Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Goosieloosie on January 08, 2016, 05:00:41 PM
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Just need a bit of advice as I swapped from Evorel conti to Femseven conti a few days ago & I feel so awful :(. I don't know if it's just a temporary blip due to the change over or if I'm just not suited to Femseven or synthetic progestins ?? :'(. I wasn't happy with the Evorel as my boobs were sore & huge, I was weepy once again (I had picked up loads and was really happy at the start of taking Evorel but could feel myself getting lower & lower moods) plus I was fed up with the on/off erratic bleeding so I swapped to Femseven only 3 days ago & omg I'm so much worse already, not only am I still bleeding but I feel sick, my mood has plummeted and I'm crying at the slightest thing, I had a big row with DH last night & honestly I could've murdered him....I feel exactly like I did before I had any HRT...the only thing atm that has improved with HRT is the constant hotness & joint stiffness, other than that I feel pretty rubbish :'(. I'm so so disappointed as I felt fantastic the first 2 weeks on HRT.
What do I do next?? Do you think it's just the transition between Evorel & Femseven and it will settle or do you think possibly I'm intolerant to progestins?? The constant sickly feeling I've only had while on Femseven.
I'm so desperate to have that feel good feeling again that I had at the beginning, reminded me of my younger days :'(
Thank you for any advice or reassurance anyone can give me as I'm truly feeling really low :'(
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So sorry to hear about this Goosieloosie. Unfortunately it may well be the synthetic progestogens causing the problems. This is one reason that many of us choose to remain on a cycle even though many years post-menopausal (in addition to the sometimes irregular bleeding/spotting that can occur). The feeling sick I thought was usually due to sudden increase in oestrogen especially as you are receiving hormones transdermally - but I might be wrong there - in which case this usually settles fairly quickly. It could be that you are absorbing the oestrogen slightly differently with the two patches. However increased oestrogen does not cause low mood - that is not its function ( although sometimes HRT preparations can cause blips due to dosage and delivery method).
My view would be to try to ride through the next few weeks and see if these side effects settle - tell yourself (and your DH!) it's the bloody hormones and see if you can get through. If after a few weeks you still feel the same or no better I would seriously consider changing to a cyclical HRT - either Femoston (if you are happy with tabs - can't remember how old you are), or patch/gel with separate progesterone. I have been on this combo for years and my mood is stable.
Of course during peri you will still expect mood swings but the aim of HRT in addition to health benefits etc is that you feel better on the whole on it than without it! :)
Hurdity x
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No advice sorry but just wanted to send you a :hug: and to empathize with you.
Its all trial and error Im afraid and what works for one might not work for another unfortunately ,if only.
But you do need to give each hrt time ,at least a couple of months ,if you keep changing your body wont know which way is up. ;)
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Thank you both, Hurdity I am 54 and post meno & would prefer not to take tablets as I'm a migraine sufferer. I forgot to add in my original post that i have also been getting headaches every afternoon :( though my migraine has improved since being on HRT overall.
I bashed my elbow just before. (not so hard though that normally I'd cry or anything) but I burst into tears & felt overwhelmingly sick, I'm fed up and feel I want to rip the patch off >:(
Obviously it would be sensible for me to persevere a few weeks to see if all this settles down but I just don't like the person I am atm and don't know how long I will be able to function feeling like this :'(
Hurdity...If I was to go onto a separate oestrogen patch & Utrogestan how many days would I take it for to have a cycle?? Would it be 2 weeks the same as the other progesterones? And would Utrogestan taken as a tablet every day be ok with me suffering migraine?
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You can use utrogeston vaginally so should overcome any migraine issues.
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You can use utrogeston vaginally so should overcome any migraine issues.
How many days would I have to use it for? Is it 2 weeks ?
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I was prescribed 100mg Utrogestan to be taken continuously, but pharmist queried that as it is normally taken for 25 days, I had my last period 10 months ago.
In the leaflet it said alternatively 200mg could be taken for 12 days.
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Goosieloosie, if you are a migraine sufferer, chances are, synthetic progestins will make them worse. Do you know why your doctor prescribed this type of HRT, was it because you don't want to have periods?
Your previous HRT contained norethisterone which is notorious for creating low mood, breast pain and migraines (although you say the migraines improved when you too Evorel?) but your new HRT contains the same progestin as the Mirena coil but obviously unlike the coil, it is not mainly concentrated in the womb and will circulate around your body.
The fact that your migraines have improved overall since taking HRT would indicate that you are the same as me, you need oestrogen to stop the migraines but the progestins ruin the good work that the oestrogen does.
Did you have migraines during your reproductive years and if so, where they just before a period?
