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[SueLW]

Hello

I need to change my HRT.  I have a lot going on with thyroid and possible adrenal issues (recent test results looks like there is less risk of Addison's disease as there might have been suspected a few weeks ago).  But my HRT is, I think, now causing me issues I need to resolve.  I have been on bioidentical compounded creams for a few years.  I currently have a 3 in 1 pump so can't separate any of the hormones out. It's a continuous regime.  I know you all hate these creams on here, but bear with me.  I'm up for a change now.

Recently I have been feeling even more bloated than ever (given thyroid weight gain + menopause that's saying something).  My fingers, wrists, ankles, stomach are full of water!  I look like someone inflated me.  I feel like I'm about to start a period (each morning when I wake I'm sore and full feeling, but it goes off when I apply the cream in the morning.  It can come back later and again goes with the evening pump).  I did actually have a small bleed last week but got no relief from it.  That was the first bleed in many months.  There is a minuscule amount of spotting happening very rarely.  I really feel like I need a good period and start again.

Other symptoms; getting suddenly hot now and then (could be thyroid related but could be sex hormones).  Very low mood suddenly sweeping in.  Feeling close to tears often but not actually crying.  All my joints hurt, and my thigh muscles hurt and are weak, I am walking like an old women (could be thyroid but could be sex hormones). I am exhausted and I can't concentrate or motivate myself at all.  I can't even remember what sex felt like.

It anything it's the awful bloating and the emotional rollercoaster that makes me think it's sex hormones.

I have never tried sequential HRT.  I was started on continuous 3 years ago from nothing.  I don't know how I would feel on oestrogen alone so can't tell if the problems I have are progesterone related.  To be honest, I've never got much resolution from HRT.  My specialist did try me on Estrogel and progesterone cream but the estrogel seemed to be too strong and I'd cry and shake very soon after applying it.  Perhaps it wasn't strong enough as I started on 1/2 pump a day and ended up on 1.  She tried me on 25 and later 50 patches and progesterone cream.  I felt good on patches for a while but then seemed to get overwhelmed with them and would feel better very quickly if I removed the patch for a day.  I tried 3 Utrogestan tablets orally over 3 nights at one point and felt suicidal and had to stop.  BUT I had also increased my patch to whatever comes after the 50 patch so I don't know if that reaction of itchy, exhausted, desperate, inability to pee and suicidal thoughts were to do with the extra oestrogen or the sudden Utrogestan. 

The one constant has been daily progesterone cream and daily testosterone cream. 

I don't know whether to ask to try a cycle; if so with what?  I'm quite terrified of Utrogestan at this point.
Or should I have a Mirena fitted and try adding oestrogen to it? (if so, what type?).   I had one a few years back for BC and after the first 3 months I was OK on it, a bit bloated but OK mentally.  Bloating has been a longstanding problem in my adult years.

What do you all think?

[Dancinggirl]

Hi SueLW

It certainly sounds as though you are needing a complete review. I suspect you are now deeper into menopause and the oestrogen deficiency is really kicking in.
The bleeding and spotting you have had could mean your womb lining has built up so you probably need a scan.

How old are you and what was happening with your periods when you started the compounded hormone treatment?

I assume you are seeing someone privately for this compounded treatment so I would suggest you perhaps seek a fresh review with a specialist gynaecologist who will advice you on the best way forward.
It sounds as though you have been tinkering with you hormone treatments, trying to find a good balance, but essentially it is usually better to be monitored while using the tried and tested hrt combinations and stick with each combination for a few weeks at a time to allow your body to adjust and settle.
There is much debate about progesterone but generally women do find any progesterone challenging, particularly when trying to help mood and energy, so I doubt that high doses of progesterone would be helpful.
The Mirena can give the low consistent dose of progesterone that suits many women really well and it allows you to use any amount of oestrogen alongside to control flushes etc. However, trying a proper sequential hrt for 3 months may be a good idea to start with as it gives your body a chance to welcome the oestrogen and allow it to work it's magic and then when progesterone is added you can truly see whether that type suits you or not.
The first thing I think you should try is to stop all hormones for at least 4 weeks to see how you feel - see if the bloating will settle? You can then start fresh. This would also allow you the chance to sort the potential Thyroid issues as well - I assume your GP has been testing this?
Why not seek out a good menopause specialist near to you to get some appropriate advice.

BTW - it's not that we ‘hate' compounded hormone treatment, it's simply that this type of treatment is not properly tested so is not considered safe by Dr Currie and the professionals within the NHS.

Do keep us posted - I'm sure you would feel better on a proper HRT regime now. DG x

[SueLW]

Hi SueLW

It certainly sounds as though you are needing a complete review. I suspect you are now deeper into menopause and the oestrogen deficiency is really kicking in.
The bleeding and spotting you have had could mean your womb lining has built up so you probably need a scan.

How old are you and what was happening with your periods when you started the compounded hormone treatment?

