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[stellajane]

Just wondering how many of us older women are still on a sequential regime (monthly/bi-monthly/tri-monthly) and what the attitude of our doctor/meno clinic may be to this?

Quite a few of us are unable to tolerate/prefer not to take daily progesterone but wish to remain on HRT so have no option but to continue to have a withdrawal bleed. Personally I find the actual bleed a breeze compared to having to tolerate 12 days of progesterone! My GP (so far) has never mentioned any problem in continuing on my bi-monthly regime, but I do wonder how long this will last.

Has anyone ever been given a cut off point age-wise?

[Hurdity]

Well stellajane - I was thinking of asking the same question!

Was wondering if it is just thee and me?! I'm thinking there must be one or two others - but maybe they don't post - I think most women over 60 still on HRT with a womb take conti HRT?

My GP (whom I saw just this week to review my HRT) is fab. She is a gynae specialist and just gives me what I want. She did query why I wanted estriol cream as well as Vagifem (as it has been taken off my repeat) and said wouldn't moisturisers do (which I've never used) and I just said I get dry sore and itchy especially around period time when I don't use the Vagifem so she just let me have two tubes!

I was saying I dread having to come off it and she said well I don't have to as it's my call now. How good is that eh? Mind you she is an enlightened GP and worked with the one and only J Studd back in the day when they were both young (she is also in her 60's and not retiring any time soon!).

I quite agree re the bleed - I feel dreadful for a day or two around withdrawal but the build up of fogginess and fatigue as the days go on is dismal - and I'm only using 100 mg now ( cycle a bit shorter too) - so couldn't contemplate using it every day all the time especially vaginally.  Also gives me bladder irritation, vaginal itching and I have to get up in the night to empty bladder! I find 100 mg not quite so bad as 200 mg but still don't get the clarity of brain and alertness/energy that I get on oestrogen alone.

I'd love to know about others too. I do have a friend on another forum who is early 60's and doing similar but she sees a private consultant - who is in agreement with her regime.

Hurdity x

[Kathleen]

Hello ladies

I am 63 and nine years post meno. I never really got going with a sequential regime and my private consultant wasn't keen anyway. She claimed to have worked with Nick Panay but I didn't see any evidence of enlightened thinking on her part. Her comments were ' you can't expect to feel as good as you did in your twenties' and 'it isn't wise to keep scanning women'.

As it turned out I didn't pursue a sequential regime but her opinions may be echoed by other members of the profession so be prepared!

Wishing you well.

K.

[Hurdity]

Gosh she didn't sound very sympathetic did she! Of course we don't expect to feel like we did in our 20's but we also don't expect to feel like s*** and not function normally. I mean 60's is not old these days is it! No longer the fluffy slippers and laying on a couch all day with white hair and a poodle at your feet! Heavens above!!! Any gynae who says things like that to women in their 60's should not be practising!!!!!!!!! As for the scanning! It does no harm whatsoever (as far as I know...). I mean it is expensive but once a year isn't too much to expect. Think how much we are saving the NHS by not having all the other medications and hopefully won't get osteoporosis etc etc. Sorry - I know you've stopped hRT so rant over but comments like those are very unenlightened these days!!!

Hurdity x

[Wrensong]

Hope it's OK to comment here as I'm not yet 60.  At 57+ & 7 years postmenopause I've just gone back on HRT for persistent meno symptoms & osteopenia, this time on a sequi regime.  The Cons who agreed to my going back on HRT initially prescribed another conti regime (I was on Evorel Conti a couple of years ago) as he said he didn't want me to have a bleed, but this was just out of consideration for me.  I couldn't continue with the Femoston Conti Ultra Low he prescribed at first, due to digestive issues & daily headaches with characteristics suggestive of the migraine I had for decades in fertile years & we agreed I should change to sequi to minimise side effects & breast risk.  My newish female GP who is lovely, didn't comment on the decision, but I'm expecting opposition to continuing with any type of HRT post-60 as I was previously told repeatedly that my surgery would not support its use after that age.

I have yet to have a bleed on the sequi regime, now in my 4th cycle & have flagged this up, but the Cons is not concerned, both of us feeling the low dose 25mcg patch is probably not building much of a lining even though I'm also only on 2.5mg MPA for 7 days per cycle, which incidentally I can feel hitting the target area via uterine cramps!  He says we can scan later & that a few months without a bleed will do no harm.

I didn't start systemic HRT until well postmenopause & having now attended 2 menopause clinics, 1 private 1 NHS, seen another well respected private meno specialist initially & now have my HRT overseen by a top Endo, I've not personally come up against any objection to sequi HRT for older women, providing the endometrium is within normal limits. 

As long as continuing to have a bleed is acceptable to the individual, we accept responsibility for arranging private scanning & can afford the cost, it seems a small price to pay for the benefits of HRT.

[Wrensong]

Hi Stellajane - I was adding a bit to the post you've just replied to at the time you were posting! 

"Out of consideration" weren't his exact words, but that consideration was behind his initial choice of another conti regime for me was obvious from his phrasing & facial expression when he said he didn't want me to have a bleed!  I know him well, he could not be more caring and very obviously wants the best QOL for me.

Actually, I was the one who raised with him the issue of cyclical exposure to progesterone being considered less risky for breast health, not the other way round!

Thanks for your empathy on the situation post-60.  There is only 1 GP surgery where I live, so no choice there.  It's a worry because the Cons who currently prescribes my HRT is already past retirement age, so if I lose his support I may be stuffed.  I think in that case I would probably go back to Newson Health.  Had a one-off with them early this year but as I've been seeing a top Endo long term it makes sense for him to oversee my HRT as well.

