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[Annie58]

Hi all
I posted a few weeks ago when I could no longer get Premique due to manufacturing problems.  The GP put me on Elleste Duet but I now have a period after being period free for a long time (probably 2 years).  Having had awful periods in the past this was the last thing I wanted as it is brilliant not having a bleed.

I went back today and saw another GP with a Gyne interest.  She spent an age looking through the reference book before printing a prescription out.  When I re-iterated that I did not want a bleed she then spent more time looking and I now have a prescription for Kliovance (1mg/05mg) continuous.  It says in the accompanying leaftlet that I should wait until my period stops before I start taking the Kliovance so am I right to follow this guidance?

Of a slight concern is that the GP is sending me for a scan (within the next 2 weeks) because of the bleeding.  I am not unduly worried but wonder if this might show up anything.  There has always been a suspicion in my mind that I might have fibroids but this has never been checked out. 
Since all this change I have had thrush and cystitis.  The cystitis seems to have made my bladder more sensitive and on one ocassion I had an accident and other times I have been very close! 
Bearing in mind the Elleste wasn't brilliant at helping me sleep I am asking myself is HRT worth it?

I'm beginning to think there is not an easy answer and I'm fed up with it all.  Premique wasn't perfect, but as I am under a bit of stress at the moment I was happy to stick with it until things settled down.  I know I have to make the decision now whether to try/persevere with the new HRT (scan results all being ok), or stop the HRT and deal with the awful sweats, tearfulness and mood swings which I've been told will come back anyway if I stopped HRT at a later date.

On the other hand I look at my cousin who is just 18 months older than me who has very severe osteoporosis (3 separate breaks and now an operation this week to try to straighten her toes.  She wasn't prescribed HRT because she smokes.

I don't expect that anyone can give me the answer but I feel better just writing it down!

[Hurdity]

Hi Annie58 - sorry to hear about your problems and dilemma - must be difficult! Was the Ellese Duet  the conti or the cyclical one? Did we discuss this before? I can't see why you can't start taking it straight away - I mean if you are on cyclical HRT which part are you on? If it's continuous combined I would say start taking it any time! What did your doc say?

Also how did you feel on the Elleste and especially the second part if you were on the cyclical type? Kliovance has the same prog in it which can cause side effects in some women. It is often the prog that causes the problems! I would have gone for Femoston myself but if you felt fine on the Elleste then you should be OK.

If you were on Elleste Duet the cyclical one - then a withdrawal bleed is expected so I can't understand why you would need to be checked out as it's just the HRT doing its stuff! Even if you were given Elleste Duet conti - (strictly speaking going from conti (no-bleed) to conti should not cause a bleed) the change from Premique could have triggered a bleed due to the different progestogens - but in this case it would be good to get checked out just to be overly cautious, and to rule anything out.

HRT should definitely not make sleep problems worse and the lack of sweats etc should improve your sleep!

Symptoms aside, if you have osteoporosis in the family then HRT is advised for as long as you can.

If you are post-menopausal then continuous HRT should not give you mood swings because your own hormones are stable and the HRT gives a constant dose. If you then stop HRT you will no longer be getting the oestrogen and instead of mood swings, if you are sensitive to low oestrogen then your mood could dip. The sweats won't nessarily come back - they do with some women - but there's no way of knowing and that isn't a reason not to take it - I mean what about the years you are taking it when you have improved your quality of life? It is a question of finding the right product and there should be something out there which will make you feel better on HRT than off it, if you are troubled by symptoms

Hurdity x

[Annie58]

Hello Hurdity
Yes we have talked before.
Thank you for your comments.  I'm now onto day 3 of the new HRT so will see how it goes. I started it before the bleeding/spotting stopped as I didn't know how long it was going to go on for. Fortunately today the spotting has stopped.   
I don't blame the Elleste for the sleep problems as the Premique didn't totally deal with the temperature fluctuations I was getting either.  None of the HRT preparations totally cure this but they all have been a big improvement on my pre HRT days when I would regularly soak all the bedclothes! The Elleste duet was the type with 2 different tablets so cyclical I think??

I've also got an increased acid reflux problem so now I've raised the end of my bed a bit and that is helping as I had been waking up hot but also coughing and needing a drink due to the reflux.  (Over the last few weeks I had 2 lots of anti biotics for a supposed throat infection but I'm sure the problems were due to the night time reflux now). The GP has increased my meds for this so hopefully that will help me at night a bit.  It's too early days to see if the Kliovance is better but I will be going back in a months time to discuss the HRT and reflux.  I haven't yet heard about the gyne scan and as I said before I'm not unduly concerned as long as the new HRT doesn't produce the false periods like the Elleste duet. I'll post again if things don't improve. 

Regarding the osteoporosis, yes that's something I don't want to happen and I also read that the PPI's I take for the reflux can have an adverse effect on bone health too. 

We should be moving house again within the next couple of months so I'm hoping I'll get a new GP to build a relationship with over time.  My current surgery is one where you never see the same doctor.
Thanks again, your help is much appreciated.

