Menopause Matters Forum
General Discussion => New Members => Topic started by: Dolly on June 15, 2017, 11:43:19 AM
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Hello everyone,
I'm new but have been reading this wonderful site for a while.
I was prescribed 3 weeks ago Estrogel 1-2 pumps per day then Utrogestan 200mg daily for 12 days for 3 months to try which I have not had dispensed yet. I tried the mirena coil at the suggestion of a private consultant for approx. 16 months for irregular periods sometimes heavy/peri menopause symptoms and had a nightmare of symptoms (sever breast tenderness, morning sickness type feeling, being hungry all the time, fatigue etc etc) it then migrated and had to be removed via hysteroscopy.
Due to my experience with mirena I feel that I don't tolerate progesterone well as many other people don't that I have read about on here and I would like to take the lowest possible effective doses of both hormones. All the research I have done so far leans towards lowering the dose of utrogestan and taking vaginally but this is not licensed in UK for HRT. I took the private prescription to my doctors but could only get to see young male doctor who was actually quite interested in the subject and pointed me towards this site ;D. He suggested patches which I don't want to use as they are not bio.
I am a 48 year old exhausted single mum of an energetic 9 year old boy, I have him 90% of the time, am working part time mainly due to symptoms with no family support, my symptoms have been bad for about 4+ years and I am at breaking point, my very low mood, low energy and feelings of rage are beginning to affect him. I just don't think I could cope with any more extreme symptoms so am reluctant to take so much utrogestan orally. So my question is.
Is it reasonable to ask the GP for a new prescription for Estrogel 1 pump and 100mg of utrogestan vaginal capsule? for 7 days as per Prof Studd to try for 3 months given my history?
I would be very grateful for any advice or suggestions.
Dolly x
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Hi Dolly
:welcomemm:
Sorry don't have time to reply in detail at the moment - lovely evening here so going down to the coast in a minute....
However - there is no danger in using utrogestan vaginally even though it is not licensed because at least as much, if not more, normally gets to the uterus where it is needed to protect it. Some limited research suggests that a lower dose can be used when taken vaginally but this would be off licence and under supervision - but better to take cyclically if used this way. It is the same product ie capsules taken orally as vaginally, although the 200 mg capsule is no longer available for oral use so 2 x 100 mg must be used orally and vaginally.
The metabolic by-products from Utrogestan taken orally are what causes some of the worst side effects - the French instructions for example recommend vaginal use if side effects are experienced from oral use.
I would start with the recommended dose but used vaginally and see how you feel and then take it from there. Then if you find the side effects too bad then yes do go to your doc and ask if you can reduce the dose under supervision - and by that I mean for the doc to eg refer you for regular scan at least until you know how your uterus responds.
You haven't said your age nor where in menopause. Sometimes gynaes prescribe lower dose progesterone when women are still having regular periods and ovulating - therefore still producing their own.
Prof Studd's regimes are lower than the licensed dose and Dr Currie said this recently:
Just to confirm, while Professor Studd is very experienced and extremely knowledgeable, his regimens are not always in line with current recommendations, particularly around use of progesterone.
As always with providing menopause advice, this should be individualised and flexibility should be applied, as long as there is a clear understanding of national and international recommendations. Some women are intolerant of progestogen and progesterone and so it is appropriate to adjust the regimens, as long as it has been fully explained and discussed.
Best wishes
Heather
Hope this helps and good luck - sorry this is rushed and a bit disjointed!
Hurdity x
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Hi Dolly
There's no vaginal version of Utrogestan prescribed in the UK at the moment (bizarrely as it is elsewhere) , so I use the oral version with a pessary dispenser and get it up there internally as high possible last thing at night.
I found it more effective that way, minimal side effects (compared to taking it orally).
So I'd suggest doing the same.
I'd suggest no point in seeing your GP if the issue is the Utrogestan.
Stay with your current dose of Oestrogel as it sounds like progesterone issues re mood?
They can't prescribe vaginal Utrogestan as it's not available in that format in the UK
GP's can be hard of thinking re HRT and in my negative experience of them re HRT.
I see Studd once a year and get a fairly standard Studd prescription: 2/3 pumps of Oestrogel daily, tiny bit of Testim gel daily and Ulstragestan 100 mg for 7 days each month- less than the over prescribed (IMO) NHS "guidelines".
I am really progesterone sensitive but find I get the necessary bleed each month, with minimal side effects compared with oral administration.
Of course medical professionals may disagree with Studd's (and others) clinical views and some may adhere more rigidly to NHS guidelines than others.
All I can say is that Studd's regime re Utrogestan works well for me and numerous other women, with far less side effects than the oral version which is twice the dose and twice the time as recommended by the NHS.
I couldn't cope with that NHS regime
I think many women give up HRT primarily due the excessive amount of Utrogestan or other forms and the horrible side effects.
I think the NHS "suggest" such large dose for so each so women don't sue them for breach of care, don't ask for uterine scans and basically don't give a damn. It's cheaper for NHS.
Just remember that NHS "recommendations" for HRT are just that: "recommendations". And not fully endorsed internationally.
"One size does not fit all"
Sure, some GP's and other medics may disagree with Studd and numerous other leading world experts in gynaecology, as they agree the NHS guidelines re Ulstragestan/progesterone are clinically unnecessary and excessive .
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It's a tough choice, I know, but personally I think I prefer to accept the advice, extensive clinical research and experience of an expert Professor in Gynaecology and HRT than that of some GP's sticking to NHS "guidelines" without any flexibility.
Of course GP's vary considerably given the posts on MM.
See your GP if you want, but I don't he/she will be that flexible or helpful.
