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[GillMarDav]

Hello, first time posting here... I'm 44.

Background: After a long spell of worsening depression, I started Evorel Conti 6 weeks ago. I've had quite a few of the symptoms on Louise Newsom's list as well. My mood is much improved since the patches, which is great.

However, since I started on the patches, I've noticed new symptoms: really dry vulva, brain fog and my libido has dropped off a cliff. I'd just rediscovered my libido after 10 ish years of very limited interest in sex, so I'm pretty disappointed about that. Have had sex once in the 6 weeks, and it was as if my body was completely switched off.

Am I imagining this? If not, what is going on, and how do I get my libido back? My GP is fab, but I can't see him prescribing anything new so soon.

Am I making connections where there are none? Or do peri-meno symptoms change that quickly? Help!

[C.Draper]

This is me just suggesting something as  I’ve tried EVERYTHING HRT related. I’ve just posted about my battle if you want to read. It might be that it’s because you’re taking the Congo patches which means you’ll be constantly having progesterone. So it’s like a PMS everyday. That’s what progesterone does to me anyway. I take the patches called everol sequil so only have the progesterone for two weeks. Maybe you could try those and see if you are better the two weeks were you only have estrogen xx

[sheila99]

If you're on evorel conti rather than sequi does that mean you're meno not peri? You can ask your gp for topical oestrogen for the dryness. For some women libido recovers with sufficient oestrogen and you should try any new hrt for 3 months to get the full effects. Others need testosterone but that usually has to be prescribed by a specialist.

[GillMarDav]

Sorry, my bad. I'm on evorel sequi, definitely peri still. I'll give it a wee while longer and chat to my GP when we have the three month review. Thanks for your response!

[CLKD]

Some ladies find that keeping a. mood/food/symptom diary of use to take along to appts.

Don't wait until the vaginal atrophy becomes troublesome!  Get some appropriate treatment to soften up the vaginal walls etc., 'vagifem' and/or 'ovestin'/estriol are the prescribed meds., as well as a mosiorisoer [sp] on the outer vulva/labia.

It's The Change - not imagination ;-). 

[joziel]

You should speak to your GP about starting testosterone. This is exactly where it is indicated and you should be able to get it on NHS (depending on where you live).

Moreover, you might want to try changing from Evorel Sequi because it contains a synthetic progestin which can affect libido and also isn't great for you. Ideally you want separate progesterone and estrogen so you can adjust the levels of each separately, not one bundled product with both in.

You probably need more estrogen as well, for example - low estrogen can cause poor libido too and many of those symptoms would suggest you need more. But the Evorel Sequi and Conti products have a pre-set amount of only 50mcg. Ask for a separate estrogen patch and utrogestan. Then you can increase estrogen to 75 and 100.

[bombsh3ll]

I agree about testosterone.

It may be that a different HRT preparation suits you better, but any estrogen as well as the norethisterone in your patch can increase sex hormone binding globulin, which then binds up more of what little testosterone you had.

This fits with the decrease in libido at the same time as starting the patch.

Whilst estrogen can increase our husband's/male partner's (if applicable) desire for us, by making us better looking and nicer to be around, taking it does nothing for female desire.

If you have vaginal atrophy, estrogen (either systemic or topical) can help with that, but desire and sexual pleasure are about far more than the absence of pain, despite how this is often spun by articles on menopause, as if we should simply be grateful that it doesn't hurt.

[joziel]

It's not true that estrogen does nothing for female libido/desire. There are many women who have had libido fixed not through T but through increased E.

I'm one of them, I've been on T since the beginning - the same dose, stable throughout. But only when getting my E higher has my libido improved.

Estrogen peaks around ovulation, so this makes sense biologically as well...

[Hurdity]

Hi GillMarDav

 

One question - you say your are peri, but I'm interested to know what your periods and cycle were doing before you started on HRT, to work out where in peri you might be. Have you started having changes in cycle length and flow and if so for how long? Also you mentioned depression - so are you taking any sort of medication for this? Some anti-depressants can cause reduction in libido.

I'm not sure that testosterone at such an early age is necessarily indicated and as per joziel maybe optimise oestrogen first, and again depending where you are in menopause.

Hurdity x

[bombsh3ll]

It is correct that estrogen should be optimised first - if we don't have enough estrogen any testosterone we take just gets converted to estrogen as our body prioritises health over reproduction.

However estrogen+/- progesterone alone can reduce free testosterone by increasing SHBG.

The potential for loss of libido is often not mentioned at the time of prescription. The same can also occur with birth control pills.

[joziel]

Transdermal estrogen does not increase SHBG.

Only oral estrogen does.

Birth control pills are oral but also synthetic estrogen, and either of those are going to reduce libido let alone both together.

Progesterone doesn't increase SHBG either. Testosterone does, out of the 3, the most. Thyroid hormones even more.