[Mary G]

Annie 58, sorry if I am being dim here (I may have misunderstood) but I am wondering why your doctor has precribed and oral HRT when you are suffering from acid reflux which is a very obvious side effect from taking this type of medication?  Correct me if I am wrong but it would appear that none of the HRT you have tried so far has worked very well either.

I can't understand why you are not on transdermal HRT because (a) it works far better and (b) it has fewer side effects.  I note that your current medication contains norethisterone which is a very strong progestin and notorious for causing problems - I can't take it at all.  Norethisterone is not bio identical either so even if the oestrogen part of your HRT is, this will undermine all the good work it is doing - it certainly did for me anyway. 

If the Premique and the Elleste didn't work, I can't understand why the Kliovance would be any different or why your doctor is presevering with prescribing oral HRT.  Sorry if this is unhelpful but I think your medication needs reviewing and I would suggest you ask your doctor about a transdermal oestrogen (preferably the gel) and Utrogestan, a bio identical progesterone. 

I hope that is helpful.

[Hurdity]

Hi Annie58

Thanks for the update.

To add to what I said before ( re the Kliovance being the same preparation as Elleste albeit continuous combined) just to repeat I still can't understand why your doc sent you for a scan because the preparation you were given (if it was the two different types of tab you described) is designed to give a withdrawal bleed so no action was necessary. If you went to the doc about the bleed this is because they gave you (presumably) the wrong preparation and didn't tell you ( or maybe didn't even realise?) that this induces a bleed!!!! It is only bleeding at the "wrong" time that warrants investigation. However good to be checked out - I wouldn't turn down any reasonable gynae investigation I was offered.

Why I asked you how you felt about the Elleste ( the second part - as you say it was the type with two different tabs - so I'm talking about the second part of the packet) - was because I said that the Kliovance had the same prog in it.

 As i said before if you felt rough on the second part of the pack then Kliovance is not the one to take!

I agree with Mary G re not taking oral HRT if you have stomach problems - the doc should know this. They are not doing you any favours through their lack of knowledge are they?! Here is what it says on this site:


Route of HRT.

    If estrogen is only required for vaginal or urinary symptoms, vaginal estrogen is available in the form of a tablet, cream, pessary or vaginal ring. If estrogen is required for more general symptoms such as flushes, sweats, joint aches or poor sleep, then it is taken in a form which circulates throughout the body and is known as systemic HRT. Systemic estrogen can be taken as a daily tablet, a weekly or twice weekly patch, daily gel, or a 6 monthly implant. Estrogen combined with progestogen can be taken by tablet or weekly or twice weekly patch, and progestogen alone can be taken by tablet, vaginal gel or by the progestogen releasing intra-uterine system-Mirena. The different routes of estrogen used have different metabolic effects (e.g. on clotting factors and blood fats) but the implications of the differences is controversial and the main factors determining choice of route are individual preference, response and past medical history. Most often, HRT is started in tablet form.

    Indications for non-tablet route.

        Individual preference.
        Poor symptom control with tablet HRT.
        Side effects such as nausea with tablet.
        Bowel disorder which may affect absorption of tablet therapy.
        History of migraine (when steadier hormone levels which may be achieved with a patch may be beneficial).
        Lactose sensitivity (all tablet preparations of HRT contain lactose).
        History of gallstones.
        Current use of medications such as anti-epileptic medication which may interfere with the break-down of tablet HRT.
        Variable blood pressure.
        High triglyceride levels.
        Risk factors, family history or past history of deep vein thrombosis or pulmonary embolus, after full discussion and specialist advice when necessary.

http://www.menopausematters.co.uk/route.php

Hope this helps

Hurdity x 

[Annie58]

Thank you for your replies Hurdity and Mary G and apologies for not responding sooner.  I went for the scan and they ended up doing an internal one.  I go back next week for the results but the nurses told me whilst I was there that there was evidence of a couple of fibroids.  They seemed to be taking measurements and I can't say I understand what that was all about. They said the GP will make a judgement on the HRT based on the readings.
Mary, I was never offered anything else but oral HRT.  In the very beginning I tried the vaginal pessaries but they weren't enough to cope with the night sweats.  That was my choice initially as I was tryng not to take HRT.
Nobody has ever mentioned that the oral medication could increase stomach problems.  When I started the tablets I did get a feeling of sickness (like morning sickness) but this did settle down and was quite different to the acid reflux. 
I am under some stress at the moment and I could have done without the enforced changing of my HRT.  We are moving house in two weeks so will get a new GP soon!  Incidentally, I opted to see this particular GP as she was meant to have an interest in Gyne matters.  She certainly didn't seem to know the HRT preparations though judging by the time she spent looking through the manual.  Anyway I will see what she says next week.
The other thing worth mentioning is that when I've looked up on the internet about urinary issues there is some evidence that HRT worsens this rather than improves things.  Things certainly seemed to worsen when I started on the latest HRT.