Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: dangermouse on August 14, 2016, 07:46:41 PM
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If anyone has tried both could you please let me know which you preferred and why, as not sure which to try to start with.
Thanks!
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This isn't an either or question really. Femoston in a combined HRT in pill form - the oestrogen in Femoston is bio identical and the progesterone in this is a kinder, less testosterone based synthetic progesterone so it often suits many women very well.
Oestrogel is simply bio identical oestrogen that you apply to your skin each day and then you need a progesterone separately in either pill form (e.g. Utrogestan or Provera) or you can have a Mirena fitted.
Many prefer using Oestrogel because it allows some flexibility in dosage and using oestrogen transdermally often means a lower dosage is more effective. Many women prefer using oestrogen patches for the same reason. Finding the progesterone to go with this can be challenging - Provera suits many women, however, whilst Utrogestan(micromised progesteonre) is hailed by many as the best progesterone to use, is does bring sedative effects and is not as good at controlling the bleeds.
Femoston 1/10 is a good ‘pill' HRT to try first and is probably the most convenient to use - using the gel and separate progesterone can be more hassle - finding the right HRT is trial and error.
DG x
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Thanks DG! Yes was just wondering more about any stronger side effects when using the pills vs the transdermal route.
If I go with Oestrogel, I'd use with Provera, especially as my GP surgery already told me they don't normally put Utrogestan with Oestrogel (just them being misinformed I think) but more because I don't want the sedating effects. I do ok with Norethisterone but terrible with Levonorgestrel, so wouldn't have the Mirena.
I suspect the gel or patches will be better but remembered seeing posts mentioning Femoston a lot, and as the pill suited me, wasn't sure if would be a more stable method? As GP will make me wait 3 months to try it I wanted to try to choose wisely.
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If you are happy using pills then I would go with Femoston first - you always need to use any HRT for at least 3 months to give it time to settle before changing to something different anyway. If you find the Femoston 1/10 suits you but you are still getting some flushes, then you can go to the higher 2/10 dose.
The gel with Provera might be good but many find applying gel every night is a nuisance and whilst I have always got on with gel well it doesn;t suit everyone - I tried patches and they didnt work well for me, whilst others love them - we are all different.
If you are trying to control low mood and anxiety then this is very difficult to gage - many believe it is just down to hormones but in my experience one needs to adopt a whole range of measures to get this under control - HRT done is often not enough. If HRT reduces most of the flushes and you are sleeping better then that is all you should expect - but this alone should improve quality of life and therefore help the mental state. DG x
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I was on femoston 1/10 and 2/10 for 2 years it was good,i recently changed to oestrogel / utrogestan regime 6 weeks ago as i was having stomach issues and my GP and I thought we should try and avoid any tablets going there and after 2 weeks on it my mood hit an all time low flushes returned with a vengeance! Today enough was enough and my GP said i should go back to femoston in case in was a change in route. As everyone says we are all different, x
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Thanks guys. I had the appointment earlier with a GP who is the only one amongst about 30 who knows about HRT, so grabbed the appointment!
She agreed my oestrogen surges sounded as if they were over and said I could have either the Femoston or the patches, but didn't recommend the gel as she believes the absorbsion level varies too much depending on how much you're sweating, what you've washed in, body lotions used that day etc. because it's a quick hit that could be a quick miss!
I've gone with the Femoston 1/10 to try for 3 months and will switch to patches if doesn't suit me.
Thanks for your help!
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Will you let us know how you get on as femoston is the one I'm hoping to try soon and like you was undecided if to go for tablet or patch..hope all goes well :)
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Yes, will definitely report back!
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Good luck Dangermouse , glad you got sorted. 30 GP's that's a big practice ! Mine has three !!
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Thanks, yes it's good for getting same day emergency appointments but not so good for continuity which can lead to misdiagnoses.
It was nice to not be told for a change I'm too young to need HRT and she's aware of this site which gives you faith!
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Just to update my experience with oestrogen replacement therapy.
I found Femoston 1/10 much too potent in its estrogenic action, so switched to Oestrogel which also gave the same issues. Had similar symptoms (anxiety, jittery, inflammation) with high oestrogen contraceptive pill when own oestrogen was high so I know it's not a settling in phase.
