Menopause Matters Forum

Menopause Discussion => All things menopause => Topic started by: anartistatheart on April 25, 2021, 07:52:50 PM

Title: New nurse wants to change my HRT regime
Post by: anartistatheart on April 25, 2021, 07:52:50 PM
Dear All, I am looking for advice and thoughts.
When I began my HRT journey over a year ago, I was dealing with health professionals who openly admitted to not understanding the regimes available.
Through this incredible group I finally managed to settle on a regime that seemed right. (15 days utrogestan every 3 months with evorel patches.)

This regime was accepted after a scan and a struggle with monthly progesterone and considering I reached almost 12 months without a period prior to HRT.

Im just settled on this and a new nurse who is the HRT specialist on the team arrives...(and she is very lovely). She hadn't heard of this regime, contacted her specialist forum (of Drs and specialists) who advised against it.

She has offered 2 options...
1. Send me to a menopause clinic
2. Try the minera coil

She is highly concerned about protecting me with the progesterone. She is calling me back Tuesday to discuss further and I would be grateful for opinions and thoughts.

Many thanks  :foryou:
Title: Re: New nurse wants to change my HRT regime
Post by: sheila99 on April 25, 2021, 10:19:57 PM
Sorry but I agree with the nurse. I think bleeding only 4 times a year is a bit dodgy and could lead to a build up of your lining. The higher  the oestrogen dose the greater the risk. I don't think you'd get scans on the nhs fot this but maybe you could arrange your own. I assume you know of the increased cancer risk if your lining builds up? Have you tried utro vaginally which might be more tolerable?
Title: Re: New nurse wants to change my HRT regime
Post by: Ms Peak on April 25, 2021, 11:27:51 PM
Hi there.
I had a mirena initially for very very heavy periods at 45. I was at a point of changing my clothes during my working day. I topped it up with 1mg of Oestrogen as I was slightly wobbly with anxiety in the early weeks.
I'm 58 and still have a mirena as I am not yet menpausal.... Still even ovulating... Shikes

Personally I can recommended the coil....
Ms Peaks x
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on April 26, 2021, 07:58:25 AM
Morning.  Who prescribed your current regime?  MayB the new Nurse should speak to the prescribing medic?  You should be sent for regular scans on a long HRT regime.  To protect your womb.

Let us know how you get on?
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on April 27, 2021, 06:28:07 AM
Thank you everyone for your input.  :)
The following is from the NHS website regarding hrt and this is the regime I'm on at the moment. I fit into the 2nd category so im guessing thats why im on the regime. I trusted that this was correct but its all so confusing with so much conflicting advice.  :(

"Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT who have menopausal symptoms but still have their periods.

There are 2 types of cyclical HRT:

monthly HRT – you take oestrogen every day, and take progestogen alongside it for the last 14 days of your menstrual cycle
3-monthly HRT – you take oestrogen every day, and take progestogen alongside it for around 14 days every 3 months
Monthly HRT is usually recommended for women having regular periods.

3-monthly HRT is usually recommended for women having irregular periods. You should have a period every 3 months."
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on April 27, 2021, 07:16:27 AM
Who prescribed your regime?
Title: Re: New nurse wants to change my HRT regime
Post by: Dotty on April 27, 2021, 07:17:48 AM
Hi there is a prescription for long cycle HRT . It’s called Tridestra.

I don’t think Utrogestan is advised on a long cycle . X
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on April 27, 2021, 10:45:30 AM
Who prescribed your regime?
Previous nurse
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on April 27, 2021, 11:12:04 AM
With the GPs knowledge or is she a Nurse Practitioner?

How do U feel this morning?
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on April 28, 2021, 07:47:53 PM
With the GPs knowledge or is she a Nurse Practitioner?

How do U feel this morning?
Think she had it signed off by the pharmacist.
I had a long chat to the new nurse and we decided to try the conti patches. There was a shortage when we first looked way back. So yet another change but I do feel more confident that this lady knows what shes talking about and has a genuine interest in it too. I hope this works out ok.
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on April 29, 2021, 06:46:33 AM
Let us know how you get on.
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 03, 2021, 07:13:34 PM
An update and The story so far....
I was originally given evorel 50 plus utrogestan on a monthly cycle.
But I was basically losing 2 weeks out of every month to severe pmt symptoms.
I was then put on a long cycle (3 monthly utrogestan) which was working beautifully! Able to work and function apart from the horrendous 2 week progesterone symptoms which I felt just about able to manage.

After a change of nurse and advice here, I was convinced that the long cycle hrt was not a good idea.

The new nurse suggested conti patches which i have been on now for 5 weeks.
I was praying I'd tolerate them, but Im not. Im now onto my 2nd heavy period in 3 weeks (not just a show or spotting) and I have had all the severe PMT symptoms for the entire time of using the patches.

Do the symptoms get better with time? Im at my wits end with this atm  :'(
Title: Re: New nurse wants to change my HRT regime
Post by: Floo36 on June 04, 2021, 06:42:42 AM
I would go back to the long cycle if that was the best for you.
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 04, 2021, 06:50:33 AM
I would go back to the long cycle if that was the best for you.

