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[Deedot1176]

I have been on HRT for 3 years now and have constantly swapped and changed meds to try and control the symptoms.
I have been on Elleste solo 2mg, utrogeston 100mg then changed the elleste solo to oestrogel 4 pumps but symptoms still same, I reintroduced the Elleste solo and only 2 pumps of gel instead of 4, also have testogel and vagirux pessary x2 pw.

Had follow up app with gp and told her what I had been doing for the last couple of months and how it had helped my symptoms, she told me the long term side effects of doing this makes my womb lining thicker and can lead to pre cancer cells in the uterine wall.
She told me to stop the gel and would go back to tablets and give me anti depressent sertraline as it combats hot flushes and changed my utrogeston to provera 10mg, I want to go back on the utrogeston as the provera are making me anxious, a feeling of bubbling sensation brewing and full of rage. I hate how I am feeling on these provera, I dont feel normal as I usually am and feel I am pushing loved ones away.
To date ive not taken the sertraline as not long come off strong anti depressents and am doing well without them, so don't want to get back in to a routine with them for the sake of meno symptoms.


Anybody have any advice or have experienced similar side effects and can relate.

[CLKD]

Don't listen to the GP who is badly informed.

Get an appt with a dedicated menopause clinic.  Don't stop your current regime.  Is the VA treatment easing symptoms because twice a week often isn't enough!  Again your GP is misleading you.

Think back to which symptom you wanted to ease B4 starting HRT?

[Dotty]

Hi what symptoms have you still got ? And what symptoms have been helped by the HRT ?

[discogirl]

Hi Deedot1176

I'm not as experienced in hrt matters as some of the other ladies on here, but I was thinking that the reason for your low mood could be that you've changed and swopped your hrt regime recently.

If some of your symptoms weren't under control and that's the reason you moved away from elleste solo, sometimes it could be that you needed to remain on the gel a little while longer.  Some ladies find patches better as this seems to give a more even dosage. so rather then remaining on the ellesete solo with some patches, it may be better to find out if the gel or the patches are better for you and then try and remain on them for a while, they say 3 months i believe, to see if that does the trick. So rather than using the ellesete solo and topping up with some gel, maybe try either the patches or the gel and see if that works.

I'm off hrt now, but when I first started I found that I didn't really absorb the patches, and plus I preferred the idea of applying the gel and knowing that I didn't to worry about the patches falling off etc. but everyone is different.

Regarding the progesterone side of things, can you tell us why you moved from utrogestan to provera? Some ladies find their symptoms are less if they use the utrogestan vaginally.

Either way as clkd said try and get an appointment with a menopause clinic if you can or try and find a gp that is a bit more informed about menopause.

All the best xxx

[bombsh3ll]

Ok so you've found an estrogen regime that works for you, that's great! Many women never achieve that.

Unfortunately the NHS will not support taking oral plus the 2 pumps of gel. They just won't, you'll have to go private.

And you do need more than 100mg of micronised progesterone to counteract the effects of this on the endometrium. That's really important and needs to be worked out with a specialist.

However it is inappropriate for your GP to punish you like a naughty little girl with antidepressants and provera. That's bordering on malicious.

I certainly wouldn't take the antidepressants, they are not recommended as a substitute for appropriate hormone therapy and should only be prescribed if there is genuine clinical depression.

That said you do need endometrial protection whilst you sort a menopause specialist appointment. If you have sufficient progesterone you could take 300mg every night with the estrogen you describe.

Alternatively you can buy desogestrel (Hana) over the counter (you would need to say it's for contraception) and take two of them every day (150mcg) if you can't take the provera.

I would recommend someone like Dr Louise Newson's clinic who recognise that the bog standard very low NHS doses don't work for everyone and provides more individualised care. They are also more experienced in preventing endometrial hyperplasia in those requiring higher estrogen doses.

[CLKD]

How often does the hyperplasia become a problem?

[bombsh3ll]

Estimates vary but in the PEPI trial 34% of women had endometrial hyperplasia after 3 years of unopposed CEE 0.625mg.

This is not cancer but can lead to malignant changes.

This can also occur when insufficient progestogen is used, with the risk increasing at higher levels of estrogen.

Endometrial cancer is still rare, but the main risk with not taking enough progestogen is the development of unscheduled bleeding, which then results in painful and invasive investigations, fear, distress and often loss of access to treatment.

This is all avoidable with appropriate progestogen use and ideally monitoring with an annual pelvic scan, although this is not funded by the NHS.

[CLKD]

Tnx - how likely is this to happen without a lady being on any form of HRT?

[bombsh3ll]

Medscape NZ estimates 2 in 1000 women around the age of 50 will develop endometrial cancer over the next 5 years without HRT.

In the WHI non-hysterectomised placebo group, 30 women aged 50-79 out of 8102 developed endometrial cancer during 5 years of study.

Historically, taking combined HRT has lowered this risk compared to untreated women however all this data came from using synthetic progestins.

I do not believe this can be assumed to apply to micronised progesterone.

[joziel]

Deedot, you need more estrogen. You've found that out for yourself. Unfortunately your GP is not going to prescribe it because they won't support anything higher than the max licensed dose - regardless of how well you absorb it. As Bob said, you will need to go private.

I am on 200mcg patches plus 4 pumps of gel privately with the Newson Clinic. Plus 300mg utrogestan for half the month increasing to 400mg the second half. My NHS GP prescribes this but only after a letter from the Newson Clinic.

[CLKD]

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