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[pepperminty]

Hi ladies,

is it advisable to get a scan of the womb to check the thickness before I start conti HRT? Just for peace of mind perhaps ? I have increased my dosage with a medium sequi regime and was thinking of checking the lining was a reasonable thickness before I start a conti regime.  Is this sensible or not? Shall I leave well alone? Trying to be proactive and all that!

Any comments welcome

PM xx

[flo69]

If you want one for peace of mind, then go ahead and book one, ultrasound direct have clinics all over the UK AFAIK.

I had a lot of bleeding from conti so I was switched to sequi and had a scan the day before my "period" started and the lining was reassuringly thin. The doctor commented I must bleed very little with so little lining now, but fact is I bled a good 200ml in the following six days, that is not very little at all!

It was useful because it confirmed I'm definitely post menopausal.

[pepperminty]

If you want one for peace of mind, then go ahead and book one, ultrasound direct have clinics all over the UK AFAIK.

I had a lot of bleeding from conti so I was switched to sequi and had a scan the day before my "period" started and the lining was reassuringly thin. The doctor commented I must bleed very little with so little lining now, but fact is I bled a good 200ml in the following six days, that is not very little at all!

It was useful because it confirmed I'm definitely post menopausal.

Thanks Flo - have booked it 

[joziel]

flo, I would really investigate if you are on sufficient estrogen there. There's no point being on HRT if you're not on a high enough dose to do much beyond treat worst symptoms. The sequi and conti regimes are only 50mcg of E which is a very low starter dose and if your endometrium isn't building up much, it's a good sign it's not providing enough growth factors to the rest of your body either.

You can bleed from your E being too low, as well as too high....

[Mary G]

joziel, that's a very good point about low oestrogen and it's something I was recently caught out on myself.

My silent migraines (and to a lesser extent IBS) made a comeback and I was baffled because I'm about 18 years post menopause and pretty ancient at 63.  I didn't think my oestrogen levels could still bottom out.  I spoke to my hormonal migraine specialist who said it could be my oestrogen was dipping too low and causing fluctuates so I have now reverted back to 2 pumps of Oestrogel every day and splitting the dose by 12 hours.  My oestrogen blood levels were pretty good at 270 pmol but my womb lining measurement came out at 1mm which is too low.

So joziel is right and my point is this, don't bump along at the bottom with minimal relief because it's likely to set off other issues as it did in my case. Looking back at my records, my best year was when I was using 2 pumps of Oestrogel and had oestrogen blood levels of about 400 pmol - I only had 3 migraine auras that year.  I increased the Oestrogel a few weeks ago and it's making a real difference. 

I hope that's useful info.

[Mary G]

peppermint, I'm glad you have booked a scan, it's always worthwhile to check your womb lining and to know you are taking the right dose of progesterone.  They check other things too like ovaries, bladder etc.

Let us know how you get on.

[joziel]

270pmol is the very very bottom of the range for a dose of HRT which helps anything at all, Mary - so not surprised you found you needed more.

I went up to 200mcg patches plus 6 pumps of gel, and was at 880pmol. This resulted in a massive improvement in my sleep, to the point where life is liveable (not perfect).

Getting worried that 880pmol was a bit too high, I reduced the gel down to 4 pumps - and kept patches at 200mcg. After a couple of weeks my symptoms started to come back again. Even this weird joint pain in my hands at night. I tested at that dose and I was at 650pmol. But I've now added the extra 2 pumps back in again.

My Newson doctor is fine with me being at 880, she said 'this is within the range we aim for - which is up to 1000pmol, with symptom control'.

Just thought I'd share that, because I see under-treated women everywhere. There is so much fear-mongering about estrogen that many women really aren't given enough estrogen to treat their symptoms and then still end up on all kinds of other meds. If people still have symptoms and are on HRT and they haven't explored the higher doses yet, I'd really encourage them to - you can always come back down again, if it doesn't help - but at least you'll have tried it.

[Mary G]

joziel, I completely agree about under treated women and have argued with gynaecologists over the years who always parrot the reduce, reduce, reduce mantra when it comes to HRT and one destroyed a perfectly workable regime for me - I was foolish to listen to her.  I don't rely on gynaecologists for medication, I just go to them for check ups and scans but they do tend to spout BS when it comes to HRT. 