I'd stick to the 2 pumps of Oestrogel daily ( as prescribed)n and try 100mg tablet vaginally for 7 days at the beginning of the month and see how that goes for a couple of months. Then review if necessary with your GP
I know digressing from the received wisdom of a GP may cause a few fainting fits for some on MM , but trying it as suggested above for a couple of months won't be life threatening and may actually work for you?
Nothing to lose by trying a variation in your applications of Utrogestan for a couple of months?
Good luck in whatever you decide!
Freckles XX
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Thanks so much for your replies Hurdity & Freckles.
I am 48 with peri menopause symptoms and irregular periods.
I am keen to go with the 100mg over 7 days option as I have regular scans due to an ovarian dermoid cyst and am seeing the consultant again in 3 month. I have emailed her secretary to let her know my plans. The GP did look at me in horror when I said I had read on forums that women were taking the capsules vaginally.
I just have a couple more questions please is there a lot of mess in the morning/do you need to clean any residue out or does it all come out naturally? :o
The prescription does not say when in the month to start my HRT? Do I start both gel and capsules together or use capsule for just the last week? Do I use the gel for a month then at beginning of the next month use the capsules? Does it matter what date I start. I'm confused. My periods are very irregular so I have no idea where about I am in my natural cycle.
Many Thanks
Dolly x
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Hi Dolly - that's great if you are already having regular scans and have told the consultant your proposed regime. I presume the scans include the uterus - because it is over-thickening of the womb lining that you need to be checking. However if your periods are still fairly frequent you may well shed the extra lining due to your own progesterone produced after ovulation. Either way you will get an answer from your consultant.
Although I haven't used oestrogen gel, the same principle applies re when to start. If cycles are infrequent you can start on any day - if they are approximately 3-6 weeks still then with some other HRT types it is usual to wait until the bleed comes and start the oestrogen on the first day of the bleed which counts as Day 1. Depending on how long since your last period then either start the oestrogen straight away or wait a week or two and see if it comes. What does your doc say about when to start?
It is usual to start the oestrogen only part and then introduce the progestogen for the second part of the cycle - so in your case if you start the oestrogen on Day 1 then if you are doing the 7 day regime, you would take the progesterone to end on Day 26 so this would mean starting on Day 18. Hopefully you would then bleed approx Day 1 - although if your cycle kicks in this may not happen exactly then. If you are doing the 7 day regime then best to do the 4 week cycle rather than calendar month as it is so much less prog than licensed - but check this when you visit your specialist in 3 months time.
In practice if you note the day of the week you start the Utrogestan then you would take the next course in 4 weeks time and needn't then count Days of your cycle - unless it all goes out of sync!
I hope that's clear about the cycle - ie the total cycle length including the 7 days progesterone phase is 4 weeks.
The other thing that might happen is you could get quite a heavy bleed initially depending how strong your cycle is - especially if you haven't had a bleed for while, and provided the progesterone does its job properly.
Re vaginal discharge - I wear a panty-liner at night (just one of those micro discreet ultra thin ones) the days I do the vag Utro - and I wear one (the same) in the day anyway so it doesn't bother me. There really is very little - you might see some white specks in the loo - but in my case anyway it doesn't seem to come rushing out so most of it must find its way into my uterus through the cervix! You don't have to clean anything out other than your usual hygiene routine. You can reassure your GP that it's not just forum hearsay re the vaginal use - these are the explicit instructions on the French Patient Information Leaflet ( your doc will know what these are!) - that in the case of side effects from oral use (eg excessive sleepiness or dizziness), vaginal use is recommended. Also many gynaecologists/menopause specialists recommend this too. In fact there is a utrogestan product for vaginal use ( 200 mg capsules) but this is for fertility treatment - but it's the same stuff - how ridiculous is that?!
Hope this helps and so let us know how you get on as your treatment progresses.
Hurdity x
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Hello Dolly- it's so nice to have you back where you belong!
The progesterone in the Mirena doesn't agree with everyone as it's a synthetic even although side effects are lessened
Utrogestan is bio identical and you've been prescribed the recommended dose- you might get on better taking 100mg daily for 25 days. You should try it to start with.
You can take it vaginally- most gynaecologist's agree with this as side effects are lessened.
You can get bio identical oestrogen patches- look at the HRT preps on this site
I've been prescribed both oestrogel and utrogestan. I haven't got on with either so it's not always the magic bullet that some women hope for.
Prof Studd has many fans on this site but not all his patients find his regime life changing. Great if it works- not so great if it doesn't.
See Dr Curries comments on his treatment regime. Caveat Emptor- there may be additional risks if you go off road.
Some gynaecologist private or otherwise are not keen on going off road but accept that progesterone intolerance can cause issues - in which case they will prescribe less but only under medical supervision.
This supervision will include annual scans of your womb lining- you may have to pay for these but might be lucky and get them on the NHS. So, it's not just ignorance and a reluctance of just GP's when it comes to treatment options- some of the specialists, equally as eminent as Prof Studd and his like are cautious but are prepared to tweak as necessary- under medical supervision.
Do not self medicate- get some medical advice beforehand or you are doing yourself a great disservice.
Tread carefully- listen to your body and safeguard it as much as you can. What works for some women doesn't work for others.
I was where you are- the " gold standard" regime hasn't worked for me. I still think that HRT when it does work, can do great things- all I would say is to proceed with caution and whatever you do, please do it under proper medical supervision, regardless of what views and opinions you might encounter on here.
I wish you well in your journey and hope you settle soon x
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Hi Dolly
In answer to your request for info:
I'm prescribed three pumps of estrogel daily which I take continuously, i.e every day.
The ultrogestan I take on the 1st of each month vaginally for 7 days.
It's the oral version but it dissolves well internally if you use a pessary dispenser (e.g. similar for thrush pessaries) and last thing at night and after using the toilet. Basically aim the dispenser as high as you can to your cervix (neck of your womb/upper side internally).
