Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: AndieKC on July 10, 2018, 02:38:27 PM
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Hi
I was wondering if anyone can shed some light on this apparent contradiction I seem to be coming across in my 'research' into menopause and HRT.
On the one hand, a lack of oestrogen in peri/menopause causes symptoms like hot flushes, cold shivers, palpitations, vaginal dryness etc,
On the other hand, even the lowest dose like Elleste Duet 1mg sequential causes/contributes to endometrial thickening, hyperplasia, polyp etc. - all signs of too much oestrogen, unopposed by adequate progestin.
My early menopause came suddenly at 44, no surgery, no chemotherapy, no illness of any kind, perimenopause was very brief - a couple of missed periods, and that's it, ovaries shut shop. The advice usually is to start HRT as soon as possible to protect the heart and bone strength (there is a window of about 2 years when without HRT there would be a sudden deterioration in bone strength, then the decline slows down).
Despite my low dose Elleste Duet, after a few months of heaven, the bleeds started, all those invasive procedures to investigate post menopausal bleeding etc, and the traditional doctors recommend to stop HRT because the oestrogen is 'causing or contributing' to all these endometrial changes, which could turn them cancerous. The fairy tale is over, and I am still only 47.
If I go off HRT, life will be unbearable again, my bones will start deteriorating very quickly, thermostat remains broken (hypothalamus will make me sweat every few minutes, then freeze, and again) and the palpitations will probably give me a heart attack as it's not normal to have a resting heart rate over 100 bpm when resting (on HRT my resting HR is 60-70). Also sleep deprivation will cause all sorts of other problems... but hey, I'll have a low risk of oestrogen related problems, and I can take a lovely thin endometrium with me to my early grave (from lack of sleep/heart attack/hip fracture/going nuts - take your pick).
If I stay on HRT, I'll continue to feel great, look young, sleep well, stay calm, have no flushes, live my life and think clearly, have no joint pain, but the oestrogen will continue thickening the endometrial lining, growing polyps, trying to turn them cancerous...
So I'm screwed if I do, and screwed if I don't...
Too much oestrogen is bad, too little is no good either. Seriously, which one is it? I get that after a certain age - like past 70 for example, the body is not meant to have levels of oestrogen like the HRT provides, but in the 40s? 50s?
If the progestogen is meant to be balancing the oestrogen, (in my case it failed) then what is the point of sequential HRT? If I remember correctly, approx 50% of women on sequential HRT will develop these problems.
I am aware that patches contain a lower dose, but they are better absorbed, so the total circulating oestrogen is the same as the 1mg tablet.
P.S. Never smoked, never drank alcohol, never been obese or overweight (until the 2 years of sleep deprivation before HRT made me put on a stone, but still normal weight).
We can send a man to the moon, so can scientists now please please please come up with something? I know al the ladies here know what I mean when I say that until you experience how hot flushes, cold shivers, palpitations and lack of sleep can slowly be killing us, it is hard to understand. But sleep deprivation has been used as a method of torture all over the world for centuries. Why? Because it breaks even the highly trained soldiers in the end. Yet, half of the population is expected to somehow just simply get on with life... Grrrrr! Rant over, I'm going to weed the garden now - brilliant anger management by the way.
AndieKC xx
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Hi I'm afraid that I can't answer your questions as I'm not medically trained and I'm sorry if you've already stated the following elsewhere, but have you thought about seeing a menopause specialist like Dr Louise Newson who would be able to answer your questions?
Oestrogel and Utrogestan have solved all my problems. A year ago I was in horrible place and very ill with what turned out to be menopausal symptoms.
I really feel for you x
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Oestrogel and Utrogestan have solved all my problems. A year ago I was in horrible place and very ill with what turned out to be menopausal symptoms.
I'm sorry, I can't answer Andie's questions either.
But Dotty, can I ask how you take your oestrogen and Utrogestan? What's your schedule and quantity? I'm going to try switching to this method but don't want progesterone all the time.
