Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Jeepers on March 29, 2019, 08:56:46 AM
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Hi all
I am so sorry to ask really stupid questions which have probably all been covered here before, but I feel very confused about things
- Do your natural hormones fluctuate when you are post menopausal? I mean will your natural hormomes augment any HRT and fluctuate? I am 3 to 4 years post meno I think, and on conti HRT
- What are the side effects of Utrogestan? I have seen headaches and nausea mentioned, are there any others?
- Is it better to take all Oestrogel in the morning, or split morning and evening? I'm currently on 2.5 pumps
- Is it too low Progesterone or too high Estrogen which causes breakthrough bleeding?
Sorry again, I feel a little lost with it all
Jeepers X
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Jeepers! Your questions ARE NOT stupid!!!! Also it's often difficult to find the answers to things like that as they wouldn;t come up in a search and there are so many new posts each day.
To try to answer:
1 The received wisdom is that our sex hormones do not fluctuate (markedly) once we are post-menopausal. However this is usually taken to mean that our natural cycling stops and the massive changes throughout the month that normally take place in our menstrual cycle and even more massive fluctuations during peri-menopause have calmed. However a paper I read mentioned that even after the last period there is still quite a bit of ovarian (follicular) activity at least during the two years after the last menstrual period, and indicating intermittent oestrogen production even in the absence of ovulation. It is known that average oestrogen levels drop dramatically in the two years following menopause but I also remember reading in the STRAW stages of reproductive ageing paper, that hormonal changes did not completely settle down until maybe 6 years or so after menopause ( sorry just off the top of my head but think I remember the gist). Some women will clearly notice these minor hormonal "cycles" or small bursts of oestrogen production - more than others - although if you are on HRT they are likely to be comparatively insignifcant as the oestrogen you are taking will cushion most small changes I would say.
If you don't know how far post-menopause you are ( because you started HRT before menopause) then you cannot say whether anything you experience is due to your own (peri-menopausal) cycle taking over or adding to the mix?
2 Don't go looking for side effects of utrogestan! There are generally more side effects from oral use than vaginal because of the large quantities of metabolic breakdown products from oral use due to metabolism by the liver. The main one that probably most women will experience to some extent is due to the sedative effect of progesterone. For women who are jumpy, anxious and jittery - they might find the sedative effect calming if the dose is not too high. For the rest of us - it is felt as tiredness - especially in the mornings - which can lead to foggy head as the cycle progresses. Some women are absolutely fine with taking it all the time!!!
3 Sorry I don't use gel - although I did use Sandrena for a brief period. Personally I would say apply in the mornings if you sleep with a partner - due to potential transfer issues - although you could apply it earlier in the evening to avoid this. Mornings again in summer you would have to be careful about close skin contact with children, partners and pets for the first hour or so after application, depending where you apply it. I can't comment on how you might feel - some split dose some do mornings, some do evenings!
4 Breakthrough bleeding can be caused for all sorts of reasons, one of which is too high oestrogen in relation to progesterone (which causes overthickening of the uterine lining which then sheds sporadically) but not too high oestrogen per se. Too much progesterone in relation to oestrogen can also cause bleeding due to endometrial atrophy when it gets too thin.
Hope this helps?
Hurdity x
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Jeepers. No questions are stupid. Ask away.
I'm sure lots of others will be interested to read the very informative answer from hurdity.
Although the info in the first bit backs up my thoughts that if I could have I would have and should have kept my ovaries. Too late now :'(
X
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Hi Hurdity
Thank you for your reply, its so kind that you take the time to explain these things.
I don't know how post menopausal I am because I didn't take a lot of notice at the time. It was only after a couple of years that things started to go awry for me.
At my scan, they said the lining was 2.8 mm , which was no cause for concern. So I am very worried that I am having another PMB.
TC, sorry to hear you had your ovaries removed, and that you now wish you had been able to make a more informed choice, I feel like we never know all of the facts, and neither do a lot of the doctors!
Thank you again
Jeepers
xx
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Hi Jeepers
If you had a recent scan (how long ago?) and your lining looked normal and was only 2.8 mm then that sounds fine.
