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[KaraShannon]

Hi everyone

One of the options suggested to me today was a continuous patch with a progesterone tablet.  Not easy to talk to doctors on the phone...

I'm currently on evorel sequi and I'm not necessarily having any problems with it, I was just calling for a review.  The doctor asked if I was still having regular periods.  I am.  She asked my age, I told her I was 51 and she said then my periods will be artificial caused by the evorel sequi and the other solution may be better. 

I'm not entirely sure this is correct?  Women can naturally still have periods in their early 50's sometime?  My periods hadn't stopped when I went on evorel sequi, I trialled it for other symptoms, sweating, mild pelvic floor issues, etc.

I just want to explore the options really and just a little bit uncomfortable 'stopping' my periods because at this age they should have stopped.  I realise they may be artificial now, but they may not be, I've not felt any different at all in that regard as yet.

Would be grateful for any advice / expertise / experience on this.  Also would the latter solution be as protective to health as evorel sequi?  Thanks everyone 

[Dotty]

Hi if you are happy on Evorel Sequi then there’s no reason why you shouldn’t stay on it. If it works then why change it ?

Your options would be to change to Evorel Conti…..this is the continuous version of the one you’re already on.

Or you could use an Evorel oestrogen only patch with Utrogestan for the progesterone.

It’s not definite that your periods are being caused by the Evorel Sequi. Some ladies carry on having periods into their late 50s.

The choice is yours…. xxx

[KaraShannon]

Hi if you are happy on Evorel Sequi then there’s no reason why you shouldn’t stay on it. If it works then why change it ?

Your options would be to change to Evorel Conti…..this is the continuous version of the one you’re already on.

Or you could use an Evorel oestrogen only patch with Utrogestan for the progesterone.

It’s not definite that your periods are being caused by the Evorel Sequi. Some ladies carry on having periods into their late 50s.

The choice is yours…. xxx

I agree Dotty, I really just wanted to review that I was doing everything properly because I take a 50 supplemental patch and it's not licensed to be used that way (I didn't know that when I started).  To be fair I did tell her that at certain times of the month I have a dizzy spell when I stand up, I've always had it though, years before ever going on HRT.  It lasts a couple of days and then eases off.  I was more concerned that I was doing everything safely.

Her suggestion was to stop my cycle as 'it won't be natural now anyway.'  She felt my body was being forced to have hormonal changes and that the other option, which involves a continuous patch and a progesterone pill (which she said is body identical, whereas the evorel sequi progesterone is man made) may be better. 

I understand it may be better, but I just don't want to stop a cycle that is still natural and it feels like my usual cycle that never stopped before I started the patches, that wasn't the reason I went on them. 

I don't understand how there's a benefit to stopping the cycle unless a woman prefers not to have periods.  I don't mind them.

[Dotty]

Hi are you taking a 50 patch as well as the Evorel Sequi ? There may not be enough progesterone in the Evorel Sequi for this amount of oestrogen. If you need that much oestrogen then you would be better changing to a 100 patch with Utrogestan x

[KaraShannon]

Hi are you taking a 50 patch as well as the Evorel Sequi ? There may not be enough progesterone in the Evorel Sequi for this amount of oestrogen. If you need that much oestrogen then you would be better changing to a 100 patch with Utrogestan x

thanks, yes that's how I'm doing it, it was suggested to me before though I wasn't told it was unlicensed for that. 

I did ask today whether I need to be taking that much, that's what I was really consulting about.  She said she doesn't think I'm 'overdosing' on oestrogen, but try this new method and have a blood test in 3 months.

I may only need the evorel 50, it all seems a bit like guesswork. 

Thanks though Dotty, I've taken on board what you've said.  :-)

[sheila99]

Your doctor is talking 💩. I was still mostly regular when I started hrt aged 57, many others have a late meno, there's a long thread on it somewhere. If you change to a conti regime while you still have your own periods you'll almost certainly get breakthrough bleeding, there's a good reason they say a conti regime is for those who are meno (no period for a year whilst not on hormonal treatment). If you want to be bleed free you could try a mirena.
You should be on the least amount of oestrogen that controls your symptoms so if they were controlled by the evorel patch I would stick to that. Why did you increase? As Dotty says there is insufficient progesterone in the evorel patch for that high a dose so you need a separate progestogen. Symptoms of too much oestrogen can be just as debilitating as too little and often very similar. If you still have your own more or less regular cycle 100mcg is likely to be too high as you'll still be producing your own too.