[Rosie63]

Morning ladies.  I'm 65 and up to 2 years ago when my HRT was discontinued, I was on a sequi regime so was into my early 60's and still having a monthly bleed.  I had been doing well on that particular HRT and would still be on it had production not been stopped. Both the private gynae I have seen and my GP have been against me being on a sequi regime since then, although I have tried patches and gel with Utrogestan and taken cyclically off my own back ! 

I'm currently taking a break from everything as I have been feeling pretty grotty on HRT and I don't see the point in carrying on with it if I feel just as bad or worse on it as I do off of it.  I'm on day 9 at the moment and feeling ok but if I do decide to try again, I will be asking for a sequi regime to at least try to alleviate some of the side effects.  I can foresee a fight with GP for this though 😏

Rosie63 x

[Wrensong]

Oh Rosie, sorry to hear you've been feeling so rough on the HRT & also that you've had opposition to continuing with a sequi regime.  Did they say why?

[Patricia]

Good morning ladies - I am 65 and use the Mirena coil and estrogel so no bleed but it suits me. The coil is due to be replaced (hopefully) next year. The last time I chose to pay but even then the gynae was a bit huffy about it. Of course I was old enough to be her mum 🙄 and I did say well just wait and see dear!  I paid that time because the time before that was with the meno clinic and the gynae there was a bit huffy too and I was five years younger.  The meno clinic is part of the sexual health clinic so it is usually busy with lots of young ladies.  So I feel there's ageism in the mix which hurts a bit coming from your own gender.
I have found if I get a bit heavy handed with the gel I will spot so I keep it strictly to the two blobs. I paid for a scan about 2 years ago and all was ok then. My GP has never commented on me still being on HRT and when I asked for Vagifem about 18 months ago he was very enthusiastic about it.
There's my tuppence worth. Keep chatting ladies I check in every day to the forum. My morning cuppa wouldn't be the same without you all. 😘😘 Patxx

[Rosie63]

Not really Wrensong.  The private guy said something like oh you don't want a bleed do you ?  I think if I'd pushed it, he might have let me have it but young female GP is definitely opposed to it.  I'm going to see how I go and if I need to go back on it, I'll ask to be referred to meno clinic, even if I have to pay again as think NHS wait is about 6 months.

Rosie xx

[Rosie63]

Just a thought for the more mature ladies on here.  Do you think it's possible that I might not need HRT any longer at my age and that I might have actually come out the other side?  Or am I just being hopeful ?  The reason I ask is that I've felt so rough over the last couple of years, I've actually felt as though I'm being poisoned at times.  I think I might be clutching at straws here 😉

Rosie xx

[Rosie63]

Thanks Stellajane. I'm not holding out much hope to be honest as only on day 9 of not taking anything and starting to feel cr*p today.  Do you mind me asking which regime you're on please ?

Thanks again.

Rosie xx

PS I didn't know whether to laugh or cry at the comment from your go on an ‘old womb' 😱😊 x

[Wrensong]

Rosie & Patricia, I'm sorry for the opposition you've encountered & sadly I do think that ageism sometimes plays a part, or perhaps ignorance of the fact that menopause symptoms aren't always only a temporary phase.  I think too that some medics are understandably uneasy with the idea that risks are said to increase with duration of HRT use & feel the responsibility of prescribing to our age group.  Every time I hear of an arbitrary cut off age (eg 50-51 for those who have a surgically induced menopause in fertile years, 60 as an upper limit etc) it seems not only bizarre, but unfair that we should be expected to somehow manage with debilitating symptoms in our older years.  As if we have been granted a temporary bonus for reasonable quality of life we could not really expect to continue.

I think private menopause clinics are the way to go in situations where sadly the NHS can't offer what we need.

[Wrensong]

Agreed Stellajane, I'm ex-NHS staff so feel huge sympathy with those who do their best to staff it, but it is under-resourced & under huge pressure.  Though it usually gives excellent care in acute situations I think chronic conditions that can require a lot of consultation time but where the patient can just about continue to function, sometimes inevitably get less attention than is ideal.

Also agree that treatment has to be a joint responsibility.  That's why I try to learn as much as I can to be sure I can be fully involved in decisions about my care.
Wx

[Hurdity]

Patricia I'm so pleased you posted. I had forgotten about the Mirena and older women (I'm always recommending it to others never having tried it  ). I now remember that when I had a hysteroscopy/biopsy age 60 for some random spotting at the wrong time, the gynae said (just before legs went into stirrups!) did I want a Mirena inserted while he was fishing about as he thought that would sort things out into the future. I did decline because apart from the first 3 months on HRT  12+ years ago and the occasional clearout in the past few years using norethisterone I have only used bio-identical hormones so didn't want to go down that route - but it is a great way to avoid a bleed for older women - although does not deal with the issue about having a progestogen all the time - since some is absorbed systemically, and of course there is a question mark over the breast cancer risk. However it is all swings and roundabouts at our age and you just choose to exchange one possible risk for another, weigh up your well-being and quality of life and go for whichever works on balance!

There still seem to be very few of us sequential gals over 60! Interesting reading your input Wrensong but it's a whole different ballgame when you're ancient as I am!!!! ..although I understand what you're saying re how far post-menopause as I only started HRT when I was almost 54 as had not reached menopause then.  There is this tendency to strong resistance to HRT post-60 though even now despite all the guidelines. I'm just so lucky to have a sympa GP (well the gynae one anyway) who understand it all and is pretty up to date.... yes to being informed - knowledge is power!!!!!

Hurdity x