No, you don't get any residue as it's absorbed easily, any possible excess you pee away first thing in the morning. I don't need panty pads or similar. It's all sorted itself out over night.
Your GP needs re-educating! For some bizarre reason the UK doesn't license vaginal use of Ultrogestan,though plenty of other first world countries do.
But using it this way as I am progesterone intolerant/sensitive, I found less negative side effects, effective monthly bleed as required.
There is no way I could adhere to the NHS "guidelines" of double that dose for twice the length of time.
Not unless I had a overwhelming desire to stay free of charge at a local psychiatric unit for an unspecified amount of time, as progesterone for me is some type of cosmic nasty joke.
I don't fancy going loppier earlier than necessary, so for me, this regime really works, as it seems to for many women on MM.
Obviously not for some.
*shrugs* Read around on here and elsewhere. Make an informed decision.
GP's for sure are not necessarily fountains of all received wisdom!
In other words medics are subjective and it's about what works for you.
Good luck but do read around and don't just take my view (or any one else's for that matter on MM) as gospel advice.
Only stating my subjective experiences.
Good luck!
Freckles xx
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Many Thanks for the advice all.
Very informative.
I will visit the GP this week, brace myself for a difficult conversation and let you know how I get on with everything.
Thanks
Dolly x
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Glad to be of help and look forward to hearing the outcome and how you fare on whatever regime you decide to use :)
Hurdity x
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Hello All,
So I visited the GP (a different one as you can never get to see the same one twice) and she was very unsure but understood that I wanted some input\control over the HRT. She has emailed the consultant and is still awaiting a reply, as am I. So she has given me the estradiol to start (just waiting to see if period puts in an appearance).
I have just read the info leaflet that comes in the box and most of it is detailing all the ways it can kill you.....blimey it's enough to make you throw it in the bin...I am actually quite nervous about rubbing the first pump in now!
Dolly x
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When I told my GP that I was inserting the oral 100mg Utrogestan vaginally to reduce side effects, she said not to do that and prescribed me the vaginal 200mg on the NHS. Perhaps I just got extremely lucky with my GP. The only thing she said she couldn't prescribe for me was testosterone. Seems different GP's tend to have their own rules.
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200mg is a hefty dosage!! With possible horrible side effects
I don't understand the concern with the *method* of using Ultrogestan.
Agree with StellaJane- there is no logical difference in using 100mg vaginally c.f. 200mg, other than the dosage
There isn't one.
Vaginally Ultrogestan works just as well orally, if not better as it bypasses your stomach, liver etc. before being effective.
So 100mg works better vaginally than orally.
Why on earth would you need double the dose?
That's why the oral prescription tells you take it on an empty stomach or two hours after eating.
100mgs for seven days each month seems to work for many women as well as being clinically prescribed by many private experts like Studd.
Tough decision I guess- rely on your GP's "expertise" or an expert in HRT who is more flexible in prescriptions for your needs?
One size doesn't fit all!
Especially if you or your GP rigidly adhere to NHS guidelines
An excessive amount of Ultrogestan can result in horrible side effects, similar to PMS symptoms .
Read around and read up so you are informed about the treatment options.
GPs (and for that matter NHS and private Consultants) aren't always that well informed about HRT so helps if you feel confident about the options.
I'd suggest you don't take their views as being written in stone and do some reading.
It's your health and future after all.
Good luck
Freckles x
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Thank you ladies, your advice is much needed.
I have read and digested more and am leaning towards 10 days 100mg taken as a pessary and 1 pump of gel....I can add more gel if needed as the prescription did say 1 to 2 pumps per day.
Would I go with a 28 day cycle with the 10 day Utragestan option? So Gel only day 1i to 17 then both on days 18 to 28? Can I start at anytime in my cycle does it matter if I started mid period or not as I have never taken hormones before? I wasn't given any guidance on when to start it by either.
Many Thanks
Dolly x
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I'm prescribed continual daily Estrogel (I'm on two to three pumps daily due to osteopenia) and take the Utrogestan on the first day of each month vaginally, for 7 days.
So basically on-going Estrogel with a 7 Ultrogestan day phase at the beginning of each month.
Doesn't matter when you start the HRT. Start the Estrogel now and just keep to the same start time each month re the Ultrogestan phase.
Think 100mgs for 10 days you might find too much after a few months (it builds up in your body) but see how you go!
Freckles x
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Hi Dolly
Are you asking when to start oestrogen or Utrogestan? If you are still peri-menopausal - then you should tie in the utrogestan with your periods so count Day 1 as the start of your bleed and if your consultant has agreed to 10 day cycle of 100 mg vaginally ( or will monitor you?) then you would start the utro on Day 17 and take for 10 days. You should then expect to bleed again on Day 1 of the next cycle - but depends where you are in menopause. You can start the oestrogen at any time - and count from there if you know what day you are in your cycle.
If you periods are few and far between - eg you have gone 4 months without a period then just start with Day 1 as the gel and see what happens ( re the bleed).
You should start with as near the licensed dose as you can with supervision of your GP/consultant and see how you get on - and then you might be able to reduce it further under supervision if necessary. I am post-menopausal and take mine approx every 6-8 weeks - I do 200 mg vaginally for 12 days - and my GP is happy with this.
Hurdity x
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Thanks Freckles & Hurdity,
I am peri-menopausal, 48 with irregular periods of anything from 2 -8 weeks between them and vary from couple of days to 17 days (worst) in duration :(
My current period started on Monday so if I use that as day 1 and then start the Utragestan on day 17 for 10 days that would mean I would finish the Utragestan on day 26 and I thought (not sure why) it was a 28 day cycle so would start on day 19 and finish day 28? Sorry if I am being a bit thick :P
I haven't started the gel yet so am I right in thinking I could start that now continuously but still count Monday as day 1 of the cycle. My foggy brain is struggling.
