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[TheKirst]

Hello all,

1st post on this or any forum, so please bear with me.
I was Prescribed Evorel Sequi in Nov 24, but was not aware this was for Perimenopause, and as it turns out neither was my GP! I had not had a period for 17 months at the time, and should have been diagnosed as Menopausal not Peri.
I was completely oblivious that there was another Evorel treatment - being Conti.

I initially asked for HRT as had been feeling down and very jittery since Jul /Aug 24.
Initially I felt better,  not as low, but over the year the anxiety and times feeling low have increased and the jitteriness has turned into a constant tremor.

9 months into Evorel Sequi I had a bleed, not heavy but almost for a day and half, followed by the same, a month later (this time, now 27m since last period)

Saw GP about a diff issue, he then fast tracked me for scan due to the bleeding being a cancer risk. I then had a 3rd bleed a few days after seeing GP.

However at that point, still not aware on wrong HRT, until Gynae nurse called to book me in for scan and asked why I was on Sequi and not Conti if I was menopausal. All news to me!

Ultra sound and internal scan seem ok but consultant wants to do hysteroscopy to make sure ok. I have come off Sequi, not being prescribed anything else until results of hysteroscopy which is not booked in until end of Jan 26.

Currently, anxiety is very high, tremors are worse, head aches and feeling depressed.  (Never had depression, also had 1st panic attack 2 wks ago. ) Tiredness and joint pain also very high, but do have osteoarthritis.
GP doesn't think tremors are anything too sinister, but not given me any real advice.

Feeling lost, bewildered, and like I am going insane.

Does anyone know what effects, if any, this would have - taking Sequi for 11m, so far into Menopause?

Thanks for reading,
Kirsty.

[CLKD]

No wonder U feel lost.  GPs really need to update their understanding of HRT requirements!

Which symptom did U want to ease first?  As oestrogen levels drop the body may become dry: inside and out; deep in the ears, eyes, nostrils, vagina, anus, skin, between the toes ......and muscles may become lax = aches and pains.

I would be asking for a referral to a dedicated menopause clinic as Gynaes often know as little as GPs still seem to about peri/menopause.  There are waiting lists both in the private sector and NHS so getting onto a list is important as the appt can be cancelled if necessary.

Bleeds are common with some regimes which a GP should be aware of.  It is correct for any 'unexplained' bleeding to be investigated so that U have a base line upon which to work.  Rarely is it anything serious.

Anxiety is often higher during these hormonal upheavals.  Tremours are 'common' but not life threatening.  In the mean time I would discuss about anti-anxiety medication to ease you through 'this time of year', keep a mood/food/symptom diary to chart progress. 

Do have sedation or GA for the hysteroscopy don't be fobbed off!  It can be painful apparently.

It won't have done any harm ........ we are a bunch of hormones anyway - do U feel any different apart from the bleeds?

Browse round. Make notes.  Get the appt for a menopause clinic arranged.  Keep hydrated as this can cause headaches. 

[TheKirst]

Thank you so much for your prompt reply.
I'm not too concerned about the bleeding tbh, but worrying about the tremors has increased my anxiety. Tremors get worse when cold, tired, and stressed, hence a vicious circle.

I am hoping to get something to help with brain fog, anxiety and definitely the tremors. Although GP thinks this is an  Essential Tremor, where they could only advise taking Beta blockers but as mild asthmatic I am unable to take them.

I have been given info on Talking Therapies. But may look at menopause clinics and ask if I can get referred.

Thanks ever so much for your time, I really appreciate your help.

[bombsh3ll]

There is no harm whatsoever in taking sequential HRT even if you are postmenopausal.

When it was first realised that non-hysterectomised women needed a progestogen for endometrial protection, the first combination regimes in the 1970s and 80s were actually formulated as sequential treatment in order to patronise women with artificial periods.

This stopped the endometrial cancers that had been occurring with estrogen alone but had high discontinuation rates as nobody wanted their periods back.

Continuous combined regimes were relatively late to the party, introduced in the 1990s, to allow (in the majority of cases) women to remain bleed free.

Cyclical HRT was never intended for perimenopause, it was repurposed for economic reasons, and the dogma about cyclical HRT being for perimenopause and the myth that it brings about a predictable and regular bleed pattern in still-menstruating women arose secondarily.

It sounds as if you have received rather inexperienced and bungling care, with overzealous investigation for bleeding which is a physiological response to the presence of hormones designed to mimic a menstrual cycle, and have now been left without treatment at all.

I would therefore recommend if you can afford it paying to see a specialist who can work with you and optimise your treatment, which hopefully the NHS will take over prescribing once established.

[TheKirst]

Thanks very much for your response Bombshell! Appreciate the HRT lowdown.

I think the tremors are a diff health condition, but not helped with the menopause mix up. Need to get the HRT sorted to determine what else is going on.

Thanks for your time, both of you xx

[Hurdity]

Hi The Kirst

 

First of all - apart from the fact that you were given sequential HRT when you were post-menopausal ( and as bombshell says there is nothing wrong ie dangerous with this - though very long term there is apparently a very slight increase in risk of endometrial cancer) one thing struck me was that you had no bleed for 9 months after introducing oestrogen.

The main point is that you are SUPPOSED to bleed on a sequential HRT though apparently a small percentage of women don't (in fact after several years of HRT on a 28 day regime I also stopped bleeding which led me to lengthen my cycles safely). Lack of bleeding either means you are not building up sufficient lining to be shed or sometimes that the progestogen dose is insufficient. You were using a proprietary brand of HRT so I would suggest the former.

In terms of investigations and a hysteroscopy - this is being overzealous due to ignorance! (as bombshell says). What you are experiencing is NOT unscheduled bleeding - notwithstanding that you hadn't bled on the sequential regime fo 9 months. As explained sequential or cyclical HRT is designed to produce a withdrawal bleed.

Now the fact that you've had a scan (OK no problem with this - it's not invasive) which has been pronounced as OK should be reassuring. Could you tell us what your results were - lining thickness, any reports on the endometrium. You may be able to view this from your online records?

First - I am surprised that the consultant has ordered a hysteroscopy if your scan is OK and I suggest you query this.

Second - you do NOT need to stop HRT pending investigation especially as so far there is nothing to indicate that this is unscheduled bleeding. I urge you to go back to your GP and ask to be put back on it immediately  (if your symptoms warrant this and this is what you want). Several times over the past years I have had investigations and a couple of hysterosocopies and have NEVER stopped HRT. It is appalling that you have been told you cannot take HRT until after the outcome of the results of the hysteroscopy . The fact is, if your scan shows a thin lining then it is extremely unlikely you have cancer - I mean I would say it is almost impossible. If your GP won't comply then if you have multiple GPs in your practice I would go to a different one. Just say you want to go back on it and there is no clinical reason to stop pending an overcautious investigation.

As for paying for private care - you really don't need to do this. If every woman who could afford it went privately at every minor setback - nothing would every change and so I hope you feel able to challenge the GP decision and request the HRT that was helping you.

I'm sorry I can't help with the tremors.

Wishing you well and do keep us updated!

Hurdity x