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Hi SueLW I take utrogestan orally for 25 days out of 28. I use 4 pumps of gel every morning on shoulders and outer arms. X
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Hello Andie,
I read your post and felt I have to respond as I have been struggling with such a dilemma myself and trying to find an answer for myself. You are describing all my thoughts at present to the dot.
I have been a long term member of this forum but lately just read and don't have the courage to post. I have been struggling with perimenopause since I turned 43, now 47. At 43, an HRT therapy saved my life as I was at the verge of going mad - shakiness, agoraphobia, extreme anxiety, insomnia, night sweats, palpitations, gastric upsets to name a few. Within 3 months of starting on Femoston 2/10 I was a new person and regained my life.
I stopped the Femoston two and a half years later due to raised blood pressure and chest tightness and that I felt intuitively that the estrogen was too much for me. I managed a year without symptoms and then all hell returned. I am now struggling again with all of the above , with full force. I am still hesitant though to restart HRT as I have the same concerns as you have. Will have to decide soon as sleep deprivation is killing me and makes me unable to do my work and my duties. As well as anxiety and fatigue.
I have concluded that during perimenopause, it is not exactly a drop of estrogen that causes my symptoms. It is rather the widely fluctuating estrogen (very high or very low, different each month), and the gradual lack of progesterone that causes women to be anxious. Surprisingly, through all this time, I have always felt better in the second half of my cycle, when there is presumably some progesterone produced. It has made me feel calm and contented, and not depressed as many women state it does. So for me, I have realized that in perimenopause I have experienced wild fluctuations which have caused my symptoms. Adding HRT to the mix may cause extreme highs in estrogen when your own is spiking, but also helps when there is a dip (which you don't know when can happen). So in itself, it helps to avoid the dips, but can cause highs that thicken the endometrium and can cause (for me) tension, anxiety and restlessness. Cannot win, can we!
I was also recently diagnosed with thickened endometrium, and all the gynies that I visited do not agree for me to take extra estrogen for that reason. All of them have advised me to wait until my estrogen drops steadily (i.e. when I enter full menopause) , and not have these peri fluctuations, before I restart HRT. However, I know that HRT helps me with my other symptoms at the times when I feel very down. It is a big challenge and I am sorry that there is no really good support from doctors who can look at the perimenopause in a holistic way, rather than just looking at the thickened endometrium and dismissing your other symptoms.
Some doctors prefer to use the contraceptive pill as it will even out the fluctuations and allow a true replacement of your hormonal environment. I don't want to go that route. I have never taken contraception in my life, and don't want to start at this age due to risks. I know that HRT is far safer at my age than the CP. So again, it is all about knowledge, personal decisions, and reading that will allow us to pass through this. Remember that in ancient times, women with menopausal symptoms were called hysterics. Hysteria was purely a woman's decease (now disregarded as such), and comes from the word "hysteria" which in Greek means Uterus. All ancient doctors believed that women's problems at a certain age came from the uterus , and proclaimed them as hysteria. Women were cured with dreadful and dangerous hysterectomies without anesthesia, or with opium. Or put in asylums and proclaimed witches. So the issues of the perimenopause and menopause are not new to mankind, just I hope now in modern times, we have to have more modern and scientific approaches on how to solve these struggles.
Sorry for the ramble, I hope I didn't bore you all. These are just my thoughts and my experience and I hope these are helpful.
Milamam
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I'm completely with you on the sleep thing. I've had years of sleep deprivation on and off and it's always the thing that cracks me. There's a huge lack of research into alternatives that might help us. Are there even any charities that fund menopause research?
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Hi Andre - I think I have been responding to you on another thread?
Frim
The outset you had some bad advice from your GP who didn't know much about treating the menopause.
If you felt good on the Elleste and simply had a monthly bleed, then you should be able to go back to this. If I remember right the problems arose because you were put on a conti hrt and erratic bleeding is quite a common side effect of any conti hrt. However, if you can bring yourself to have the mirena fitted this would offer you some reassurance that you are less likely to develop hyperplasia, polyps etc and can safely use oestrogen at a level that suits you. You clearly did well with a low dose of oestrogen and if your periods stopped over a year ago then your natural oestrogen levels will be bottoming out soon anyway.
