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[Louise2010]

Hi ladies
Before my subtotal hysterectomy for fibroids and heavy painful bleeding I was on 2 pumps oestrogel a day, utrogestan 10 days a month and pea sized amount of testim a day. Also have taken fluoxetine 20mg for many many years which has kept my serotonin levels up due to episodes of clinical depression.
9 weeks on and I saw my night sweats return, anxiety especially at night, pounding heart, insomnia, with the addition of vaginal dryness, itching and pain with sex. I thought I’d get away with it but at 52 I was kidding myself I think that my ovaries would be still working! 
I saw my consultant surgeon who is also supposedly a menopause specialist who took bloods and suggested my night sweats were because of my antidepressants and my anxiety perhaps because “something wasn’t right at home”.
He told me to stop my testosterone and gave me Evorel 50 patches which made me feel suicidal.
I stopped them and went back to the gel upping to 2 pumps in morning only which made no difference to waking and sweating. The anxiety on waking in early hours isn’t as bad but my brain just won’t shut off with intrusive thoughts. I’ve not used the testosterone for a few days and I do feel calmer but more tired.

Bloods came back these are the results: thyroid function- normal
FSH - 8.3
Oestradiol -352
Testosterone - 2.90. (Normal range 0.1. - 1.42)

My gp is always saying I’ve been on HRT for “a long time now” and I should be coming off it. For some reason they are not keen on me being on it despite having no health reasons whatsoever not to. No breast cancer in family, no heart conditions, healthy weight, healthy bmi, exercise every day, low blood pressure.

I’m now doing 2 pumps in morning and 1 pump around 8pm (arms) which has pushed the sweat and waking back to 5am now.
I’m speaking to my GP on Monday and I want to ask for Vagifem and Ovestin however the consultant has written a letter to my GP stating as he thinks my “ oestrogen levels are good I’m not convinced using any other preparations will help.” I just hope my female GP will be a little more hopeful for me!!

My fear is she may take that letter as Carte Blanche to refuse me any more things containing oestrogen!
Are there any facts and figures anyone knows to prove that you CAN have systemic oestrogen and local oestrogen at the same time that I can show the GP?
I’m really struggling to understand why I’m still getting sweats at night and VA if my oestrogen levels are “good” according to the blood test ?
Is 352 “good”?

[ATB]

I’m not that experienced with this but I see someone at Newson health who says that estrogen above 250 is what the general rule is but that it is different for everyone- mine was much higher and she wasn’t that alarmed although we did take down my estrogen to 50. Anyway I think you are coming up against a common problem and they aren’t treating you based on your symptoms, which is actually what they are *required* to do based on the NICE guidelines, perhaps send them a copy as a reminder that blood tests are not used alone and that your symptoms determine whether you need HRT. I’m not sure why you’d stop taking testosterone? What was the reasoning? Have you tried other things to address anxiety, such as magnesium glycinate? I take it for that and so far so good- it’s helped the morning anxiety or panic. Sometimes diet adjustments can help night sweats. I never had them so hopefully someone more helpful will come along.

[ATB]

Oh was that your free testosterone? That’s not too high, between 2-5% isn’t it that they aim for?

[Flossieteacake]

Hello Louise. You can have VA despite your blood test not showing anything. Using ovestin or vagifem is a mild treatment and can be taken for life. I do not understand why you are being told you have been on HRT for a long time. It is of my understanding it needs to be taken or the symptoms will come back. I think it may be an idea to ask to be seen at an actual menopause clinic as the person you saw does not seem understanding. I looked up fluoxetine and read it is well known for causing night sweats. I really am sorry you are going through all this and your GP is not being supportive at all. I found the same and am now being seen at a menopause clinic were the people are much more helpful.

[Louise2010]

Thank you ATB the consultant said my testosterone was too high and I need to stop taking it. He also said he thinks it’s causing my anxiety. My anxiety was borne out of waking with a pounding heart and not being able to sleep and the fact that I possibly won’t be able to return to my job because of the lack of sleep. I will try the magnesium glycinate - thank you.