Are you bleeding now - like a proper period?
Also how long since last natural period had elapsed before starting HRT - I presume you started conti straight away?
Sometimes bleeding on conti HRT doesn't settle (is this new bleeding after a long time on conti HRT of no bleed?) and cyclical HRT can be preferred on something like Mirena coil.
Hurdity x
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Hi Hurdity
Thank you for replying.
The scan was on 1st March, so very recent. The first PMB was beginning of Feb.
I am bleeding now, not like a proper period. Its not a lot, more than spotting, but very light. Its been since Tuesday.
Ive been on Conti HRT since last June, no problems at all for the first six months. Started on Utrogestan and two pumps, then it was increased to 3 pumps in Oct/Nov tie. I did go back down to 2 pumps for a while, due to painful breasts and increasing anxiety. My meno dr said I need to go back up to 3, but so far I've only managed to go to 2.5, as my breasts get so sore. I did adrofeme in for a while, but the anxiety made me stop ( i took it from Dec to Feb).
I think I was already at least 2 years post meno before I started the HRT. That's when things started to be intolerable for me.
Thank you again
Jeepers xx
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Hi Birdy
It was last October when she took my bloods.
I felt great for the first 3 months too. ..
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Hi
Thank you all for replying. I think I might go back to 2 pumps, as I said, I haven't got past 2.5, so no way will I get to 3,
My anxiety is better than it was, I am doing mindfulness, CBT and stopped testosterone. I just don't want it to go back to how it was last month, when I was having horrendous chest pains, gastric problems, constant shaking , could not eat etc
CLKD, PMB stands for Post Menopausal Bleed
thank you all again ladies :foryou:
Jeepers xx
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Thanks Birdy
I was sort of hoping that the bleeding had stopped today., bit I am now passing small amounts of , well ,I don't even know have to describe it. It's not blood , but like
Pinky red matter. Sorry if that's tmi.
It's all so weird . ...
Jeepers xx
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Sounds like the bleeding is caused by excess oestrogen in relation to progesterone so if you are not feeling good on higher oestrogen I would agree with the others that why not reduce it - but do let your doc know too.
As already said it's best to go by symptoms but if your blood tests show you really weren't absorbing it then that might explain why doc said to increase? You've probably said elsewhere but what did the blood tests show? They are only a snapshot in time anyway.
The main thing is to feel as well as you can and hopefully better overall than before HRT - which is what makes it worth it :)
Try not to worry!
Make sure you keep your blood sugar levels steady by eating regularly and lots of slow release foods - v with ery little sugar and refined pure carbs.....
Hurdity x
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Hi
thanks Birdy, :) I am really trying to hang on to what you said. I think not knowing why is a bit of a killer for me. Your kind words mean a lot.
Hurdity, I looked up my results. I had two sets of bloods taken:
Sept 18
Oestradiol = 303
SHBG = 153.9
Testosterone = 0.3
Dec 18
Oestradiol = 743.64
SHBG = 111
Testosterone = 1.71
So, meno doctor said to continue on 3 pumps as that was what I was on on Dec. However, I did have really sore lumpy boobs, and anxiety was starting to creep back in.
I've sort of split the diffference now, and am taking 2.5 pumps (an as I mentioned, I've given up on the androfeme, not sure whether to try taking it every other day or something)
Thanks for taking the time to look at this Hurdity
Jeepers xx
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Hi Jeepers - do you mind my asking is this a private doctor? If so I don't know why they are hung up on actual oestrogen levels! They are but a snapshot in time. Also it is symptoms that should be your guide.
For instance I don;t know what my blood levels are but once I ad them measured on my 50 mcg patch and they were maybe 212 pmol/l but I had no symptoms - was just fine. For me maybe I would feel on top of the world if they were around the 300 mark or maybe it would seem like too much.
743 is a high level! For reproductive depression the Studd regime suggests that consistently high levels are needed to alleviate this debilitating condition or state - but the rest of us don't need levels this high. I did read that the aim of HRT ( other things being equal) would be to provide the average over the menstrual cycle ( accepting that individually this would have varied).
Sorry I can't remember what your original symptoms wree and why the doc said you should increase to 3 pumps?
