Dear All,
please could you help me as I'm at a bit of a loss what to do safely and effectively. I think I'm intolerant to progesterone in HRT but worried it might just be me - being meno or being just me!
On the advice of my very helpful female GP I started on Elleste Duet Conti 2mg 2&half years ago and felt great for a year. Excellent symptom control, fully functioning emotionally and at work, and no bleeding at all. Then I started to get hot flushes, night sweats and bad sleep again. After six months of hoping it would settle went back to the GP and asked for more oestrogen. She changed me to Evorel Conti and Evorel 50 patches. I was to use two patches at a time, one of each. She said there were no 100mcg Conti patches available and wasn't sure why I was getting symptoms again but was happy to find something to help me. In effect we were "having a go" which I was cool about. Unfortunately, this caused chaotic bleeding. So after 3-4 months of this and of my own accord I started to use two Evorel Conti at a time, for two weeks, followed by two Evorel 50 at a time for two weeks. In effect, like Evorel Sequi but double dose. This has worked well for the last 9 months in terms of flushes, sweats and sleep. Bleeding is once a month just like being on the pill and totally managable.
However, my issue is the two weeks I'm on Conti I feel emotionally and psychologically awful - like having PMS and a very similar feeling to when I was on the desogestrel mini pill (Cerelle/Cerazette). The two weeks I'm on Evorel 50 (using two patches at a time so getting 100mcg oestrogen) I feel fab. Happy and normal. Husband and daughter also notice the difference. When I went on holiday in this summer I did Evorel 50 for three weeks which was even better. Three weeks of normalness!
My question is this: what evidence is there for long-cycle oestrogen-only use? I know I can't take Evorel on its own for months on end but how many weeks could I go for? Also, is there a better way of taking the progesterone element of HRT? Could I do it orally or vaginally - if so, what dose for 100mcg transdermal oestrogen, and for how many days?
In other words, what's the least amount of progestogen, for the fewest days, with the minimum of side effects? I'm 54 years old and very reluctant to have a Mirena. I know it would be a good way to protect the endometrium but I feel rather squeamish about having one fitted and I wouldn't need it for contraception for much longer.
I'm pretty confident if I went to my GP with some robust evidence or a well-thought-out argument for a change in HRT she would be more than happy to help me. Appointments at the surgery are tricky to get and I know all the docs there are under pressure and have limited time. I feel if I can do some of the hoof work this will make better use of both our time.
Thank you all so much for any advice - and just for being here!