[Louise2010]

Hello Louise. You can have VA despite your blood test not showing anything. Using ovestin or vagifem is a mild treatment and can be taken for life. I do not understand why you are being told you have been on HRT for a long time. It is of my understanding it needs to be taken or the symptoms will come back. I think it may be an idea to ask to be seen at an actual menopause clinic as the person you saw does not seem understanding. I looked up fluoxetine and read it is well known for causing night sweats. I really am sorry you are going through all this and your GP is not being supportive at all. I found the same and am now being seen at a menopause clinic were the people are much more helpful.

Thank you flossieteacake - I have taken the fluoxetine since forever and I’ve never ever sweated at night or day on it. The fact that I wake with pounding heart drenched in sweat says to me it’s meno because before I took hrt I had exactly the same thing. Thank you for that advice re vagifem and Ovestin. I’ve bookmarked the NICE guidelines to quote if I need to when I speak to my gp.
And I’ve also booked a consultation with the Newson clinic for 3 months time. 

[Louise2010]

Thank you you both do much for taking time to reply to me, I really do appreciate it 💜

[Flossieteacake]

I can understand you thinking the night sweats are hormonal then. If you had not had any previously then it makes sense. I am so pleased you have booked an appointment too. I hope you can hold out until then.

[CLKD]

Which consultant would even suggest that  .  Obviously has little knowledge of menopause symptoms    hopefully not one employed in a menopause clinic?

There is no need for anyone to stop HRT regardless of age.  Most users will be on it for Life.  As with Vaginal Atrophy, treatment is for ever. 

1 cannot check oestrogen levels!  Bloods tests are reliably unreliable  .  Oestrogen levels drop as we age so the whole body may become dry: inside and out; skin, scalp, anus, vagina, eyes, deep in the ears, nostrils as well as muscles may become lax = aches and pains.  Sounds like another medic that needs some training!

Don't take any crap from your GP - if necessary refer him/her to the VA and bladder issues threads on this Forum.  Buy, read and pass on to your Surgery "Me and My Menopausal Vagina" written by a member - worth reading ;-).  Available from Amazon.

Let us know how you get on. 

[Gnatty]

I'm afraid these consultant surgeons who are supposedly Meno specialists are too often behind on current thinking. You have improved on upping to 3 pumps but still have a way to go before you are fully better. It's not rocket science to notice the link. And as has already said go by your symptoms not the bloods. Lots of women need both types of oestrogen, again this should be well known. My oestrogen levels are 600 on 5 pumps and I need this to feel well. It's also relatively common for ovaries to pack up after a hysterectomy which would make sense in your situation. Hence you now needing to increase your hrt.

It's so frustrating isn't it. Gynaecologists are not specialists in hormones, they are surgeons. I would see if you can see a proper Meno consultant. If you look on Newson health Balance App there are loads of leaflets. There is bound to be one on VA and the fact women need topical as well as systemic preparations. Why not download everything that seems applicable to you and take it with you to GP?
It's great you have seen a bit of improvement, keep going, you'll get there. It's a shame we have such a fight on our hands sometimes.

[Louise2010]

Thank you

Which consultant would even suggest that  .  Obviously has little knowledge of menopause symptoms    hopefully not one employed in a menopause clinic?

There is no need for anyone to stop HRT regardless of age.  Most users will be on it for Life.  As with Vaginal Atrophy, treatment is for ever. 

1 cannot check oestrogen levels!  Bloods tests are reliably unreliable  .  Oestrogen levels drop as we age so the whole body may become dry: inside and out; skin, scalp, anus, vagina, eyes, deep in the ears, nostrils as well as muscles may become lax = aches and pains.  Sounds like another medic that needs some training!

Don't take any crap from your GP - if necessary refer him/her to the VA and bladder issues threads on this Forum.  Buy, read and pass on to your Surgery "Me and My Menopausal Vagina" written by a member - worth reading ;-).  Available from Amazon.

