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[Jo24]

I am 55yo, last monthly period Sept '15
Started Femseven Conti Oct '16 for multiple menopausal issues - hot flushes, night sweats, insomnia, anxiety +++
Had breakthrough bleeding on Conti, so changed to Sequi - which made my anxiety worse.
GP px Conti again (July '17) and investigations into bleeding - polyp found, and removed, otherwise TV ultrasound and biopsy normal.
On Conti but still having slight break through bleeding (7 months of full treatment) - it seems to start on the day I change my patch? Also, my anxiety/stress levels are high again.
No flushes or sweats, and sleeping fairly well.
Please help, I feel so anxious, tearful, and stressed all the time; it's ruining my life just now.

[Dotty]

Perhaps you need a change of hrt. Have you discussed this with your doctor?

[CLKD]

It can be Trial and Error  .  I am sure that ladies with experience of HRT will be along.  However, there are anti-anxiety medications for 'as necessary' use so maybe consider trying the two to ease immediate symptoms.  Will allow you to C the wood for the trees.

[Mary G]

I've never used Femseven but it is a 50mcg oestrogen dose which I found way too low.  Added to that, you also have a constant dose of progesterone which will lessen the positive effects of the oestrogen.  The breakthrough bleeding on the day of the new patch could mean you are not absorbing it well.  The anxiety could be either your oestrogen levels being too low or the progesterone level being too high or both. 

Personally, I would switch to a different type of HRT.  Do you mind having periods again?  If you change to a cyclical regime you will probably find you feel much better on the oestrogen only days and hopefully not to bad when you add in the progesterone part as long as you keep your oestrogen levels up.  The best way to achieve this is to go onto an HRT regime that offers you maximum dose flexibility and I would recommend you look at Oestrogel for the oestrogel part (you simply rub it on your skin) and a separate progesterone.  Depending on how you feel about the progesterone in Femseven, you could consider a Mirena coil which contains the same progesterone although I would urge you to use significantly more oestrogen (3 pumps of gel) to keep your levels high enough to counter any side effects from the progesterone in the coil otherwise you will be back to square one.  Alternatively, you could look into Utrogestan which is a progesterone that can be used vaginally for a few days each month and has fewer side effects.

Please don't suffer any longer.  I hope that helps.

[Jo24]

Thank you Mary, very helpful and kind of you to reply ...
I did have a trial of the Sequi patch, but felt even worse on that 'mood-wise'
A Meno specialist I saw a while back told me 'a slow trickle of both hormones' is the ideal ....
I wonder if I could try upping my Oest with supplements such a soy milk etc?
After the disaster of the Sequi trial I am really loathed to tinker too much with my HRT px.

[Hurdity]

Hi Jo24

  from me too.

Yes it is all very well in theory to have a steady trickle of both hormones - it does prevent the high and lows associated with cyclical HRT but as Mary G says it is often the continuous progestogen that causes problems - low grade pms type feelings, and the anxiety you describe, especially as the progestogen is synthetic.

As you are well post-menopause, depending on how you feel about the Mirena coil, another alternative is to try for a longer cycle which is what I do. OK I don't like taking the progesterone but I keep it to a minimum by only taking it on a 6-8 week cycle (and having it vaginally). It may not be that you need a  higher dose of oestrogen - just that you need to be on oestrogen only for a longer time before the progesterone is added. I started HRT at just under 54 when I was in late peri-menopause and had a 50 mcg patch. This was almost 11 years ago now and have been on more or less this dose ever since. Long cycles require medical supervision to monitor the womb lining.

You won't know whether your symptoms are due to insufficient oestrogen or the continuous oestrogen unless you try one of these regimes ie Mirena + oestrogen (patch or gel), or oestrogen ( patch or gel) + separate progesterone.

In your position I would try not to change too many things at once ie keep to the patch at first with separate prog or Mirena, and if necessary increase the oestrogen dose - and if after a few months you don't feel any better then perhaps think of changing to the gel? I should add that there is still some systemic absorption of oestrogen from the Mirena even though most of it is absroibed locally and keeps the uterus lining thin.

