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[Peacegirl]

Hi, Im 63 and have been on various hrt from age 50. Currently on Femoston conti 5:1 with top-up of estrogel (1 pump) twice a week as agreed by menopause specialist. Ive been having horrible symptoms since April, gum disease - usually well managed is out of control, aching bones, muscle loss and weak muscles, extreme fatigue, headaches, migraine aura, insane itching, dry eyes and vagina, breathlessness, irritability, catching every cold going,  insomnia and generally feeling ill. A pro- hrt doctor mentioned during a consultation about my prolapse that we don't need as much estrogen as we get older. Hence Ive tried to reduce hrt as the only thing left to try, having ruled out vitamin deficiency, thyroid levels and had fbc done. Since reducing, I now feel substantially worse and couldn't sleep last night due to wrist and hand ache to name one symptom. Is it true then that we need less estrogen post menopause? Im wondering what to do next regarding hrt. (My testosterone levels are top of the normal range)

Thanks and sorry for the long moany post.

[Gnatty]

Couldn't the reverse be true in that as we age our oestrogen lowers and lowers and so what hrt worked for you before now won't be sufficient to cover the deficit? I can understand maybe in your eighties needing less but you are only in your early sixties! All of your symptoms shout out low oestrogen.

[Hurdity]

Hi Peacegirl

No need to apologise! Thats what we're here for! To read and help if we can....

HRT pre se is not going to cause those symptoms so reducing HRT generally is not going to improve them! What did you reduce?

If you are planning on taking HRT in the long term it may be better to think about transferring completely to transdermal HRT as it is considered to be of lower risk healthwise than oral HRT - but if your HRT specialist is happy and your general health is being monitored then that's good.

Dry vagina - if you're not already using vaginal oestrogen then this is indicated. Systemic HRT does not always work on the vagina sufficiently so you may need both, as many of us do ( including me).

When did you change to Femoston and did it coindicde with worsening symptoms? Was there a time when you felt good on HRT and what were you taking at the time, as Gnatty asked? When did you transfer to conti HRT?

One other thing I would suggest is that continuous progestogen can cause undesirable symptoms in some women though yours do sound quite extreme, though most would not want to return to a cycle at your age to try this out if you have had many years without bleeding.

Although there is some uncertainty now about measurement of testosterone levels and which is the best one to measure (free or total) - if you are taking oral HRT then your leels of a compound called SHBG will be increased which reduced the availability of free testosterone. This used to be thought to be more important than total T levels though I'm not sure now. Have you had SHBG measured as well? This together with total T can give an indication of free T.

Your lowered immunity and generally feeling ill is likely not to be related to oestrogen levels I would have thought.

How is your diet and general lifestyle?

Hurdity x

[Peacegirl]

Hi,

Thank you for your really useful and thorough (and kind) reply I was worried that if I was taking too much hrt that might cause symptoms. Ive reduced by cutting out the top- up gel. I haven't seen a specialist for 8 years and have been on femoston conti this whole time. Hashimoto means my thyroid levels do fluctuate so i expect ‘fluctuating’ symptoms but not constant as they have been.

My diets not terrible (vegetarian - some fish) but blood sugars have  high normal and i have oit in a lot if weight. That and transdermal hrt are worth looking at definitely ☺️

Would you say its not true you need less oestrogen as you age then?

[Peacegirl]

Couldn't the reverse be true in that as we age our oestrogen lowers and lowers and so what hrt worked for you before now won't be sufficient to cover the deficit? I can understand maybe in your eighties needing less but you are only in your early sixties! All of your symptoms shout out low oestrogen.

Thank you  - yes my symptoms do suggest that and I have gut absorption problems so maybe the tablets aren't hitting the mark now and switching to transdermal would be good.

[Hurdity]

That's a difficult one. I don't think there is a cut and dried answer. For example oestrogen levels drop dramatically for the first 2 or so years after the last period/ovulation and then stabilise (though still some small fluctuations I understand) at a lower level. Sometimes at this point women find symptoms return and so they need a higher dose to achieve the same level of efficacy. Over the long term - do we need as much oestrogen as we did when younger?  Do we need the level that we had when fertile? I think that is a value judgement because we are now living up to half our lives post-menopause eg with women who reach menopause at 45 and may live until 90.

We certainly need enough to prevent the negative effects of ageing that lead to health issues like osteoporosis, if we can, and cardiovascular disease, but as to actual  levels - I'm not sure this has been studied because there is insufficient research looking at this in older women and especially with the type of hRT now used ie transdermal, though I haven't looked up stuff recently.

As far as I understand it is not a question of higher levels doing you any harm or causing adverse effects, but just that we may not need them to be so high as we age - other than minimal for health reasons as stated (as well as any residual symptoms like flushes and sweats if they persist?). Many women also who still have their wombs, want to minimise the amount of progesterone and therefore want to take the minimum amount of oestrogen needed for health and well-being, so that they dont have to take so much progesterone - and this is the case both for cyclical and continuous progestogens due to ongoing side effects.

That's a bit of a ramble and just a few thoughts rather than anything sicentific!

Don't forget about vaginal oestrogen.

Also if you have hashimotos - I know there is an interaction especially with oral HRT and availability of thyroid hormones but I'm a bit vague about that. I suggest you maybe start another post mentioing thyroid and hopefully Wrensong might see it - as she is very knowledgeable in this area.

Hurdity x

[sheila99]

I'd like to know the answer too. Same age but a late menopause. Every time I try to reduce my symptoms return so either I'm not old enough or it isn't true for me. Given that there's a limited number of older women on hrt I'd be interested to know what it's based on (and as a victim of the 'every woman is menopausal by 54' mantra I tend to be a little sceptical.

[Mary G]

Peacegirl, the symptoms you list all point to low oestrogen.  I'm 62 and also suffer with migraine auras and judging by my records and breaks from HRT over the years, the auras are much worse with low levels of oestrogen and/or high levels of progesterone. 

You are taking Femoston conti 1/5 which contains a well tolerated form of progesterone but in my opinion, you seem to be having the same problem I had with Angeliq (which also contains a well tolerated form of progesterone) and that is too much progesterone for 1mg oral oestrogen.  Basically, 1mg oestrogen did not control my menopause symptoms or my migraine auras so I topped up with a 50mg oestrogen patch and that was much better although still not quite there. 

I take it you topped up with one pump of gel twice weekly?  It might be better to top with with one pump of gel every day and have regular scans to check the womb lining.  You are taking 5mg of a strong synthetic progesterone which gives you a decent margin to play with.  Alternatively, you could switch to the low dose conti (2.5mg progesterone) and top up with one pump of gel every day.  It might be better to ingest as little oestrogen as possible and take more transdermally.

Generally speaking, you can get symptom relief on a lower dose once you are very post menopause but if you suffer with migraine auras, you can never go too low on oestrogen.  If you suffer with the same migraine sub type as me, I'm afraid they get worse post menopause, not better and you may need HRT very long term.