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[VanessaM]

Thank you all for your wonderful help and support!

This may be a basic question, but just how does a doctor/specialist decide what HRT is right?

So - I had bloods done in November which showed very high estrogen but virtually non existent progesterone.  I was given 100mg bio identical progesterone to be taken daily, no breaks. At the time I had not had a period for 3 months, but now I am having them again with an ever decreasing cycle.

From all I have read here, this seems a huge dose of progesterone, and there is no break.

I have been taking the HRT for 5 weeks, so there was quite a gap between being prescribed and actually starting them.  This is my fault - I went into a panic about taking them. However, I did ask the specialist if I should just take them and he said yes.  But he based this prescription on one blood test which as it turned out was about 2 weeks before my period started.  Surely a blood test only gives a snapshot in time and depends upon the time in the cycle.  He did do a consultation of course but so many of our symptoms are very general and non specific.

I now have many classic symptoms of low estrogen, headaches, dizziness, leg cramps. (these symptoms started before taking the progesterone, so it is not that that has caused it)  Time for another trip to have the prescription reviewed?

I know there are many wonderful resources on here about HRT, but I would prefer to go the bio identical route if possible!

[VanessaM]

Hi Hasty

At this point in time I don't actually have a GP as my surgery is closing and I have to re register.  However, most of the doctors I have seen don't even seem to have heard of bio identicals!  So I think I will have to see the specialist again.  Do you take anything?

Vanessa

[Annie0710]

From my understanding taking progesterone lowers oestrogen (not sure by how much) so sounds like from what you're saying you need to introduce some E to possibly calm some  of your symptoms down

Investigate the types of bio identical hrt and take a list of options to choose from x

[dangermouse]

Are you taking the progesterone as Utrogestan, a cream or lozenges?

I have a 50mg cream twice a day so also
on 100mg. It's is hard at first as when you have high oestrogen (usually in pre perimenopause) the receptors get dulled down due to the naturally falling progesterone levels not being enough to mop up the excess oestrogen.

When you then add back the progesterone you feel great but a few days later the balance is registered by the brain and the dulled down oestrogen receptors wake up and you get the high oestrogen symptoms again.

It's then about finding the right amount for you that gives you enough progesterone whilst not over stimulating the oestrogen receptors. It may be that adding a little oestrogen will help with this rebalancing act (I've not tried that yet) but I think like with HRT post menopause it's about trial and error.

You can get bio-identicals from the NHS (Oestrogel, estradiol patches) but they only have large measures as it's mainly manufactured to help very low oestrogen for post menopause, and progesterone (Utrogestan) to protect the womb from the oestrogen stimulating cell build up. My endocrinologist prescribes these (and encourages getting them from NHS on her website) and the weaker compounded creams and lozenges for those who have more complex issues like the migraines.

Blood tests are, as you say, just a snapshot that can change momentarily but it's still a useful gage to check against what's 'normal' on a specific day of the cycle.

Hope some of that helps!

[dangermouse]

Oh and just to add, some women are prescribed very high oestrogen doses to suppress their own volatile cycles in the pre and peri years, as the brain senses the high levels and dampens down its own receptors. The birth control pills also do this but are mainly synthetic hormones but you can get some like Qlaira which have bio-identical oestrogen. None have the natural progesterone though as it's not strong enough to stop a pregnancy.

[VanessaM]

Thank you ladies.  I had to have a lie down as I came over very peculiar indeed! Woozy and odd.  It comes and goes.

I think I do need to get things adjusted as I don't really know if the estrogen is high or low or just all over the place.  I am self employed, so taking time off work is not an option for me.  This thing is really getting me down now as it affects me on a daily basis and I have loads of work on much now.

I did see a very good private GP so I may visit her before going back to the HRT specialist. I am just not sure about the specialist; I have a slight feeling that he just prescribed and made some money, although he came very highly recommended by  a close friend.

[Hurdity]

Hi Vanessa M

If your blood test was taken 2 weeks before your period then that is exactly right - oestrogen is at its highest point ( the pre-ovulatory surge) and can be as high as 1800 pmol/l in some women. Progesterone is normally undetectable at this point because it is only produced in significant measurable quantities once ovulation has taken place - so would be at its peak approx one week after ovulation ie a week before your period - so really those blood tests were meaningless re the prog and encouraging re the oestrogen. In between periods your oestrogen may be high or it may not achieve very high levels - and depends on what your follicles are doing!