Dolly x
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Hi again Dolly
Not thick at all - difficult to get your head round at first! Yes it is a 28 day cycle but theoretically initially ties in with your own cycle. The withdrawal bleed should occur on or around Day 1 - so you take the utro from days 17-26 ( for a 10 day prog regime). The first night without the prog would be Day 27 and by Day 28 the progesterone levels will have dropped - leading to a bleed fairly soon. It is not an exact science anyway since during peri-menopause as in your situation - your cycles are irregular - although some may be anovulatory, especially those that occur more frequently eg after 2 weeks. Once you have started then just note the day of the week you started the Utro and just take it 4 weekly from then on (if this is your cycle length). If you get random bleeds then you might need to adjust the start date.
So - yes start the gel now and count the start of the bleed as Day 1 and then start the utro on Day 17.
Hope this helps and good luck :)
Hurdity x
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Dolly, Freckles has given you some excellent advice and I can't really add much. I was also prescribed daily Oestrogel/100mg 7 day Utrogestan regime and it works very well - if you use the Utrogestan capsules vaginally it hits the target, works better at clearance/thinning and it has fewer side effects.
So my advice would be not to overdo the Utrogestan to the extent that you end up giving up on HRT altogether and if necessary, take less of it and have regular scans.
I hope that helps.
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Thank you all.....again....
Well my GP just called, she spoke with the consultant who advised her to tell me that I should take the hrt exactly as she has prescribed Utragestan 200mg orally for 12/14 day..can't remember which..she has never heard of using it vaginally!.....otherwise I risk thickening womb..cancer...I will then have to have painful intervention (hysteroscopy\biopsy) etc etc etc....pretty much exactly what you all predicted.
I find this so unfair....I do understand they have guidelines....they have to be careful ......I am regularly scanned.....surely they should be flexible enough to allow the patient some input into treatment and take their needs\wants into consideration. As I am not experienced or knowledgeable enough yet with taking hrt I would prefer medical agreement\guidance. Am so disappointed. I applied the gel for the first time this morning so will discontinue until I have thought some more.
I think I need to find a more sympathetic\open minded consultant. The GP was lovely but lacks any real knowledge about hrt. . Does anyone know if the specialists listed in the search on here are knowledgeable\open minded enough to be flexible in their approach etc? Feeling very deflated.
:-\
Dolly x
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Dolly, I suggest you ring Professor Studd's office now and make an appointment - he does telephone consultations if that helps. There is no way he will prescribe 200mg Utrogestan for 12/14 days if you are progesterone intolerant so you will not be wasting your money - that is why I am recommended him to you. Putting it bluntly, he told one member that 200mg Utrogestan for 12 days each month is bollocks!
It is incredible that your doctor has never heard of Utrogestan being used vaginally, it is in every other country. It is exactly the same capsule for both methods of use but the boxes in other EU member states are marked 'for oral or vaginal use'.
Your consultant is sticking to the book which does not work for everyone and certainly would not work for me. As Freckles so rightly points out, the NHS over prescribe the progesterone part of HRT because they don't offer women regular scans. Obviously this doesn't matter if you can take shed loads of progesterone and are not affected by it but it is a complete non-starter if you are intolerant.
There is only one way to find out if you are taking enough progesterone and that is by having a uterine scan and having your lining measurement taken. You certainly won't find out by just talking to a doctor from the other side of a desk.
Please don't give up on this and make that phone call!
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Mine was Dolly but he's in Scotland- he was willing to make some tweaks but not go as far as some.
Could you e mail Dr Currie re using it vaginally and perhaps at a slightly lower dose? You can then take response to your GP but maybe you'd be better to arrange private consultation based on recommendations/ geography.
Mx
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My consultant won't hear of it vaginally either. I take 100mg. I managed a week had a week of every other day and the consultant said I had to take it every day. It's making we feel sad and like crying and I want to sleep day and night. My hair is better with it every day though. The gel and the patches are the same hormone. I think it's just personal preference.
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Dolly I had the same inadequate response and knowledge from my GP, as I've posted before
Like many women posting on MM who've also inadequate clinical information and HRT treatment from either their GP, NHS Specialist or both, I bite the bullet and paid out £350 (from memory) to see Prof Studd last August.
I fully agree with Mary G.
200mg of progesterone for 12/14 days a month if you are progesterone intolerant is "bollocks" as Mary G said. Wholly unnecessary treatment regime
Do ring re see seeing Studd. Your health is SO important and the NHS rigid adherence to HRT treatment "guidelines" (which are primarily financially and not clinically driven) and the "one size fits all approach" clearly does not work for many women.
You won't IMO get better treatment options from your local NHS from what you've posted so far
Given the choice of a GP's opinions and your NHS Consultant who has never heard of Utrogestan being used vaginally (that's so worrying in itself) and a world renown Professor in HRT (i.e. Studd) who actually started the first HRT clinics in the UK ... mmm ... tough choice (!) but I'd invest the cost of a weekend away and my future physical and psychological health by seeing Studd*
*Other independent HRT specialists are available"- just in case I get flamed yet again for recommending the Studd treatment regime and/or assessment.
Just commenting on my own personal experience- which of course is what MM is all about. Isn't it? :)
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Just to add- if you don't try Studd or his regime, you'll never know if it is life changing/works for you?
Was for me and I know he and his team are considerate of women with different HRT issues
Nothing to lose except about £350 and if it doesn't suit, at least you can go back and/or email him and have the treatment tweaked to suit you as an individual.
Rather than being treated by generic NHS "guidelines" by a NHS Consultant who doesn't even know Ultrogestan can be used vaginally in most countries!
That's worrying in itself!
Good luck regardless, but it sounds like you'll get a less than clinically helpful treatment from your local NHS service and therefore more ongoing stress and problems.
