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[Kikie]

Well its now about 10 months on 2 pumps of O (reduced to 1 for a while when fluid retention hit) and one tablet of U. Vaginal atrophy almost completely gone but zero increase in libido or well being, physical, mental or emotional.  I shall try to see a specialist (I'm in Spain for a while) but wondering if anyone has any thoughts, suggestions, pros/cons of other things to try?  Eg Tibolone/Livial seems either wonderful or horrendous!  Open to any ideas for me to pursue please.

[Cassie]

I think that combo will def help for physical symptoms such as flushes, healther bones, heart, VA etc but no it wont really help for libido etc, sadly there does not seem much that does help for that...I have resigned myself to the fact that I have no symptoms and so the combo must be working but emotionally you would probably need to address that with some other medication.  Its a great combo and I cannot honestly think that another may be any better some of the ladies use testosterone you may want to look at that?

[paisley]

Have you tried all the other types of HRTs ie patches, tablets pellets. I had tried every HRT & in the end just came off all of them but that was my decision.

[Butterfly22]

How about a tablet and pro separate? Or patches like others say? I think it's all trail and error. Xx

[Katia]

Kikie, I'm wondering the same, but I haven't been taking it long.  Have you tried adding a little testosterone to it?  It would have to be prescribed by a specialist, but it might be just the bit your missing.  I read a stury on Tibolone last week and it didn conclude that androgen therapy (tibolone) was superior to adding E, P and T.   

[Kikie]

Thanks everyone.  Yes I'd like to add in Testosterone tho my gynae friend says to try DHEA first.

[Annie0710]

I think you need to show them guidelines and ask for a 3 month trial of testosterone.... sounds like it's your missing link x

[Mary G]

Your are lucky to be in Spain, it is so easy to get hold of a wide range of HRT there and as you probably already know, you can buy it over the counter and without a prescription in any pharmacy. 

Firstly, are you taking Utrogestan every day?  If so, that could be why you are not getting a sufficient lift from your regime because the oestrogen is being surpressed by a high dose of Utrogestan.  You could try taking Utrogestan cyclically (I used to take just 7 x 100mg capsules vaginally every 5 weeks) and see if you get any improvement.  This will mean having periods again. 

Alternatively and if you are post menopause, have you thought about the new progesterone/period free Duavive?  I bought some in Spain and it cost me €35.00 so it is expensive but it would be well worth a try and has good reviews.

[Katia]

I read somewhere that tablets are better for libido than transdermal. Also like Mary G says maybe the Utrogestan is dampening it down. How do you feel on the progesterone break?  I'm hoping now lots of people are using gel more progestegens will be available on their own rather than combined

[liauq]

I was on oestrogen and progestin for seven days a month and my libido definitely picked up! Unfortunately, it didn't suit me in other ways so one it's back to the good old VA 

[Katia]

Liauq, I'm like that at the moment, one progestin suits me better but doesn't help the VA, the other one helps the VA but doesn't suit me in other ways.  I feel like I'm between a rock and a hard place as there is so little choice of progestins

[Hurdity]

I read somewhere that tablets are better for libido than transdermal. Also like Mary G says maybe the Utrogestan is dampening it down. How do you feel on the progesterone break?  I'm hoping now lots of people are using gel more progestegens will be available on their own rather than combined

Just to clarify - it's the other way round! Transdermal HRT is better for libido. Oral oestrogen raises SHBG which binds free testosterone meaning there is less available to use in the body.

Bad VA is best treated by local oestrogen in addition to systemic HRT, but if not the latter then definitely as high a dose of local as you can get! Maryjane and Dancinggirl know a lot about this!

Hurdity x

[Katia]

Hurdity, doesn't all estrogen affect SHBG, not just oral?  Different P's affect it in different ways too

[Hurdity]

From what I've read studies show that adding oestrogen transdermally has little or no effect on SHBG but oral oestrogen has a dramatic effect - sometimes increasing it by 100% I read:

"Oral HT of any type has been shown to increase SHBG,frequently by greater than 100%, although production is dose and individual dependent. However, studies have verified that lower dose TD E2 has little or no effect on SHBG levels" TD = transdermal. E2 = estradiol. SHBG = Sex Hormone Binding Globulin.

http://www.drmichaelgoodman.com/wp-content/uploads/2012/11/Publications-J-Wom-Health-Are-all-estrogens-created-equal.pdf

There are plenty of other reports of this. The biochemistry of it all is very complex and I haven't looked into it in depth - but as with all our endocrine functions there are complex interactions and feedback loops governing how it all works which would need close study to learn and understand. The main issue though is as above.

There is also the fact that contrary to this some women seem to benefit libido-wise from the testosterone derived progestogens - and not sure of the mechanism for this - maybe direct binding to androgen receptors? ( haven't looked this up!).

Hurdity x