I think you are due to go back to have the polyps removed ? so if you can have the Mirena, I think after a few weeks with this, together with using a low dose oestrogen patch or the daily gel, you will quickly get your life back on track.
Many of us share your view that menopause treatment still has a long way to go but try not to overthink things - you are not alone with these issues - there are thousands of women out there suffering as you are.
Keep us posted. DG x
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Hi girls,
To Dotty,
I have thought about Dr Louise Newson, I might still do that, but I have a feeling polyp removal and Hysteroscopy etc still needs doing on the nhs, but thank you xx
To Wilks,
You're right, we need a menopause charity- we kind of have it already, Menopause Matters, I understand is a charity set up for this purpose. And all those £25 fees we pay for email questions & answers with Dr Currie goes to support this charity and the work. My understanding is that Dr Currie and Menopause Matters is/has been in charge of educating GPs and gynos on all Matters menopause and hrt
Xx
To Milamam
From everything I've read, and what all the docs are saying, the Mirena Coil for progestogen with estrogen as patches/gels is the best combination due to lowers levels of hormones circulating in the body, especially estrogen. This means fewer side effects and it's better if hrt is to be taken longer term. I don't know what your stance is on Mirena, (I am totally irrationally frightened of it, even though in my head I accept it is the best, but I'm working on accepting the fact that I'll havd to have it), everyone seems to think it is worth considering.
I am sorry you feel you don't have the courage to post - this forum has been such a great help for me, but I am currently on hrt and feeling great except for the worries re Hysteroscopy, polyp removal and Mirena fitting etc. I completely feel for you god awful it is when your body is ravaged by symptoms, I felt utter despair before hrt, symptoms were relentless and I didn't have the will to do anything.
I agree with you on the peri menopause and fluctuating hormones, move was extremely short, a couple of missued periods, and that was it. I was nearly 2 years post menopausal (at 46!) when I started hrt. Can't quite work out if I felt different on the oestrogen only two weeks, or the estrogen + progestin two weeks. I had all the side effects in the first few months but all settled, and I have even lost some weight (gained during those 2 years before hrt due to severe symptoms and no sleep). So I have no idea where my extra estrogen could be coming from as ovaries are completely dead (no activity on the scan) and body fat is the biggest producer of estrogen.
You know, regarding CP vs HRT, some of them contain exactly the same preparation - if it helps your concerns, look it up for ingredients and amounts - and some contain the same. For example, Dr Currie recommended for me a continuous combined Hrt with extra progestin to arrest hyperplasia and it's Kliovance (same estrogen and progesterone as Elleste Duet I had been on before) but plus Noriday for extra progesterone- exactly the same as in Kliovance, yet Noriday is Contraceptive pill. It's all about the type and amount...
Have you thought about using Dr Currie's email service ? I found it amazing, just pay £25 through this website and email Dr Currie with your question, I did that a couple of times.
Don't suffer in silence, we are all here for each other, and remember it's anonymous xx
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Hi Dancinggirl,
Thank you for your reply,
My problems started on sequential hrt, bleeds didn't settle into a neat monthly pattern, had spotting mid month, after intimacy etc. I should have been put on continuous combined hrt at some point, because I started the original sequential hrt when I was already 2 years past menopause, after periods stopped completely. I had a very sudden onset menopause, no warning, hardly any peri menopause.
My understanding is that sequential hrt is more likely to lead to hyperplasia, Conti is better because on Conti progesterone is delivered every day, protecting the endometrium but a few months ago I didn't know any of this.
P.s. I really hate being a woman sometimes 😒
Thank you for your support xx
You are right about the mirena, I'll have to overcome my reservations about it, am working on it...