I suspect my oestrogen to progesterone ratio is still too high (I got my period yesterday so defo still peri), but fortunately without the intense nausea that used to kick in by Day 2 when surges were extreme.
Currently studying Ray Peat's (endocrinologist) theories and may start progesterone only once I've tried some of the Peat dietary advice - I used to do intermittent fasting which can apparently throw out the endocrine system. (He doesn't sell books etc but others have produced dietary advice for free based on his theories). He believes the high oestrogen to prog in peri-menopause lasts for 4 years but he is anti oestrogen therapy even in post-meno as believes it over stimulates and causes adrenal problems as makes you feel great at first but then drains your resources, where progesterone is the opposite (rough at first but then it starts to replenish everything due to the calming nature). Who knows? Does sound contrary to most of your experiences here though.
Anyway, I don't even get the 'great at first' bit so will try other options for now.
Oh I also had a sicky feeling on Femoston that started the 2nd week. It felt more like a stomach irritation than the dizzy sickness from over stimulation. It wasn't a problem to put up with and I suspect it passes in time if no other problems with the HRT.
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Thanks for the update...I'm even more put off trying femoston 1mg now especially after the recent cancer mention in the paper..but the oestrogel and utrogestan set up seems very hard to work out too with so many variants..I keep putting off starting hrt aa just when I think one seems good I get put off...so confused 😏
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dangermouse - I do think there is a great danger of over thinking all this. The oestrogen dominant theory has been looked at by many and I believe does not really stack up with the medical profession as a whole - we ladies on MM certainly experience more benefits from oestrogen.
The peri stage is very challenging - with hormonal fluctuations causing all manor of problems. I believe there is still much to be learned about the endocrine system - how it works and effects on our body - hormonal treatment will undoubtedly improve many meno symptoms but could also create some issues as well. The idea that progesterone will help at this stage in our lives is highly questionable (unless you need to control problematic bleeding) as it is usually progesterone that gives many of us problems - not benefits. Progesterone is only really given to protect the womb lining and those who have had a hysterectomy usually only need oestrogen to restore some balance.
I think, in your case, you are possibly in early peri meno and with many fluctuations happening, so adding in any hormones may not be helping as yet or you haven't yet found the right balance. You haven't told us what dose of Oestrogel you used or for how long? Did you use one pump per day for at least 2 weeks and then added in a progesterone for 10-12 days? Until you do at least 3 months of a particular HRT regime you can't really tell if it is beneficial. The nausea could be other things at play - again, looking at diet can be helpful e.g. eating small amounts often and drinking camomile or fennel tea to calm the digestive system.
Your comment about diet is relevant - I think diets that include fasting e.g. the 5/2 diet, is simply not a good idea when in peri and post meno as this will inevitable bring problems with blood sugar levels which will make everything worse.
I can't remember why you have started HRT treatment - is it low mood and anxiety? I personally believe it is very difficult to control these meno symptoms and that we should only really expect HRT to control flushes and night sweats. If flushes etc. are under control, then this will usually mean we feel generally better, sleep better and things feel generally more in balance, so this should have a good effect on mood and anxiety. However it takes time and patience and, for many of us, months of trial and error .
Dg xxxx
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Oh please don't be put off trying it Peroxideblader, everyone is different and many do really well on it - it's just my experience with exogenous plant based oestrogen, and could be to do with my specific stage or my individual body make-up.
Thanks Dancinggirl - challenging it is! My hormone hell had been going on for years but then last summer I started getting severe nausea which culminated in me only being able to keep milk down for weeks on end and I lost 2 stone in 2 months, which was all over-stimulation of eyes, ears, stomach etc. It was like being on a rough boat ride (always had travel sickness!) whilst having severe food poisoning from 5am to 9pm every day and was in an out of a&e to get drips for dehydration. You could see my stomach moving constantly and when I had to have a gastro ultrasound the technician gasped and said it was like an Alien in my stomach! Due to the severity, no-one including myself, came up with hormones as the cause and I had to wait 5 months for an endoscopy (London North Midd wait times!) despite barely being able to sustain myself and living on my tod.