Progesterone alone does not really count as HRT and taking it all the time is only needed to protect the womb and usually during post-menopause. Taking it all the time could lead to continuous low-grade adverse side effects - but could also prevent the progesterone withdrawal and associated pms symptoms that happens before the period.

What is it that led you to seek specialist help anyway? Were there symptoms which you wanted treatment for?

Hurdity x

[VanessaM]

Hi Hurdity

I originally went to the specialist as I had missed my period for 3 months and was feeling very depressed and nauseous.  My friend suggested I went along to see her specialist.  I do feel that maybe I have been given something to "make me feel better" as it were..  my symptoms have certainly worsened since then.  Its a bit of a minefield and I am certainly confused!  Since November I have had monthly (ish) periods with ever decreasing cycles.  One very odd thing - I have no hot flushes. (then again I had no contractions whilst giving birth) Sometimes night sweats, but that could well be husband refusing to open the window!  No anxiety as I have had a scans and tests and know that my brain/heart/bloods are normal. 

One interesting thing - today I saw an osteopath as a last resort to sort out headaches.  He did not rule out hormonal matters, but said he thought my problems may be caused by cerviogenic issues. 

Much confused and just want to feel normal again! Most grateful for everyone's help.
Vanessa

[Taz2]

Hot flushes are usually linked to low oestrogen levels. Not sure if that helps.. 

Taz x 

[VanessaM]

Ladies, thank you for your really helpful suggestions.  My current plan is to give the osteopath a try - I have an appointment next week for treatment.  I should know pretty quickly if this going to help.  I do have a history of arthritis, so it is possible.  I also work on a lap top and do a lot of craft and pulled my shoulder badly last year.

I do think it strange that other than differences in my cycle, the headaches/dizziness are really the only other thing that is troubling me. (Apart from a bit tearful from time to time!)  Other things seem to come and go, but can generally be referred back to something else. I know the whole worrying about being seriously ill is a peri symptom, but at the moment I'm not!

I do actually wonder if I am really in need of HRT at all, but I think I will know the answer to this after a session or two working on my neck. But you are all right - a trip to the GP may be a better option than the specialist.  I had no idea that non-synthetics could be obtained on the NHS.  Its not that I would mind paying for them if I knew a) I needed them and b) they would work!  I just find the costs of the preliminaries a bit on the expensive side especially when I have not benefitted a jot from them.  I had the headaches before I started the progesterone, and ongoing.

Thank you all again and hope to update on headache progress soon. 

[Hurdity]

Pms is known to worsen in many women in the months ( or even years) leading to peri-menopause ad in the early days. If you have started skipping cycles then you are likely to be peri-menopausal but as Taz implies, if you are not yet having flushes your oestrogen levels may not be low yet - and the blood tests bear this out. They will be fluctuating though and this may be partly to blame.

Here is an article on peri-menopause from this site:
https://menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

Hope your headaches improve soon ie lessen.

Hurdity x

[VanessaM]

Well ladies..  I had my first proper session with the osteopath yesterday.  There has certainly been an improvement in the severity of the headaches with the first short treatment and yesterdays full on treatment.  I think there is something going on with my neck, but oh my goodness last night strange things were happening to me!

My legs have been aching a lot, especially my left leg.  Kind of achy, like a pulling feeling. Maybe a bit tingly.  This has become worse.  (Takes my mind of my head I suppose) But I am still having odd little dizzy spells, and last night in bed there would be a very short spell of hotness.  Not the spreading through my body, just instant and gone, and with a sicky feeling too. This lasted on and off through the night.  I didn't sleep much despite taking a nightol. 

Could this be a hot flush?  Do they come in different shapes and sizes like everything else seems to in peri?

 

[VanessaM]

I should add I have just finished a normal kind period, although probably only about two weeks after the last one!

[VanessaM]

I thought the treatment with the osteopath was working, but today (after 2 sessions) headache, dizziness and tingling are back.  I am going to give it one last try.  Honestly today it felt like I had an ants nest inside my head!  I have also started calculating cycles, so it would appear that this is day 14 - is it linked?

If this does turn out to be hormonal, could anyone advise what might be the best HRT (if any) to take? Just so when I return to the doctor I have a clue what to ask for!

Thank you

[VanessaM]

Sparkle, this does help, thank you. Did it go away?  Did you take anything for it?  Perhaps its a combination of more than one thing.