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Hi Andie. Have you got to have the Mirena ? Can't you stay on the Kliovance if that suits you? X
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I personally don't think it's too much oestrogen that causes the hyperplasia,as some women take very big doses of oestrogen with on abnormal build up. Many women stick on sequential hrt ( well into post meno) because it gives a predictable bleed instead of erratic bleeding that so often occurs with conti hrts. We are all different and our bodies respond differently to hrt. I think it's just that for some women the lining won't shed properly - I had this problem when I was roughly 15 years post meno and on the lowest dose of oestrogen. This is why the Mirena can be good. You are just unlucky that you need so much progesterone to stop the lining from building up. At least you aren't intolerant to progesterone - so many women are. DG x
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Hi AndieKC - I also responded on your other thread about the balance between oestrogen and progesterone - in the New Members section. Yes that's all it is - endometrial hyperplasia is caused by too little progesterone in relation to oestrogen - and as Dancinggirl says this is very individual - some women won't get it at all but because there is a causal relationship between too much unopposed oestrogen and ultimately endometrial cancer (only in some women!) - we all have to take the right dose to keep the lining thin.
On sequi HRT it is perfectly OK for the lining to thicken and it will be at its thickest at the end of the combi part of the cycle ie the end of the progesterone phase. With the right amount of progestogen the lining should be shed so that it measures within the normal range just at the end of the bleed - that is the time it should be measured. On conti HRT it should remain unformly thin ( after 6 months) with no beleding - otherwise more progesterone will be needed.
If you want to remain on sequi HRT then you just need to take separate oestrogen and progesterone ( or take extra progestogen during the second part of the cycle) - but a slightly higher dose of progestogen.
As advised several times if you are prone to endometrial hyperplasia then the Mirena is ideal as Dancinggirl recommends.
Hurdity x
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Hi Hurdity and Dancinggirl
Thank you for your posts.
Can I please ask you about the thickness of the lining - I have only been on Elleste Duet 1mg sequential for nearly a year (not Conti) so do you think this is what caused the thickness and the imbalance between the 2 hormones? I am literally only just now about to start the continuous combined hrt (Kliovance +
Noriday).
My 6mm lining was measured about 2 months ago - on Sequential HRT (16 white pills, 12 green pills) - when I was towards the end of the white pills (oestrogen only). A couple of days ago they measured the lining again - still on sequential as I am just finishing the green pills (estrogen + progestin) - so the result 8.7mm was 4 days before the end of green pills.
I keep reading that thickness should be measured after the bleed has just finished to see if the lining sheds properly but no one seems to know or care about that when they measure it! So it's never been measured just after the bleed. Is it possible that my lining could be normal if only they measured it at the right time?
As you say, Sequential HRT builds the lining up then sheds it, so now I will never know what mine is after shedding.
I am finishing the last two green pills of sequential Elleste (today and tomorrow), and then I'll be taking the Kliovance + 2x Noriday combination (progesterone continuously) so bleeds will be different I guess.
I am trying to come to terms with the upcoming op now, I think I'll go for GA, but gosh I really want it all to be over.
To answer DancingGirl's question- I could have progestogen treatment orally instead of Mirena but the polyp still needs cutting out and the oral progestin is insanely high amount compared to Mirena so Mirena is better, I understand that... I really really hope the polyp is going to only benign (most cases) not abnormal because then they would take me off hrt and it's hysterectomy usually recommended. Apparently if there is postmeno bleeding and hyperplasia and polyp, it's more likely to be something nasty on the polyp... fortunately biopsy showed simple hyperplasia only without atypia but who knows what that polyp is... hope we get there soon and it will be over
Thank you for your support il. Keep you posted xx
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Angie - the last time I saw a very good specialist gynae, he explained things really well. I was getting erratic spotting and bleeding and he insisted I have a scan right at the end of a bleed as this is the only way to tell if there is hyperplasia. It turned out I had a ‘patch' that was clearly not shedding properly but he was not concerned. The chances of endometrial cancer are very small and polyps and fibroids are common when using HRT - they are usually benign. To be honest I really wouldn't be happy taking a lot of progesterone orally all the time, so the Mirena will be your easiest option and if you have GA they will be able to fit this after doing the polyp which is the ideal scenerio.
I really think you have been unlucky as I fear they have simply done your scans at the wrong stage in the cycle. The only way to be scanned at the right time is to have it done privately so you fix the date when you know it's the right time.
