Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Hurdity on May 08, 2015, 07:12:05 PM
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Hi there all
I just wanted to report on my visit to a consultant today in case it is helpful to anyone.
By the way I am a lifelong supporter of the NHS and so feel a bit like a traitor having made a private appointment but it is a one-off (I hope) and the libido issue is not dealt with on NHS (not where I live) and I was also getting really fed up with the commnets from my GP (I mentioned these a while back) about HRT and cancer and how we weren't designed to have oestrogen this long etc. Anyway I went to see Annie Evans in Bristol - as others have on here and she was lovely and really helpful.
Staying on HRT over 60: she showed me the paragraph in the paper from the International Menopause Society (2013):
http://www.imsociety.org/pdf_files/ims_recommendations/updated_2013_ims_recommendations_on_menopausal_hormone_therapy_and_preventive_strategies_for_midlife_health.pdf
"There are no reasons to place arbitrary limitations on the duration of MHT. Data from the WHI trial and other studies generally support safe use for at least 5 years in healthy women initiating treatment before age 60. Continued use beyond the 5-year window may be appropriate, based on a womans individual risk profile.
Whether or not to continue therapy should be at the discretion of the well-informed woman and her health professional, dependent upon the specific goals and an objective estimation of ongoing individual benefits and risks."
This same recommendation is also in the British Menopause Society Paper.
HRT post 60 She said I could stay on it as long as I wanted - obviously provided I have no health problems preventing it. Also she said that all gynaecologists she knew (of a certain age) were on it and didn't intend to come off it! The starting age of HRT relative to menopause was the crucial thing regarding risks, rather than age per se.
Length of cycle: She was happy with my self-designed cycle of 5-8 weeks with the current dose of progesterone I take (ie 200 mg Utrogestan vaginally for 12 days per cycle), especially as I have never had any bleeding at any time other than after withdrawal of progesterone.
Scan of uterus: I asked her if she thought I should have an annual scan of my uterus (for peace of mind due to my age and long cycle and because I have a small fibroid) but she says there was no reason to do this in my case as I do not have any bleeding problems. If I did (have untoward bleeding), then I would be properly investigated through the NHS.
Dose of oestrogen: I said I thought it would be great to have a higher dose of oestrogen (than 50 mcg) to feel generally better rather than just not having symptoms of flushes and sweats ( although this is good!) and she did suggest I could have a 75 mcg patch if I wanted!!! However after discussion of libido I decided to leave this for the moment and deal with one thing at a time as she suggested.
Type of HRT: she confirmed that I was on the least risky formulation of HRT ie transdermal estradiol and "natural" progesterone - which she described as "breast friendly". Also that being on a cycle was better for the breasts than continuous combined HRT - although slightly more risky for the endometrium (womb lining).
Libido - the big one! After hearing about my symptoms (total lack of libido which started decreasing some time ago, coupled with tiredness etc) she thought this would be worth a try. Eeeeeeek - scary!! So - I have now come away with a box of testogel sachets which will apparently last me 10 months!!! (if I go on with it that long). She said that it would take several months for the testosterone receptors to be re-activated (they've "gone to sleep" - my words!) - also that if I didn't suffer acne/hairiness in my younger days then I shouldn't have these side effects if I stuck to the tiny (petit-pois size) amount of gel. Well I'm now very nervous of trying it especially as I'm 5 days into utrogestan and woke with a neck/headache and foggy head - but seems to have abated at the moment. I'll start another thread on the T stuff.
The most interesting thing she said - which I didn't know, was that when women find that their flushes return after taking oestrogen for some time, it is not always increased oestrogen that is needed, but a little testosterone. She said that it played a small part in the control of flushes and sweats (I know metabolism of these two hormones is linked). I can see why this makes it difficult for most women because testosterone just isn't available on NHS except as implants and only sparingly to some women with total hysterectomy/ovary removal.
Follow-up: She's going to write to my GP so the letter will go on file and I can refer to it if she (GP) starts to make comments about my being on HRT when I go to see her about various symptoms (this is when I can't get an appointment with my lovely gynae GP who is only part-time and you have to wait weeks for). I don't have to go back to the consultant for a review and if I want another prescription for the T, I just phone up and they can send one - I don't have to pay for the service again (except of course for the prescription) unless I want her to review my HRT.
