Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Bo]

Hi Everyone
I went to my 6 monthly check today at Dr Panay's clinic. The doc wasn't happy with me using Utro 100mg PV every other day but added that many women in the clinic "aren't taking enough progesterone" (because of side-effects that they can't tolerate). She also told me that some women who attend the clinic are using oestrogen only (when they need the prog) and just winging it, basically, in terms of their womb lining possibly building up.
She suggested a (prog) coil but didn't prescribe it. She has booked a uterine scan to see how I am getting on. However, she thought it might be unlikely that my womb lining will be too thick because my blood oestrogen level is just 110 - reference range given with my result is 70-500. The clinic doc said that the range is (apparently) 200-800 post-menopause though.  I wasn't expecting levels to be so low, although I do just scrape in the reference range given with my results.
She said that I am not absorbing from the patches well enough. I am currently on 75mcg Estradot. I tried increasing to 87.5mcg a few weeks ago but could not tolerate the increased painful breasts and bloating and headaches - I felt like a little barrage balloon - and went back down to 75mcg after 2 weeks. She has changed me to Oestrogel to see if I absorb that better.
Or she suggested I stop HRT altogether as I am obviously sensitive to hormones so struggle to get the levels up to where I need them, and because it's not worth the risks and the side-effects if my symptoms (flushes) aren't gone (they're gone mostly during the days, and I have one mild to moderate flush at night, with an occasional sweat - which is good compared to flushes/sweats every 1 to 2 hours at night before HRT).
Anyway, anyone else have these issues? 

[NaturalMystic]

Hi hun,

I've been on 3 measures of the gel for over 6 weeks.  I don't feel any real negatives that I cant cope with but have noticed less "heat waves" and sleeping better ( I also take one 385mg night kalm and the occasional 3.5mg zopiclone)  I still have my womb so having the prog coil fitted in a couple of weeks so will have to see how I cope with that.

I recommend the gel

[Hurdity]

Hi Bo

Sorry to hear of your problems with HRT.

Alternate day vaginal use of progesterone is sometimes prescribed by specialists because preliminary research has shown that for low and medium doses of oestrogen this can be sufficient on average - to protect the womb lining - although obviously individuals will vary. It is a starting point though if you are progesterone intolerant but specialists who prescribe should be prepared to check your womb lining. Also any bleeding would need to be reported in case it is due to thickened lining.

Howeber in your case  as you say, despite a medium to high dose patch your oestrogen levels are not very high - although blood tests don't mean a lot - it is the effect on symptoms that is more important. If that size patch is not completely controlling your symptoms then a higher dose is indicated. I can't see any reason to stop HRT though. What a strange thing to suggest - although clearly the benefits must be greater for you than the side effects.

What risks is she talking about? Puzzling I must say!

By the way those blood levels (ref range) don't seem right to me. Post-menopausal in the absence of HRT they would be quite low. Maybe that ref range is for women on HRT if it is given as post-meno range?

In your position I would actually increase the dose and see how I felt - and if the clinic is prepared to measure your levels again then by all means. Best probably to have the blood tests done half-way through the patch dose ie not when it's due to be changed? This would give you a more average level although still better to go by symptoms.

If you do increase the oestorgen dose then yes you would need to minitor your prog intake as well to ensure no thickening as you might need to increase this too if abnormal bleeding?

The other alternative is to go to a cycle - perhpas a longer cycle ( you haven't said how old you are?). You would then get a bleed regualarly but benefit from oestrogen only the rest of the time and might be able to safely increase to a higher dose.

This is what I do - 62.5 mcg oestrogen patches ( I do absorb it well) + Utroegsatn 200 mg PV every 6-8 weeks. I am mid 60's and been on HRT for 11 + years.

Hope this helps.

Hurdity x

[Bo]

Thank you.
I am nearly 57. Not had any bleeding or spotting. Started HRT in July 2017 (100mg Utro daily orally + 2 pumps of oestrogel a day), wasn't doing well and stopped in December. Re-started in Feb following referral to this clinic, with a gradually increasing dose of oestrogen patch (starting at 25mcg and gradually increasing) + 100mg Utro orally,: I have twiddled with the Utro dose because of depressed feelings & fatigue on it, finally settling on PV every other day.

The reference ranges given on my results sheet are just post-menopausal levels, not to do with HRT use. The 70-500 range is different to the other reference ranges for follicular, mid-cycle, and luteal phases. The results showed I had a "Normal" result, no action needed, but it is at the low end of the range.

I asked about cyclical Utro but she said the regime is 200mg orally for 12 days a month and I didn't fancy that. I also asked her about the Australian and French regimes where they only use prog PV twice a week. She said the dosages will be different, but didn't know what they are.

She meant the usual risks of being on HRT - increased risk of blood clots, breast and endometrial cancer etc.

I had a sense that she may have had a morning of women not doing well on their HRT - dropping their prog altogether etc - she was running 45 mins late, and I was the last patient. Still...I found her quite dismissive which wasn't nice.

