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[mags4691]

Hi everyone.. I thought I would update you as to what has happened since I last joined here one month ago. I went back to my practice and was able to see another lady GP who, although wasn't totally against prescribing me HRT she had reservations because I smoked and because she felt as did the first doctor that HRT carried too many risks.. However, I persevered and as I had been off work yet again, I told her how it was absolutely controlling my life at the moment to the extent that time I felt so awful and ill that I couldn't even attend work.   She has put me on a very low dose of combined HRT which I have now been taking for one month...  This is may be where I need your views again here.. how long is it until I will notice a change??  So, far I have felt nothing, the sweats remain during the day and at night I'm soaked with them.   I do not have any side-effects, which in one way is good, but on the other I feel that they are not working.. Am I being too impatient. Should I have to wait the full three months before coming to that conclusion?  The doctor wants to see me for a check up at the end of two months.  I would value your views as to how long it does take for HRT to kick in, or if I am not feeling anything now is it likely they could possibly be the wrong dose?   Thank you. 

[bev567901]

Well done on getting the HRT Mags. I still haven't managed it but have read quite a few posts saying you need to give the meds a chance of 3 months. I hope they work for you xx

[Dancinggirl]

Hi mags4691.  Well done for getting the HRT .
What HRT have you been given?  You say it is low dose but how low?  Lower dose HRTs may take longer to kick in.  I'm sure others will be along with more advice but I think I read somewhere that lower dose HRTs will take longer to work as the oestrogen needs to build up in your system - I could be wrong about this. 
By the way, I assume they have tested your thyroid function?
You mentioned you were moving and it sounds as though life is pretty stressful - anxiety and stress will certainly increase sweating etc.
I am personally concerned that you smoke and this may be the reason your doctors have been so reluctant to give you HRT.  If you can give up smoking this would help enormously - I know this is tough.  The trend is very much towards giving the lowest dose to relieve symptoms and as you smoke this will be even more important.
I certainly think you need to give the HRT longer to work.
Keep posting.  Good luck  DG 

[Hurdity]

Hi mags

Glad you managed to get some HRT!

I have looked back at your posts and you said you were hypothyroid and I know this does interact with HRT - and especially if you take thyroxine at all, and needs careful monitoring I understand.

Personally I would have thought you should have noticed a difference by now if you have been taking it for a month, so you may well need a higher dose - but better to increase it gradually.

As dancinggirl says - what HRT have you been given? If it's an ultra low dose then it's not surprising that  you haven't noticed anything! They are all listed here:
http://www.menopausematters.co.uk/postmeno.php

I agree with dancinggirl about smoking - this is likely to increase the risks, and therefore the transdermal route ie patch or gel would be far preferable to tablet HRT, if this is what you have been given.

Here is the abstract if a paper (published in 2005) which discusses it (I've put in red the bit about transdermal) :

http://www.ncbi.nlm.nih.gov/pubmed/15638743

Smoking, estradiol metabolism and hormone replacement therapy.
Mueck AO, Seeger H.
Source

Section of Endocrinology and Menopause, University Women's Hospital, Calwerstrasse 7, 72076 Tuebingen, Germany. [email protected]
Abstract

Many women receiving hormone replacement therapy (HRT) smoke; in the Women's Health Initiative (WHI), one of the largest interventional studies on HRT to date and which recently had to be discontinued, 50% of the 8,500 women on HRT had smoked before or continued to smoke during the study. Remarkably, there is little knowledge about the impact smoking has on the efficacy and side effects of HRT. However, it has been proven that, depending on the type, duration and intensity of nicotine consumption, smoking can reduce or completely cancel the efficacy of orally administered estrogens. Not only does smoking diminish the otherwise well-established beneficial effects of estrogen on hot flashes and urogenital symptoms and its positive effects on lipid metabolism, i.e. by reducing cholesterol, but smoking also specifically reduces estrogen's ability to prevent osteoporosis. The reduction or loss of therapeutic efficacy is mainly caused by dose-dependent elevated hepatic clearance, partially in conjunction with lower estrogen levels, and has been demonstrated only with oral estrogen applications. This failure of therapeutic action should not be compensated for by increasing the dose in smokers as this might result in the production of toxic, even potentially mutagenic estrogen metabolites--compounds recently associated with a higher risk of breast cancer. The favorable effects of estrogens are not lost in smokers when they are applied transdermally. This route enables low dosage and also avoids the formation of unphysiological metabolites by bypassing the liver. Women who continue to smoke despite all warnings should therefore only be treated via the transdermal route. Oral contraceptives, but not HRT, are contraindicated in elderly smokers. However, the principal conclusion of the WHI study was that the lowest dose possible should be chosen, especially in patients with an increased cardiovascular risk, as is the case in smokers.

I'm not trying to alarm you but provide additional information to help you, and perhaps persuade you to start to give up smoking - which will be so much better for you at this stage in your life. And - as well maybe to change the route of HRT.

I do hope this is helpful

Hurdity x

[mags4691]

Hi all, thank you so much for your advice, kindness and support.  I am making every effort to stop the smoking.. I have replaced quite a few with an E cigarette now and whilst at work I am very limited.  I will keep trying I promise.  I have heeded the warnings Hurdity, thank you.  I asked for thee patcsh of HRT at the time of my appointment but she was reluctant to start with that.  I have been put on Premique low dose 0.3mg/1.5mg, modified release.  I am concerned too about the thyroxine levels and I am monitored for this at three monthly intervals because even before HRT the levels dont ever seem to stabilise.  Its almost like they guess at a figure!!  Ive been hypothyroid since 1995.  Yes moving hopefully in two weeks so maybe all these things will settle just a bit.. Thanks again its great to have you there.x

[Hurdity]

Hi mags

Well done for your efforts with smoking - sorry I wasn't trying to preach or imply you hadn't thought about it!

In your position I would definitely go for a bio-identical HRT - not Premique. The oestrogens in this one are known as conjugated equine oestrogens - from horses , so many of the them are not the same as in our boides. Also the progestogen is a synthetic one. Body identical hormones are least likely to involved risks, and as I said below, transdermal oestrogen (pacth or gel) would be better.

I don't know why the doc was reluctant to start with patches - because there are low dose patches you can start with (25mcg) - but you would need a separate progesterone. Try to find out as much as you can about HRT from the menu (headings in green on the left) and ask us if you want to know more. I would suggest patch oestrogen and separate progesterone such as utrogestan (micronised progesterone). You will need to be clued up though so that you can talk knowledgeably to your doctor!

Hope the move goes well and keep up the good work (re smoking)!

Hurdity x

[Maggies]

Hey Mags

Can inbox me anytime and will send you hugs xxxx