If 2.5 pumps suit you then stay with that and forget about blood tests!
It's interesting though that despite the high levels of oestrogen and your high systemic levels, and the bleeding - your lining was thin so maybe you are someone who seems to shed it when it gets too thick without additional progesterone - annoying though if you want a bleed-free regime!
Re the SHBG and testosterone - not sure why you stopped this? The results show your Free Androgen Index (which is Total T divided by SHBG x 100) increased to a better level and within the reference range whereas before it was very low (although measurement of T in women is inaccurate....). If you;re not experiencing side effects from the Androfeme I would continue with it - perhaps every other day as you said. This wouldn't be the cause of the bleeding.
If you are with a private consultant then maybe take it up with them too?
Hurdity x
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Hi Hurdity
Thanks for your reply, a lot of information there.
Yes, this is a well known private clinic, I will PM you the name.
Its very interesting what you said about 743 being high. Can it build up even further, even on the same dose? I went to the meno clinic in June of last year. My main symptoms were terrible anxiety, inability to sleep properly joint and muscle pain (hot flushes, only a few compared with other folks). I did have bladder issues, but had by this time already started on Vagifem with good effect.
Started on the 2 pumps, and felt a lot better really quickly. No breakthrough bleeding at all Went back for my 3 month follow up, and based on those blood results, was advised to go to 3, and add in the Androfeme.
Then went back in December for second lot of bloods, and meno dr said, looks much better continue with the 3 pumps. It was at the end of Jan that I had my first PMB. IT was just a really pinkinsh discharge. That's when I panicked and took a 3 day break from the utro (I take 100mg orally - originally 25/28, but meno dr said no need for a break, so was taking continuously), which may have caused more bleeding over 5 days. I also stopped the Androfeme, as was feeling so jittery, another panic decision.
Back to the Meno clinic at beginning of March,my anxiety was completely out of control, pains everywhere and Dr said I need to go back up to 3 pumps and restart the Androfeme. I have managed to get back up to 2.5 pumps. My breasts are now really lumpy, and its a worry, as I don't know if its the hormones, or something to worry about.
When I had my scan, my gynae said I should just take enough to ease the symptoms, but meno dr is encouraging me to go up, I think she thinks it will help with anxiety and random pains.
thanks again, I feel all at sea with this, and am starting to wish I had not gone down the HRT route, as anxiety is back, and it feels like more things to worry about :'(
Thank you again
Jeepers xx
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Hi
Just an update, I now have my re referral back to the hospital for the PMB, its next Weds.
Continuing on with the 2.5 pumps.
Thank you all again
Jeepers xx
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Just to add re blood tests levels - I think with gel these can be very inaccurate as gel is applied daily so there will be daily spikes - so depends when in the day you apply the gel and time of day the blood was taken. Also depends where you apply the gel and where the blood was taken eg if applied to shoulders/upper arm maybe the vein at the elbow would show higher levels due to the concentration gradient from the application site into the bloodstream? Just a thought and it may not affect it that far away.
If you are post-menopausal then it shouldn't continue to build up on the same dose once steady state has been reached after a couple of weeks or so but fluctuate within certain levels. Also depends on the skin too though - if you cover the skin with products ( as GypsyRoseLee found recently) levels cao nog down as absorption is reduced, and as you age over the long term, the skin becomes thinner so levels may increase gradually due to increased permeability to the gel maybe? This would be over a longer period of time though!
Try not to worry - have you had lumpy breasts before? Hope all goes well at the hospital and do let us know the outcome.
Hurdity x
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Hi
Thanks for the info Hurdity, :-)
Just thought I'd update this, following my gynae appointment.
So, Dr decided to do the hysteroscopy. It was very, very painful, and it was all I could do not to scream at her to stop. I think maybe I am quite sensitive, as I seem to remember almost fainting when having an IUD fitted many years ago. Anyway, I am now recovering, with bad period type pains, which hopefully will go soon.