.
Freckles X
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Katia- I think it's "personal preference" as to whether you accept treatment regimes that are making you distressed, sad and crying each day or whether you challenge those regimes as being clinically unnecessary and/or unsuitable for you.
Daily intake of 100mg of Ultrogestan seems wholly unnecessary to me (and wholly in contrast to the rigid NHS "guidelines").
Maybe pull your "big girl knickers up" and research posts on here and clinical papers?
Then maybe think about querying your treatment?
For some of those who may be have difficulty re abstract thinking on MM, as seems to be the case judging by PM's I've had, that's a local *metaphorical* expression that just means taking charge of your life, health, decisions and accepting responsibility for the same.
It doesn't mean*literally* you wear big knickers! Although of course you may do. I do!
Freckles X
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You need to calm down Freckles and let people make their own minds up! In my opinion your views are not sufficiently balanced.
And if I object to my forthright views, I'm not bothered. I'll leave the forum like a few others before me as we're fed up with the " bad vibe"
Get back in your box.
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Michelemabelle- I'm just stating my personal views and personal experiences, which I thought was the whole of point of the MM forum?
And as I have consistently stated, women have, or should have, valid choices to make about their HRT treatments and be informed as much as possible about the many different options that are available to them.
Whether that is on the NHS or otherwise. Which if you read my posts, you will find to be the case.
As indeed have many established posters on MM also done consistently.
Often NHS services provide inadequate HRT treatment for women. as attested on MM.
I have no problems with alternative views being expressed to mine- I am just giving my opinions, which folk can consider or ignore, as they choose.
Like me they read and comment or just scroll past.
Many posters on MM post comments that could be considered "not sufficiently balanced" including yours, as well as many others.
I don't think I need to "calm down" or "get back in your box" as you suggested, as I don't think I have posted anything inflammatory, inappropriate or in any way excessive.
If you think I have, do please advise me of both how and why you think that is the case in your view.
I truly don't understand what you mean by the "bad vibe" on MM - unless you mean women posting with views that don't wholly agree with yours?
I'm sorry you seem to be so upset by my post.
I found your reply unnecessarily personally insulting and inappropriate.
I don't know if the moderators on MM might also consider it to be the case?
I would be sorry if you left MM because you have difficulties in reading alternative view points to yours (like mine, amongst many others).
I'd suggest however that there is no need to post something so personally aggressive and insulting in your reply when you disagree with someone (like myself) has posted.
Just some things to think about perhaps?
Freckles x
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That's fine Freckles but I consider your views to be inappropriate in certain cases- just because the Studd regime works for you, doesn't mean it works for everyone and you need to be careful about advocating that it's the be all and end all. There was an intervention by Dr Currie recently about this and the opinions voiced about deviation from the NHS guidelines. You seem to have ignored this. In two recent examples you banged on about less progesterone and longer cycles for a woman who had no apparent issue with her progesterone regime and another who hadn't even started the progesterone part of her cycle. You need to take into account what people are saying at times.
I have tried the same regime as you ( privately) and it's not worked for me so it's not all about the NHS failing us and I don't think that you truly recognise this as you are quite inflammatory in your comments about NHS treatment.
There are lots of different views on here and I recognise and respect most of them - I apologise if I've offended you but I do believe that you don't present a truly balanced view as you are too fixated by what has worked for you. Studd isn't a guru and it's different strokes for different folks.
I am happy to accept that tweaking is required. I am happy to accept that HRT doesn't work for everyone. I am happy to accept that everyone can have a voice and an opinion. I am happy to accept views that differ from mine. What I'm not happy with is someone who doesn't take the whole picture into account. And if that means me being kicked off this forum, so be it...
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First I thought your post was wholly unnecessarily abusive and inappropriate to mine.
A *full*apology as to your post being inappropriate and ill judged to me and other MM posters would have been appreciated.
It wasn't provided.
Second, I acknowledge Studd's regime works perfectly well for me and many, many, other women (whether privately or on the NHS).
Third, just because it did work not for you, if indeed you have ever fully tried it, it doesn't mean that women should not be made aware of it as a reliable, valid and and clinical alternative to the current NHS rigid "guidelines", and which doesn't suit them, does it?
Nor is it necessary for you to dismiss that particular treatment regime just because it didn't allegedly work for you?
Fourth, valid information is so important BEFORE you start any HRT treatment, whether its progesterone or oestrogen, the dosage and method of delivery.
I don't see any problems in advising women to consider this information, the problems in some NHS prescriptions, alternatives and to consider all treatment options, not just the NHS treatments you advocate and you consistently saying posters should contact Dr Currie online for her pre -paid advice.
I don't know of course if you and Dr Currie have any form of formal or informal agreement in advocating her services?
Of course NHS GP's and NHS Consultants vary considerably in their clinical efficacy and knowledge.
I'm simply saying that there are many views about HRT treatment out there, uniformed and otherwise, and my personal preference, was, due to wholly inadequate response from my GP, I had no alternative but to go privately for my health. That worked for me. The proposed NHS option was woefully inadequate and entirely clinically irresponsible.
The NHS does, IMO, frequently fails to provide appropriate HRT for thousands of women, as often attested by the frequent posts by distressed women on MM.
I don't think it's "inflammatory" in any way to recognise their distress and their inappropriate and inadequate HRT treatment and to make suggestions about alternatives to consider when their current (and usually NHS) treatment is ineffectual.
I do consider the "whole picture".
lf women find their NHS treatments work, and post accordingly I scroll on by. They are pretty rare in case you haven't noticed!
It's when (as is so very frequently the case on MM) women experience appalling symptoms that I sometimes offer my experiences, suggestions for alternatives treatments re method of delivery and dosage.
The NHS is NOT omnipotent.
Truly don't understand what you find problematic with that?
