Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Love_vodka on February 03, 2017, 05:19:36 PM
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Hi
I'm 44 and had a hysterectomy 5 years ago, kept my ovaries. Recently had bloods done (2 lots) and have been prescribed Everol 50 patches.
I'm on my 3rd week and not noticing any improvements and not sure if that's because I'm expecting too much? Haven't given them long enough? Or am on the wrong dose?
My symptoms are tiredness, but not at night!! Extreme night sweats,hot flushes, a bit tearful/over emotional and zero motivation.
Am I going to feel like this forever? :'( or is the Everol just not working for me yet?
At the moment I would gladly lay in front of the tv all day doing nothing which is so completely out of character.
Any ideas,words of wisdom or advice much appreciated xxx
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It won't last for ever. Hormone levels don't suddenly drop so it can take a while for any HRT to kick in. I don't take HRT - if you use the 'search' button for 'Every 50' you should see related threads.
Browse round. Make notes! Nowt wrong with laying in front of the TV - it is Winter after all! Treats are important when we feel low.
:welcomemm:
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Hi and welcome to MM Love_vodka
You may have been really low on oestrogen when you started these patches so it could take a few more weeks for the oestrogen levels to build and do their magic. Sometimes the patches don't absorb that well either so in 4-6 weeks I'd ask for a blood test to see what your oestrogen levels are and then the doctors can advice from there - possibly move to a higher dose. You need the oestrogen to protect your heart and bones for the long term and, in fact, as you have had a hyster you may be able to use oestrogen for the rest of your life unless other health issues prevent this.
Do have a good look at your diet as well - it's mid winter and most people are low on Vitamin D so it's worth getting a supplement with Vitamin D and magnesium to give yourself a boost. Vitamin D deficiency will result in low mood and low energy!!! I find Omega 3 and B12 essential as well.
It's early days - give things a bit more time - I bet in a couple of weeks you will start of feel better. DG x
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Have any of your symptoms abated or are they all still the same as when you started? If they're all still the same, you're not getting enough as most women on transdermal will see some sort of results within 2 weeks, some earlier. Even if you're E is very low, you should have some mild relief by now. Have a chat with your doc next week but every women's needs are different and whilst some ladies get good control with 50 patches, some need double that for the same control. What were your blood test results?
Mxx
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My symptoms are far worse since starting the patches Murphydurf.
Keep working up on a morning and bursting into tears for no reason at all.
My fsh level was 109 and LH was 57.5?
I can stay on estrogen patches till I'm 50 as I have a blood disorder which means I'm high risk of DVT.
Dancinggirl I'm taking vitamin d,calcium,magnesium,b complex,omega 3,6,9 ,zinc for the past 3 months and eat healthily, good wait and active.
I feel like I'm loosing the plot and don't feel like myself anymore :'(
Should I peservere with the patches? Or is the fact I'm getting no relief at all mean the dose is too low?
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Keep going - Love_vodka - you need this oestrogen at your age and I suspect your body is just reacting at the shock of getting the oestrogen in quite a big hit. Your hormones levels were very low and may have been low for some time - your body is screaming for this oestrogen and it's going to take time to adjust and welcome this great stuff. When I went back on HRT after a one year break, my gynae told me to do a lower dose for the first 2 weeks and then build - sometimes we need to start low. My level after 4weeks was 475. However 50mg is only an average dose so not to much for you and you should start to feel better in the next couple of weeks and possibly increase dose if your levels haven't stabilised. Increasing too much too soon may not be a good idea. I would get a blood test done in 2 weeks - by then your oestrogen level should be between 300 - 500 and this would indicate you are absorbing the oestrogen - if it isn't a reasonable level, then you may need to use Oestrogel or perhaps have pills alongside the patch. DG x
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Thanks Dancinggirl. I just don't get how I'm feeling worse instead of better. Will try ring dr for a chat next week, do I ask if she can test my Oestrogen?
Because of risk of hrt I can only really use patches I think?
