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[Hollyhock]

Hello All,
I'm in perimenopause and have been on 100 mg of  Utrogestan (25 on with a 5 day break) and 160 mg (2 pumps) of Oestrogel (Estradiol gel) daily, for the past 9 months.  I only missed one period before my Dr prescribed the HRT.

I found that my symptoms of fatigue, joint aches and pains, brain fog and low mood were alleviated by this combination for a couple of months, but my symptoms have all gradually come back, along with weight gain, bloating, headaches, insomnia, strange pains in the back of my legs, restless leg syndrome, late periods, terrible menstrual cramps, 4 episodes of quite severe depression (although it's anyone's guess if this is related to hormones, but it's not beyond reason that it could be) and very tender breasts. 

I am sort of feeling, also, that if HRT only waylays the symptoms of menopause, I might as well face it head on now, instead of dealing with it a few years down the road when I come off the HRT.  I feel this especially at present, since the Utrogestan/Oestrogel doesn't really seem to be working for me anyway.  I'd kinda like to know where my body is at, without the extra hormones, and to better understand how diet, exercise, meditation would help me through this stage in my life. 

My question is, what is the best way to come off HRT, without putting my body into turmoil?  And if I do come off it, how long does it take for the bio-identical hormones to leave my body so I can accurately assess where I'm at with the hormones my body is producing on it's own (or not producing, as the case may be)?

Any thoughts most appreciated!  The Dr's at my local surgery don't seem to know too much about all of this, and sometimes I feel like I'm shooting in the dark.

Cheers!

[Conolly]

Hello Hollyhock,

The best way to come off any drugs (and by that I just mean chemicals) is to taper off, unless you have an allergic reaction. With HRT is exactly the same. You can reduce the gel to 1.5, 1, 0.5 pumps in let's say 2-3 months and have the Utrogestan take sequentially instead of continuously for the last 10-12 days of the cycles. You may or may not experience bleed/spotting.

On the other hand, if you had only missed one period before HRT, your doctor should have prescribed you the sequential regimen instead of the continuous, unless you didn't want a bleed at the end of each cycle. Continuous regimen is more suitable for post menopause. Two pumps may also be not enough to override your own hormonal fluctuations during perimenopause.

Hope it helps

Conolly X

[Ladybt28]

Missing one period does not post menopause make Hollyhock, what is your GP thinking and I would agree with Connolly probably not the regime for you.
Medical wisdom conventially says you need to be period free for about 12 months before being classified post meno.  Your own hormones are still flutuating and kicking in and out with your hrt regime as Connolly says and so all those symptoms you outline are very common for peri women and made worse by the wrong regime.  At one point in the cycle you are getting loads of oestrogen and then it is dropping drastically in peaks and troughs plus continuous progesterone can be hard on some of us who are post meno and it causes major depression without it being added to your own bodies production.

You can give up if you like but I would say you should have another shot at getting a sequential regime. Also the symptoms you refer to may continue for up to 10 years depending on where in the meno you are.  To be honest I had all those you mention in peri for that amount of time because no GP clocked that I was on the wrong hrt (despite being on hrt, although a now discontinued one) and yet when I got the right stuff for me nearly 80% of the problems stopped.  They sent me for rhuematoid arthritis tests, a head mri for migraines, fibromyalgia consults, counselling, cbt and prescribed more pain meds and AD's than you could shake a stick at!  Now I take oestrogel 4 pumps utrogestan 12 day cycle, a couple of pain meds as and when and my blood pressure medication.  Dont have the depression sorted but we have a plan for that. 

I have to say also that my hrt problems only got sorted in the last 6 months but now I am much more comfortable.  Maybe persevere a little more.  It is not a foregone conclusion that you get the hrt for you first time and especially if your GP is clueless.