When I finally worked out what it was (docs were all useless - just got the anxious woman making a fuss ::)) the GP put me on the pill as they said HRT was not strong enough to deal with severe oestrogen surges (which can happen mid peri-menopause as ovaries start throwing out excess oestrogen in an apparent last ditch attempt for pregnancy) - suddenly they knew all about them, just couldn't diagnose them... The pill made it worse for the first 2 weeks, which I knew it would as I was adding more oestrogen, but then it all calmed down and I was nausea-free for 6 months apart from when I tried to take pill breaks as even a day off the pill had me dry heaving - so I was told to take it back to back. I recently stopped as I'm very good at reading my body (hyper sensitive even to even herbal supplements!) as could feel something had changed, like I'd just got off the dodgy boat, and that the hormones in the pill were now overwhelming me and making the tachycardia I had adopted over the past year much worse.
Felt lots better since stopping the pill, just had a few random hours of tachycardia at about 100bpm resting as the oestrogen left my body and my own natural oestrogen came back through - another reason I don't want to take it as I believe it suppresses our own production so very hard to get the right balance. However, I still have the physical exhaustion and lack of motivation that I had before it all went crazy. I work for myself in private practice, plus I've just started a new demanding part-time job at a college and I study and write so this is biggie for me. However, I recognise how lucky I am that its my worst symptom for now, after the hell I went through before! I do get hot a lot but not drenching sweats but don't have other classic low oestrogen symptoms - but an endocrinologist told me when I was in my 20s that I had very low oestrogen for my age which was affecting my energy and was put on oestrogen dominant contraceptive pill then. A Chinese TCM doc also said I must have the pill as herbs could only do so much - she said she'd never advise it normally though so I must have appeared beyond drained!
I guess I just wanted to know if natural oestrogen would, therefore, perk me up (like the pill's oestrogen often did), but it over-stimulated me once I started absorbing the Estradiol (felt it week 2 of the Femoston) and the gel felt very similar. I did do better with the combined Femoston pills that contain the progestogen but still not great, but it certainly felt a relief from too much oestrogen. Completely understand things can settle and change in time and maybe I'd even suit synthetic oestrogen over the plant based if I do decide to take it in the future.
I think the oral oestrogens do cause stomach irritation, in fact, I wouldn't even call it nausea, more like a constant acid stomach. Its been reported a lot but they always said it wears off in time but this didn't happen with the gel. I was all set to go and get the patches from the GP (she wanted me to have them instead of Femoston but I wanted to try it first as it seemed more stable) but I just don't feel anything good from natural oestrogen so maybe its just not the right time for me until my ever dwindling progesterone levels are being matched by lower natural oestrogen.
Yes, I used to love IFing, did the Warrior Diet for years in my youth and it made me feel good and got rid of my sugar cravings - but over time I think it may have caused some background degeneration as apparently it leans towards fat for fuel, like ketosis with Atkins, which creates more endotoxins in the body. That's the problem with all these theories, we can only become guinea pigs ourselves to know if they apply to us or not as serious trials are only done on hardcore drugs due to the costs involved.
At least we can have some element of comparison here though so we're not just fumbling around in the dark!
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My life has been rubbish these last 3 years and until 6 months ago I never even thought of peri menopause...the insomnia is my worst aspect affecting my life I don't get to sleep til 3 or 4 am despite trying everything and the last 6 months I've been so down and volatile no sex drive hot flushes 24 7 and the last month getting nausea everyday it's not stopping me eating sadly but it's like morning s8ckness. All on top of becoming a recluse and never going out socially I haven't been out socially for nearly 5 yeas...this isn't a life it's barely and existence...so at 47 I know I have to give hrt a go or I'll lose my partner he won't put up with me much longer when I know he thinks I'm using peri as an excuse for everything...( already take escitalopran since a recent breakdown and occasional sleeping tablets for some sleep but I don't think I'm depressed I think it's just having my life collapse around me and I'm not the person I used to be)
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Perioxideblader - Do give HRT a go - unfortunately it tends to be the women who have trouble with HRT that post on MM but you seldom hear from the women who do really well.
The cancer risk is very, very small and doesn't really apply unless you are on HRt fro more that 15 years and over 60.
Quality of life is very important and at 47 HRT will actually help to protect your heart and bones for the long term.
Femoston is a very good one to try - the progesterone is kinder and suits many women very well.
dangermouse - after reading your story I am not at all surprised you are having problems. Tackling digestive issues is particularly difficult and being over sensitive to any change within your body must be very challenging. I assume you have had full tests to look for allergies? Have you done the thing where you literally start on one or two types of food e.g. pears and chicken and then gradually add in more things to identify what you are allergic to?
