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Author Topic: What to do if HRT seems to have stopped working for you  (Read 998 times)

Emma

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What to do if HRT seems to have stopped working for you
« on: April 04, 2019, 10:41:30 AM »

After taking HRT for a couple of years, some women find their symptoms begin to return. Why does this happen and what can be done to remedy the issue?

https://patient.info/news-and-features/what-to-do-if-you-think-your-hrt-has-stopped-working
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Extremely busy Forum Administrator - please excuse my brevity.

Stellajane

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Re: What to do if HRT seems to have stopped working for you
« Reply #1 on: April 04, 2019, 12:02:21 PM »

I definitely had to bump up my oestrogen dosage about 2 years after starting (which I'm assuming is when I finally crossed over into post meno) - but now 10 years on I'm only on half the dose I originally took. 

Using gel is brilliant because its so simple to tweak your dose.
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Sgtvhilts

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Re: What to do if HRT seems to have stopped working for you
« Reply #2 on: April 04, 2019, 12:12:46 PM »

Excellent- thanks very useful.
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Hurdity

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Re: What to do if HRT seems to have stopped working for you
« Reply #3 on: April 05, 2019, 10:47:39 AM »

This is a great article - is it on the main website or if not could it be pinned as it's worth our referring members to in the future?

Hurdity
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Lynnhunter

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Re: What to do if HRT seems to have stopped working for you
« Reply #4 on: April 06, 2019, 04:52:50 AM »

Thanks so much for posting this.
After 4 yrs on HRT I have had to change from kliofem to Evorel conti in patch form as my anxiety /low mood has returned. Just 3 days on patches and have developed skin rash on arms and chest. But hopefully this will go away and I will be ok and hopefully patches help.
This forum is amazing. Thanks everyone. It helps knowing that there are others feeling the same as me and that there is light at the end of the tunnel :)
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Kathleen

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Re: What to do if HRT seems to have stopped working for you
« Reply #5 on: April 06, 2019, 04:15:22 PM »

Hello Emma.

Thank you for posting the article.

I have a question that members with a science background may be able to answer.

The article says that HRT doesn't stop working so if we find that symptoms are returning it is because our own supply of oestrogen has declined further and we need to make up the shortfall. My question is how does the body's system of homeostasis fit into this scenario? We know for example that when using steroids a patient has to lower their dose very carefully, a slow taper in other words, because the Adrenal glands have registered that there are more steroid chemicals in the body and has therefore reduced natural production to take account of this. If a person suddenly stopped using steroids the Adrenals would not be able to supply the proper amount of hormone quickly and that could be life threatening. How do we know that our ovaries are not doing the same thing and are infact shutting down even more than they would naturally because of the influx from HRT.  In other words the HRT isn't just benignly topping up our hormones but is actually making our own supply decline.

I'm not sure how this idea fits in with real life experiences (  for example how is it that Stellajane now only needs half her original dose ) but I thought the question was worth posting.

Take care everyone.

K.
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Hurdity

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Re: What to do if HRT seems to have stopped working for you
« Reply #6 on: April 06, 2019, 07:26:29 PM »

Our hormones are regulated by complex feedback mechanisms - and this is how the pill works when we are fertile by suppressing the menstrual cycle through high oestrogen especially (which inhibits FSH). Once we are post-menopausal though, and especially 2 years following the last ovulation, our ovaries have shut down - at least that part of it which stimulates follicles to grow, ripen and produce oestrogen. They atrophy and seemingly disappear and are often impossible to find on scans - although they are actually still there (they haven't found mine for years - in the last few scans I've had - good sign though as it means there is nothing wrong with them). Once all cyclical activity has stopped ovaries do continue to secrete some hormones - definitely androgens I understand - which ultimately can be converted to testosterone eslewhere in the body, and also to oestrogen though not sure if this actually happens in the ovary or other tissues? The feedback mechanisms no longer happen I don't think because that loop has finished (pause to look up the name...) - hypothalamic gonadal axis - which is the complex endocrine feedback mechanism whereby LH, GnRH , FSH etc are produced and govern ovulation etc. I have to look up the exact details as not in my head!!