I assume you are seeing someone privately for this compounded treatment so I would suggest you perhaps seek a fresh review with a specialist gynaecologist who will advice you on the best way forward.
It sounds as though you have been tinkering with you hormone treatments, trying to find a good balance, but essentially it is usually better to be monitored while using the tried and tested hrt combinations and stick with each combination for a few weeks at a time to allow your body to adjust and settle.
There is much debate about progesterone but generally women do find any progesterone challenging, particularly when trying to help mood and energy, so I doubt that high doses of progesterone would be helpful.
The Mirena can give the low consistent dose of progesterone that suits many women really well and it allows you to use any amount of oestrogen alongside to control flushes etc. However, trying a proper sequential hrt for 3 months may be a good idea to start with as it gives your body a chance to welcome the oestrogen and allow it to work it's magic and then when progesterone is added you can truly see whether that type suits you or not.
The first thing I think you should try is to stop all hormones for at least 4 weeks to see how you feel - see if the bloating will settle? You can then start fresh. This would also allow you the chance to sort the potential Thyroid issues as well - I assume your GP has been testing this?
Why not seek out a good menopause specialist near to you to get some appropriate advice.

BTW - it's not that we ‘hate' compounded hormone treatment, it's simply that this type of treatment is not properly tested so is not considered safe by Dr Currie and the professionals within the NHS.

Do keep us posted - I'm sure you would feel better on a proper HRT regime now. DG x

I am just 55.  I had not had a period for years because I had a Mirena coil.  When the coil was taken out my periods didn't return and I started HRT around a year later I think.

I haven't been tinkering with HRT.  I am seeing a private HRT specialist and women's doctor and it was her who tried me on the various things I listed and each was tried for several months at a time (except the Utrogestan!).  We ended up on the cream because I struggled to tolerate the other things.  I had a scan a year and a half ago and all was good.  I could do with another.  I'm not sure how to get one though.

I dread the idea of stopping altogether.  I can barely work now and I have to work.  It's my own business.  It's not a option to stop.  I did try coming off HRT around a year and a half ago and felt like a zombie.  My thyroid is a work in progress and has been for a year now.  It's not going to resolve in a month.  My GP is trying to help but doesn't know much.  My HRT doctor is the one who is helping the most and yes, I'm being monitored by both.  Sadly there are no menopause specialists very near me, so I go to London.  But Louise Newson is opening up in Stratford later this year so I might switch at that point for ease of access.

[Dancinggirl]

Perhaps try one pump of Oestrogel daily with Provera for 10 days each month? This could be a good hrt combo to try and would give you a chance to see if a bit more oestrogen would help. One pump per day of Oestrogel is still a very low dose so you could increase to 2 pumps after 2-3 weeks to see if things improve.
I think you need oestrogen to lift your mood and increase your energy - it might also reduce the bloating.
 I assume you have stopped all caffeine, fruit juices and reduced alcohol? Drink plenty of water.
Your HRT specialist should be able to get you scanned.
It is tough finding a balance and at 62 I am now relieved to not be on systemic HRT any more, as the progesterone was always a problem.
You might find you feel better without HRT??!! You won't know till you try.  DG

[SueLW]

My Mum has severe osteoporosis and rheumatoid arthritis.  I really don't want to come off HRT.  I want to find one that works better for me if I can.  Hence asking for thoughts on the progesterone side of things.

[Mary G]

SueLW, how well did you do with the Mirena coil, did you have any side effects like low mood or breast pain?  If not then you are not progesterone intolerant and it would be worth a try with Oestrogel.  If you can persuade your specialist a better option would be to have a Jaydess coil which contains a lower dose of progesterone - quite a few specialists will agree to a Jaydess off licence and I think it would be a safer bet and have fewer side effects.

If you can tolerate a coil of some kind, it would give you a lot of flexibility in terms of how much Oestrogel you can use and the worse than can happen is that you will have the occasional bleed. 

Re cyclical HRT, if you felt that bad on Utrogestan then I would not recommend you try it again but perhaps you could try Provera with Oestrogel? 

[SueLW]

Thanks Mary G.  I was sluggish, down, bloated and flat for the first 3 months of Mirena but then I was fine after that, for years.  It totally killed my sex drive.  But I do wonder now if that was low oestrogen.  I have always been prone to lumpy, sore breasts from time to time.  I don't think it was any worse.  I would not be afraid of having another.  But I too had wondered about the Jaydess.

My biggest problem with the Utrogestan is not knowing if it was the progesterone or the higher patch of oestrogen that caused those feelings.  I stopped both and switched back to a cream.  I won't know unless I try again.  But I'm scared to try.  It's big benefit is that it is body identical.  The coils aren't as far as I understand it.  I'm not really sure how that affects the cancer risk.

[Dancinggirl]

Sue - those early symptoms after the Mirena was fitted are quite normal and if you were OK after that then I would go for the Mirena again as ti really is a no hassle HRT combo with separate oestrogen.   If you want to help your bones then more oestrogen is what you need and I suspect you will feel a lot better once you are using a good 2 pumps of gel per day - but you will need to let things settle.  DG x

[SueLW]

Thank you DancingGirl

I think you are right.  I am hoping to discuss this at my hormone review in a few weeks time and initiate a change to gel and a coil.  If I can't get it there, then I will probably have to go elsewhere.  However I looked it up this morning and found a clinic who inserts the coil charging £500 for it.  Gulp!

Meanwhile, the clinic have advised me to have a 24hr break from the hormones I use and then to restart slowly and after I have built back up to the dose I am currently on give it 5 days, to have a blood test.  So it looks like they think I am taking too much.  But when you have 3 hormones in 1 cream it's impossible to experiment with the components.  It's all or nothing.