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[Pink68]

Hi is anyone in continuous hrt and experiencing, sore breasts, bloating, fatigue ? Iam currently on 2x75mg everol and 2 x utrogestan tabs. I have been told you don’t get progesterone intolerance when on a continuous regime .
What your thoughts please? X

[Flossieteacake]

Hello Pink. You can get progesterone intolerance no matter what the regimen. It can take a while to find progesterone that can be tolerated. The symptoms you describe could be due to getting used to HRT rather then the progesterone. I notice progesterone intolerance is more likely to be psychological symptoms. 

[Pink68]

Hi I have been on hrt for 3 years now but just changed in the last 6 months to continuous regime. X

[DottyD68]

Hi Pink68,

I have tried twice (& failed) to move to continuous (daily gel and 100mg  utrogestan) from sequi (daily gel and 200mg utrogestan days 15-28) in the past 7 months.

I was peri-menopausal when I started HRT 19 months ago at age 53 and told by GP to move to conti after 12 months on the assumption I had reached menopause due to being 54.

Both times the physical symptoms were unbearable - swollen painful breasts, bloating and aching. I was recovering from Covid the first time so GP assumed it could be related to that but I tried again a couple of months ago and the same thing occurred. I don't think my body is ready for it. So I am currently back on sequi for the foreseeable and have another GP appointment next week because although my physical symptoms are more manageable my anxiety (which had disappeared for a couple of months) has gone through the roof and I now have no clue what I need to increase/decrease.

It feels so difficult balancing the dosage of HRT when my own levels seem to be making a step change every few month.

[Losingtheplot]

Hi DottyD68 that sounds so awful big hugsxxx My Gp started me on Evorel sequi 1st 2 weeks patches my body copes ok week 3 and 4 on Evorel conti suffer extreme tiredness, extreme bloating, headaches and dizziness like I was on verge of fainting! Annoying thing is these patches have helped with other symptoms severe itchy of skin and mood swings with bouts of morning crippling anxiety. My Gp told me to stop patch immediately and offered me anti dep! Saying maybe I didnt need HRT my response to this was to be referred to a Meno specialist. I am also on contraceptive implant so not sure if too much progesterone maybe?

[HellsBells]

I have spoken to doctors who prescribe bio-identical hormones many times over the years. I have been to the Louise Newson Clinic, and I have spoken to my GP.

The simple facts are that there are certain regimes (doses) which have been through 'clinical trials' and have proven stats. Stats are the overarching figures and deal with the majority not the individual. BHRT gives you a dose and mix for your individual needs. It is usually much LOWER than the standard doses, but always uses progesterone safely as a foil to the estrogen.

The reason there is 'no evidence' they work is that you can't do a clinical trial for one person's dose. The doctors who prescribe BHRT are excellent and are very much up to date and working within guidelines.

The most interesting thing is that they prescribe what you need, rather than trying to build circulating levels to a much younger woman or pre-menopause. If you look at the research, low dose estrogen can be enough. 200mg of Progesterone is incredibly high.

I have a prescription for BHRT for my bones and the levels are much lower than we are being asked to tolerate. They are backed by research and not reckless prescribing.

[Pink68]

Hi sorry d68, Iam 55 and I still had periods when I started hrt. I don’t know if it’s to much estrogen or to much progesterone. Like you before continuous my anxiety was bad as well.
I wish we had a magic wand to just sail through this time in life. X

[DottyD68]

Thanks Losingtheplot. Like you HRT has definitely improved lots of varying symptoms that I had been trying to manage myself for 6+ years before going on HRT. I wasn't expecting a fix all and that was fine. I have been fortunate never to have had anxiety in my life pre peri-menopause but life is now a rollercoaster with it. I have changed from a happy, active, confident, sociable person to feeling on high-alert most of the time, having low self-esteem and low confidence as I can't trust my body anymore. I think the thing I wish for most is stability. I can't believe I'm 8 years into this "phase" with no end in sight. Despite trying to avoid taking anxiety meds I am now considering them (as well as HRT) just to see if they make any positive difference as the balance of HRT just seems a never-ending lottery for me.