The dr showed me the picturres, and pointed to areas and said they were atrophy of the edometrium, which is almost certainly the cause of the bleeeding (2.8mm is quite thin). She did also take a couple of biopsies, but said that she would not be surprised if they came back and said there was not enough there to do any testing on. She said that in itself is a good thing.
she also reassured me about my cervix, she said she is a colposcolist (is that the word? ), and she can tell by looking that the cervix is healthy, and would also know if the bleeding was coming from there.
She said that my meno dr is probably correct and that given the atrophy, I probably need the 3 pumps. So its really a trade off? Painful and even more lumpiness in my breasts or endometrial atrophy. I will have to discuss with meno dr she said (I'm due to go back there in 2 months and will be getting my bloods done again). So, that's the decision I now have to make. I think she was happy with everything from her perspective.
I have also this week, recommenced the testosterone, hopefully, it wont send my anxiety back into orbit.
I use the gel in the mornings , one pump on either inner thigh, and half a pump on outer/upper arm. Androfeme outer thigh
Thanks again
Jeepers xx
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Sorry, its me again
I have been thinking about what the Endometrial atrophy means, and I am still confused. If I were not on HRT, then my Oestrogen levels would be even lower, presumably, and the atrophy would be bad, maybe worse. So, would I get the PMB , which is a major red flag,especially if no HRT.
I am not due back to the Menopause clinic until May, so unsure what to do next
Does anyone understand all of this? sorry to be a pain
Jeepers xx
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Hiya jeepers I was wondering how you got on.
It sounds like reassuring news.
It sounds realy painful. No wonder you wanted to scream.
I must confess I realy dont understand the lining thing myself. I was told at my scan.that thin is good. I hope someone comes along to explain it for you. I dont know about you but that word "atrophy" is fast becoming my least favourite word in the dictionary!!
How is your pain today? sending love and hugs.and look after yourself. I know you have your colonoscopy next week..xx :foryou:
JEEPERS. I've just looked back at hurditys reply to your original question and she mentions endometrial atrophy in it.
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Hi TC & Birdy
Thanks for your replies. I'm feeling a lot better now, period type cramps have all but gone, and bleeding (post procedure) has stopped. Feeling relatively calm too, thankfully.
I don't understand it either, but I start to try to guess, and that's probably not good. So, my guess is that because I am on the Oestrogen a tiny bit of blood builds up, which would not happen if I were not on HRT. The picture the gynae showed me was patchy areas, which aer unstable as there is not enough Oestrogen to make it so? I dunno. Yes, I looked back at Hurditys reply, so now wondering if the Utrogestan is too much for me? I feel so confused about it all.
I'm trying to just think of the positives. Nothing sinister found, womb or cervix. I've added back in the Testosterone, which I don't know if it will help? I don;t know if SHBG is all hormones or not. I may try going back up to 3 pumps, I'm still deliberating that one.
Yes, the colonoscopy is Weds. It feels like soon there will be no orifice on my body that has not been probed... you have to laugh don't you? Just hope i get the same result, nothing sinister found. Birdy, yes, it IS literally all blood and guts for me! ;D. Have you had a date for yours?
Hope you are both good today.. :foryou:
Jeepers xx
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Hiya. Lovely ladies. Glad to hear you are feeling better. Jeepers.
I looked it up and it would seem that a predominance of P over E can cause the lining to thin. But your eastrogen levels are now high so maybe it started when your E was low and as your body adjusts to your new higher level it will stop. Thin lining is good post meno but obviously you had to get the bleeding checked out.. It was a lot of positive news though. At least you can adjust your levels with the gel.
I am feeling a little better today thank you. I whacked on a 100 and a 75 patch yesterday out of desperation. my mood is a little brighter today..dont know if it will last but the last couple of weeks have been awful. So I've decided it's been a bit silly of me to hold back from adding Testogel and changing how I take the utro whilst waiting for my E levels to rise. They havent and I need to throw everything I can at this depression now. So gonna add T and take utro vaginally instead.
Jeepers why did you stop using the T.?
Hope your o k birdy. Did you get a date?
Love to you bothxxx
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Hi TC
I'm so glad to hear your mood was a little brighter yesterday, I really hope that it continues for you, keeping you in my thoughts :-)
I have PM'd you
Jeepers xx
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Jeepers. I have replied to your PM XXXXX