Let us know how you get on. 

thank you CLKD he is a gynae surgeon but advertises on his website that he specialises in menopause. I’m sure he’s a great surgeon but I made a huge mistake asking him to help me with the symptoms that followed my surgery. Funny thing was about 4 weeks after I felt great, my skin and hair were fab, my old mojo was back even libido not that I could do anything about that recovering from hysterectomy 🤣 and I thought this is amazing I’ve done the right thing no more fibroids sucking the life out of me. Almost like my ovaries were having a last surge hurrah.
Then just like that it was as if they’d fallen off a cliff everything came back, hair falling out, night sweats etc etc
I will let you know how I get on Monday.

[Louise2010]

I'm afraid these consultant surgeons who are supposedly Meno specialists are too often behind on current thinking. You have improved on upping to 3 pumps but still have a way to go before you are fully better. It's not rocket science to notice the link. And as has already said go by your symptoms not the bloods. Lots of women need both types of oestrogen, again this should be well known. My oestrogen levels are 600 on 5 pumps and I need this to feel well. It's also relatively common for ovaries to pack up after a hysterectomy which would make sense in your situation. Hence you now needing to increase your hrt.

It's so frustrating isn't it. Gynaecologists are not specialists in hormones, they are surgeons. I would see if you can see a proper Meno consultant. If you look on Newson health Balance App there are loads of leaflets. There is bound to be one on VA and the fact women need topical as well as systemic preparations. Why not download everything that seems applicable to you and take it with you to GP?
It's great you have seen a bit of improvement, keep going, you'll get there. It's a shame we have such a fight on our hands sometimes.

Thank you Gnatty. Yes I’ve improved that’s something snd I’m trying to hold on to that.
The new VA and constantly feeling like I need a wee are demoralising when I am exercising by walking every day because I know this helps.
 
The sweats start around 4am snd stop about 5.30am then I’m awake till 6.30am then I want to sleep again. It’s interesting that it’s at the same time every night. Which is why I tried applying the oestrogel later at night to see if it helps keep the levels up and stop the sweats and waking.

That’s interesting about your oestrogen levels because if we are to believe my gynae surgeon that would be off the chart but if you are feeling good that is the key!
Do we build the oestrogen up circulating in our bodies by upping the dose? Do some women process it and not hold on to it long enough do you think?

I suddenly feel very cold and tired about 6pm and I can’t get warm. Polar opposite of 4am when I’m drenched.

I will try upping my dose to 2 in morning 2 in the evening and see how that goes.
I’ve tried not to up things in the past because I’ve been worried about having to much oestrogel and causing other issues due to dominance but don’t fully understand that either!


It is frustrating and stressful to have to feel like you have to arm yourself each time you ask a medical professional about wanting your hormones back so you can feel well & live your life.

[Postmeno3]

Last paragraph......I'm at a loss, to be honest. We are all so, so uniquely configured that it's hard to fathom out what's going on, both for us and the professionals. I don't know of any other condition where dosages and delivery methods and absorption issues are moved back and forth like a game of snakes and ladders. As for guesstimating a pea-sized blob of something, titrated with accuracy in products unlicensed for our NHS, it's archaic! Hmmmmmm.......🤔

[CLKD]

Louise - I would complain to the British Menopause Society if he's advertising himself as a 'specialist'.  Trouble is there is no path to excellence in that they don't have to take specific exams/courses on menopause so some jump on the band wagon and if they work from private practice .......... have a look-C to see whether he is registered at the BMS?

Keep posting.  We don't bite ;-)

[Louise2010]

I know Postmeno3 it is ridiculous and a crying shame that despite the fact that 50% of the population will go through menopause, that it’s not made a top priority in medicine and research. However I think there are some great doctors out there and things are slowly changing I just wish it wasn’t such an uphill journey for women who are suffering to get what they need or even just to be listened to without being told to “increase exercise & sunshine” which I was by my consultant surgeon.