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[hereandthere]

Has anyone here experienced carpal tunnel after going on Tibolone (Livifem in my case)?
I experienced wrist pain within 24 hours of starting it, after changing from Femoston, as I thought I needed more estrogen as my flushes had increased slightly, but gynae said actually my estrogen levels were on the high side. I have my SHBG from him, which was 194.7 (and looking up online I see that normal is 18 to 144). An estrogenic state is known to increase SHBG.
I also experienced stiff ankles/Achilles after about a further day.
He said he’d never heard of this being a side effect, however I showed him a doctor’s case note I found online where CT was experienced by two patients of a doctor.
He said this would be an idiosyncratic symptom, but he told me to try coming off HRT for two weeks, and to rather go back on to Femoston if the pain goes away. Otherwise I have to consult an orthopod for it being coincidence.
He also prescribed me vaginal Premarin cream for in between, and because I’d complained about dryness.
Believe it or not I forgot to tell him that I had a UTI for about 3 days in the week before (which I haven’t had in years, and reading the vaginal atrophy threads, it looks like this could be related to that).
I’m wondering now whether my estrogen really was so very high, and coming off the Femoston on to Tibolone has maybe caused the estrogen to dip and bring on symptoms.  Although this doesn’t seem to make sense according to my SHBG reading. I feel like I need a doctor’s degree to understand myself right now.
Anyway after a few days I’m feeling quite good- better libido I noticed and my wrist seems like it may be better, not sure. My flushes (which were quite frequent on Femoston and Tibolone have not got worse- if anything they are better, but it’s early days.

[CLKD]

Well - I know that women can be affected by Carpal Tunnel Syndrome during pregnancy.  Which disappears after the baby arrives.  ? hormonally linked ?

Do read our threads on 'bladder issues' and 'vaginal atrophy'.  Great advice in both.  Regular treatment essential 

Some find that keeping a mood/food/symptom diary of use.  To chart progress and to share with a GP/Practice Nurse.

Let us know how you get on.

[hereandthere]

Thanks CLKD.
As a matter of interest, in South Africa we don’t usually have practice nurses to GPS.  We also don’t go to regular GPs for gynaecological related issues, although of course indigent people living in the townships wouldn’t have a gynae. For us the price is not so different to consult a gynae as a GP, as it clearly is for women in the UK.
Tibolone does mention muscular issues on the pamphlet, so we’ll see. Will report back.

[CLKD]

Oh - U go straight to a specialist similar to mainland Europe?



Or R U covered by insurance.

Pain relief might help? 

I love proteus [sp] and mesembreantiums [sp] but they don't like our winters ;-)

[Postmeno3]

It's interesting. I have developed carpal tunnel syndrome and am very post-menopausal. I'm kind of linking it to everdiminishing oestrogen and hoping to restart some form of systemic oestrogen replacement.

[CherrySG]

I was prescribed Tibolone and of course went online to read other women's experiences!

A number of women reported joint pain after a few months. I only took it for a few days because it didn't help me. My joints and tendons were fine, even though I have RSI and have had tendonitis on my ankles also, it didn't make that worse on the short term. My VA was shocking on it, which was why I came off. That and the migraine and itchy skin.

Either it really disagrees with you or it's the drop in oestrogen as Tibolone is quite weak in oestrogen.

[hereandthere]

Oh - U go straight to a specialist similar to mainland Europe?

Or R U covered by insurance.

We do go straight to a gynae every time e.g for the annual Pap smear. We don’t have the NHS (although SA has been looking to implement for some time), so working people in the formal sector all have ‘medical aid’ (insurance). If you don’t have that you have to go to a public hospital or a clinic in rural areas. When I was a child the public hospitals were good, but with a few exceptions, standards have dropped drastically.
We’ve long been a centre of medical excellence (Chris Barnard et al), but now there’s so much graft and incompetence when it comes to public hospital resources. Take for example this year student doctors are protesting and suing the state for delays in placing them into their two year internships. After that there is a contentious, compulsory one year of community service.

[hereandthere]

Postmeno3 and CherrySG, I was thinking along the same lines with the drop in estrogen.
It just seems logical, but there seems to be a contradiction in the SHBG reading.

[CherrySG]

Postmeno3 and CherrySG, I was thinking along the same lines with the drop in estrogen.
It just seems logical, but there seems to be a contradiction in the SHBG reading.

Tibolone is a bit different, it seems. I wonder if the hormones it produces bind to some oestrogen receptors better than others. I agree, we have to do so much research, it's like we could get a qualification in this stuff 

[hereandthere]

CherrySG, CLKD, and other ladies, I’d really appreciate your further advice-
My GP is currently off sick too, to ask what she thinks and I’m feeling anxious about this.
So now on no HRT for two weeks, since about a week ago I’ve developed quite bad pins and needles in BOTH my hands on top of the carpal tunnel like pain in right wrist (more persistent). Slight numbness if example holding my phone, like now.  (My ankle stiffness that came on with the switch to Tibolone is about the same- comes on the first walk after waking).

My gynae had agreed that if what was  maybe CT got better off the Tibolone, I go back on the Femoston rather than back on the Tibolone and he gave me a prescription for it. Trouble is I’m worse than ever.
So I wrote asking if maybe it’s not so much the Tibolone as the drop in estrogen, first changing to Tibolone, then nothing.
He replied to direct me to consult a neurologist due to the new pins and needles symptom.

So my concern is that this sounds like a long, expensive route to follow without a quick fix, and the CT pain occurred first time 24 hours after changing to Tibolone and now the pins and needles literally a week into no HRT. (Previously I used to sometimes get weird tingling in my shoulders and sometimes from sleep my arm would go dead from a funny position, so thinking there was an underlying tendency, but nothing like this).
Maybe there are other things at work, but the sudden complete removal of estrogen concerns me, reading other posts in  the forum, plus I found papers suggesting estrogen removal resulting in CT eg https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279038/

“ The rapid drop in estrogen concentrations induced by aromatase inhibitors is believed to reduce the protective anti-nociceptive effect of estrogens, which decreases the threshold for pain stimuli, thereby exposing patients to symptoms from underlying musculoskeletal conditions such as CTS.[35]”

I’m agonizing whether I should go back on the Femoston like tomorrow already and separately worry about investigating my hands, or stay off it in the meantime until further investigations turn something up.
I feel like I brought this on myself by suggesting a tweak in my prescription when I was essentially fine.

I’m very concerned having read about sudden withdrawal of HRT having a more negative effect than natural menopause as the body gets used to higher circulating hormones, especially in my case when my gynae has commented that per the SHBG test indications are I have ‘too much estrogen’. Or rather ‘had’ too much...