Once we are well post-menopause we are doing just that as you say,  blithely topping up our hormones.

You mention some women only needing half the dose? Well what is need? Discuss!!! We need whatever we want to control our symptoms and we decide that. We might tolerate a sporadic return of flushes when we are older for example - to minimise the progestogen dose we have to take. We can also wean ourselves onto a lower dose as we get older sometimes. (Think I should start doing that at some point - when I'm 70?).  If we want to give protection against osteoporosis then there is a minimum dose to take whatever we feel.

I don't think that helps at all does it? Saturday night ramble after a small glass of wine!!!

Interesting question anyway Kathleen!!!

Maybe Dr Currie could answer and it would certainly be clearer than mine!!!

Hurdity x
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Perinowpost

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Re: What to do if HRT seems to have stopped working for you
« Reply #7 on: April 07, 2019, 07:29:55 AM »

Interesting question.  If Iíve followed it correctly then Hurdity is saying the ovaries have all but shut down once post meno anyway, so they are not shutting down because of taking hrt?
Thatís good to know.

I know at a recent scan I was told my ovaries were normal size for my age (54) whatever that means. Either way I havenít had to increase my hrt dose since becoming post meno (I suppose Iíve been quite lucky) it is still working which Iím pleased about x
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Kathleen

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Re: What to do if HRT seems to have stopped working for you
« Reply #8 on: April 07, 2019, 01:15:39 PM »

Hello again Ladies.

Hurdity  - thank you so much for your very interesting reply.

I agree that ovaries can produce some oestrogen after the menopause,  infact a consultant confirmed this to my friend when she began having night sweats in her late sixties following a hysterectomy. I didn't know about the androgens though. Also, as you say perhaps other tissue can also produce hormones, certainly we now know that fat tissue is not inert but also contributes to hormone production. That being the case would the feedback mechanism still apply to these other systems and thereby impact on our natural hormone production?

Many thanks for your comments and all the information that you provide.

Take care.

K.
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Stellajane

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Re: What to do if HRT seems to have stopped working for you
« Reply #9 on: April 07, 2019, 05:38:04 PM »

"What is need?" 

For me its taking enough to stop night sweats but not so much that it creates breast discomfort (and in my case possibly cysts?) and too much lady lube for comfort! In my case its been enough to keep osteoporosis at bay.

I wouldn't have been influenced by the thinking around need to reduce dosage as we get older, I simply reduced for reasons of comfort. I would definitely have continued on a higher dose had my DEXA scan not been so positive.

Different for all of us I think. As we always say "one size doesn't fit all".

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Hurdity

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Re: What to do if HRT seems to have stopped working for you
« Reply #10 on: April 08, 2019, 07:35:58 AM »

OK I'm scratching at the limits of my knowledge here without looking stuff up and don't have time right now!

From what I read not so long ago ovarian activity continues ie the "death" of follicles etc whether we take HRT the Pill or not - and it is the ?primordial follicles that eventually develop into eggs. These start to die from the moment we're born ( I think.....).

Endocrine feedback mechanisms involve the brain - hypothalamus. Not sure what is involved re estrone production in fat cells nor what controls the conversion of androgens to testosterone and/or oestrogen once we are post-menopausal..whether it is still involved? The enzyme aromatase is involved in the metabolism, but not sure what controls activity of this enzyme in target tissues with oestrogen receptors?. I don't think there is the same feedback so that what you put in is what you get combined with any endogenous production! I don't know what the rate limiting factor is re our endogenous post-menopausal oestrogen production. The adrenals are involved too. Sorry I am somewhat sketchy here! It is somewhat specialised. Can you see I'm waffling?! You would need to delve into the biology of it all and it does take some time! Very interesting though....

Hurdity x
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