I just feel like my hormones are absolutely raging,especially night and when I wake up. I've nothing to be sad about but just crying and crying for nothing! I was just hoping to feel better not worse.
Thank you again xxx
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Hi Love_vodka - The impact of HRT will effect us all differently. I do think there can be an initial hit of oestrogen that the body simply can't handle at first but this should settle in the first 4 weeks or so. I did find that patches gave me an initial big hit of oestrogen for the first 24 hours, making me sweat and feel dizzy, and then it trailed off over the next couple of days and this tended to happen with each new patch - so for me it was a bit of a roller coaster. You could be better with Oestrogel which is applied once a day so gives a more constant dose.
Can I suggest that once you have done 4 weeks on these patches, do pop back to the doctor and ask for a blood test to see what's going on - a blood test for oestrogen will indicate whether it's absorbing or not. Maybe ask to switch to the Oestrogel - Oestrogel will give you more control over dosage as well, as you can start with just one pump per day and gradually increase over several weeks ( up to 4 pumps per day) until you find the balance you need.
The emotional side effects will also reduce as the oestrogen does it's magic. The emotion, flushes etc are just your body crying out for oestrogen.
BTW - I do hope your forum name doesn't indicate that you drink a lot of vodka????? It's great to have the odd alcoholic drink but too much won't be good if DVT is a possible risk. Vodka is also not good for mood or flushes.
Keep us posted. DG x
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Hi again Love_vodka - we spoke on your introductory thread (and I made a similar comment about vodka ::) !!!).
Just to add that if you want to continue with patches you might find Estradot better - they are very small and stick well - I would always recommend them over Evorel ( which I had for 3 months when first starting hRT - but didn't get on with the progestogen in them) as Evorel are MAHOOSIVE!!!
My oestrogen levels are around 200-250 (probably - haven't had them done recently) on the 50 mcg patch which is a medium dose - but has always been sufficient to eliminate all flushes and sweats. However the dose required to eliminate flushes and sweats is not related to the actual oestrogen level in the blood - this seems to be a very complex phenomenon! ie some women like myself can be fine on a medium dose like 50 mcg - while others need a higher dose or blood level of oestrogen to achieve the same effect.
Hurdity x
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You know what vodka - if you drink a lot of vodka, it's really no-one's concern but yours! Time and again posters on this site advocate gel - one poster in particular, or estradot - another poster in particular. Sometimes I wonder if they're sales reps for these products! I'm tired of them banging on about the same protocols which, for them, might be perfect, but for others are not. One of them even told me that my recent low E level blood test couldn't be trusted! It's your body, your side effects and up to YOU whether you self medicate with vodka, oestrogen or any other substance that helps you make it through the night, or day for that matter. Don't be swayed, trust your instincts.
Mx
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Hi Love_Vodka - I do hope you took my comment about vodka as a positive - I suspect your forum name is simply ironic?
Anyway, I know that Hurdity and I are trying to offer some positive and helpful support. I personally suffered with early ovarian failure ( peri meno started in my mid 30s), I have therefore had nearly 25 years experience of meno symptoms and treatment and tried all sorts of HRT options. I would still not deem myself, in any way, an expert but offer advice and support based on my own experiences.
The Oestrogel I recommended is a transdermal form of oestrogen so would be safe for you as an alternative to Evorel patches. Oestrogel is one of the preferred ways of delivering Oestrogel and many women find it excellent. I know that Hurdity uses Estradot patches (Hurdity has a science background so has done a great deal of research into HRT) - the Estradot patches are known to stick better and might therefore allow better absorption of oestrogen, so could be a another good option for you. Sadly all HRT is trial and error - we are here to share our experiences.
You do have options and our mission on this forum is to give support to each other.
Do keep us posted - I really hope things improve for you. DG x
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You have options.
Mxx
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Time and time again, I see women having problems who have to take estrogen only HRT. Myself included, and also AbbyH and Annie0710. There is no coincidence in this, I feel. Estrogen only sent me BONKERS. Annie has had anxiety constantly whilst using estrogen only HRT, and AbbyH can't get her patch dose above 25mcg without going crazy on it either. I also recall Cubagirl, one of our dearest long term members, saying that she couldn't tolerate a 50mcg patch.