After years of being on the wrong medication, doing my own research/trials and seeing Professor Studd, I now know that I must have a steady dose of oestrogen and a minimal amount of progesterone in order to avoid migraines - silent migraines in my case which consist of migraine aura without headache. I am not a migraine sufferer per se, I only get migraines if (a) my oestrogen levels fall too low and (b) I take synthetic progestins. I never had migraines during my reproductive years despite taking the BCP because apparently my own natural progesterone overrode the synthetic stuff. It was only when I stopped producing my own progesterone that I started getting the migraines when taking progestins. Synthetic progestins alter the brain receptors and cause migraines in some people.
It sounds as though you could be similar and if that is the case, you need to take a separate transdermal bio identical oestrogen (gel or patch) and bio identical Utrogestan (preferably vaginally) for 7 days per month. I now take 1 pump of gel every 12 hours (to get an even dose) and 100mg of Utrogestan for 7 days per month plus a pea sized measure of testosterone. It does mean having periods again but it is a small price to pay for getting back to normal. So far, it seems to be working!
Hope that helps.
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Hi Mary, Thank you for that very informative reply. I was put on conti patches because I was 14 months without periods and I am 54 & because the patches are supposed to be better for migraines sufferers rather than taking tablets. Yes my migraines have most definitely improved both with the Evorel..... and so far on Femseven I haven't had one...but it is early days although before HRT I was getting migraines about 5 times a week sometimes. I started getting them in my late 30's when I was still having a normal menstrual cycle but I can't remember if they came just before a period or not :-\ I do remember though that they became more and more frequent as I ventured into my late 40's (obviously peri menopause) & even worse after menopause although I never knew at the time that this was what was causing them. Not one doctor had ever suggested HRT to me or that they might be menopause linked.
If I don't feel better on Femseven I am dreading going back to my GP as she just didn't seem to have a clue, she had to look Femseven up despite her being of a menopausal age herself :o so trying to explain to her about utrogestan will be a challenge I'm sure, I briefly mentioned gels to her but she looked clueless and said she would have to ask and find out about that if that was what I wanted :-\ . Do you think I would be ok taking Utrogestan orally being a migraine sufferer? So 7 days a month would be all I would have to take it for?? And this induces a bleed when you stop? I feel quite anxious at the thought of trying to explain all this to my GP if the Femseven doesn't work out :-\
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Goosie, I had a lot of trouble with the progesterone in Evorel, and was switched to Evorel estrogen only patches and provera for 10 days a month. That worked for several years then I switched the prog to Utrogestan 200 14 days per month, and eventually 100 all the time. Ask at your GP surgery if any of the doctors have a special interest in menopause/women's health and ask to try using two products. The progesterone in patches is not nice but the estrogen part works very well. I hope you get it settled soon. It's very hard to think straight about this stuff when the meds themselves make you so miserable but see if someone with more knowledge can see you.
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Goosie, I had a lot of trouble with the progesterone in Evorel, and was switched to Evorel estrogen only patches and provera for 10 days a month. That worked for several years then I switched the prog to Utrogestan 200 14 days per month, and eventually 100 all the time. Ask at your GP surgery if any of the doctors have a special interest in menopause/women's health and ask to try using two products. The progesterone in patches is not nice but the estrogen part works very well. I hope you get it settled soon. It's very hard to think straight about this stuff when the meds themselves make you so miserable but see if someone with more knowledge can see you.
Thank you for that, ironically the GP I chose to see at our practise is actually the one that deals with womens health & contraception & she fits the mirena coil so I thought she would be the best informed :o I was actually gobsmacked at her lack of knowledge :-\
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Goosieloosie, yet another GP who knows nothing about the menopause or HRT, you are lucky she didn't start Googling, I despair.
Hormones are Professor Studd's speciality and he always prescribes 100mg of Utrogestan for 7 days per month for hormonal migraine sufferers and from what you have said, it would appear that your migraines linked to low oestrogen levels. That is the minimum Utrogestan dose and it always produces a robust bleed for me. It is much more effective when taken vaginally because most of it reaches the womb and it also carries fewer side effects like breast pain, headaches and digestive problems so I would recommend you take it that way.
If you are happy with the oestrogen only patches then it would be better to stick with them and change to the separate Utrogestan. Otherwise, you could ask for the oestrogen gel - the new NICE guidelines mean you should now be able to get the gel and the Utrogestan on the NHS.
Good luck!
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Do you have to have a yearly scan if you only use it for 7 days?
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Thank you Mary, I will try persevere with the Femseven if I possibly can & if things do not improve my next suggestion to my GP will be to try the Utrogestan. Tinkerbelle has a point, do you have to have a scan regularly if you only take it for 7 days? This seems such a short amount of time. So is the bleed quite long and heavy when you stop?
