Hi JoLouise
Oh dear (for many reasons!)!
Firstly - no wonder you haven't been feeling right - none of this treatment apart from the last one - is really ideal for menopause.
The effects of the BHRT that you were prescribed - are typical and this is not recommended by the mainstream medical profession. It is extremely expensive, non-standardised - so that you don't know how much of each hormone you are getting, and it is not regulated. Creams are not well absorbed but yet these clinics continue to get away with charging exhorbitant prices to women and prescribe them!!!
Anyway at least you realised that - but unfortunately the doc at the clinic prescribed far too low a dose of oestrogen so no wonder you were still feeling down.
Please don't take this the wrong way but if your depression was new onset - and not due to life events ( or even if it was) you should have been given a proper trial of HRT at a suitable dose BEFORE drugs like Fluoxetine were consdiered and given (unless there was a compelling overriding reason in your case to do so). The NICE Guidelines on Menopause are very clear about this.
Your doctor should have put you on at least a 50 mcg patch and not prescribed the AD (subject to your situation).
The other thing is you are quite right - one of the most common side effects of utrogestan is nausea from oral use and in continental Europe it is licensed for vaginal use for women who experience this side effect - and many doctors and gynaecologists here in UK also prescribe it for vaginal use when nausea and fatigue etc are experienced severely. In addition you are taking it every day - and although this no-bleed regime is usually recommended for women who are post-menopause, in practice many women who take utrogestan (and especially those who get the side effects) take it cyclically to avoid the continuous side effects like you are experiencing - quite extremely. I presume you were taking it last thing at night and on an empty stomach?
You oestrogen levels are still low but hopefully they will build up once you have been using the Estradot patch for a few weeks. You may well need to increase the dose a bit more depending on how you feel? In your position and if you can bear to have a bleed, I would try the utrogestan vaginally and take it for 11 days per month. The licensed dose is 200 mg but if you are seeing a specialist and your bleeds are not too heavy then you might be able to reduce this. You should not get vomiting when taking vaginally unless the progesterone itself is causing this? If you don't want to have a bleed then I'm not sure where to go from here, if like most women you don't want to take it vaginally on a continuous basis?
The other alternative would be the Mirena coil which delivers most of the progestogen locally and then you can add in whatever dose of oestrogen you like.
I am interested in the Androfeme as this is the only product available for women - but not licensed yet in UK. Creams are not especially well absorbed but with testosterone it is not so crucial to reach certain levels - well I should say that insufficient is known about this!
Ideally once you have got yourself sorted on the right regime you might be able to come off the Fluoxetine - because it is most likely that the hormones are causing or exacerbating your depression and anxiety if it is new onset.
I hope this is helpful - and you manage to sort something out that suits you. Do keep posting and talk it through with us if you need to and if it helps!
Hurdity x
PS I've never taken Utrogestan orally and only vaginally so have never had nausea with it