Evidently SOMETHING is missing that we can't tolerate the dose of estrogen that we need - and if one pops over to Hystersisters, you will find hundreds of post hysterectomy only or hysterectomy/oopherectomy ladies who are having exactly the same experiences. Ditto the Surmeno forum. Not all - but an extremely large proportion. Those that are ok on ERT seem to stick to low doses.
My theory - and this is just MY theory (but also backed up by research over at the Surmeno information website) is that Estradiol is too stimulating without the balancing effects of a progestogen (yes, I know how many of you hate the prog. phase of HRT) but seriously - the common phrase used by women who try to take 'decent' levels of Estradiol only and for whom it turns into a nightmare is 'feeling like the energiser bunny on acid, and not in a good way', and that's exactly IT.
For the love of God, in these women I just don't know why they aren't allowed to trial the addition of a progestogen or are offered Tibolone if post menopausal. There is enough evidence that THIS HAPPENS, some of us feel rotten and really struggle! It's only here in the UK that we're forced to make a 'square peg fit a round hole' with our HRT and then made to feel like lepers if we're not feeling good on a 'decent level' of estrogen only, because 'we don't need progesterone because we've had a hysterectomy'. Well, in all my reproductive life I NEVER walked around with just estrogen in my body. It's a lop sided and for some women, cruel approach because it makes us feel DREADFUL.
Sorry, but this is just my two pence worth. It's not wonderful, it's not 'rejuvenating' or 'energising' when it turns into a nightmare of horrible hormonal imbalance. Think about it! It does NOT mimic a woman's natural cycle. At all. And therefore it is highly alien and uncomfortable to a great many of us. I really wish the medical establishment in this country would wrap their heads around this and start seeing us as individuals, and treating accordingly.
Thanks for letting me get this off my chest. I'm just seeing too many women being let down and feeling inadequate because they don't fit their HRT, whereas it should be the other way around.
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Well said -clap, clap, clap-
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Stellajane - I entirely understand that the same info has to be repeated but new members can also access the old info by searching. The same BRANDS don't have to be mentioned over and over. That's only part of my point - once again, these people are NOT medics and as such, are NOT qualified to prescribe to others.
Tempest - great post, I always feel better with very small amounts if prog, it's just getting the balance, as always!
Mxx
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Thanks for all your replies. Just working my way through and trying to make sense of it all. I'm factor 5 so the Dr was really cautious when prescribing the estrogen patch and prescribed the 50 as a middle ground?
My symptoms have got progressively worse over the last month. I'm really not familiar with brands or even how the hrt works. I just naively presumed I would stick on the patch and it would take any symptoms away and make me feel better.
Btw love_vodka is just a user name I've had for ever.
Thanks again for your help xxx
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Hi, Love Vodka!
In your case and with the clotting risk, I would return to GP probably and ask for Estradot, as it's available in 37.5mg as well and it's surprising how a little jump down might make all the difference. Sorry if things got a little 'political' on your thread there! And don't apologise for your forum name - we're entitled to call ourselves whatever we want! There are a LOT of things I used to love before this meno. rubbish thwarted me, and it's a good thing I don't use one of those as my forum name as members would have a fit! Hugs!!!! xxxxx ;D ;D
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Thanks Tempest. I've just been looking at specialists in my area. I'm doing everything I can to help myself and refuse to just put up with feeling crap indefinitely! I was literally crawling to the end of the day at work last week :(
Weirdly, despite all the flushes,sweats and tearfulness my sex drive has gone through the roof, which doesn't add up to low oestrogen levels does it?