[Dancinggirl]

Hi and welcome to mm hollyhock

You have already been given some good feed back by Connolly and Ladybt28.
You haven't told us how old you are or what symptoms you are trying to control?
Your GP put you on the wrong regime - you are on a conti regime for post menopausal women!!! You should be on 200mg of Utrogestan for 12 days each month. It would also be better to start on a lower dose of the Oestrogel as well as your own hormones will be fluctuating.
If you want to take a break from hrt for 2-3 months this can be a good idea as you can then start again fresh. Though Oestrogel with Utrogestan is hailed by many as the ideal hrt regime it doesn't suit everyone and you might do better with something like Femoston 1/10 - so perhaps consider trying this.

I have tried tapering the dose when coming off hrt and I've tried going cold turkey and and it didn't make a difference - but taking a break will hopefully help you to access whether you are getting true benefits from hrt.  As said before, do try the sequential hrt regime first before abandoning HRT as you may find it will help You better than your current regime. DG x

[Hurdity]

Hi Hollyhock

In fact you haven't been put on continuous combined HRT nor proper sequential HRT - but somewhere in between! Proper cyclical/sequential HRT involves 200 mg utrogestan not 100 mg -  and for 12 days per month as has been said. Sometimes if this does not control bleeding sufficiently docs can advise taking the progesterone for longer eg 21 days per month - but at the 200 mg dose not 100 mg. Given that you were probably nowhere near menopause then the low dose of utrogestan as well as only a medium dose of oestrogen - was far too low to suppress your natural cycle hence the bleeds and cramps.

In addition as Ladybt says you will have had far too much progesterone at some points - as you ovulated naturally - and only 5 days without it - not giving the body sufficient time to recover!

It may be the wrong time for you to be on HRT - I didn't start it until late peri-menopause - I had had two long gaps (of several months) without periods - and it worked like a charm and has done ever since - while taking it. I did put up with quite a long time of symptoms of flushes sweats and tears - and trying various "natural" remedies - (which of course didn't work even though I thought they did!) but it meant that I didn't end up having all those other symptoms you describe once I started HRT.

If you want to stop - research shows that the outcome ( resumption of flushes etc) are not affected by whether you stop suddenly or gradually although this (how slowly or quickly you stop) can affect how quickly they come back if they are going to. If you are still very much peri-menopausal then just stopping suddenly may well not have much effect if your own hormones are still dominant - but you might notice an increased amount of pms when oestrogen drops to its lowest just before your period. You shouldn't notice the fall in progesterone - in fact you will probably feel better for stopping it - or at least reducing it to coincide with your luteal phase  ( of your cycle) ie second half - which is what cyclical HRT aims to do  (12 days of prog in second half of cycle).

Hurdity x

[Hollyhock]

Hello Hurdity, Dancinggirl, Ladybt28 and Connolly,

Thanks so much for your feedback (I hope this is OK my responding to all of you in one post).  What I've gotten from all of you is that I'm on the wrong regime!  I really have had that feeling for a while now, thus this strong instinct to get off HRT, for the time being anyway.  Dancinggril, you were asking how old I am: 49 at present.  The symptoms I'd like to control are the depression (although I've had this all my life to be honest), the insomnia for sure, restless legs, lack of get up and go, aches and pains, & weight gain.  So basically everything I'm struggling with! (as a side note, I don't really get hot flushes and sweats)  I really appreciate you sharing your own experiences, plus your wisdom as regards HRT and the best approach for peri-menopause. I feel, after having read your contributions, the best thing for me to do is to come off it and see what my body is doing, and then get a sense of where my periods are at.  Am I still having them naturally, or not?  And then, re-approach with a sequential regimen.  Ladybt, I'm glad to hear your HRT is finally sorted!  It seems it can be a very up and down time in a woman's life, and how frustrating that our doctor's just don't seem to know enough about it. 

Thank you also for the advice on how to stop.  I shall give it a go at quitting cold turkey and see what comes.

All the best ladies!

What a valuable resource this is!

Hollyhock x