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[Hothothot]

Hello everyone,

I would really appreciate some help/advice regarding Sandrina and Utrogestan. I am 50, perimenopausal, though haven't had a period for 4 months.

A brief background: started Venaflaxine in July '16 due to excessive hot flushes (every hour, 24 hours a day) as reluctant to use hrt as awful reactions to the pill when younger. Nasty side effects, so eventually went on Fem 7 sequi. Patches wouldn't stick, and then caused itchy rashes, so switched to Evorel sequi. Worked well, but gained loads of weight, so came off in Spring this year. Lost the weight, but hot flushes came back worse than ever! Went back on Evorel sequi a few weeks ago, but it's no longer working for hot flushes, and I've developed an allergy to those patches too. Despite no experience of prescribing it, my GP agreed to let me try Oestrogen gel (she prescribed Sandrina) and Utrogestan so that I can play about with the Oestrogen dose until the flushes stop. I then plan to reduce the dose to the lowest I can tolerate without the flushes coming back.

Sorry if that was a bit wordy! I have been gradually upping the dose and am currently using 2.5 mg Sandrina and still having hot flushes (although fewer and less intense), but am a bit reluctant to go higher. I am currently on day 12 of 200mg Utrogestan orally, but have had some issues with nasty headaches, constipation, spotting and bleeding since day 6, and generally feeling a bit rubbish. I wonder if anyone could answer some questions for me?

Is Sandrina comparable to Oestrogel in dosage? Can I go to 3 mg if necessary? This seems to be the maximum stated dose for Oestrogel, but Sandrina says maximum dose 1.5 mg, which I am already exceeding..

Am I likely to have less side effects if I use the Utrogestan vaginally? And if I try it vaginally, can I reduce the dose to 100 mg? Would I need scans to check the lining of my uterus at this dosage?

I cannot see a way forward without the use of hrt, as my hot flushes are so debilitating and mortifying, to say nothing of the sleep deprivation  .  I had a terrible experience with the Mirena coil when I was younger (bled constantly for six months, no sex drive, and awful acne), so that's not an option for me instead of the Utrogestan. I really want to stay away from hrt tablets because of the gut issues I had with the pill (tablets). I was also diagnosed with endometriosis at 21, and have autoimmune thyroid disease too, both of which complicate matters somewhat.

I did suggest to my GP that given my endometriosis and thyroid history that a referral to the menopause clinic might be useful, but she doesn't seem to want to do that. She is a lovely GP though, and in my experience they can be hard to find.

Sorry this is so long, but I would really appreciate any advice. I have read all the related threads I can find using the search facility, but not all are directly relevant.

Many, many thanks in advance for any replies. 

[Maryjane]

Really sorry but haven't properly read the post just skimmed , I was on sandrena and didn't get on with it , I swapped to oestrogel which I much prefer , one sandrena sachet is equal to 0.75 of one squirt of oestrogel , I am also on utrogestin and local oestrogen for VA.

[Hothothot]

Thanks for the response Maryjane,

In what way do you prefer Oestrogel? My GP just plumped for the first one that came up on her computer which is why I ended up with Sandrina. It's a lot of little packets to squirt out!

[Maryjane]

Dries very quickly , ease of use , and can up and down dose of necessary much easier .

The San made my breasts hurt all the time , the O does not.

[Hothothot]

That's useful to know Maryjane, thank you. 

[Hurdity]

Hi Hothothot

I would definitely push for a referral to a menopause clinic or some other specialist in view of your endometriosis - depending how bad it has been during your reproductive life? As I understand it oestrogen can cause the endometriosis deposits to grow and if they are outside the womb this can be problematical. It is usual for progestogens to be given all the time in such circumstances I gather?

This is what it says on this website about endometriosis:

Endometriosis
There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.

I hope your flushes gradually subside - at the right dose they should be eliminated after a couple of weeks at the most if the cause is due to menopause. There is some interaction with thyroid metabolism and meds but more particularly when taking oral HRT, so I've read - so it could also be your dosage of these need adjustment. Your doc should be monitoring thyroid levels after starting HRT in case your dose needs tweaking. Countrybumpkin is the thyroid expert on here but can't remember if she takes HRT as well - but there are several on here who take both.

Hurdity x