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[Shannonplussed]

I've been viewing this forum for a few months, and now it's time to introduce myself and get posting! You are a great, supportive bunch of women.

I had peri symptoms two years ago at age 40, and three practitioners said "nah, you're too young". I was on Mirena, and while I wasn't getting periods, I didn't like my hormones fluctuating (causing vaginal dryness, painful sex, night sweats, huge painful boobs), so at year 4 of my Mirena, I had it taken out and switch to birth control pill. Ob-gyn said to take the Pill back-to-back, since there was no need to have a period. I liked his modern take and obliged! I soon got annoyed at being in control of birth control, felt my sex drive lacking, so I pressed my partner to get a vasectomy. He reluctantly agreed, and I went off the pill in late December. I quickly gained a lot of weight, but pressed on, thinking it would fall off once I got my cycle back. My cycle never returned. Fast forward 5 months and 40 lbs, and I was finally diagnosed as post-menopausal based on two high FSH blood tests.

I begged my GP for HRT, and he easily agreed but had to research because he couldn't remember the last time he had prescribed it. He took my recommendation and prescribed what I was wanting:  estrogel (1 pump/day) and prometrium/progesterone 100mg continuous. I initially questioned the low dose of estrogel, as the product label and monograph says the starting dosage is 2 pumps/day, but he insisted. He did agree that I could tinker, but wanted me to give it time. As I'm 42, and my hormones essentially nose-dived after stopping the Pill, I think I need more estrogen than that, despite not having classic hot flushes. The massive weight gain, fatigue, lethargy, low sex drive, sore feet and sore coccyx were my main symptoms. Also wanting to protect my heart, brain, and bones (my mom has heart disease and early Alzheimers...she had a hysterectomy after I was born and no HRT).

At 4 weeks, I increased to 2 pumps/day. My energy came back, and I've been able to reintroduce fitness. 4 more weeks, and I added another pump. I noticed my sore coccyx is no longer an issue. It's been just over 10 weeks now and the main outstanding concerns are lack of sex drive (I think it's slowwwwwly on the upswing but it's not where I would like to be), massive weight gain not shifting, and sore feet (perhaps related to weight gain??). I suppose it is still early, as it's not been 3 months yet, but I really hoped my metabolism would start to correct by now. I'm heavier than when I was pregnant, and well above the set point that I'd maintained for the entirety of my teenage/adult life. (I do have a referral to an endocrinologist, as the GP was also stunned at the weight gain. But I'm in Canada, so it will take a while for the referral appt.)

How will I know I'm at the right estrogen dosage? I'm looking at upping to 4 pumps in two more weeks.

Question as well:  what causes the spotting on HRT? I was a grumpy bear last night, and when I got to work (midnight shift), I found I was spotting. This made my foul mood make a LOT of sense. Reminiscent of when I was premenstrual and had PMDD, for which I still take Zoloft/sertraline. So was that a sign of not enough estrogen? The progesterone doing one of those weird progesterone things? Both dipping together? Is there any point in tracking this?

Finally:  I had seen it before but can't find again--at what dosage of estrogel does the progesterone component need to increase? I can go up to 4 pumps with 100mg continuous, correct?

Thanks all for your input!

[MicheleMaBelle]

Hi Shannonplussed. 
There's a few points you've raised here.
Firstly the weight gain. Maybe it's related to having an under active thyroid. Have you had the levels checked? Secondly, it is common to gain weight in menopause and can be a bit of a shock. Your metabolism flips on its head so instead of burning 70 % of the calories you consume and storing 30% , it flips to 70% of storing and 30% of burning. Isn't Mother Nature cruel? In a nutshell, you have to eat a lot less than you maybe did before, eat healthily and exercise.

Lack of sex drive. Again this is common. Mine has never really come back. A small amount of testosterone gel can help if applied daily I believe ( mostly not licensed in the UK for females , although it can be prescribed privately or off licence) . I'm not on it as I'm suffering from some hair loss so trying to get this under control first.

You can go up to 4 pumps of gel if your symptoms aren't being controlled by 3 pumps. The doc was right to start you on a low dose but the beauty of the gel is that you can control how much you use. Why do you feel that you need to increase it to 4? It can take a while to get right and this is also the case with your spotting. If it continues after six months or so, get it checked out but it's normally nothing to worry about. I'm not familiar with the progesterone you're on but certain ones can be a bit more unstable in the body. ( eg the body identical Utrogestan) . I started spotting after 2 plus years on it! I'm not sure that tracking it is going to help. I sometimes think that we look for answers that aren't there as we all react in different ways and our own natural hormones are doing things in the background. Check out your progesterone though, if you have a sensitivity to it, a norethisterone based one might make the pmt type symptoms you experience worse. Sometimes switching to a kinder type helps as does moving to a cycle, but it's the part of HRT that a lot of us struggle with.

Re your sore feet, this could be related to your weight gain and could also be the result of low oestrogen levels affecting the tendons ( reduced collagen ) . We all start to get aches and pains everywhere. Going on HRT helped mine but most days I still wake up with sore shins for some reason. Disappears after I start moving about but I'm certainly not as supple as I once was. I've joined a Pilates class to see if this helps as I'm a bit of a couch potato which I know isn't good for me.
I'd try and tackle the weight issue first as this can't be helping your feet.

You're making progress, it might just take you a while to find a regime that works for you. Good luck and let us know how you're doing! X

[Shannonplussed]

Thanks for the welcome and your kind reply, MicheleMaBelle.

I have had my thyroid tested, and the results are in range. I'm hoping the endocrinologist will do a more extensive panel, in case there's some subclinical issue (or another cause altogether). I've asked my dr about testosterone, and he isn't in favour of it. I will try to get the endocrinologist to test my hormones as well, and maybe I'll have some luck with a testosterone prescription there.

The progesterone I'm on is the same as Utrogestan; its trade name is Prometrium but generically they are both bioidentical micronized oral progesterone. I'm inclined to increase the estrogel to 4 pumps in a couple of weeks because I see positive changes and I want more! Since, after menopause, the body stores excess abdominal fat in order to provide estrogen, I suspect some of my excess weight might be from my body hoarding whatever estrogen it possibly can. So with an ample  (or at least adequate) supply, I hope my body relaxes some of that need to hoard belly fat. I've read that the replacement estrogen needs for someone with early menopause, such as myself, are higher...but I haven't found anything evidence-based on that.

My feet are also sore in the morning, and after getting up from sitting for a while. I do yoga and I keep pretty limber and active (I love mountain biking), so I'm doing the best I can. I won't actively try to lose weight by restriction or over exercising, either it comes off as I live my life, or I accept this new stage for what it is. I'm just glad my energy has come back so I can do these things!

[CLKD]

Welcome.  Seems your Doctors over there are about as useful as chocolate fire guard! similar to some over here 

Read, make notes!  We have threads on bladder issues and vaginal atrophy. 

As oestrogen levels drop the body may become dry: inside and out - deep int he ears, nostrils, skin, vagina and muscles may become lax = aches and pains.  Bugga .........

[jillydoll]

Hi shannonplussed
Just wanted to welcome you....
Get posting, ask anything, someone's always on to offer advice and support...

Jd xx

[Whatsupwiththis]

Hi Fellow Canuck...went thru meno years ago but now dealing with the darn atrophy.  Wished I had been on HRT earlier and maybe would have avoided all this agony.  Good luck and hope all works out for you.  I'm still on the journey...