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[Emby]

Hello all, a very confused newbie here ... had terrible menopause symptoms last year, eventually put on prozac by my GP (not HRT which I wanted) Eventually went to one of Nick Panay's team in London (privately, I was so desperate!) and was was put on estrogel 4 pumps plus utrogestan 100 daily and testim gel in October.  Brilliant! symptoms stopped, and I started to feel normal again!  4 months in, I suddenly had an unexpected bleed, quite dramatic but stopped after about 15 minutes, and nothing since ... I had an endometrial ablation 10 years ago so the bleed was a bit of a shock, as I haven't bled since then. Referred quickly by my GP to local Gynae (I don't live in London) who dropped the estrogel to 2 pumps daily and took endometrial biopsy, ultrasound; all good.  When I went back for results, he took me off the Estrogel/utrogestan and put me on evorel conti plus the testim gel.  Since then (about 6 weeks) I've gone downhill big time. Night sweats are back along with the insomnia and the depression symptoms, literally want to sleep all the time and feel like I'm wading through treacle. My question is should I contact the gynaecologist who did the ultrasound and ask to go back on the previous regime or should I stick it out for a bit longer.  I'm so confused, and I've now ended up with two follow up appointments, one with Nick Panay's team and one with the local gynae, I'm assuming the Gynae will have written to Nick Panay's team to let them know the change in HRT.  I'm not usually so indecisive, but this whole menopause thing has turned me into someone I don't know anymore. TIA

[Dotty]

Stick with the Oestrogel and Utrogestan. It’s much better than Evorel Conti. Why did the gynae change the hrt?

Breakthrough bleeding is normal for first 6 months on any hrt so you shouldn’t have been referred at that point.

[Emby]

Thank you for your reply Dotty.  He changed the HRT because he felt the utrogestan wasn't the progesterone for me.  I'm sensitive to progesterone.  I'll email the Consultant and ask if I can switch back to the Oestrogel and Utrogestan I definitely felt better on it. I guess this HRT thing is a work in progress!

[Dotty]

Utrogestan is a natural progesterone and norethisterone is a synthetic progesterone and is not tolerated by a lot of ladies. I'm not a dr but I can't follow his logic!

You have dropped your oestrogen drastically so that is why your symptoms have come back.

[CLKD]

Ring Nick Panay's Clinic?

[Emby]

Dotty ... I'm beginning to doubt his advice myself now, it does seem an odd thing to do in the light of what you've just said about progesterone and reduced oestrogen, I didn't realise that my oestrogen had been reduced by taking the evorel conti, I thought it would be the same amount, in which case it does explain why I feel so rubbish again.

CLK ... I'll contact them tomorrow, definitely and I'll also email the gynaecologist I saw locally too.

Thank you both

[Dotty]

4 pumps of gel is approximately double the amount of oestrogen that is in Evorel Conti, although it is hard to compare them exactly.

[Dancinggirl]

Emby - The Evorel patches have a different (more powerful) progesterone that may be giving you side effects.  The sudden bleed may have been because of the high dose of Oestrogel you were on - Utrogestan isn't that good at protecting the lining from building up, so this was probably why the gynaecologist put you on the patches instead.   Perhaps consider having a Mirena fitted as this should allow you to use the 4 pumps of OEstrogel without worrying about erratic bleeding - the Mirena is good for those who are sensitive to progesterone as less is absorbed systemically.

Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
DG x

[Emby]

Thank you Dancing Girl ... theres just so much to think about, the menopause is such a minefield!  I was so desperate, I would have taken anything they gave me if it was going to make me feel better.  I suppose I should have done some homework first, and asked a few more questions ... hopefully I can get sorted soon.