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[shoppingqueen]

Hi
Just need some advice please! I was on Premique which was discontinued so Dr swapped to Kliofem. I have done the three months but am constantly weeing especially when trying to go to bed (I can visit toilet to empty bladder several times before settling) and waking early 4pm ish with hot sweats, needing the loo again and pins and needles sensation with the early morning dreads/panic back. Feeling headachy as well. Sorry for the whinge. I'm also feeling as if it's having a negative effect on my breathing. Anxiety not great so am trying Lavender oil capsules in desperation. I have digestion problems and feel the kliofem is making it worse as been back on omeprozole anti acids.
I have tried to persevere as the kliofem had a better impact on my bone aches, which never completely disappeared with Premique, and no dizziness which was terrible pre HRT.
I'm back for review this week and feel I probably need to switch. I don't know what to do! Either try Premarin with a progesterone added in (maybe something different to one included in Premique) such as the micronised Utrogestan?? I slept well on Premique, no flushing just a few off days/weeks here and there, especially if unwell. Only the bone ache was problem, along with feeling flat (progesterone element??) but it was small price to pay for feeling absolutely shocking pre HRT.
I was on HRT for 18 months before the switch to Kliofem. Prior to this had not had a period for about a year, but have had 2 random bleeds within last 20 months on HRT. I'm almost 49. I just want to feel on even keel not bothered if I have conti or sequential.
Any advice would be very welcome.
Thanks
SQ

[Daisycat]

I am sorry SQ I know very little just wanted to say this sounds not great and I hope your GP will have some ideas.

I am honestly starting to think we should all see someone who specialises in menopausal symptoms it's a minefield.

Hopefully someone a bit more informed will be along to help you soon.

xxx

[Hurdity]

Yes I agree with Stellajane - you have changed both the oestrogen and progestogen - and Kliofem is one of the higher doses of continuous combined HRT so you can't really go higher. Some women seem to report more hot flushes when on the norethisterone part of HRT - this is just anecdotal and an impression I have got - but I have read also that sometimes progestogens can interfere with the beneficial effect of oestrogen ( which it is intended to do in the uterus - but not elsewhere).

If you have digestive problems then maybe you are also not absorbing the tablet preparations very well - in such circumstances transdermal HRT is preferred.

Therefore if you were OK with the Premique I would go with Stellajane's suggestion of Premarin ( at the same dose as the Premique you took) and Provera ( the same progestogen), or totally change. Continuous combined patch HRT only comes in one oestrogen dose - 50 mcg - which may not be enough for you, so separate oestrogen and progesterone could be the way forward. The good news is you were OK with Provera (MPA) so this may well do the trick and you can adjust the oestrogen dose to suit. Patches start at 25 mcg and increase to 100 mcg and are usually changed twice weekly. Gel comes in sachets or a pump canister and is usually applied daily.

If you do change type then you might be better off going back to a cycle - and personally I would recommend this anyway especially as you are so young - then you would not have the permanent dulling or sedating effects of continuous progestogen.

All the different HRT types are listed under Treatments/HRT preparations ( top tabs).

Hope this helps

Hurdity x

[shoppingqueen]

Hi
Thanks so much for the replies, Daisycat, Stellajane and Hurdity! I agree that the change in both has left me not knowing what's what so wasn't very helpful. I had to take the Kliofem as I couldn't get an appointment for three weeks so thought I'd show willing and try it out.

I agree that I need to try separates now then at least I can eliminate/ change the progestin element if I struggle in future.
I intially went for tablets for ease to be honest, but the Kliofem has flaired my IBS/ acid and I'd be surprised if I am absorbing fully. I think patches/ gels need to be my best next step. I'd worried about patches as I can get skin irritation. What is the view on gel/ vs patch for success in absorption? I'm happy to try patches. In fact, I'd try anything to get this sorted 

Also, as I was on the highest dose 0.625 conjugated estrogen on Premique, what would be an equivalent in patch/ gel?? Can you get the bioidentical estrogen in patch/ gel?

I'm tempted then to try Provera again first and to go cyclical. Is this do-able with this type? I also fancy trying the Utrogestan, but read they need to be taken on empty stomach at night. I don't usually get my evening meal until 7.30 so at what point would your tummy be empty, do you think? I like the idea of this as it's supposed to be more bioidentical. Do people have positive experiences with it? I'd felt flat on the Premique (but didn't care as at least I could function) and had Depovera injections briefly when I was younger and felt it had affected my mood so stopped. I'm wondering if this is the same progestin.

Sorry for all the questions- I so appreciate any help as I know I'll need to go in armed and request items rather than take the doctor's lead as no-one in my practice seems to specialise in women's health/ HRT. I agree, Daisycat, am tempted to ask if I can request a referral to a specialist unit- if there is one!

Thank goodness for your help, support and advice. Like others, I don't know what I'd do without this site.

XX

[shoppingqueen]

Ps
I've looked on the treatment/ preparation link and on line elsewhere. The suggestion is 0.625 conjugated estrogen equivalent would be 50mcg patch. At least I could start there then move the estrogen up as needed. Some recommend the Estradot patch for stickability- would you agree here? They are all same estrogen it seems just different brands. I can see all the patches are estradiol (bioidentical?)
Also have seen that I could do the progestogen part sequential for both Provera and Utrogestan so that gives me flixibility. What a minefield
Any thoughts would be gratefully received re the Utrogestan and taking on an empty stomach in the evening? And how successful/ popular it is for users. I know it'sown to the individual but it gives a starting point, I guess.
Best wishes
SQ xx

[shoppingqueen]

Thanks Stellajane
I'm at the doctors tomorrow so fingers crossed I get sorted! I'll talk through with the GP and take it from there. I feel much more informed now so thanks for your support.
SQxx