Anyway I realise that this was tailored to me and wouldn't suit everyone but hope it gives confidence to some of you out there who are having trouble with GPs about HRT anyway. :)
When I get around to it and after a few months ( if I take it that long) I will report on the libido effect ;) - my husband sounded very pleased at the prospect ::) (he doesn't know this was a private appointment though - I didn't really need to tell him and he didn't ask!!)
Hurdity x
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That sounds like a very positive experience Hurdity - thanks for sharing and explaining it all - especially about the testosterone. Makes you wonder how many of us who try to come off HRT but fail due to the horrible sweats need that instead of oestrogen!
I'm sure if the testogel works then your husband wont mind at all that you paid for a consultation so, one day, you may tell him ;D ;D
Taz x :jiggy:
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Thank you for sharing that, excellent post , will await the testogel reports, :D
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Thanks for your report glad you got to see a good,knowledgeable Dr,watched her give a talk on you tube she seemed like a person one could talk to.
I will now be asking my private gynecologist ,who by the way is also easy to talk to and highly thought of in this region, again about testagel as before he said no ,he said he would give the implants but not testagel. So will try him again ;)
I know he is happy to prescribe off licence as he gives me the utrogeston pessarys so will try to persaude him. I wouldn't have a problem having an implant once I knew testosterone suited me ,although I know one is derived from male T and one female T as I understand it, well thats how I interpreted what he said,please let us know how you go with it.
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I'm glad you had a good consultation Hurdity, and you've explained it do well
I can't wait to read your reviews on the testosterone, it gives me hope :-)
Plus very good news that can continue your hrt
Annie
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Hi Hurdity
Interested to read your post. I have been seeing Nick Panay and after blood results showing very low testosterone prescribed testigel which I am worried about adding to the mix as have been struggling for a while now.
Lesley x
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:thankyou: ……. my GP told me many years ago that testosterone would lower my voice (I wanted to try it to encourage libedo) ::)
Let us know how you get on!
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Hi Hurdity
Really informative post!
It makes me wonder if my return of symptoms may be due to lack of T and not that the Oestrogel was not being absorbed......Mmm
I had Testosterone implants in my mid late 30's for PMT symptoms. The only side effects I had was increase in libido, so much so I had to nip home at lunch time for a bit of nookie...... ;D my then DH couldn't keep up with me. Found out later he had another women on the go....... As you can imagine it ended in divorce.
I never had any further implants :-\
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If it worked Warwick, wonder why my GP didn't prescribe it .......... B..ger !
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Hi Hurdity, thank you for such an interesting and informative post. It's especially interesting for me as I'm 65 and only been on HRT for six months! Interesting to know that many female gynaes are on it and intend to stay on. Fortunately, I don't have a problem with low libido but my DH does....shame!! How great that you can have a higher dose patch too. I'm on 25mcg Estradot (twice a week) with 1mg Climaval daily. I have wondered if I could switch to a higher dose patch and do away with the Climaval tablet. ::)
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Hi Hurdity,
Very interesting. I think from what I have read as long as you only use a pea size dose you are fine. I hope it works for you. Good luck !! :)
pepperminty xx
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Gps will generally not prescribe off licence meds without instruction from a consultant
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Interesting post. I'm glad your appointment so worthwhile. I was fortunate that my GP fully supported my seeing a private gynaecologist. In fact she suggested I see my gynaecologist, who she had worked with as a registrar a few years ago. I, too, would rather go through the NHS, but testosterone is no longer available on the NHS as it is no longer licensed for women in this country for commercial reasons. It is only licensed for men. I had to sign a disclaimer.
I wanted to try testosterone, which I did for a few months, as I have very low levels. I was prescribed Tostran, which is gel in a pump can, which is easier to apply than gel from sachets and more accurate in dosage. Implants are available at the clinic, but not considered suitable. I used testosterone for several months, with no noticeable benefit. However, I did have facial acne like blemishes quite badly and more hairs on my chin than before. I didn't have acne as a teenager, but did have 2 long periods of acne during the peri menopause period, though not as horrid as this. The acne is only calming down several months on after stopping testosterone.
In order to take testosterone, I had to start oestrogen and of course progesterone to protect my womb. The benefits of oestrogen have been wonderful, though not everything is hunky dory, but now I have a life! But I am very sensitive to progesterone. I currently take Provera for 12 days every 3 months, but dread those cycles a bit, but unlike periods I know what to expect and when and how long, so I can plan accordingly or postpone if say I go on holiday. She has suggested different progesterone preparations to try in her follow up letter to discuss with my GP after my yearly review appointment last week. (At my initial appointment, she did say I could have just 2 cycles a year, but I would have to have a scan every year.)