If the NHS has menopause clinics in all major towns that had scanning equipment, management of the menopause would be far better. Even without HRT, so many women get fibroids, polyps or excessive bleeding in the peri meno stage and this could be treated more efficiently with appropriate clinics in place.
Hope things work out ok for you.
DG x
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You are so right, Dancinggirl, if only we could have the scan at the right time, it would mean less worry etc
I'll hold on to the hope that it's nothing to worry about, i'd love to have it over and done with, and feel relief... hate this waiting
In the next life I'm coming back as a bloke, that's a promise !
Xx
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Hi SueLW I take utrogestan orally for 25 days out of 28. I use 4 pumps of gel every morning on shoulders and outer arms. X
Thank you Dottie. That's a lot of hormones. But it's good to know it works for you.
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Hi Sue LW - it's not really a lot of hormones. It's all within licence x
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Hi I'm new here but just wanted to share my experience of Mirena coil and patches (evorelle) I've had three Mirena coils fitted in last 15 years first one after my daughter was born. I've literally never looked back. I had a little spotting but very soon stopped having periods all together. I've been using Evorelle patches since for about 15 months and although initially I had continous spotting when I tried to increase dose to anything abovery 25mcg. I slowly increased by cutting patches in quarters! Am now on 50mcg Having the Mirena fitted is not the best experience and I found it very painful for a few seconds each time but for me the benefits have outweighed this. Just wanted to add that I'm not brave about medical procedures, I feel faint having blood taken! Hopefully this might reassure you about Mirena if doctor thinks that's an option for you.
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Hello Andie, and I am sorry that I didn't respond earlier but was really occupied with work these past two days (just finishing a consultant assignment ). Thank you for your generous response. I am a relatively shy person overall, but this forum has been a lifesaver for me through the years (registered I think 5 years ago when peri started). The women here helped me so much go through the rough times. Now, weird or not as it may sound, I am afraid to post when I feel well for the fear that things may deteriorate the next day >:( But you and everyone else is right: sharing your wobbles is probably better than keeping to yourself . When I feel rough , I open the forum and read and I usually , immediately, find someone else that has felt just like me or feels like me at the moment. This is such a great help at moments when things go really dark! Thank you all, wonderful women here! You have been my rock !
In terms of the Mirena, I have many times considered this option. I am definitely not progesterone intolerant as when on Femoston, I definitely felt much better on the progesterone/estrogen days than the estrogen-alone days! I was sleeping better, felt more composed and content and with more energy! But - and this is just me perhaps - and my fobia of pills and ailments - I don't want to have something in me that I cannot remove straight away if I feel bad! If you can understand what I mean. So, no , Mirena at this point is not an option for me.
As to getting Dr. Currie's advise - this is such a great service with MM and I would love to be able to get access to it, but I am not in the UK (I live in Bulgaria), and the preparations and combinations here are not the same as in the UK, so I don't want to put Dr. Currie in position to advise on a different medical system than in the UK. I don't know fully the pharmaceutical market here, there is no such website as MM to summarize in a great way what is available to women. I have to trust the doctors here to prescribe what's available.
For now, I have decided to change a few lifestyle approaches like doing more regular walks and trying to add more supplements to my daily routine. I eat very healthy, cook every day from scratch , no conservation foods, everything is bought from the local market (same for the whole family, this is how we are used to). We rarely eat outside, as we are so used to cooking at home. No frozen meals, lots of vegetable dishes (for me - I don't like meat), no sugar ( I don't like sugar ) , lot's of vegetable juices, lemon water. So the problem is not in my diet, nor in my exercise. I am sure it is from the hormones, but for now I have decided that until I am convinced that my estrogen has fallen down steadily, I will not take HRT in order not to aggravate things further (re the hyperplasia).
My symptoms that make me think my estrogen is too high are:
- water retention, with blotches of puffiness on face, arms and mid-section;
- all of a sudden, developed cellulitis - never had that before! I have been a tiny skinny person all my life.