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Good question. Professor Studd did not tell me I had to have a scan every year but it's a good idea to have one anyway and not just because of lining build up but to check for things like vaginal wall thickness, cysts and ovary health - the one I go to checks the bladder too.
I can tell you that 7 days of 100mg Utrogestan is definitely enough for me because I have been checked several times and it's always OK. The problem with the NHS is they have to prescribe on a "one size fits all" basis so they will work on worst case scenario i.e. they have to allow for women to need a lot of progesterone to get a bleed. The other point I would make is, for no logical reason whatsoever, the NHS has not licenced Utrogestan to be taken vaginally which means they have to prescribe higher doses of it because you need about double the amount to get the same result if you take it orally.
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Thank you both, Hurdity I am 54 and post meno & would prefer not to take tablets as I'm a migraine sufferer. I forgot to add in my original post that i have also been getting headaches every afternoon :( though my migraine has improved since being on HRT overall.
Hurdity...If I was to go onto a separate oestrogen patch & Utrogestan how many days would I take it for to have a cycle?? Would it be 2 weeks the same as the other progesterones? And would Utrogestan taken as a tablet every day be ok with me suffering migraine?
Hi again Goosieloosie
You've had some great information from Mary G about her regime and Prof Studd's prescription for women who are highly progesterone intolerant.
My answer to your original question would be to start with taking the licensed dose of Utrogestan 200 mg orally for 12 days and see how you get on.
Like you I began to suffer with migraines when I was in the late reproductive stage - when I was getting really bad pms just before my period. I think in my case it was probably progesterone withdrawal - which is one reason for the pmt symptoms of headache, tension, irritability because they stopped as my periods stopped and were replaced by flushes and sweats. When I started HRT I continued to get them after the withdrawal most cycles, for a few years. Also sometimes during the progesterone phase.
It doesn't necessarily follow that because you might not tolerate synthetic progestogens, the same will be true for progesterone. Many women are quite happy on this - OK with some mild sedating side effects or head fog - but tolerable. I agree that the licensed dose is designed so that the incidence of endometrial hyperplasia in minimised but better to start with this and cut back if it's doing its job but you find the dose too high. The 7 days a month regime is the absolute minimum for highly progesterone intolerant women and will lead to endometrial hyperplasia in some women - and this will depend to some extent on the oestrogen dose. Prof Studd's own research from the 1990's demonstrates this - I think 12 days a month pretty well elimninated any thickening in the studies he carried out ( this is from memory - I would have to look up the papers again), but the percentage of women with hyperplasia increased as the number of days was reduced.
As has been said this could be monitored by means of a regular scan ideally annually. Originally Studd said on his website that when women used progesterone for 7 days, the threshold for endometrial sampling would need to be lowered - in other words any signs perhaps of spotting etc, a biopsy or scan should be carried out.
If you are using this regime on NHS then I would not use 7 days per month unless you are prepared to pay for an annual scan - or unless your oestrogen dose is very low. Even so I would still feel women should be scanned.
Interestingly where Utrogestan is licensed for vaginal use for HRT - such as in France - the same dose is given as for oral use, although the research papers have demosntrated as Mary G says that maybe 50% of the oral dose can be used vaginally to give the same effect. As far as I understand though - it is a combination of dose and duration of progestogen that is needed, so for example giving a very high dose of progestogen vaginally for says 5 days wouldn't do the same job ( because much would be lost).
I'm not saying don't do the 7 day course - but this is just omne option, but I wouldn't start with this unless you are on a v low oestrogen dose - and in any case you may be quite happy on it, or even not need it at all if the Femseven agrees with you :)
Just to say also I use 50 mcg Estradot patch and Utrogestan 12-13 days per 2 months vaginally and I am post-menopausal - this suits me fine. I am on the prog at the moment and feel a bit tired but not too bad.
Sorry if this is a bit long-winded but hope it's helpful!
Hurdity x
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Thank you Mary & Hurdity, That's alot to digest & I'm actually away this weekend (taking son back to uni after the holidays!) so I shall read and absorb it properly once I get home tomorrow! I don't feel too bad today but that could be because I've not had a stressful day just sitting in the car! I have noticed however that every afternoon I develop a headache in the back of my head, it wasn't too bad today but nevertheless it was still there & not the type of headache that I normally get. It just feels 'different'. I am still bleeding aswell :'(. Thank you both so much once again for your help.
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Snap with son going back to uni - I took my youngest back to the train ( town 15 miles away) to go back today too - but he is over 260 miles away - we agreed we would do the run just once a year with all his clobber. At Christmas and Easter they come on the train (with big suitcase and bag). This was the same for all four of them - they all went quite a long way away! Two went to the one above, daughter was 230 miles away, and the closest was 150 miles but he took his car as it wasn't a big city uni. Hmm wonder why they went so far away! Probably because we live in the rural southwest and 3 went to big northern cities and one to midlands!