I am also not surprised you are suffering with fatigue - your body has been through so much with the extreme digestive issues and that would take some time to recover from.
If your oestrogen and FSH levels indicate peri meno then HRT would still be your best option but you must do what you feel is right for you. DG x
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Dancinggirl - I only had slightly elevated FSH at my last test so was given the pill based on my symptoms and me realising all my a&e visits were whilst I was on my periods - kept putting it down to bad luck when I had to keep rushing to the loo hoping I wouldn't miss my name being called out after 7 hours of waiting! I'm actually ok with foods and don't have any allergies, just really funny with herbs, vitamin and mineral supplements and medications. I have had so many tests in the past and alternative investigations and tried so many lotions and potions in the hope of finding the Holy Grail but never to any avail! Caffeine makes me feel the opposite to most people, relaxed and clear minded, apparently this happens to some people (also those with ADHD I think?). I didn't have any for 6 months when very ill and wondered if I'd been addicted, although only had green tea and the occasional Red Bull (that used to chill me out!) but when I started the caffeine again I had no buzz, just felt nicely relaxed. However, if I had lemon balm I would be knocked out as if I'd been given a sleeping pill! I am also fine with alcohol and my liver handles it really well which I know isn't the case for a lot of you here. I've come to the conclusion that I'm just a bit weird!
Peroxidebladder - Please don't feel under pressure to 'have to' get better and be great company to others - you're not a performing monkey! As long as you keep the people close to you in the loop about your situation, it's their responsibility to then be a good friend/partner/mother etc. back to you with support and patience. If people think you are making excuses then that is a fault in their personality and a test of their strength, not yours. It's easy to take it all on yourself but your only responsibility is doing your best and being frank if necessary so that people have the facts, beyond that, it's their choice. However, if you know you've been unreasonable and perhaps emotions have taken over at times, then say you're sorry and try to explain more about what is going on for you. A lot of hurt can occur through miscommunication and others' assuming your personal issues are a reflection of your relationship with them - its easy to get sensitive and blame ourselves and not feel good enough but equally its easy for those close to us to do the this too, assuming they're causing us to be unhappy and thinking they should avoid us! Communication is key.
If you try your HRT and it doesn't suit you, you can try something else or stop - its all reversible. Nausea is a funny one as there are so many different forms of it. I haven't had kids so assumed mine was like morning sickness after hearing about Kate Middleton's extreme form but then when people said try ginger etc. I realised we are talking completely different types of nausea!!! However, in desperation I did try it one day and it made it SOOOO much worse as ginger is stimulating so added to the oestrogen surges - but would be perfect for sluggish digestive nausea. I suspect low oestrogen to high progesterone could cause that type of nausea along with constipation, which is what I had years ago (slow transit). However, this can also be debilitating when its constant as it's all relative to your current experience. If I try again I will go with patches and, again, you can just remove them if they make you feel too bad. The hormones will be out of your system within a couple of days and, depending on how long you give it, your body will gradually revert back to how you were pre-HRT.
Also, if your AD isn't working for you then consider changing or coming off of it. Three months seems to be the average time check to know if something suits you (unless its obvious it isn't what you need or the side effects are getting untenable). Unless these things are making you feel better then don't be afraid to say 'next!'. Goes for people too, although you can probably give them at least 4 months. 8)
Try to reframe your anxiety for trying the HRT as exciting - who knows what great things might happen!!!
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My life has been rubbish these last 3 years and until 6 months ago I never even thought of peri menopause...the insomnia is my worst aspect affecting my life I don't get to sleep til 3 or 4 am despite trying everything and the last 6 months I've been so down and volatile no sex drive hot flushes 24 7 and the last month getting nausea everyday it's not stopping me eating sadly but it's like morning s8ckness. All on top of becoming a recluse and never going out socially I haven't been out socially for nearly 5 yeas...this isn't a life it's barely and existence...so at 47 I know I have to give hrt a go or I'll lose my partner he won't put up with me much longer when I know he thinks I'm using peri as an excuse for everything...( already take escitalopran since a recent breakdown and occasional sleeping tablets for some sleep but I don't think I'm depressed I think it's just having my life collapse around me and I'm not the person I used to be)
Hi Peroxide
I can totally relate to the insomnia aspect. That was my worst symptom of menopause. I also got hot flushes, but I would have happily traded the insomnia for them. I went from being a perfect sleeper my entire life, to literally overnight either not sleeping at all or, like you, maybe I'd get an hour or two from about 4am. It's totally debilitating and soul destroying. My life was spirally out of control with anxiety and depression and I even considered suicide. There's a lot more to my story than that, with a dependence on sleeping tablets etc, but I won't go into the whole sorry saga now.
