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[Optimist]

Hi all, I'm new to the site, posting as a new member but have been browsing now for quite a while. Fab site.
Please could anyone give me any advice as I'm feeling slightly mad with it all!
I'm peri (likely have been for years) but earlier this year, following 4 months period free I got terrible night sweats & hot flushes. I also have had a bad back for a year and recently started to get knuckle pain in the mornings. I was started on elleste duet 1mg, had been prescribed hrt reluctantly by very young gp. I was prior to hrt taking black cohosh & St. John's wort which was working very well sleep wise, no more hot flushes or night sweats. I asked to try hrt for mood swings and back and joint pain.
Joint pain and bad back gone within the first week, I felt amazing but then noticed I wasn't sleeping well on the oestrogen, night sweats returned then onto the progesterone! Omg tearful, mood swings from hell,  1st month bled for whole 12 days on it. Advised to keep trying to get in my stystem which I did but still not sleeping on oestrogen waking 4+ times to go to the loo (already been on oxybutinin for 5+ years) & an absolute nightmare after 10 days on progesterone again (very aggressive violent flashes of anger, tearful etc).
Spoke to gp in tears and she said she'd leave me another prescription to pick up after researching as I'm likely reacting to the pro part of the hrt. Picked up prescription and she's given me horse urine?! Prempak-c 0.625. I feel sick reading up on these as the way the urine is extracted from the pregnant horses is horrific.
What do I do??
Do I tell her what to prescribe me?? Was thinking patches and utrogestan? Or do I ask to try Femostan as least progesterone derived?? Help please, I'm very tearful and can't talk to anyone about it.

[Dancinggirl]

I hated Prempak - I'd ask for Femoston 1/10  first as this is easy for the GP to prescribe and find in the book - most GPs don't know what Utrogestan is!!!.  If Femoston doesn't suit you then try the separate oestrogen with Utrogestan but you'll need to print things out from this site to show them.  Do look under treatments and print stuff out anyway to show the GP if necessary. It's trial and ego till you find the right HRT - Femoston is a very popular one as it suits many women very well.  Problems with the bladder are a common meno symptom and HRt should help but you may also need local oestrogen as well - ask for Vagifem.  Good luck.  DG x

[Optimist]

Thank you, it's good to know there are other ladies out here who know what I'm going through and have trialled these medicines.
I'm getting to the stage where I feel my Gp will think, oh not, her again!
Think I will go for the Femoston as reading around the forum a lot of ladies appear to tolerate this.
I will print out the treatment pages, thanks for the tip.
I feel bloated a lot of the time also and appear to be putting on weight around my middle at a fast rate! Another hrt side effect no doubt?
I will get this sorted......
Thank you for taking the time to reply.

[Dancinggirl]

Gaining weight around the middle is a meno symptom not really to do with HRT.  We all need to eat a lot less when the meno hits I'm afraid.  Good luck  DG x

[Hurdity]

Hi Optimist

  - I do love your name

Sorry to hear about your problems with HRT and I agree with Dancinggirl and what you yourself feel re Prempak and Femoston, the latter which is the oral preparation in tablet HRT most like our own progesterone and the least testosterone derived.

You haven't said how old you are - but your worsening symptoms may also be that you need a higher dose if you are young especially. Also if you don't absorb the tablet HRT well then yes you might find your symptoms improve better on patch HRT and maybe also utrogestan. The other thing is that you will still expect to get normal pms taking cyclical HRT as your body adjusts to the progestogen and then stopping it, but you should feel better overall on it than off it. If not - it's the wrong type! You should give it 3 months though to allow the body to adjust.

Good luck and let us know how you get on

Hurdity x

[Optimist]

Thank you both, going back to the GP tomorrow to ask for femoston.
I'm almost 51....how did that happen
I will give this one 3 months if progesterone part okay and hopefully that will do it!
Thank god for this forum is all I can say !!
Happy Sunday all.

[dahliagirl]

Hi Optimist

A lot of doctors start with elleste duet - it does the job well (provides oestrogen and norithisterone is very effective at protecting endometrium)suits a lot of people and it is cheap, so it is encouraged  (It is similar to when they start people on COC these days and give them microgynon).

