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[Dmt]

Hi, I am aged 52, still menstruate regularly, but am very peri menopausal. Depletion of my hormones started in my early forties. My symptoms were hot sweats during the night and also in the afternoons, problem sleeping, depression, no energy or motivation for anything and anxiety, pulpitations and panic attacks. All of these symptoms have been very gradule over a number of years, but although I can cope with the physical ones, the anxiety & depression are very bad & unmanageable. My first GP prescribed the antidepressant citalopram 20mg, which I was on for about 8 months and totally spaced out for most of that time. Needless to say, I wasn't depressed, so it didn't work! Came off the AD's & saw a different GP who prescribed prempak C, the estrogen content made a very slight difference, but the progesterone gave me 2 weeks of very badPMS. So after 3 months she took me off them. Because I also needed contraception, she then suggested I have a merena coil fitted (progesterone) & take estrodial in pill form. This was a disaster, my hair became thin, I bloated everywhere, mainly my face, dry skin and I suffered from extreme PMS the whole time. I had the coil removed & was HRT free for 6 months. All the original symptoms returned, the hot sweats were more or less constant and I felt like my heart was going to leap out of my chest! I was still ovulating, but knew I needed something. I researched BHRT & found it was available on the NHS. Went back to GP she wasnt happy prescribing me BHRT as she didn't know enough about them, so she gave be premarin instead. 2 weeks of feeling ok (estrogen) then 2 weeks of hell (progesterone & estrogen)After 3 months of highs & lows, I read lots of data including Prof John Studd & realised I am progesterone intollerent. Armed with all my research, I go back to GP & beg her to give me BHRT. She gives me Sandrena gel 1mg used everyday & Utrogestan 100mg used vaginally 7 days per month. Ive been using these since 2nd of December 2016. Didn't start feeling any benefits from the sadrena gel until just after Christmas & it's only a very slight difference. However, the Utrogestan I find to be suitable, as it helps me sleep makes me feel like I used to, for example, just as it starts to build up & i start to feel tetchy, tearful & angry (PMS) the 7 days are complete & I'm back using estrogen only. I have to see my GP mid February 17, to discuss if the BHRT are working for me. Has anyone had any problems with Sandrena? Do I need a higher dose? Has anyone used a more effective form of estrogen BHRT? Or should I persevere for say 6 months to see if it's effect's improve?

[Hurdity]

Hi Dmt

 

The standard dose of gel is usually 1.5 mg which is two pumps of oestrogel. Sandrena is more concentrated and I think 1 sachet = 1 mg? However some women only start on 1 pump of estrogel ie 0.75 mg. How much you need depends on your own cycle and how much you are producing - some women report that if they are still menstruating regularly and add in too much oestrogen - they feel over-stimulated at the cycle high point - which is just before ovulation. I have no experience of this - and if I ever experienced symptoms of too much oestrogen I didn't know what they were!

It depends on how well you are feeling? The additional oestrogen throughout your cycle raises the background level so theoretically you should not experience the same mood dips - but of course in peri-menopause you can't eliminate them completely.

Amazing that your GP was happy to prescribe this regime.

I would also say that this dose of Utrogestan is far less than the licensed dose which is 200 mg orally for 12 days per 28. It is recognised by gynaes that absorption vaginally is usually higher and therefore some prescribe half the amount - - but in your case both the dose and duration is reduced to a very low amount. However as your oestrogen dose is low, and if you are ovulating regularly and therefore still producing plenty of your own progesterone - it may well be sufficient. I would expect any GP who prescribes so much less than the licensed dose to agree to scan your uterus on a regular basis to check for over-thickening - but maybe this is less usual when women are still having regular periods?

I think if you are progesterone intolerant the side effects cannot be eliminated entirely. The only other alternative is to try tablet HRT - such as Femoston. The progestogen - dydrogesterone - is very very close to progesterone and the estradiol is of course - bio-identical with our own. You might find fewer side effects?

I use oestrogen patches (Estradot) and they have always worked perfectly for me - but it is up to both individual preference and how much you absorb.

Hope this helps

Hurdity x

[Dmt]

Thank you Hurdity. I feel that I have found the best progesterone, for me, so far and need to get the correct estrogen. I'm going to talk to the GP about  Femoston and changing or increasing my current estrogen. Is the Estradot patches you are using bioidentical?

[Hurdity]

Hi again - almost all the oestrogen in HRT is bio-identical - it is mostly estradiol (some of the oral HRT is estradiol valerate which is metabolised to estradiol quickly in the body). The only types that aren't are the ones made from horse urine which contain conjugated equine oestrogens (sometimes known as CE or CEE) and always start with the prefix: PRE- .

You could increase to 1.5 sachets Sandrena which gives the same as 2 pumps of estrogel. If you are generally happy with the gel as well as the progesterone then personally I would try to increase the dose of this first before changing types. Don't be put off by using part sachets - my testosterone gel comes in sachets which last aboue 2 weeks so making one last two days is not a problem. You just fold over the top and put a paperclip over the opening (not sure what size they are!).

Hurdity x

[Dmt]

Thank you, wow you really know about this  I was totally unaware that most estrogens were bioidentical. I'll follow your advice and try 1.5 sachets now, so that I have plenty of time to see if it works, up to my GP appointment & if I don't improve then I shall discuss the other estrogen options you have suggested.

[Cassie]

Ask for the oestrogel, its wonderful, you can adjust the dose as per your symptoms, really a brilliant bio identical HRT

[Hurdity]

I suggested increasing the Sandrena dose rather than changing to estrogel because of the different concentration of oestrogen in the latter and therefore with estrogel you need to apply more to get the same amount of oestrogen. Better to increase the dose of the one she is used to for this reason, I would suggest?

Hurdity x