I think it's about being women being informed about alternatives to that being provided by their local NHS GP's/ Consultants, when it clearly doesn't work for them
HRT treatment options can be confusing at best.
What I do find relevant and interesting is that you state you are "happy to accept that everyone can have a view and opinion. I am happy to accept views that differ from mine. What I'm not happy with is someone who doesn't take that whole picture into account".
So unless someone doesn't take the "whole picture into account" by your definition of whatever that is, you won't agree with their personal experiences and views?
Simply, it's not a political issue re the NHS, and when the NHS fails to deliver appropriate care I don't see anything wrong in advising women of alternative treatment options.
Long post I know but I thought it necessary to clarify things.
You clearly do have issues contrary to what you said about " happy to accept that everyone can have a view and opinion. I am happy to accept views that differ from mine"
I'd suggest you do just that and just scroll on by in future if you don't agree with a post.
I haven't said anything different from many other posters with similar views as mine.
Posting offensive and abusive personal comments just because you disagree with a post isn't necessary or helpful. To say the lvery east .
I'm not going to engage in any further comments as I think the above says it all.
I haven't reported to you to the moderators, although it may be the case others might.
Best wishes
Freckles x
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Thank you all.....again....
Well my GP just called, she spoke with the consultant who advised her to tell me that I should take the hrt exactly as she has prescribed Utragestan 200mg orally for 12/14 day..can't remember which..she has never heard of using it vaginally!.....otherwise I risk thickening womb..cancer...I will then have to have painful intervention (hysteroscopy\biopsy) etc etc etc....pretty much exactly what you all predicted.
I find this so unfair....I do understand they have guidelines....they have to be careful ......I am regularly scanned.....surely they should be flexible enough to allow the patient some input into treatment and take their needs\wants into consideration. As I am not experienced or knowledgeable enough yet with taking hrt I would prefer medical agreement\guidance. Am so disappointed. I applied the gel for the first time this morning so will discontinue until I have thought some more.
I think I need to find a more sympathetic\open minded consultant. The GP was lovely but lacks any real knowledge about hrt. . Does anyone know if the specialists listed in the search on here are knowledgeable\open minded enough to be flexible in their approach etc? Feeling very deflated.
:-\
Dolly x
Hi Dolly
So sorry to hear you have had this experience. I presume it was the consultant you originally visited that prescribed you the gel and utrogestan, that your GP referred back to for advice about vaginal use?
There are two issues - firstly the dose and duration of the progesterone regime, and your consultant is right that taking it on a shorter cycle could risk thickening the uterus lining - this is strongly supported by evidence from trials and led to the NHS Guidelines. However as Dr Currie said (I think I quoted her post earlier in this thread) for progesterone intolerant women this can be varied under supervision but regular scanning/monitoring would be necessary.
Regarding the vaginal use of progesterone - this is not a matter of safety or not, but some quirk of our own prescribing guidance and approvals process. As I said earlier, there is evidence to show that vaginal use provides at least as much if not more progesterone to the uterus - by avoiding the liver (first pass effect) and the digestive system. Unfortunately there have not been large trials about this but in France ( as I think I've already said) for example, the patient information leaflet states that vaginal use can be used as an alternative to oral use for those who suffer adverse side effects. It is quite alarming that your consultant ( presumably private) had not heard of vaginal use when the information is out there for all to find!
Aside from Studdmania, (you really do not need to consult him unless you really want to - supremely eminent though he is!) - I think Michelemabelle's suggestion of sending an e-mail to Dr Currie at minimal cost of £25 is a good one - with your specific questions (notably aboit vaginal use of progesterone), and giving your history/menopausal status. She generously offers this service through this website as part of her mission to help other women through these difficult times and recognising that most women just do not have the funds to consult private gynaes - nor should they need to. As for who else to consult - it depends where in the country you live - I am sure someone will be able to recommend someone if you get nowhere - but do consult Dr C!
Please do not stop the HRT - please carry on with the gel - it may well be that you are fine with the Utrogestan dose as it is - and sometimes it is the synthetic progestogens like in the Mirena that cause more side effects. The most common sdie effects from utrogestan are excessive tiredness and sometimes nausea - but as with all medication some sdie effects wiill settle - and vaginal use does mitigate some of these.
Good luck and please don't be put off by the discussions - this topic always causes controversy because there is tension between those who advocate radical departure from NHS regimes and those who advocate caution unless under medical supervision.
Good luck and please ask if there is anything else we can help with :)
Hurdity x
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GIRLS! can we remember that we should be referring to Professionals with their correct titles for which they have worked very hard! i.e. ?? Professor Studd ?? ....... it is VERY disrespectful :bang: to not address people correctly. Would you go into Professor Studd's Office and say "Hey Studd, I want ..... " ? >:( ?
Would you feel it OK to call you by your last name? I know it's done in Public Schools however :-X. Dr Currie is Dr Currie
surely :-\.
This is a Forum on which to share experiences. The written word is static. Maybe state your point/s then back off to allow others to digest what has been suggested?
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CLKD !!!!!!!!!!!!!!!!!!! There are more important issues raised on this thread than how someone is addressed!!!! After all this is a chat forum - not a newspaper, academic paper, web page etc so however we refer to people is often shorthand and not how we would address them in real life!!
Also to clarify, in the academic/scientific world ie published papers or scientific articles - it is NORMAL to use the authors' surnames. In the case of Studd/Prof Studd/John Studd/Mr Studd - he has/had a variety of roles so could have a different title according to the context. As a member of a research/teaching establishment he held the rank of professor (and I believe that once held even when retired or doing a different job this title can be used for life - correct me if I'm wrong someone?), as a consultant - if a surgeon ( I think) he would be known as Mr - although as he did both perhaps he was always referred to as Prof? Whatever - if you were writing about his research - and he has published numerous papers he would be referred to as Studd as in - Studd's research showed x or y... etc. This is the correct usage. It would actually be improper to use someone's first name or maybe even their title - as this is irrelevant to the research paper. As an aside his website is studd.co.uk - a domain name he will have chosen himself - leading naturally to referring to it as Studd's website.