I think most of us have war-stories about our trials and errors of different HRTs until we found the right one, but you have to start somewhere. You may not get it right with the first one you try, but you really need to make a start. Your life is worth a lot more than what you are going through right now. It's no big deal if one doesn't work. You just try another one. There are lots of options and most of us finds a routine that suits.
In a way I was sort of "lucky" in that I never really went through any peri-meno, apart from irregular periods for a while. My meno symptoms hit me like a freight train with no warning at all. I think I must have sailed pretty briefly through peri and when straight to post-meno because when my doctor saw my blood test results she put me straight onto a continuous HRT (Livial). I think my estrogen levels must have dropped so low, literally overnight, that there was no doubt in her mind about it.
My routine now is 50mcg patches (estradot) and Provera on a 2 monthly cycle. Sure there are some stories about progestins, but I don't listen to them because currently I only take about 12 x 5mg tablets every second month, so I really don't think there is too much of a risk with that. I may need to review that if I want to go to a continuous method, but for the time being I'm very happy with my routine.
I do also think we have to realistic about what our lives are like with menopause. We are never going to be the same person we were in our 20s or 30s, but then I don't know that I want to be that same person anyway. I don't have the same energy I had, I tend to be more of a procrastinator now (but then I am also now retired), there are some days when I just feel "blah" (I'm not depressed, just feeling a bit down), and I still get the occasional hot flush, mainly around 4am for some reason. However, I sleep really well most of the time and I'm generally pretty content with life.
I hope you give HRT a try soon, as you really deserve to feel a lot better. :)
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Thanks danger mouse and Dana for your kind and useful replies...Dana did your insomnia improve on hrt at all..that's my only big worry as so much of my depression and irritability and ill health is through lack of sleep...and if the hrt gives me weight gain and other nasty sude effects and has no benefit on sleep I don't think I could handle it. I have a life long eating disorder I eat fine nowadays but you always have it with you you never recover so I'm finding it hard enough to cope with the extra spare tyres and flabby tummy despite more exercise and no change in diet..so to gain a lot of Weight and still not sleep would push my anxiety and depression to new levels...I can cope with the nausea and headache and flushes blah blah but I can't take lack of sleep...if I was a dog they'd have put me down lol 😥
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HRT definitely improved my sleep. I now go to sleep around 10-11pm and apart from a couple of loo visits I sleep pretty soundly. Occasionally I'll have a night where I can't sleep, but a small dose of my amitriptyline AD or a doxylamine antihistamine solves that. Those nights don't stress me anymore because they might only happen once a month, if that.
Insomnia has a dramatic affect on mood, depression and anxiety. Before taking medication for those conditions, I think you really need to try the estrogen because that will be a far more natural way to solve the problem. It's going to be up to you to decide what kind of estrogen, and subsequently what kind of progestogen, but you need to give something a try because things are not good for you right now, and I'm pretty confident the estrogen will help sort things out for you.
As for weight gain, that is definitely not inevitable. We tend to blame it on menopause or HRT, but really it's up to us to take measures to make sure we don't gain weight. I used all those excuses because I didn't want to admit it was what I was eating that caused my weight gain, but after joining Weight Watchers at the end of last year I have now lost about 20 pounds and I'm still losing. I didn't really have to change what I ate. I just became more aware of the in between stuff I was eating and also portion sizes.
I'm also not sure what nasty side effects you are concerned about. It sounds like you are allowing all those exaggerated media stories to affect your thinking. I don't have any side effects, unless you want to call a renewed enjoyment of life a side effect.
I'm afraid no one can really give you categorical answers to all your concerns. You just have to take the leap and try it for yourself. You've got nothing to lose, but a lot to gain.