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[Fran74]

I started HRT last August, Estradot 25 patches and Cyclogest 200 (cut in half with gynaecologist permission due to constipation). I have IC so I am always careful with the dosages of anything, lest they hurt my bladder. In November I started Amitriptyline 10mg to ease the bladder discomfort and frequent urination (it also allows me to eat and drink some problematic foods). I was quite ok until I upped Estradot to 50. Once Estradot 50 kicked in, my nether regions felt "active" 24/7. I tried to double Amitriptyline for a couple of days, to no avail. I could not bear it. As my gyne follow up is very far from now (they won't answer phone, email...) I took matters in my hands and last week I went back on Estradot 25. The first day I felt "at peace", but now I'm not so sure. I feel a bit of dryness and discomfort in the vagina. Is it normal? Anyone with experience of Amitriptyline while on HRT?

[bombsh3ll]

I would think about increasing your estrogen and using vaginal estrogen as well if needed.

This is far likelier to help your bladder and vaginal symptoms.

Regarding amitriptyline, whilst some people do absolutely need it for neuropathic type pain, intractable diarrhoea etc, it really should be a treatment of last resort as it has a very high cholinergic burden and also causes a lot of constipation.

It seems counter intuitive to be cutting a cyclogest pessary in half due to constipation, whilst taking amitriptyline!

You are probably aware that constipation really isn't your friend if you have bladder problems.

[Hurdity]

Hi Fran 74

 

I would definitely go for vaginal oestrogen to help ease things vaginally. Many women ( self included) need vaginal as well as systemic oestrogen and even on much higher doses.

Are you using the cyclogest as a suppository or pessary? I'm a bit confused because you mention pessary yet talk about constipation. Are you saying you insert the cyclogest rectally and this gives you constipation?

I also find that when on the progesterone phase of my HRT cycle, I get more bladder irritation - though I have always used it vaginally (except when I used cyclogest I used it both ways at once - but only on a cyclical basis and was prescribed 2 x 200 mg pessaries).

I was going to suggest using them vaginally if rectal use is causing constipation, but not if it will irritate your bladder.

aAre you taking the progesterone continuously? You haven't said how old you are or where in menopause. You could take the progesterone cyclically which would limit the number of times you have to insert it, but then you would have a withdrawal bleed - if you're not having them already. Another option might be not to insert anything anywhere and go for one of the tablet progestogens to protect your uterus which might caise less irritation.

As for the amitriptyline - I was prescribed this once for some sort of spasms/pain in vagina but got it home, looked at what it was meant to be for and the side effects and decided I didn't need it! Waste of medication sadly but GP just prescribed it and there it was ready for me to take home....(rural practice with in-house dispensary).

The dose of oestrogen you need depends on where you are in menopause, your age and the reason you;re taking it but agree with bombshell for a higher dose, and in principle a mimimum of 50 mcg is what you should ideally be aiming for.

If you;re in UK you shouldn't need to wait for gynae follow up to change your hRT unless you;ve been referred for specialist treatment due to your bladder problems etc? I would research the options for vaginal oestrogen/treatment as well as different progestogens, even tablet hRT= depending on age and stage....

Hope this helps

Hurdity x