out the dryness you might then be OK using Utrogestan vaginally - and eventually you may well be able to use a bit less than the licensed dose - depending on how your bleeds are.

Incidentally the Mirena does not contain norethisterone - it is a different progestogen called Levonorgestrel - the same as in Femseven combi patches. Many women are fine with this one.

Do let us know how you get on and so pleased you managed to sort this out with your male GP

Hurdity x

[Dediva Ann]

How lovely to come back on MM tonight and find these helpful responses.  You really are an invaluable bunch

Absolutely Dazned - validation helps so much.  That GP appt was the first time I have felt hopeful in what feels like forever.  And yes Hurdity, wouldn't it be wonderful if all GPs had the time and inclination to look things up on the spot!

Really though none of us should have to be reaching rock bottom to get what we need or have to fight so hard and sometimes even then never get it.

I guess the only way to find out if the Utrogestan is going to further irritate my bladder if used vaginally is to give it a go.  I really want to avoid the oral route from now on if at all possible.  It seems some of you have found the irritation has settled whilst others have found it intolerable and that addressing the dryness might help with it too.  I'll definitely take it as you've detailed Dancinggirl.  Thanks for the link  I very often struggle to get to sleep and waking to wee so often drives me round the bed so if I can sleep through the urge it might even be a good thing!

I am so tempted to start the Testogel right now but I think on balance waiting might be better as you've echoed my own thinking Dazned and Hurdity.  Am going to sleep on it (not literally!) I have just opened the box as I am curious.  There are 30 x 5mg sachets in there so am I right in my understanding that this is enough for at least 30 weeks? That's amazing!  The pharmacist kindly gave me a syringe so I can be as accurate as possible with the titration.  I said I was going to use 0.7mg a day but actually think I will start (when I eventually do) at 0.5mg a day having just read the (slightly scary) leaflet and because I am morbidly obese with a cardiac pacemaker and already suffer from acne! (although I am quite sure my GP would not have given it to me if he was concerned about such a tiny dose.)  I have a shower every morning but then go swimming at lunchtime and sometimes have a bath in the evening, so I think applying it (pharmacist said to my thigh - he'd read it on here!) in the evening will be best for me in terms of optimal absorption.

Hurdity - does this persistent dryness mean I am getting VA?  It is such a sudden change and horribly depressing. I bought some Vagifem from Boots at the weekend (because I saw it on offer!) but was saving it as a treat before sex!  Have I got that wrong?  Ideally I'd like to use it regularly but couldn't afford to do so.  Is this something other ladies get from their GP?  I really don't feel I can pester mine for anything else at this stage though!  I do have some (possibly out of date) Gynest Cream (0.01% estriol) my GP gave me a couple of years back (before I was peri but I barely used it as the problem resolved itself.)  Can you use estriol cream at the same time as HRT then? (I was scared I'd be overdosing!)  I was hopeful that this change of HRT regime might rectify the problem anyway? And also if the T might help with arousal eventually that it will aid natural lubrication?

Thanks so much as always for your expertise everyone.  Dediva Ann xxx

PS.  Hurdity - yes I see now that it's Levonorgestrel (isn't that in the morning after pill?) in the Mirena.  Was convinced I read it was Northisterone somewhere!

[Dediva Ann]

Further to the above and me moaning so much about the Femoston my GP just called and said I can stop my Femoston today (Day 13) then wait a fortnight and start the Estrogel / Utrogestan regime on my next Day 1. Does this sound reasonable folks? I'd quite like to give my body a break but am a bit concerned about an Oestrogen crash?

[Dancinggirl]

I have done a break like this before now and it can be a good thing - you may get a bit of a withdrawal bleed(possibly nothing) as well which, sort of, does a clear out before starting fresh.
It does sound as though your GP is on the ball - how great.  Don't over think things and don't expect it to work too quickly - it takes time of the body to respond and adjust.  DG x

[Dediva Ann]

Thanks DG  Am quite looking forward to having a break and feeling quite positive in fact - just hope that's not the Femoston finally working on the day I opt to stop it! Definitely guilty of over thinking but am going to try and heed your advice. New me here I come - MAYBE!  Thank you x