Xxx
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Hi again Love_vodka
Because you've had a hysterectomy - you don't have periods or lack of them to tell you where you are in menopause but the extremes you are feeling are typical of peri-menopause. Your hormone levels will be fluctuating up and down as you ovulate - and you may well only feel good when your oestrogen peaks at ovulation. Oestrogen will not be low all the time if your ovaries are still working well - but will fall to a low level just before your bleed would have been and in the first part of your cycle. Initially in early peri-menopause (and even before this) some women do find that flushes start as oestrogen levels crash - because sometimes they actually go even higher just before peri and in peri - but only at certain points ie mid cycle. Some women do find that libido increases just before menopause and this would be an indication of normal/high oestrogen levels (at the peak). I think it is the ovaries last ditch attempt in achieving fertilisation before they fail - and accounts for many a late unexpected pregnancy for women in their 40's!
HRT is intended to iron out the crashes during peri-menopause and to give you a baseline level of oestrogen so you do not become oestrogen deficient with all that entails.
There is information on peri-menopause here:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php
Also on estrogen types here:
http://www.menopausematters.co.uk/treatafter.php
You will see that I recommended Estradot if you want to continue with patches and Tempest has also done so. Perhaps to explain in view of some of the comments:
Estrogen comes in a variety of different preparations and doses as you will see from the list.
Pills come in different doses and even types of oestrogen - horse oestrogens (Premarin), estradiol valerate, and estradiol as well as some which are a mixture.
Patches come in different brands and doses but all contain estradiol. Some patches are very big, and some are a different type - the micro version like Estradot. They are all designed to deliver the same dose of oestrogen if they have the same number eg 50 mcg - but the total amount of oestrogen can vary and because the patches are different sizes women seem to absorb differently. I think many gynaes who recommend patches would recommend the micro ones such as Estradot. I mean given the choice - a smaller patch is defo preferable I would say (from experience!).
Gel - is available as two brands in slightly different concentrations - and different gynaes/GPs and women - seem to have their preferences.
Hope this helps :)
Hurdity x
PS please do not be alarmed about the advice given on this forum despite some caveats expressed! Tempest reported from her consultant - a leading gynaecologist who chaired the committee that produced the NICE Guidelines on menopause, that this forum is highly respected. Since it is the chat/informal advisory part of the main very well respected website managed by Dr Heather Currie, the mods would soon intervene if anything was amiss and if anyone was overstepping the mark re advice. Also anyone who is reading - there is info in the forum information about what we can/cannot post:
Members are kindly requested to give references (eg links) to any health/medical information they provide, when it is not personal experience. Personal experience is anything the person has undergone himself/herself.
Information posted by members must be true and correct to their knowledge.
All members are, by default, considered to be non-medical professionals.
http://www.menopausematters.co.uk/forum/index.php/topic,8308.0.html
No-one needs to reveal their background or qualifications because we are all equal on here - but as you see we are asked to provide back-up to any scientific or medical information. As always - we advise anyone who is concerned about a problem to consult their GP - but in some cases we provide information that corrects the errors made by some GPs!!!
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Hi love Vodka
I'm a classic example how just oestrogen doesn't work to make me feel better !
Hysterectomy when I was 32, kept ovaries.. within 6 months I was waking drenched in sweat, extremely itchy skin, knackered etc
Doc did bloods and I had low oestrogen levels. She said the blood supply to my ovaries had been compromised and although still ticking over they weren't as efficient as they were pre hysterectomy so gave me 1mg oestrogen tablet. Within a couple of days I was back to my old self. Within a few weeks symptoms were coming back so she gave me max dose 2mg
I felt great for 13 happy years when suddenly ahe 45 I felt like I'd been run over by a steam roller, no night sweats but omg so many aches, pains, extreme dizziness, anxiety and low mood
Drs did bloods and said I was in peri, ovaries finally packing in and nothing they could do because I was already on max dose oestrogen. I kept asking was there anything else alongside it they could give me ? Just antidepressants which I refused.
Anyway I think I became post meno quite soon after although this wasn't official until a couple years ago.