[Dotty]

Hi so what regime are you on now ? x

[KaraShannon]

Your doctor is talking 💩. I was still mostly regular when I started hrt aged 57, many others have a late meno, there's a long thread on it somewhere. If you change to a conti regime while you still have your own periods you'll almost certainly get breakthrough bleeding, there's a good reason they say a conti regime is for those who are meno (no period for a year whilst not on hormonal treatment). If you want to be bleed free you could try a mirena.
You should be on the least amount of oestrogen that controls your symptoms so if they were controlled by the evorel patch I would stick to that. Why did you increase? As Dotty says there is insufficient progesterone in the evorel patch for that high a dose so you need a separate progestogen. Symptoms of too much oestrogen can be just as debilitating as too little and often very similar. If you still have your own more or less regular cycle 100mcg is likely to be too high as you'll still be producing your own too.

Thanks Sheila,

I've got mild pelvic floor issues that improve at certain times of the month, I think mild prolapse which I wanted to discuss but didn't get around to it.  She's aware there are other things to discuss.  She said that may improve if I change.  It's only been in the last year and on and off so I want to do what I can to try and improve it while it's early.

That was one reason to increase the patch, but as I say I had no idea it was unlicensed for that or any of this stuff you guys have told me about possibly not getting enough progesterone.  Since I've increased the patch in the last 3 months I've noticed my usual dizzy spells (had them all my life and linked to the cycle and only last a couple of days) have been more intense, but I'm not totally sure it's the patch because I was rushed off my feet and dehydrated on the occasions it happened.  Keeping an eye on it though.


Another reason for increase was that my energy levels are very low (though there could be other reasons) and I noticed a bit of sweating coming back, but its very mild, not even worth mentioning.  I just noticed it and wondered if I needed more oestrogen and with the pelvic issues, just thought perhaps I wasn't getting the optimal treatment.

I will think very carefully before changing, but also aware I'm possibly on too much oestrogen.  I may check out a private clinic.  Has anyone else done this? 

[sheila99]

Can you describe the pelvic floor issues? If it's a prolapse I think you can get an oestrogen ring - I'm not very clued up on this but you could put it in the search box. The other thing you may consider is testosterone. I leaked from having DD ar 42 if I didn't do regular pelvic floor exercises until I went on testosterone at 58. It has improved muscle tone overall including pelvic floor and I no longer have to do the exercises.
I wonder if may find a specialist in pelvic floor (not sure of the technical term) more useful than a meno specialist. It might also be useful to check out other candidates for low energy such as vit d, b12, thyroid.

[KaraShannon]

Can you describe the pelvic floor issues? If it's a prolapse I think you can get an oestrogen ring - I'm not very clued up on this but you could put it in the search box. The other thing you may consider is testosterone. I leaked from having DD ar 42 if I didn't do regular pelvic floor exercises until I went on testosterone at 58. It has improved muscle tone overall including pelvic floor and I no longer have to do the exercises.
I wonder if may find a specialist in pelvic floor (not sure of the technical term) more useful than a meno specialist. It might also be useful to check out other candidates for low energy such as vit d, b12, thyroid.

Thanks Sheila

Time to ask to see a pelvic physio again I think, I had asked before but didn't pursue it.  I went from having 100% reliable pelvic floor to a few occasions of slight leakage when sneezing.  When I told my friend she couldn't believe that was it and said she'd had that for years.  But I suppose because I'd never had it, it was more noticeable and worrying to me.  Well, it was also temporary and disappeared.  But now it's a feeling of weakness in the back passage    well if you didn't laugh you'd cry, lol.  I don't have any incontinence or anything but just a feeling that everything is not how it should be down there and bowel movements are difficult at times, as if muscles are not working properly.  Some times are worse than others.  It's very odd and I did wonder if something in the HRT has helped this develop as 2 years ago when I started HRT I didn't have this.  It's not a major problem but I worry that it could get worse over time and I should be sorting it out.  The doctor said the continuous oestrogen might help with this. 

[KaraShannon]

I've been watching Dr Louise Newson on you tube and also there was one video with Davina McCall, she takes testosterone also. 

Thinking of looking into testosterone, everything Dr Newson said about low testosterone is what I'm experiencing. 

before I can get my GP to consider that though she'll want me to have 3 months on continuous HRT. 

And I suppose my question therefore is, do I need to be on continuous yet, and are there any benefits to one over the other.  Cyclical is what the body was always used to so I'm curious about that.  I know nothing though, just thinking it through.