- constant anxiousness , jittery, esp. in the mornings, nausea in the mornings;
- sleep disturbances - I wake up at least 3-4 times /night with anxiety and have to get up, go outside and calm down;
- hot flushes and night sweats stopped miraculously a month ago. No hot flushes now.
- feeling sluggish, lethargy, no motivation, brain fog, forgetfulness;
- Periods come every 17-20 days, last 4 days with dark blood, not particularly heavy, but sufficiently (sorry TMI).
- enlarged boobs , painful, as if in a constant PMS.
So my questions are, if anyone can help:
1. If I am deficient in progesterone, which I probably am, can I go to a continuous combined HRT regime at a low dose so that it can ensure that I have a steady dose of progesterone and a relatively small dose of estrogen throughout the month to avoid the wild fluctuations, skyrocketing estrogen in particular, during this peri period? I know I still menstruate , frequently, and I am not a candidate for a continuous regime but has anyone gone to a continuous before they have reached the menopause?
2. If that is not an option, is there a way that I can only add a progestin as a everyday support (i.e. we have dydrogesterone sold separately here (Duphaston) and Utrogestan as well coming only at 100mg)?
3. If none of the above is an option, what do women do to alleviate these estrogen surges when they happen? Any success stories will be very helpful!
Thank you !
Milamam XXX
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Milamam - I fear you have misunderstood what is going on in peri menopause. It is not oestrogen that surges in peri meno, it's the dips in oestrogen that are the problem. Essentially, through peri meno, ovulation will vary, the ovaries are struggling to produce oestrogen so you get flushes and night sweats - some months there is no ovulation and this can result in not enough progesterone produced to shed the womb lining properly - so erratic and sometimes heavy bleeds are the result. The ovaries are also struggling to work and oestrogen levels fluctuate and gradually drop through peri meno - sometimes there can be months of very low oestrogen production and then the ovaries will try to come alive and start Producing oestrogen again. Flushes and night sweats will come and go because of these fluctuations and a sequential Hrt can help control this.
As you are still peri meno, you can't use a conti hrt which will have progesterone every day, as your own hormones will still be fluctuating in the background and this can result in erratic bleeding, but the sequential hrt treatments will control the dips in oestrogen and this will balance things better. Starting with a low dose is best.
You can just have progesterone only, without oestrogen, but this is unlikely to control flushes and sweats.
The Mirena is the best way you can have low dose progesterone all the time in peri meno and it can help to protect against heavy bleeding. Once the Mirena is in place you can just use Oestrogel or oestrogen patches alongside to reduce flushes and sweats. The Mirena is very easy to remove if you don't like it and it gives contraceptive protection in peri meno. DG x
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Thank you, DG! Your advices are so very helpful all the time. I guess I'll have to rethink starting some sort of a sequi combination soon if my symptoms continue as they are now which is quite debilitating. Femoston worked well for
me and it is so unfortunate that here it is offered in 2/10 only! I've tried a patch (50) with Utrogestan 200 for 12 days but this regime did't quite help. Femoston worked faster and was much more effective.
Will have to go back to my doctor and rethink. I am also thinking to ask for a blood test soon to see where I am now without HRT although I know tests vary and are unreliable.
Back to the drawing board!
Milamam xxx
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There are quite a lot of women who have very high oestrogen in perimenopause (or the time just before that as never sure what's technically pre or peri?). My endocrinologist said she sees many women with this issue but not many seem to report it on this particular forum.
It may be due to a last ditch attempt to trigger ovulation and when measured the levels can be much higher than younger women's oestrogen.
Mine has been high for nearly 3 years now and I have growths in my liver similar to what women apparently get in pregnancy. I suspect it's responsible for the oestrogen driven breast cancers too. The surging feels very over stimulating and can trigger migraine and heat coming up the back and neck. It can also cause breast tenderness, bloating, nausea and diarrhoea. Adrenaline goes through the roof too!
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Ditto, dangermouse! Bloating, nausea, diarrohea is what is me nowadays! Frequent bleeds, insomnia, jittery, anxious. I think I am having final estrogen surges - will go for blood tests and will update here.
Thank you!
Milamam