Interestingly, I have had 3 completely flush-free nights recently...10th & 11th Nov and last night. This is being on 75mcg Estradot and Utro 100mg every other day PV, although (as I said) a few weeks ago I tried increasing the Estradot to 87.5mcg for about 10 days, and went back down to 75mcg on the 4th Nov. I hope the flush-free nights aren't because of the higher dose because I couldn't tolerate the side-effects on that dose. I think I will continue as is for now regarding the oestrogen dose and see how I go - change to gel see if that's any better. I agree that it's best to go from symptoms not from blood results.

How many days do you administer Utro for every 6 to 8 weeks please? 

[Bo]

PS I am on Levothyroxine too. Been stable on the dose for a few years

[CLKD]

So even at Dr Paney's Clinic the 'experts' don't seem to be reading from the same page!

A scan is advisable anyway to keep an eye on the womb lining.  You know that upping the dose didn't help .

I don't understand 'sensitive to hormones' statements.  Our hormones fluctuate with The Change ........ it really is up to the professionals to try to find a regime that suits individuals rather than suggesting that women stop taking the amount that may be relieving at least some symptoms!

[Bo]

Yes, I agree CLKD. I think she was trying to frighten me into taking more prog with stories of perhaps needing biopsies to check for endometrial cancer if I carry on at every other day. But the previous doc I saw in May said I would be having a 'routine' scan this time anyway just to check. I am waiting for the appt.

O she also suggested I just whack up the estradot patches to 100mcg, no point gradually increasing, and just put up with the side-effects for 3 months to see if I settled. 

[Hurdity]

Absolutely CLKD - I am suprised that at the Panay clinic the doc was adhering to the licesned doses as I thought that the whole point of menopause clinics is that the treatment is individualised. I wonder if Nick Panay himself sanctions this approach (that you experienced Bo) and especially the usual stuff about risks - which should all be qualified rather than general and depend on the age of the woman, time since menopause, HRT preparation, lifestyle and genetics amongst other factors! I am really surporsed at this from a specialist menopause doctor at such a prestigious clinic too!

By the way that ref range  most definitely includes levels for women on HRT. 500 pmol/l is only experienced on HRT or during our fertile years. For the doc to quite your level as normal is meaningless if it is an accurate level and if subsequent  tests show a similar low level and if you are still experiencing symptoms.

One source I read said that the oestrogen level we should be aiming for is the average  over the menstural cycle which is around 300 pmol/l - although many women are happy on lower than this (I'm pretty sure mine are lower) - in the 200's.

Like I said - if your levels are that low and you are not absorbing it well then your progesterone dose is likely to be perfectly adequate - although it would be good to have the doc's approval for this.

Sorry I forgot to give the number of days - it's 12 days of Utro 200 mg PV every 6-8 weeks and I get a smallish bleed for a few days (nowhere near when I was fertile and menstruating normally). Maybe 1 heavyish day but still not v heavy.

Hurdity x

[CLKD]

Maybe ask this Doctor for a copy of what she told you?  Then you can go through it with a fine tooth comb ;-).

[Bo]

Absolutely CLKD - I am suprised that at the Panay clinic the doc was adhering to the licesned doses as I thought that the whole point of menopause clinics is that the treatment is individualised. I wonder if Nick Panay himself sanctions this approach (that you experienced Bo) and especially the usual stuff about risks - which should all be qualified rather than general and depend on the age of the woman, time since menopause, HRT preparation, lifestyle and genetics amongst other factors! I am really surporsed at this from a specialist menopause doctor at such a prestigious clinic too!

Hurdity x

I agree. I originally asked for a referral here because my GP could only prescribe the licensed dosages (which apparently most women at the surgery tolerate well) and he couldn't advise anything else. I also wanted to try testosterone which he couldn't prescribe (I don't tolerate that well either). So, yes, I have been expecting individualised treatment at this clinic - especially as every visit means I have to take a day off work and it takes over two hours to get there! After giving me all the 'scare' talk, (after i'd said i was only administering the prog every other day), she then looked at me and said 'well, you're fit and healthy and don't smoke so you shouldn't be at too much of a risk of blood clots'. That's as individual as this visit got 

[CLKD]

Thinking aloud then rather giving one-2-one?

[Bo]

Yes, that's it. I don't see the point in losing money taking a day off work (being self-employed) and paying train fares for this. I think I'll ask for referral back to my GP. 

PS I was just looking for where to write to have a moan (about the clinic doc) and I noticed the oestrogen reference range figures on the hospital site: "Serum estradiol results should be between 200-600pmol at six months". So, the ranges this doc gave me were for women on HRT (the ref range on my GP test were for post-meno generally), and at 110 I am definitely below this range. However, I have had a few nights in a row now of almost uninterrupted sleep, so i'll stick to Estradot for now: perhaps i absorb better from this brand 

[CLKD]

Do U keep a diary?

[Bo]

I kept one over the last two months or so because, at one point, all my symptoms started creeping back and, at the same time, the side-effects resolved. After a few weeks of this, i had symptoms like i had before starting HRT - flushes every 1 to 2 hours etc. It's possible it was a duff pack or batch of patches, and i changed brands - from evorel to estradot. She wasn't interested in my diary either.

[CLKD]

Gives you an idea as it is easy to forget.  I have to tick every time I open my bowels 

Oh the fun of ageing .............