Thanks for your reply Floo36. There are problems associated with that cycle and the new nurse at the GPs was adamant that I shouldnt be on it. Personally, I would rather monitor for the risks and be on that cycle as I felt mostly myself again. Its becoming a bit of a saga really!
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on June 04, 2021, 08:16:29 AM
Which problems have been suggested with a long cycle?
Title: Re: New nurse wants to change my HRT regime
Post by: Dotty on June 04, 2021, 09:33:59 AM
Hi it could be that your body isn’t ready for a continuous patch which is causing the bleeding. Or you may have to give it time . Breakthrough bleeding can occur for up to 6 months when starting a new Hrt . X
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 04, 2021, 11:08:25 AM
Hi it could be that your body isn’t ready for a continuous patch which is causing the bleeding. Or you may have to give it time . Breakthrough bleeding can occur for up to 6 months when starting a new Hrt . X

Thank you Dotty - I did wonder that. Not sure I can give this much more time - I just feel awful - like I've lost my soul and don't have a vitamin left in my body! sounds a bit dramatic, but true. x
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 04, 2021, 11:13:47 AM
Which problems have been suggested with a long cycle?
Hi CLKD, The Nurse Practitioner was concerned about the the length of time without progesterone (it was a 3 month cycle) and the lack of protection that affords. She suggested that it was 'dangerous' and not recommended without regular scans. She even went so far as to say that I had 2 choices - the conti patch or the evorel 50 + mirena (?sp). Outside of those choices would mean a referral to a private clinic. I didn't challenge her at the time despite knowing that that wasn't actually the case. I wonder whether I should press for a blood test since I haven't had one yet.
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on June 04, 2021, 11:46:54 AM
Hi! blood tests don't show much.

How about being referred to a menopause clinic?  If you have regular scans because the regime suits you, mayB it's about quality of Life?
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 04, 2021, 05:51:56 PM
Hi! blood tests don't show much.

How about being referred to a menopause clinic?  If you have regular scans because the regime suits you, mayB it's about quality of Life?

Thanks CLKD, I hoped to do that but the nurse told me that I would have to do that privately which isnt an option at the moment. I'm unsure if thats strictly true or whether there simply isnt an option in my area? Its definitely the way I need to go... I think!
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on June 04, 2021, 07:08:15 PM
Not if you are in the UK?  There are private Clinics, i.e. Dr Louise Newsom near Stratford upon Avon, there are NHS clinics .

U can send Dr Currie an e-mail for a fee.
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 04, 2021, 08:22:54 PM
Not if you are in the UK?  There are private Clinics, i.e. Dr Louise Newsom near Stratford upon Avon, there are NHS clinics .

U can send Dr Currie an e-mail for a fee.
Thanks CLKD, im in north England, and private isnt an option for me right now unfortunately.  I'll do a bit of digging!  :)
Title: Re: New nurse wants to change my HRT regime
Post by: sheila99 on June 04, 2021, 11:05:48 PM
It's highly unlikely you'll get regular scans on the nhs, providing you with progesterone is a more cost effective solution (and there are many of us who would rather have a scan than take progesterone!).
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on June 05, 2021, 07:45:43 AM
If regular scans are required then the Health Service should provide them?  Would that depend on the health authority? 
Title: Re: New nurse wants to change my HRT regime
Post by: Mogster71 on June 05, 2021, 06:51:14 PM
CLKD I think because the regime is away from the standardised range of options, the NHS probably would not fund the additional scans.

I've got a pretty forward-thinking and clued up GP and although he has been happy for me to try several HRT's to find what suits, he won't prescribe anything "off-piste", I'd need a specialist to do that.
Title: Re: New nurse wants to change my HRT regime
Post by: CLKD on June 05, 2021, 07:34:15 PM
Cost cutting ? 
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 06, 2021, 09:55:40 PM
It's highly unlikely you'll get regular scans on the nhs, providing you with progesterone is a more cost effective solution (and there are many of us who would rather have a scan than take progesterone!).

Thank you Sheila. If only cost wasnt an issue!  ;) What i dont understand is that the long cycle regime is clearly outlined on the nhs website..and it seems that it is not considered off piste. Im not saying that I shouldn't have the progesterone... I just cant tolerate it continuously.
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 06, 2021, 10:00:25 PM
CLKD I think because the regime is away from the standardised range of options, the NHS probably would not fund the additional scans.

I've got a pretty forward-thinking and clued up GP and although he has been happy for me to try several HRT's to find what suits, he won't prescribe anything "off-piste", I'd need a specialist to do that.

This regime is discussed on the NHS website as follows, which suggests it is standard practice ..
https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/

"There are 2 types of cyclical HRT:

monthly HRT – you take oestrogen every day, and take progestogen alongside it for the last 14 days of your menstrual cycle
3-monthly HRT – you take oestrogen every day, and take progestogen alongside it for around 14 days every 3 months
Monthly HRT is usually recommended for women having regular periods.

3-monthly HRT is usually recommended for women having irregular periods. You should have a period every 3 months"
Title: Re: New nurse wants to change my HRT regime
Post by: sheila99 on June 07, 2021, 08:22:48 AM
Tridesta is designed to give you a 3 monthly cycle but I think it's the only one that is. A long cycle regime using utrogeston or provera is generally considered to be 6 weeks.
Title: Re: New nurse wants to change my HRT regime
Post by: anartistatheart on June 07, 2021, 05:44:03 PM
Tridesta is designed to give you a 3 monthly cycle but I think it's the only one that is. A long cycle regime using utrogeston or provera is generally considered to be 6 weeks.
Thanks Sheila, that's interesting! I will take a look at that :)