If it does not fit you, then you need to change something.  It is customary to change one thing at a time, so that you know what is working and what is not.  If you change lots of things together, then you will never know for sure what is working    So what you do is change the progestogen, if you are having progestogen problems, let it settle for 3 months,  then change the oestrogen/increase the oestrogen when you have oestrogen problems or not enough (or vice versa) until you get it right.

If you look above at Treatments/hrt preparations/ for perimenopause, you will see that elleste duet 1/10 is estrodiol and norithisterone and low dose, whereas prempak is conjugated estrogens, medium dose and norgestrel.  So that is three changes all at once 

So yes - go back to the GP and ask for Femoston 1/10.

If this is ok and the symptoms go away then come back again, then you may need to try a higher dose.

Hope it goes well with the doctor.  Someone needs to write a blog on 'How to go back to your doctor and ask for the right thing, if you think s/he has got it wrong' 

[Dancinggirl]

Excellent post dahliagirl - sound advice and so logical.  DG x

[Optimist]

Thanks for the excellent advice, I'm so glad I found this forum.
I spoke to a male GP on the phone who actually knew more about HRT than the 2 women GPs I've seen!
Dhalia I wish I'd seen your post first as he's prescribed me Femseven sequi patches which has the Norgesterol progesterone. But is this what you meant as it's the same oestrogen as elleste duet but different progesterone. I'm feeling hopeful that the patches will work better for me. When I gave the prempak back to the pharmacist she was gobsmacked that they use pregnant mares for the conjugated oestradol ! (As was I).
I'll keep you posted with progress. I'm at the end of week 1 oestrogen tomorrow so thinking I should start week2 with the new patch as can't bear the thought of reacting so badly to the progesterone again if I finish the month out on elleste duet!
Is this okay?
Keep up the good work you're all doing by posting so well on here. Thank you 😊

[Optimist]

Ps meant to say, the GP said he couldn't prescribe femoston as not available in Uk. Guess this is a world wide forum?

[Dancinggirl]

Femoston is a standard HRT available in the UK - the GP needs to have a proper look in his drug book!!!!

There is a UK version of this site which show the HRts available in the UK and there is a USA version that shows the HRTs avail be in America.

If you do need to try something different then you can print out the list from this site to show the GP:
http://www.menopausematters.co.uk/perimeno.php
You can probably just switch straight to the patches - the progesterone in these Femsevern is levonorgestrel and this might suit you better.  It is join to be trial and error I'm afraid till you find one that suits you.

Hope you get on well with the patches  - keep us posted.  DG x

[dahliagirl]

Yes Femoston is available - I take it.

The patches have benefits over taking pills as they do not pass through the liver.  Hope it goes well.

[Hurdity]

Yes Optimist it would be fine to change straight over to the oestrogen patch from the oestrogen tablet - in fact is better to change now as you are then just changing one thing at once - but does mean that you will only do a week of the oestrogen patches before changing over to the combi ones - otherwise you will be out if sync with your cycle (that is if you have one). If you are sure your cycle has more or less gone (ie you are very late peri- or post-meno) then you could just start the whole thing from the beginning with the Femseven, and do two weeks oestrogen alone and then swap to the combi patches as per the packet. Depending on what your womb lining is doing though that would mean an extra week of oestrogen - which could make the bleed a little heavier - although this should all settle down after a few months....

Let us know how you get on !

Hurdity x

[bramble]

Just a lone voice in the wilderness putting the case for prempac. I was on premique as it was the only hrt I could cope with. Despite its bad press, the prem* type hrts can be tolerated by a lot of women and they have been around forever which proves they are efficacious. Not saying that I agree with the method of production, but needs must etc.

Bramble

[Dancinggirl]

Absolutely Bramble - finding a HRT that suits you is very important and if the Prempak/Premique HRTs were not OK to use then they wouldn't be on the market.
So many on this site rave about Utrogestan as the safest and most natural progesterone to use, however, my experience of using Utro was not particularly good and certainly more problematic than most other progesterones. This is why I always say we shouldn't undermine the type of HRT a women is prescribed by their doctors unless of course it is the wrong regime i.e. a peri meno women has been given a conti HRT. DG x