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[Tulip256]

I started taking HRT 3 years ago following early peri menopausal signs at age 41 (I am a Fragile X carrier which is associated with premature ovarian insufficiency). At the time I had a blood test showing my FSH was 58 and LH was 35. Also my bone density was poor at -2.3 hip and -1.8 spine.

I have been taking evorel 75 patches and utrogestan 200mg 12 days for these 3 years which at first helped with symptoms (hot flushes, aches, low energy).  Last summer  however I started getting some other symptoms (which at the time I did not put down to peri menopause) - painful oesophagus (feeling of pain whilst eating rather than reflux post eating) and increasingly bladder pain/cystitis.  I also have had zero appetite resultant weight loss and have had to force myself to eat.  Strangely though I have had plenty of energy and none of the typical menopausal symptoms.  I also had another dexa and my bone density has reduced in my spine to -2.1 (whilst remaining at -2.3 in my hip)

I recently approached my GP to review my HRT (as I thought it might help with these symptoms and felt it needed to be higher to improve my bone density) and got these blood test results
FSH - 12.6 iu-l
LH - 12.1 iu-l
prolactin 142 miu-l
progesterone - 12.3 nmol-l
oestradiol - 439 pmoll
testosterone 0.555 nmoll
free androgen index 0.5
SHBG 110 nmoll

My GP says because my oestradiol is ok at 439 I should not increase my dose however I had a few spare patches and in the last week cut them to trial a dose of 100mg (this completely resolved my painful oesophagus and also my appetite feels normal again and I have not had further bladder pain) but I have been feeling really dizzy and have less energy and heavy legs.  I am thinking/hoping that these might be a short term adjustment symptom and the additional dose is helpful?

I am wondering if it is worth going privately to get a higher dose?  Also I think my testosterone looks low (does anyone know?) I have had zero libido for years (the only time I had libido was when I was pregnant so I think it is probably hormonal?)  I am only 44 so am wondering if I need higher doses than the NHS prescribes to protect my bones and help with my symptoms. Any ideas?

[CLKD]

Hi you shouldn't have to pay for information.  You can ask for a referral to a dedicated menopause clinic if your GP is resistant.  We know our bodies best!

Could you cut the patch and use on alternate nights?  It may be a bit much otherwise and if you have had a good result, then a bit of trial and error might be the way to go?  It is important to get HRT levels as even as possible B4 introducing testosterone, otherwise you won't know what might be/not working.

As for bladder pain, has it been suggested that you begin vaginal atrophy treatment?  This condition is due to low levels of oestrogen so appropriate replacement by pessary or cream can help a lot.  'vagifem' and/or 'ovestin' - do read the vaginal atrophy threads.  Make notes ;-).

The body naturally loses density as we age.  How is your exercise regime as brisk walking can help keep bones healthy and cleaning teeth carefully helps keep jaw bones fit.

Also hormonal blood tests are reliably un-reliable  so a medic should treat on symptoms. 

[Tulip256]

Thanks for your reply. I think the waiting list for the nhs clinic is over a year so I will probably go private.

When you say cut the patch and use on alternate nights is this better than just making the patch smaller? I would have thought it would make levels more uneven? I am currently cutting 50s in half to give a 25mg.

I did try vagifem for a while but it seemed to cause more pain. Maybe I need to persist in case it was the tissue healing. I did see a pelvic floor physio though and she felt there was no sign of atrophy.

Bone density wise I strength train 4 days a week and try to get 8000+ steps as well addressing through diet so no idea why it is not improving.

[Hollyboll]

Hi. Sorry you’re struggling.
Clkd is an amazing support and wisdom here.
But fwiw I’d not alternate or chop and change dose levels. Alternating 75 and 100 will give you fluctuations that cause more symptoms.
If you feel 100 solved some but exacerbated other symptoms, have you thought of cutting into quarters and trying 87.5?
Probably best to stick at / trial one dose for a few weeks though.

Hth. X