Why, when ovaries were producing 'some' progesterone and testosterone alongside my oestrogen hrt did I feel great but suddenly didn't ? I think my body needed the balance
Anyhow I was only offered high dose patches of oestrogen against my almost zero progesterone levels
It's said we don't need prog after hysterectomy, well no we don't for the uterus but I believe some women do need it for the balance
Last year I sourced my own progesterone tablets and felt much better. I fessed up to the nurse about and she said I mustn't take them. I asked what harm they'd do and she said none but I don't need them. I felt resentful that I wasn't allowed them yet I felt better
Fast forward and I am trialling Tibolone and although early days and I'm not perfect a damn sight better than on oestrogen alone. Oh yes I had a scan last year and my ovaries have shrivelled and disappeared. Personally I think they went around age 45 when these symptoms arose out of the blue
We are all different and vary greatly in our needs of hrt and doses. Whatever you try always start low and build up . For me oestrogen only hrt is distrastrous, it makes me a nervous wreck
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Thanks for sharing your experiences,it does help knowing I'm not going completely insane! Hurdity I do suspect my hormones are fluctuating. I was told I was definitely post menopausal due to my high levels but who knows ::)
Because of the factor 5 I think I'm advised to use patches rather than pills, I'm not sure about the gel but will look into my options.
I do think I might need a higher dose and haven't suffered any side effects at all from the patches.
I'm also going to try eating little and often at work and see if that helps my energy levels this week. I do eat breakfast, snack at half 10,small lunch, so might help having something mid afternoon. I know my blood pressure is low too so not sure if this is adding to the feeling of crapiness.
Thanks again xxx
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Love_vodka - you sound pretty sorted to me - your plans for the coming week are good. So much is made of high blood pressure but low blood pressure can bring side effects e.g. lethargy,dizziness, headaches etc. Eating small amounts often is a good strategy - keeping the sugar levels up can be tough when meno hits - I try to have a banana, and a handful of nuts or seeds mid afternoon.
We are taught about puberty and what to expect but nobody prepares us for what happens when our oestrogen levels drop and it is a shock for many of us. This site is great for getting you through this maze - we all learn so much.
You are still at the early stage of trying HRT and, as I mentioned before, it can take time for the levels to build and do the magic.
If you look under TREATMENTS at the top of this page you will find all the different oestrogen options available - so it can be good to print this off to discuss with your doctor. As others have mentioned (i think it was Tempest) Tibolone (Livial) might be an option for you if nothing else works.
It might be worth trying to find the research regarding the risk factors of oestrogen and DVT. Oestrogen is known to protect the heart as it helps to stop the arteries furring up. Can someone help me out over this??? I know that the DVT risk increases if we start HRT too deep into post meno but I'm just questioning whether you are actually at more risk from a DVT without oestrogen at your age???? Could be worth asking to see a specialist about this - GPs don't always understand the full picture.
I have a sneaking feeling that in a couple of weeks you will start to feel the benefits. Keep us posted DG xxxx
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Thanks DG. I really appreciate you taking time to point me in the right direction. I'll check out the Treatment info and look at Tibolone.
My dr took advice from a specialist regarding my risks. Unfortunately there isn't much research in under 50s on hrt with factor 5 but I've been told the risk is 13-16 times higher than my normal 8 times higher risk with hrt. It's probable slightly higher than that in the first year and doubles after age 50. And then obviously I have the risk of osteoporosis because of my age. I have just had a bone scan because I have frozen shoulder at the moment :( luckily it all looks fine but get the results in a couple of weeks.
Thanks again xxx
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Wow. Well I never thought about progesterone having continuously be told like many others because I had a BSO I don't need it. I've never thought about it like this so thank you. Will definitely ask specialist about this. :o
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Hi everyone
Just jumping in here to pick up on the 'little bit of progesterone' point. It makes great sense to me that to reach hormonal 'balance' we should be working with more than one hormone (ie estrogen), although I acknowledge the vast variability in all of our individual needs and the fact that some women feel more comfortable sticking with just estrogen. Indeed at the moment, this is me, as I have so far been very intolerant to any form of progesterone preparation and appear also to suffer from my own progesterone production which is why I have my cycle suppressed (lucrin).