It is not disrespectful at all and as I said we are a chat forum.
The same goes for Heather Currie - if we were referring to one of her research papers: "Stopping hormone replacement therapy: were women ill advised? Cumming GP, Currie HD, Panay N, Moncur R, Lee AJ." we could correctly refer to Currie's research.
The issues at stake here being discussed are more important at this juncture I feel - but had to put the record straight!!!!!!
Hurdity x
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Oh for heavens sake.
Can we just not be nice for a change.
What would a browsing newbie think.....not exactly encouraging I think.
After all Dr Currie wants to encourage new members.
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Quite!!!! My sentiments entirely!!!
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Being off the forum for a long while has taught me to think before I post.
One upmanship and point scoring against other members is unnecessary and totally pointless.
I would suggest to read before you click and as my old dad would have said.
If you don't have anything nice to say, then say nothing at all.
We all need to remember that.
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:-\
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That was a general statement and not targeted at any member in any way.
When you read and can't post it teaches you to be a lot more careful when you return.
The forum should be informative, supportive and friendly so in that theme.
:hug:
To all :)
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The forum should be informative, supportive and friendly so in that theme.
:hug:
To all :)
I find on the whole that it is, but occasionally, as in real life, feelings spill over and we all like to be right and have the last word. How that is done is not always in the best tone and, with the unforgiving typed word, things can sometimes be misunderstood and the tone read wrongly.
What saddens me is when a misunderstanding is not addressed in a civil manner and insults start being thrown. that's not what we are supposed to be about :(
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Blimey..... you are a feisty lot...and I thank you all for your advice......you haven't scared me off just yet ;)
If I could just steer this back a bit if that's OK?
So I suppose I could just carry on with the gel daily (although I didn't apply it today as was soo fed up with medical response) then use the prescribed 200mg Utragestan for 12 days down below then I am not really veering from the prescription am I?.....if I do this do I use a calendar month or 28 days...honestly they tell you 'nowt' about what cycle to use! And email Dr Curry.
Otherwise just stop and look around for a more flexible consultant then start again.....it's medical insurance through work and a bit limited so am not even sure they would allow me to change consultants now.
Think I need to think some more tonight. :-\
Dolly x
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Hurdity - you fell right in then! Did you really need to go on and on about 'the academic and scientific world' like we are all stupid? Which record exactly?
I have typed more Scientific Papers than have eaten hot dinners! I have also worked within the Scientific Community as well as for Professors and Noted Surgeons and one would never think of addressing them either personally or in a Forum by their surname. They have earned or been awarded their title.
If I didn't think drawing attention to someone's correct title, then I would *NOT* have bothered to mention it.
Himself thinks that people on here are disrepectful by calling people by their surnames. I don't often discuss with him what this Forum is about, however ...........
Some people have simply too much time on their hands >yawn<
Carry on, as you were ;)
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CLKD - I really don't care two hoots about how scientists, gynaecologists etc are referred to on this forum - but you were the one that brought it up and seemed to be bothered by it! I wouldn't ever think to mention it otherwise! I just responded to say it was OK to do so (refer by surnames on occasion) - no-one said or implied anyone was stupid but you most emphatically pointed out that it was disrespectful which most of us think it isn't, and certainly isn't when referring to scientific research! That is not "going on and on" - just answering your post - which incidentally diverted away from Dolly's queries about HRT which I was trying to get back to!!
Shall we call it a day on this one as we clearly disagree!?
Hurdity x
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Dolly! Glad you haven't been put off by various things on your thread!!!
Yes do just carry on using it as prescribed. Did you say it was 3 pumps? That is a higher than average dose - but depends how well you absorb it. Exactly - using the utrogestan vaginally will not really be deviating from your prescription - it is the dose and duration that matter. Some women do calendar month and others do 4 weekly - it won't make that much difference. I find it better to ease into the utrogestan by starting with a 100 mg dose so you could do 10 or 11 x 200 mg and a day either side of 100 mg. My worst side effects are fatigue and generally thick head ( this morning I am first morning after 200 mg and I could hardly wake up and still feel a bit groggy - but that's no big deal - I can cope!). You can think again if you suffer serious side effects but don't look for problems - you may well be fine!
Good luck and let us know how you get on :)
Hurdity x
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From where I am sitting Hurdity, it is obvious that you didn't read my post thoroughly, my point which you appear to have missed completely!
: which was that people here are being disrespectful .....
Come in Dolly - my time is up!
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This thread appears to be stuck in a loop, or a time warp, unrelated to Dolly's original post.
As a newby I consider she deserves an apology from those members who have turned her thread into a battle ground and that you conduct your squabbles elsewhere.
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Dear Dolly- I'm very sorry that this has happened. Feelings run high at times, especially when it comes to treatment regimes. Hurdity described it well in her earlier post- don't be put off. You just do what's right for you and I wish you well.
M x
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thank you Michelemabelle :)
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As I tried to say before.
Think before you post .....and then think again.
Hopefully that's an end of things now and Dolly can get the help that she requested.
Mrs Brown
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Well I didn't re apply the gel after the first time, it was all getting too much :-\
I have managed to get authorisation from BUPA to see a second consultant and am going to see Mr Mather (got his details on here) in Oldham in 2 weeks. Fingers crossed for a more sympathetic and collaborative approach.
Dolly x
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That's good news Dolly and two weeks isn't that long to wait. Let us know how you get on.
Taz x :)
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Dolly, that's great, I'm so pleased you are seeing another specialist. Hope it goes well and please do let us know how you get on.
