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[LittleClaire]

Hi all,

I have my 3 month HRT review tomorrow morning and was wondering, are you allowed to ask for an increase this soon after starting?

The first 8-10 weeks I’d say on Evorel Sequi was great and noticed about 90% of my symptoms vanished after a few days and I’d been feeling more like me again, but the past month or so I’ve had the joint pains, hot cheek flushes, mood swings, bad sleep and itchy skin come back. I also posted about VA a few weeks back which I’ve had all the time which I am mentioning tomorrow anyway so hopefully get that sorted separately with topical cream.

It’s just with me being quite young still (37) and only been on HRT for 3 months I have a feeling I’ll be told I can’t have an increase in my patches or that they’re not working hence the symptoms I’m having so may aswell come off it etc.

Thanks in advance

[CLKD]

It can take a while for HRT to ease symptoms: especially when hormones are joining in!  It issn'a cure but a means to deal with peri as much as possible.

MayB make a list to take to discuss so that U don't forget anything.  Loss of oestrogen can cause some of the symptoms U have described.

Do get VA treatment ASAP - U don't need any blood tests nor examinations, it should be prescribed on symptoms.  U R NOT TOO YOUNG for HRT - don't let the medics lead you up that road.

Let us know how you get on. 

[MadCatLady]

Yes you definitely can! My GP was quite happy to increase my dose on my 3-month review, and said we can increase it more in future if I want. Definitely worth you asking tomorrow. Good luck!

[bombsh3ll]

I would have real concerns about a 37 year old only being on a 50mcg patch, which is the dose in evorel sequi.

Younger women generally do need and should receive higher doses of estrogen than those experiencing menopause at the usual age.

A new and very comprehensive guideline on POI has recently come out which is well worth reading. If you look up nick Panay, he is one of the authors. The whole text is available without any kind of pay wall.

The Daisy Network also has some valuable information on their website.

You should be asking your GP for a referral to a specialist service given that you are under 40 and needing MHT as there are special considerations in this age group.

It's not OK to just be given what your mum or nan would get and sent packing as POI has long term health implications.

[CLKD]

Also there is the daisy website for advice on 'young menopause' though no one is too young !

[LittleClaire]

Thanks for all your replies.

So has my appointment and requested to increase HRT which they said no problem, I am getting the 75 patches plus 200 progesterone in a tablet which is great. I’ll pick it up tomorrow.

Mentioned VA, she has also prescribed me a pessary to insert, but for the external area they “don’t prescribe anything to put on that so just get some over the counter moisturiser” !!

Am I being fobbed off? Or won’t they give me it as I’m not over 55.

Seriously considering getting the Gina one now and lying about my age online has anyone done this?

Thanks again

[Ayesha]

I wouldn't rush things, you might not need two topical treatments as you will be on systemic treatment. Wait and see how it goes but just to say the instructions are wrong, you can have both Vagifem and Estriol prescribed together to use topically.

I use both but I am not on systemic HRT.

[CLKD]

I have 'ovestin/estriol/ internally and smear a little of that or KY Jelly around the vulva/labia when necessary.

Your GP is incorrect or lacks knowledge !

[LittleClaire]

Yes I thought as much. It might be my irritability at the minute but I was starting to get annoyed at even the way she was looking at me in the room as if she was thinking menopause symptoms yeah right, too young etc.

I will see how I go with the increase of patch/pill and also try the pessary as you’re right I might not need anymore than that.

I’ve been using Yes moisturiser around the outside and while it does help short term and soothe the skin, it’s not treating the underlying issue of low oestrogen which hopefully the increase I get will help.

Thank you again

[CLKD]

So swop the YES for a smear of VA treatment.  Let us know how you get on.

[sheila99]

It seems to be another nhs failing that they won't prescribe both. They say I can have cream to insert and smear some outside but if I insert a tablet (easier, my preferred option) and I use a small amount of cream on the outside I will almost certainly die from cancer. I found anything without estriol doesn't cure it, I have dryness and the end of my urethra is extremely sensitive. You could ask for ovestin (cream) and use it for both or stick to the tablets and I think you can buy ovestin online if you find you need it.

[Ayesha]

Its not an NHS failing in my part of the woods, I've just had a review with my new GP, previous review was with the nurse, and he's happy to continue with my prescription of both Vagifem and Estriol because that's what it takes to fully control symptoms inside and out. I did have to explain why I needed both and I put my case forward as to why the need, he agreed with everything I was saying including the part when I told him I don't follow the NICE guidelines but the recommendations of the BSSM.

Agree its easy for us to buy over the counter but only if you are over 50, in LittleClaire's situation she is up against it being so young but if systemic HRT was not enough to control the symptoms of GSM, the pessary should also be a great help, but if Estriol cream is also needed going forward I would be getting an older friend or relative to buy it on my behalf.

[LittleClaire]

Yes I totally agree with the above, I feel in my case personally it’s more the outside that’s the problem. I don’t get itchy inside although I’ve noticed on a few occasions especially after sex, that my bladder feels irritated like I’m going to get a UTI but then it goes after a couple of days. Could that be GSM or VA related? In which case the pessary should ease that. I’ve honestly been terrified to have sex lately because of the worry it’ll be sore and I’ll get a water infection. I’m 37 and only been married for just short of 2 years so it makes me sad to feel like this. If I still feel irritated after time using the pessary I’ll ask if someone older can get the ovestin cream for me.

Just while I am on the subject, do you still take the pessary when you are on your period? Sorry if that’s a stupid question!

Thanks again

[bombsh3ll]

Yes you absolutely can use the pessary during your period.

BUT you shouldn't have to be trying to figure this out on your own or getting someone older to buy you vaginal estrogen, because 37 year old vaginas shouldn't need any of this.

Yes absolutely if you have seen a specialist and been optimised on age appropriate systemic treatment and you still need vaginal estrogen, which is uncommon with adequately treated POI, but if you do that's fine.

There are clear guidelines about women under 40 experiencing menopause being referred to a specialist clinic, and I would strongly advise seeking a referral so that you can get the right care.

[Ayesha]

That's a very good question and I don't know because most women are over the age of periods when prescribed treatment. Hopefully someone might know the answer to that.

Vaginal Atrophy is now referred to as Genitourinary Syndrome of the Menopause (GSM) and hopefully the pessary will sort things out for you but if it doesn't there is no reason why you can't ask again for the cream to use on the outside. It will be a battle for you because of your age but the discomfort will make you more determined to get the treatment needed to relieve the symptoms.