However, before I started with mainstream HRT, I was using progesterone cream and I do remember it calming my somatic anxiety symptoms (heart palpitations and aches etc) - for those of you using progesterone as part of your regime, how much do you use? I don't tolerate the amount needed to confer uterine protection but my Endo has said since my uterine lining is so thin I don't need to take progesterone (for now). But I do wonder about adding in some cream again in tiny doses to 'round off' the stimulatory effects of estrogen. My Endo has kind of rubbished the cream, but I am re thinking things following this thread. Also, for those of you who have tried the gel - would you recommend against it for someone with a known history of not tolerating fluctuations? I didn't seem to get enough consistent coverage with patches and am now on pills but getting headaches and feeling pretty bad on them - the next step is gel. Do people ever combine patches and gel??!! Am pretty sure my Endo would freak out at that suggestion but I think I saw someone here mention combining methods.....
Many thanks, Frankie 41 ps. Apologies if I have high jacked this thread love vodka - I fear I have, but was just picking up on a couple of points people raised. I'm 42 and peri - I was initially great on 50 patch then needed higher 100. But I waited 6 weeks before increasing.
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Hi Frankie 41 - I've used patches and gel together previously (tried everything quite frankly!), and I'm going back to that today. I'm using 50 patch and adding a pump of gel morning and if necessary evening. I find the patch blows me up in higher quantities but does seem to provide a continuous dose and I need around 2.5g/3G of transdermal E. I find the gel runs out after 6-8 hours so I'm trying this approach. I'm also trying alt day 100mg utrogestan oral route as I'm better with prog but only in very small amounts as I seem to metabolise it very slowly. I'll try to have a withdrawal bleed in around 4 weeks but I've not long had a Mirena removed so don't think my lining will be too thick just now. I'm also using pea sized amount of Testim gel daily. My biggest probs at the moment are joint aches/low mood/energy so I'll keep posting on results. Sorry for hijacking thread but some other ladies might be interested.
Mxx
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Frankie41 There is nothing wrong with using a patch and gel together as long as you are aware that it is a higher dose of oestrogen, (and your doc has approved), and therefore needs a corresponding amount of progesterone to protect the uterus. Maybe start your own thread as it sometimes gets difficult having two convos going on at once and replies leapfrogging over each other ::)
Hurdity x
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It really is Trial and Error at a time when we are tired, hormonal, worried, seeking advice ....... at a time when it would be nice to have GPs reading off the same hymn sheet as well as being prepared to discuss us as individuals!
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No problem Murphydurf/Frankie41 power is knowledge and all that.
I'm keeping a diary,waiting till 4 weeks and then will visit my gp if no improvements.
Xxx
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This is such a good post TEmpest, I'm going to print out and show doc. When I finally get seen, still no joy, she didn't ring me back, and now first appointment is on 22 Feb.. I'm going to storm the surgery on Friday and see if I can get a prescription, this is ridiculous, I've been waiting/trying since june last year to get hormonal balanced. And yes you Re right get on E only is just wrong (for me)
Thank you thank you for writing this !
Abby xx
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When I went to see a gynae about menopause and libido - she didn't mention anything about progesterone - but that the reason many women didn't feel good on oestrogen alone was that they needed testosterone because these are the two sex hormones that are in balance that make us feel good or not. She said that many women try (or are advised) in vain to keep increasing oestrogen but when they added a small amount of testosterone their symptoms improved dramatically. Presumably this could explain why many of you are feeling better on Tibolone.
The other thing about Tibolone (mentioned on this thread!) - I think I said elsewhere - is that although it is very weakly androgenic - in terms of its affinity to T receptors, because it lowers SHBG ( Sex Hormone Binding Globulin), it increases free testosterone - and this is the testosterone already in your body. It is always difficult trying to replicate the natural hormonal conditions in our bodies and adding one or two of them can only be an approximation - it's all we've got though!
Hurdity x