HellsBells. Thanks for your reply. I understand HRT isn't an exact science as there are so many variables. I have tried tweaking it under guidance of different GPs and they all seem to have a different view. It doesn't help when anxiety can apparently be a symptom of too much or too little estrogen, so a lot of trial and error in the meantime 

Pink68, thanks for your reply. Yes I never saw this coming! I find it hard to explain to family and friends who knew the happy-go-lucky person before how awful I feel about everything. It's a very lonely time. I hope you find the right balance soon.

[ange63]

Hello, Hells Bells, interested in your body identical HRT comments.     I thought the view was that BHRT has the risk factors of old..   I've tried 3 variations of HRT with Newson and my GP and I had reaction to all 3 and had to stop.    Please could you explain where you found out about a BHRT practiioner as I would like to explore this more.  Many thanks.

I'm 60 nearly and in Nov 2021 4 years post meno the real debilitating meno symptoms hit me.   I had been managing symptoms up to then - not nice but could still function and some quality of life.    Then it hit me and worst thing was the anxiety - totally debilitating.  HRT didnt work so in desperation I agreed to try AD (Citalopram)...  WORST DECISION EVER.  I had terrible side effects and now having terrible withdrawal.   For some people ADs do work well.  I would urge anyone thinking of trying AD to research and check out user forums about side effects and withdrawal. Read the latest NICE guidance to GPS about how to support people to get off ADs - the  NHS guidance says it lasts 2-3 weeks but this is now very out of date..  It can take months and sometimes years.  Please do your research and understand side effects and withdrawal before you try them .  I wish I had checked user forums to get a true picture.   For me once I'm through this I will go back and look at trying HRT again and may be BHRT.

[HellsBells]

The difference with BHRT (and the reason they are criticised) is that the prescription given is particular to you. So they can start you on a lower dose. The Newson clinic will put you on much better quality product than the standard GP stuff, but the minimum dose with Estrogel for example is 0.75ml....I am on 0.25 (BHRT) estradiol. I am also on the same for testosterone and 40mg for progesterone. That combo has not been through a specific clinical trial (despite evidence on the various doses individually) so it is talked about as 'not evidenced'.

I couldn't take the higher doses - there is research to suggest very low dose estrogen works so my doc has prescribed it. I have been to the Marion Gluck clinic and now I use the Online Menopause Centre. I am still required to have bloods, TV ultrasound, mammograms etc. and they are very cautious.

As good as the Newson Clinic is, if you don't do well with the standard protocols there is little flexibility, which I fully understand and accept.

If the main criticism is that I have too low a dose which won't work, well I am 'wasting' my own money and I have less chance of side effects/further cancer than those on higher doses.

I do everything under the supervision of an excellent and well regarded doctor.

[Kathleen]

Hello ladies.

I just wanted to agree that my experience with Newson Health is that they seem to believe that more Oestrogen is better. I am post meno and a few years ago my Oestradiol levels were  600 but my moods were still up and down plus I developed bleeding and breast problems. My NH doctor was unable to advise me and said that I should have been good at that level. In truth I did feel good some of the time but then I would crash and have crying episodes or panic attacks. I certainly wasn't emotionally stable and the physical effects made me reluctant to increase Oestrogen further though she said that was still an option.

My most recent experience has been with the NHS and here a 'less is more' approach seems to dominate. Following this protocol I have found that 25 mcg of gel is insufficient for both physical and emotional symptoms however 50mcg controls the physical but not the emotional stuff.

I believe a more personal and nuanced form of treatment is the way to go in the future. The closest to that at the moment is fiddling with amounts of gel or using Utrogestan orally or vaginally, every day or alternate days. I currently cut in half  200mcg progesterone pessary and I have just changed to using it every night.

Perhaps with the growing pressure of menopausal women and the burgeoning of both NHS and private Meno clinics there will be more choice in the future. I hope so for the sake of our daughters.

Wishing you all well ladies and take care.

K.