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[Wendiwu]

Hope someone can help me. 1st timer poster here
I'm 57 and have been on evoril conti for 7 weeks, the first few weeks I felt like the old me was coming back. The awful daily anxiety was going and I left the house by myself for the first time in 2 years.
After about a month the first flush of happiness started to wane and the anxiety has been getting worse again.
I went to see the nurse practioner today and she has changed me to Femoston conti 0.5/2.5 this seems like a lower dose and it's worrying me.
I also take citralpram 10mg.
Can anyone get me any insight into what they think and any postive experiences of Femoston

[CLKD]

Hi!  I wonder why the Nurse changed your regime rather than hiking the Evoril?  Hopefully some1 will be along who is familiar with the HRT.

Browse round.  Make notes.  U may require a hike in Citalopram too - 10mg isn't much.  I take the sister, escitalopram 10mg at night and 5mg in the morning.  When my brain wakes low for more than 3 mornings I add 5mg at breakfast.  This usually lifts the threatened depression enough after 5-7 days.

Ask away.  There's usually some 1 here.  Maybe keeping a mood/food/symptom diary would be useful 2 U?

[Wendiwu]

Thank you for your reply.
The nurse said it only came in one dose .I asked if I can use the estrogen gel along side the evoril and she said No.
I also asked about upping the citralpram and she said one thing a time  🤷
It's a minefield isn't so much to learn

[bombsh3ll]

They are both very low doses. You can't make a direct comparison between transdermal and oral estrogen as people vary greatly in their absorption.

So if this doesn't help you don't despair, there is plenty of scope to increase.

It may also be that the norethisterone in the combination patch was pulling your mood down. It can do that. Dydrogesterone in femoston is anecdotally one of the best tolerated progestins, so you may find that helps.

There was also a study done some years ago showing better mood improvement on oral vs transdermal estrogen, however that may simply reflect more effective delivery.

Finally don't forget about testosterone - it can be really helpful with the psychological symptoms.

[Wendiwu]

Omg that makes so much sense to me.
Thank you so much.
 A few years ago I was on evoril sequi and stopped taking as the progestogen patch would turn me into a hormonal mess.
I've heard that Dr's can't prescribe testosterone and you have to get a private prescription from a menopause clinic, is this correct 🤔

[bombsh3ll]

Generally speaking that's true of testosterone but there are NHS menopause clinics that can do it too.

They typically have very long waits though and will only prescribe it for low libido - women's quality of life and wellbeing isn't considered worth treating but if there's potentially a male partner not getting his oats they'll blue light it over to your house!

[CLKD]

Love it bombsh311 

[Wendiwu]

Omg I'm on the phone ASAP 🚑🚑💙💙😂

[joziel]

It would be much better to stay on transdermal estrogen because there is zero increased risk of blood clots, which there is with oral.

Moreover you haven't really tried an increased transdermal dose if you were on Evorel Conti because it is 50mcg only. You need to be increased to 75 and even 100... Which means you need separate estrogen patches and utrogestan progesterone (or another progestin).

I'm with Newson Health and was started on patches and increased to 75, but then switched to gel. I then increased gel up to 12 pumps. (Where 4 is the max licensed dose.) Because I wasn't absorbing it well. Now I've been put on a combo of gel and patches and am currently on 100mcg patch and 6 pumps of gel. The dosages many women require are simply impossible to get on the NHS because of the excessive caution around higher doses, despite the fact that women don't absorb it often.

Only if ALL THIS failed, would I be put on oral estrogen. I think your nurse doesn't really know what she's doing and has leapt to oral for some reason...

[Wendiwu]

The nurse said I couldn't use the gel with the patches I did ask.
I would prefer to stay on the patches to be fair.
I have felt crappy last few days and woke up this morning to  breakthrough bleeding so maybe this is the reason for the way I've been feeling

[joziel]

You need a better practitioner and seeing getting the right HRT dose can literally take years, it is worth the search.

If there is no doctor experienced in menopause care at your practice, you'll need to change practice...

[Wendiwu]

I'm going to ring surgery again and ask for a dr who is more experienced in menopause to talk to
Thank you for your advice

[Hurdity]

Hope someone can help me. 1st timer poster here
I'm 57 and have been on evoril conti for 7 weeks, the first few weeks I felt like the old me was coming back. The awful daily anxiety was going and I left the house by myself for the first time in 2 years.
After about a month the first flush of happiness started to wane and the anxiety has been getting worse again.
I went to see the nurse practioner today and she has changed me to Femoston conti 0.5/2.5 this seems like a lower dose and it's worrying me.
I also take citralpram 10mg.
Can anyone get me any insight into what they think and any postive experiences of Femoston

It's far too soon to change HRT after 7 weeks.

It is possible to add oestrogen to Evorel conti - because the conti progestogen dose is also the same for sequi HRT and usually the conti dose would be half that of sequi. This is off-licence (?off-label). As far as I recall the BMS guidelines suggest this as an option though I may be wrong, and I can't remember which of their guidelines it was suggested.

I agree, go to a doctor who is more knowledgeable and do your homework first! Nurses presumably go by the book.

Testosterone is very much hit and miss. Not necessarily only private clinics. I went privately initially but this was in 2015 before the NICE Guidelines made provision for T to be prescribed off-licence for women with low libido, at docs discretion. Since then I always get on NHS - my local GP practice. The BMS have guidelines:
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf

Yes if you are ovulating and till have your own cycle - then this could account for your symptoms, but could equally be the norethisterone.  Also breakthrough bleeding is expected in the first few months of conti HRT.

Hurdity x

[Wendiwu]

Thank you for the advice. I'm researching loads and learning so much.
Totally agree about the nurses just following guidelines, I don't feel she listened b4 she was writing the prescription out.
It's been 3 years since my last period so definitely just breakthrough bleeding.
I'm going to carry on with the evoril for the full 3 months and see how I feel and ask to speak to a Dr I know understands the menopause more. It's so hard to get an appointment at the GP nowadays which doesn't help anyone.