All the different types of HRT are listed under Treatments ( above tabs).

At this point I would concentrate on getting your HRT right and not think about medicating anxiety - this is often not necessary and not advised (by NICE re menopausal symptoms), except for extreme cases or for women who may have had life-long anxiety or very traumatic stressful life events. There are various strategies available eg nomorepanic website and a blog on this website about CBT (DIY!) and self-help measures: https://www.menopausematters.co.uk/daisyblog.php

Hope this helps - and do get in touch if you need any more advice

Hurdity x

[Jo24]

Thank you ....
on my trial (3 months) of Sequi patches, I felt even worse than when on the Conti - which would seem to indicate that I require both hormones, and did not cope with the 'swings' of progesterone ?
The Meno specialist did advise that SSRI's (and the like) are not appropriate, which I agree entirely, not a route I wish to explore.
I personally think I need more Oest, but given my age my GP is not overly keen to 'up' that, so I feel a bit trapped ....
I could request another referral to the Meno specialist who may be a bit more 'adventurous' than my GP.

[CLKD]

Your age shouldn't come into it!  Have a browse.  Maybe see the Practice Nurse to see if she knows more about HRT?

[Dancinggirl]

Hi Jo24 - at your age I had the Mirena with 2 pumps of Oestrogel daily alongside and this was my best non bleed HRT option at the time.  I think it should probably give you the balance you are looking for with the minimum hassle.  I only had a bit of spotting for the first few weeks after the Mirena was fitted - then after that, no problems at all.
The Mirena is very good at protecting the womb from erratic or problematic bleeding and will shrink fibroids & polyps. 
DG x

[Bring me Sunshine]

Hi Jo i am almost 52 and the elleste solo tablets did not start working for me until I was on 3mg.  The gp was not allowed to prescribe over 2mg but the menopause clinic wrote to them and told them they had to give me 3mg.  The  progestorone was same as dancing girl via the mirena coil (3rd coil and no problems with them).  All was wonderful until I started getting migraines so I was taken off the tablets before Christmas and put on 2 pumps of oestrogel.  Plunged back into the abyss again low self esteem, night sweats, tearful, anxious....went to 3 pumps.....nothing.....4 pumps all prescribed by the menopause clinic that my gp has to abide by.  This was last Thursday.  Feeling better day by day this week and pleased to say no headaches since starting on the oestrogel.  Hope is back again.

Good luck to you!

[CLKD]

   Bring me Sunshine

[Jo24]

Can anyone advise if the Mirena coil would give me a 'systemic' trickle of Prog (as well as the local effect)?
Previous experience has shown that my sleep is disrupted without Prog, and I felt more anxious without it, so I am loathed to change my HRT to one that does not give systemic Prog.
I think I need to get back to my GP and ask for another referral to the Meno Clinic ..

[Dancinggirl]

I slept really well with the Mirena. There is some systemic absorbtion but the theory is that the Mirena gives less systemic absorbtion overall, as opposed to pills or patches, and therefore gives fewer negative side effects like pmt. There does tend to be an initial big hit of progesterone in the first few weeks so I did feel slightly sedated but this settled quite quickly. You can also gradually increase you oestrogen dose till you find the perfect balance. The Mirena tends to be a favourite with many gynaes because it sorts so many problems. There will be some women, who are very sensitive to progesterone, that don't get in with the Mirena but I believe the success rate is pretty high. If you go online you will find lots of horror stories -  those that are fine with the Mirena don't generally need to give reviews - they had it fitted and got on with life. DG x

[Jo24]

Thanks ....
I am wary of having 'negligible' Prog systemically which I assume will be the case with the Mirena?
My sleep patterns are terribly disrupted without Prog.
I am thinking about asking my GP to consider upping my Oest (currently 50mcg/day) and see if that helps first before going down the Mirena route ...

[CLKD]

Different hormone though  delivered differently