She also diagnosed a prolapse that needs repair. Having read up on symptoms, it seems I have been having problems for some time and I have been blaming it on IBS. Now I have to wait 2 weeks to see my GP as she works part time. I don't want to discuss HRT with any other doctor in case the age issue comes up. I'm 61.
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Thank you for sharing everything Hurdity - really informative and helpful. There are a number of us posting on this site who are 'a little more mature' and facing the prospect of HRT being taken away from us in the not too distant future.
I am still experimenting with the best cycle using Oestrogel and Utrogestan - the longer cycle gave me heavy and painful bleeds so I am now on my fourth phase of Utrogestan after 3 weeks of Oestrogel only and it'll be interesting to see what type of withdrawal bleed I get this time. I have also reduced the amount of Oestrogel I use to one pump per day - which is quite a low dose but my flushes are still under control!!!!
The other thing that I have noticed is a slight return in libido :gym:. Now my urethra is not so painful this must also be helping.
I will be really interested to know how you get on with the Testosterone. Personally I'm not convinced that more oestrogen will result in more energy but if you don't try, you don't find out. DG xxx
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Thank you for sharing it was so interesting, you have helped me along with others with advice regarding HRT. Hurdity as you know I have chopped and changed regimes with utrogestan just trying to get the system that I can cope with side effects etc. Do you mind if I ask you, I know you take 200 mg Utrogestan and 5-8 week system, how does that work? Also do you get side effects from this dose age? Good luck with the Testo, also to you dancing girl as I'm sure you have tried to advise me too, I do feel bad repeating myself about the utrogestan, hope you have a good result too D/Girl with your utro usage.
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Hi Hurdity, I haven't posted for a while but as someone in your age group felt I just had to say thank you for your informative and heartening post.. Dr Annie Evans sounds great.I will be especially interested to learn how you find the addition of the testosterone into your regime and look forward to your updates.Hope it works!
Diamonds and pearls x
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Thank you for your very interesting post, Hurdity. I hope you achieve the desired effect! ;)
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Thanks for all your replies everyone! Will answer them later if I need to! :)
Evey - I'm not sure what you are asking? I take 200 mg Utrogestan vaginally for 12 days in every 5 - 8 week cycle (instead of 200 mg orally for 12 days in every 28 week cycle as licensed). This needs to be done with medical approval for your particular case and where you are in menopause - I have had gynaes say this is OK for me as no uterine problems and no serious abnormal bleeding at the wrong time. I vary the cycle as I said depending on when I'm going away as at my age I don't want to be doing the vag Utro nor bleeding (well at least not the first 3-4 days) while I'm away.
Hurdity x
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Hi Hurdity
Thanks for posting the useful update/information from the Consultant. Reassuring that the long cycle is acceptable.
Are you also now on Vagifem 10mcg x twice weekly? (or Orthogest)
I've used Testogel (in a tube before) lentil sized amount - recall it was very highly scented - it took me a while to pluck up the courage to use it, kept putting it off! Don't think I persevered long enough to wake up the T receptors.
I hope it works for you, please let us know how you get on with it.
Night_Owl
x
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ps - just remembered, it was Testim that I used (with the strong cologne smell) - not Testogel.
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Thankyou for posting Hurdity, really informative...sorry for being a bit slow, but can you explain the sentence below, as I started HRT @ 40 due to Prem Men....was just wondering about this.... Thankyou.
The starting age of HRT relative to menopause was the crucial thing regarding risks, rather than age per se.
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Hi Night_Owl Thanks - yes it's Testogel and it doesn't smell (well my sense of smell has declined but I think I would smell that!). I started it today because I was so tired after working this morning and exercise class last night I thought I've nothing to lose, even though I'm still on the Utrogestan! Yes a very small amount - haven't started feeling weird yet! Not sure when side effects might start.... Yes I am still using either Vagifem twice a week or Orthgynest ( still got some left!), as well as everything else!