Anyway I digress - hope your trip was good, but sorry to hear about the headache - I wake with that sort of headache every morning after the utrogestan but it does usually clear, although sometimes becomes a foggy head. Fortunately not like a migraine which lasts for 3 days.
Hope you're not too tired for driving back - I used to find those long drives pretty tiring - especially the long busy motorways which I'm not used to!
Let us know how you feel when you get back.
Hurdity x
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:bighug: I know that 'truly awful feeling' for different reasons. Try not to think more than 1 hour ahead …..
Headaches can be due to dehydration ………….. or are you sleeping heavily?
It's years since DH went to Uni that first morning :'( ……… but I do remember it - me and his Mum took him to the train, 11 miles from home; then he had an 8/9 hour train journey with a suitcase, bag and a trunk which went in the Guard's van. No taking students to Uni in those days! most families had 1 car and there wasn't the money nor time to tranposrt them. If they wanted to go to Uni they had to get themselves there and back. He didn't have any Lodgings to go to either ……. crikey!
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Hello all I'm back! Well I'm not sure how I'm feeling to be honest. if that makes any sense :-\. I have never felt as good as I did the first 2 weeks when i went onto HRT back in October. I thought i was feeling ok today but no...I'm feeling really irritated again & my mood is kind of 'meh' but I don't know if this is anything to do with the constant bleeding I have, for 3 months I have pretty much been bleeding with only the occasional week bleed free here & there. The sickly feeling seems to have gone now though, which is great & headaches not too bad,just a bit of pressure in the back of my head late afternoon but not bad enough to take paracetamol. So...I'm just fed up and don't know what to do next...do I hang fire with the Femseven conti for a couple more weeks? Will the Dr listen to me now if I go to her this week and ask to try an oestrogen patch along with Utrogestan after only being on Femseven for a week? I feel i have to go to her with a plan as she doesn't seem very knowledgeable about the different HRT's available. I wish I didn't have to think about all of this, it's really getting to me now :'(
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Hi Goosie
Isn't 3 months pretty much the point where you can go and ask to change if you're not happy? You know, we worry a lot about whether it's ok to do these things, but the bottom line is, you need to feel as well as you can. Why don't you give it one more week, as it sounds like it's improving, and then if you're not happy, go back with a plan and see if you can try it.
When I was just starting out on HRT our lovely local pharmacist told me that there are so many different things to try, and that women often give up on it too quickly because they haven't found the combination that suits them. He said to keep going - I hope you feel better very soon x
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Hi Goosieloosie
Yes I would give it a little longer. Conti HRT patches especially should stop the bleeding after 6 months. If you have stopped feeling sick and your headaches are so minor that you don't need painkillers then that's great :). However the mood side of things - well, again your body is getting used to a different progestogen so may well settle down.
Hang in there and try to give it another month or so - then you will have been on conti HRT for 4 months - your bleeding may have lessened, and any side effects from the progestogen (irritated mood, headaches) will have settles if they are going to. Good point from Worrywart re her pharmacist and persevering!
Try to concentrate on the things that have improved and keep a diary to see if you notice any changes....
If all else fails - then you can change to the regime we have recommended ie patch or gel with separate utrogestan on a cycle or continuousy depending on your reaction to it, or your preference.
Hurdity x
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Thank you for all your help and advice.Today I am feeling kind of the same but at least I seem to have definitely stopped feeling sickly and ....I'm still bleeding...making me wonder where it all comes from :o and if it's ever going to stop, but I will try to give it another month if I possibly can. I so want to get this HRT right as overall I do feel much better than I did without it.
The Utrogestan confuses me a little....can you take it like a conti every day and if so are you still prone to bleeding until it settles? OR do you take it sequentially and have the withdrawal bleed only? I mean if you take it for the 12 days do you have a bleed when you stop? And why do you only take it for 12 days when other progestins are taken for 14 aren't they?? Thankyou
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Some of the progestgoens are taken for 12 and some for 14 days if you look at the list here: http://www.menopausematters.co.uk/perimeno.php It depends partly on the potency of the progestogen ( in thinning the lining) and also with patches it is 14 days for convenience so as to keep the changeover days the same.
Utrogestan is taken for 12 days x 200 mg for perimenopausal women or those who want to remain on a cycle and 100 mg x 25 days (or 28 days) for those who are post-menopausal - and should either give no bleed (on 28 days) or a light bleed on 25 days if the lining is building up. Doctors and women experiment with these doses to some extent depending on bleeding pattern. If you do the 25 days out of 28, or continuous prog when peri-menopausal then this increases the chances of erratic bleeding. So yes if you only take it for 12 days you will get a bleed when you stop.
Hurdity x