I think Newson clinics follow similar prescribing guidelines to the Professor Studd clinic.  There are a lot of women who need very high doses of oestrogen to have full symptom relief (particularly those with depression) and Professor always recommended aiming for the 800s. 

It's interesting what you say about my oestrogen levels being rock bottom but there are some women on here with even lower levels than that, so much so, it's probably only working as a placebo.  Luckily my bone health is excellent so I've been taking enough oestrogen for that but not enough to keep the migraines away and stabilise blood pressure etc.

Sorry to hijack your thread pepperminty but hopefully this is providing some useful information on going too low on oestrogen.

[pepperminty]

peppermint, I'm glad you have booked a scan, it's always worthwhile to check your womb lining and to know you are taking the right dose of progesterone.  They check other things too like ovaries, bladder etc.

Let us know how you get on.

Thanks Mary G,  I will let you know how I get on . I have booked one with Utra sound direct. I am considering going to conti which would mean 2 packets of femosten low dose conti to give me the same dose I am on now of estrogen - 2/10. The meno clinic indicated that this would be ok if I want to. No idea if the change will work for me but if it does the no periods would be fabulous. So I want to check that my bits are A1  .

PMxx

[joziel]

MaryG, yes - check out this paper out last week from the Louise Newson team which confirms what we're saying: https://pubmed.ncbi.nlm.nih.gov/39689249

" One in four women (24.84%) using the highest licensed dose had subtherapeutic levels (<200 pmol/L)."

She just did an Instagram Live on it tonight, where she also said 'we know that the level of estradiol in the blood is not the same as the level of estradiol in the brain' - WHICH IS EXACTLY WHAT I'VE BEEN SAYING  as a hypothesis, without anything to back it up. Just on the basis that we know this is the case with ferritin and other things.

[AmandaJR]

I use more than the licensed dose and my GP is now on board with it. At 6 pumps I was getting joint pain in my right wrist and hip pain doing squash, football etc. I increased to 8 pumps in November and the joint pain has gone.
I saw an orthopaedic surgeon about the hip pain, he said he has lots of peri/meno female patients and that their problems are due to low estrogen. My physio says the same.

[Kathleen]

Hello ladies.

I just wanted to add that when I was with Newson Health I managed to get to 660 pmol/L of  oestradiol on six pumps of gel.
All of my physical symptoms resolved. I still had mood swings and some emotional outbursts plus anxiety which came and went. Unfortunately I developed increasingly painful breasts followed by spotting then heavy bleeding. I was using very little progesterone at the time and I was very post meno. Investigations ensued and luckily all was well but I was told that the HRT was causing the bleeding and I needed to reduce my oestrogen dose.

Fast forward a few years and I am using a sachet of Sandrena gel and Utrogestan 100mg orally. I would say that this is okay for the physical symptoms but sub therapeutic for the psychological ones as I am still on a daily rollercoaster ride emotionally.

I was recently prescribed Pregabalin to try and calm my central nervous system and this is in addition to the AD that I have been taking for years.

I agree that my regime is far from perfect and I am not happy about adding yet another drug however what else can I do? Higher levels of Oestrogen cause breast pain and bleeding while lower levels are of limited help, hence the Pregabalin.

It may be that starting HRT at three years post meant that getting HRT right would always be more difficult.   I believe that many of us have the same experiences and anyone who manages to get a good result from HRT is doing very well.

Wishing you well ladies and take care.

K.

[joziel]

Kathleen, really in that situation, the best thing would have been to increase your P. As you say, you were on 'very little P'. If that wasn't possible, then the Mirena coil or even progestins would be preferable to making you reduce your dose.

In the UK, we don't even test P levels. I think we can't test accurately when women are on oral P because only the LC MS P test is accurate if you take oral P - and that isn't available in the UK. (It is in the US.)

I have just this cycle switched to vag P only and I'll be testing my P this cycle around day 20. If I have decent levels using vag P, then I know I'm okay - and could add in some oral for sleep purposes.