Cassie - this was just in relation to the caution about starting/taking HRT at a late age eg over or nearing 60. It is the time since menopause that is the crucial issue re stroke/arteries thickening etc. The damage to these (blood system ) occurs gradually over the years following menopause and the research shows that HRT started after the "window of opportunity" - eg 5 - 10 years since menopause, is more risky in terms of heart etc because of this. HRT started before menopause or before 10 years has elapsed does not carry this specific risk - according to research,
Ju Ju - sorry to hear about the sdie effects of the T - especially as you had no noticeable difference :( - this is what worries me especially as I never had acne as such, but I wouldn't want a return to the menopausal "acne" or rosacea I experienced before starting HRT - although this particular complaint disappeared swiftly after starting oestrogen. I would be concerned also about hair loss as my hair is still pretty thick and don't want to lose it! Well I can only try - and will have to see how it goes.... I know what you mean about the age issue - but presumably if any GPs you have to see about something, mention HRT - you also have the info on file where the consultant is happy for you to be on it - so they can't argue with that?
marras - lucky you with no libido problems at 65 :). The lovely female part-time gynae GP ( not the one that disapproves - my actual GP) at thew practice says this happens in women where more T production is adrenal led rather than ovary led (as in my case). T is still produced by the adrenal glands. Not sure why you take a tablet too - my preference would be to be on a 50 mcg patch rather than the patch and the tablet???
warwick - I've never heard of T implants for pmt - but then I don't know what the treatments are for this. I like the sound of the side effects though!!! Sorry about your husband though. You are under a meno consultant aren't you? Maybe you could suggest that maybe you need a bit of T in addition to the HRT?
CLKD - your GP was not well-informed ( years ago they knew little about T for women). As I understand it, T should not lower your voice as it is hopefully being given in doses that are within our natural range - ie just reolacing some of what we have lost! I would certainly be worried if my voice went deep!
I'll let you all know how I get on!
Hurdity x :)
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Thanks Hurdity, so kind of you to reply :). No, I don't really know why I'm on a patch as well as tablet but I'm doing so well on this regime that I don't want to rock the boat! My gynae consultant has signed me off for a year so am not due to see her til then. As I still have a womb I am due to take progesterone every three months starting in August and she has given me Cyclogest and told me that if I get any really nasty side effects then just throw them away and phone her! Can't say I'm looking forward to it; I can put up with anything except a return of migraines but I shall have to 'suck it and see' as they say! I hope you get the desired (excuse the pun) result from your testosterone!
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Thankyou and pls keep us posted. I too was offered Testosterone but up until now have not taken the plunge, so am following your post with interest x
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Hurdity, I had no problems with losing hair, just a few stray hairs growing on my chin, which have stopped making their presence so obvious since stopping T. I would have carried on had the acne become more than I was prepared to tolerate. I hope you have more success. Had my libido returned it would have been rather frustrating with things going south down below! :o
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Congrats Hurdity and way to go. Still here and still researching the crap out of all this hormonal stuff. I too plan on taking testosterone ( or it's precursor DHEA) in the very near future, and I'm still perimenopausal. Libido is in the toilet and THIS IS NOT OK BY ME. I think if your middle aged and your libido goes and you're a woman and you're OK with this ( I think a lot of women are) then power to you, but if you're not ok with it then we need treatment!!
I think doctors are terrified of HRT to begin with ( even the 'womanly hormones') of progesterone and estrogen let alone the 'manly' hormone testosterone. But If a 40 something year old man went to his doctor and said "I'm incapable of having sex, or my sex drive is completely gone" you better believe he'd be getting some help super quick. !!!
I have read that acne is a possibility on testosterone but in many cases it resolves after a few months...so even if you break out try to hold out to see if it will resolve. I think some increased greasiness and oil production is pretty normal on testosterone, but it doesn't mean your body won't adapt. And a little oil is great for dry and aging skin :)
I have been reading a fair bit about testosterone as far as libido, energy levels, muscle tone and bone density. It can help all these things at the right dosage.
I'm glad Annie told you you can keep your HRT over 60 if you want. For me life is about QUALITY of life and if I know my risks then let me do what I want with my own body!
If my choices are " possible increase risk of breast cancer" or "for sure you're going to lose your hair, your skin, your energy, your sex life, your sharp mind, your eyesight, your bones, your very essence" due to lack of estrogen...then give me the estrogen. Thank you.
Vent ended :) Congrats Hurdity. I have all my body parts crossed for you. I think it's going to work!!
Tara
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Bumped for Estelle.
Estelle - my report about my visit to Annie Evans is the first post in this thread - it's not the Private Lives one as that was about testosterone! I'm not sure if it is relevant or helpful to you as it was mainly about my age and HRT etc but anyway it might be of some use since you asked and this will be more accurate than my memory now!
Do pm me if you want to talk further - if I can remember!
Hurdity :) x