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HI Dolly, do you mean Mr Mander? I have seen him and go back in a few weeks. He recommended gel and either Mirena (which I won't have as levonorgestrel didn't work for me in a pil and is bad for hair) or Utrogestan. I'm having issues with it, but want to give it a fair try. I spoke with him about vaginal and every other day and he said they aren't safe and better to change the progesterone. I hope you get on ok. He's a lovely man
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Thanks ladies
Katia...yes it's Mr Mander not Mather :P.....I expect a bit of resistance but I do want to try the vaginal delivery......I just hope I can get his support....so I can proceed with medical supervision......I had the mirena too but had very bad side effects...it then migrated and had to have it removed via hysteroscopy.
I am not taking it orally and Utragestan is supposed to be the most natural or identical form....lots of ladies on here have really good results using it this way too.
What issues are you having with it if you don't mind me asking?
Dolly x
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Hi Dolly,
It seems to be making me flat and a bit down, which is not like me. It's also causing a bit of bloating. I'm not sure if I've got used to it, or they are not as bad. The first week I got terrible fluid and bloating and stopped it for three days, then took it every other day. I tried it vaginally and had just the same, if not worse, side effects. I would think (but I'm not sure)! if you've had problems with the progestegen from the Mirena not staying just in the uterus, you will have side effects from vaginal utrogestan. Mander said I had to take it every day for it to be safe and didn't seem to know what I was talking about with using it vaginally. I do want to give a fair go as I think some of the symptoms do disappear as your body gets used to things. At the minute it's tolerable, but I don't think it's right for me. The options I have are to change the progesterone or go back on Femodene pill. I've read positive things about crinone gel.
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Dolly - I hope your consultant appointment goes well and do let us know the outcome!
Hurdity x
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Dolly, are you taking Utrogestan at the moment? If so, why not try it vaginally for a few days? I did and still had the same symptoms so didn't push it. I have another appointment next week. I hope yours goes well.
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Dolly, on a thread are the links to the studies on the vaginal utrogestan. It might be helpful for you to take them with you.
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Thanks ladies.
Katia, no not taking anything at the mo, wanted to talk it through with another consultant before I started taking anything, if Utragestan is the one he suggests then I will tell him I want to take it vaginally and see what he says. I do not want to take anything in tablet form orally. Since you mentioned crinone gel I have searched round for info and found a few interesting positive articles (American) not sure what reaction i will get if I mention that one though as it seems that suggesting anything other than bog standard hrt is met with disdain!
I just want to take the minimum effective safe dose of 'natural' hrt transdermally or 'down below' I had bad side effects with the progesterone in the mirena coil and don't want to repeat them. Am quite anxious about taking progesterone again so want to start slowly. My appointment is next week too...good luck with yours.....let me know how you get on.
Dolly x
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Hi!
Just for information, here in Germany, Gynaes prescribe Uterogestan 100 mg or 200mg depending on your needs for perimenopausal women. It can be taken orally or vaginally depending on how you react to it.
FYI.
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Thanks for the info sn00py.
I had my meeting with Mr Mander yesterday and he was really good and listened/made loads of notes/ examined me etc. He thinks I am not really peri but I have a disorder...like PMS but really really bad. I can't remember the name now I will have to ring his secretary. They can use injections to stop my ovulation but he thinks I would be better off in the long term having a hysterectomy with ovaries removed too. Then use estrogen/ testosterone as I would then be menopausal. He mentioned professor Studds work on this too.
My ovarian cyst is causing discomfort and sometimes pain and will need to be removed at some point, he was not happy that it was just being left there. I just need sometime to get used to the idea so he is going to write to my GP and arrange an initial meeting with surgeon. Due to previous surgery they can't do laparoscopy.
So more reading I think once I get the name of it right :-\
Dolly x
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Thanks for the update Dolly and good to hear you were pleased with your consultation :)
I'm puzzled though why your consultant thinks you are not peri-menopausal - because in your first post you mentioned irregular periods? Once the cycle starts lengthening (or changing between cycles by more than 7 days) then this is one of the defining characteristics of the early peri-menopause if the irregular cycles are new for you - when combined with symptoms? I think this is the approx definition (comes from the STRAW stages of reproductive ageing and represents the average of many women although there will be some individual exceptions as always).
I think the condition you are talking about is PMDD - Premenstrual Dysphoric Disorder - which is like very very bad PMS. There is a lot of information on the web about it. There are other women on here who have had this treatment (the various injections) to prevent ovulation and then trialling oestrogen replacement prior to possible operation. There is a member who has had this ( probably several!) who posts on here from time to time but I can't remember her name - maybe will come to me!
Maybe start a new thread with something like that in the title - re Injections to stop ovulation or something - to attract the attention of other women who are in a similar situation?
In the meantime are you still taking the gel or re-started it, or did your consultant suggest remaining off it?
Hurdity x
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Hi Hurdity thanks for the post.,
Mr Mander has made an appointment for me to see another Gynecologist as he doesn't do surgery anymore. I will clarify the peri-menopaus point, amongst others, with him next week when I see him. In the meantime I will read read read and raise a new thread.
I didn't continue with the gel so no..not using anything at the moment. I know they don't like you having major surgery whilst on hrt and like you to stop it for a few months so no point in re starting again at the moment until I fully understand risk/benefits of the hysterectomy.
I also want to learn more about the injections and if they are worth a try....lots to do in the meantime
Dolly x
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Hi Dolly, I'm so glad you got on OK. He's lovely isn't he. I saw him on Thursday too. I'm having to come off for a week to do some bloods. He's given me a prescription for the proper estrogel, but thinks I'm not menopausal. Well see what the bloods say. I'm sure it will take some time, reading, talking to experts to get your head around it.
K
Xx