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[Lizab]

Just an idea- maybe 2 is actually not enough? You say you are a year post surgery, could it be that your levels have taken some time to drop to produce these symptoms and it's coincidence that you've recently started the gel? I'm only putting that idea out there in case backing to 1 pump doesn't help. You're "too much" symptoms sound very much like my "not enough" symptoms.

[MIS71MUM]

I'm inclined to agree with Lizab.  I was woken up with an electric shock type feeling this morning and my hot flushes are back. It crossed my mind that maybe I have become used to my 1 pump. Going to give it a few days and then may increase it.

Husband has a cold, so want to ensure that I'm not coming down with his bug before increasing. 

How are your other symptoms?

[Hurdity]

Tempest - in your case I do think blood tests may well be helpful because it is the only way to see how much oestrogen you are getting and because of your symptoms - which as Lizab says could be also be due to too little oestrogen. As I said before in your condition (total hyster with BSO) you should need a much higher dose due to the fact you are making very little of your own. One blood test won't tell you a lot as it varies according to time of day - but it would be a start especially as your levels should not be fluctuating.  As it stands 1 pump isn't sufficient to protect against osteoporosis according to the general info (although of course every bit of oestrogen gives some bone protection).

The oestrogen dominance thing is an old chestnut not backed up by proper scientific evidence/trials. Its role in any quantity in post-menopause has not been established. Oestrogen "dominance" does occur during peri-menopause when there are anovulatory cycles ( no ovulation) - which can lead to heavy bleeding since progesterone is needed to oppose the oestrogen effects on the endometrium (womb lining). However the need to use progesterone to counter the effects of oestrogen elsewhere in the body is not consistently supported by evidence - although may help a very small proportion of women according to some sources. The information out there is usually biased and produced by those selling - guess what - progesterone creams - as in the link in the post below given by Mother bean.

I hope you're feeling better today

Hurdity x

[Mary G]

Tempest, I agree with Hurdity that blood tests would be a very good idea in your situation because you need to know how much oestrogen is getting into your bloodstream.  I soak up the gel like a sponge and you could be similar but you need to find out first by having the blood tests because you then need to tailor your oestrogen dose.  I need very high blood levels of oestrogen and have to keep it high all the time and you may also need to do this, particularly at your age.  I very much doubt you need any progesterone but you might need to testosterone at some point in the future.

I think you might need to consider upping and splitting the Oestrogel dose to 1 pump every 12 hours to keep your oestrogen levels up - I have been doing this for a while now and it works really well.  I certainly think that 1 pump of Oestrogel everyday is far too low. 

Why on earth doesn't your consultant want you to take HRT, has he given you a very, very good reason?  You are only 47 years old and have had your ovaries removed and he expects you to do what exactly?  Live with all the debilitating symptoms for years on end and then end up with some dreadful condition caused by years of oestrogen deprivation?  I don't get it.  I thought the new NICE guidelines meant there would be consensus amongst medics but it seems we still have a very long way to on on this one.

Most importantly Tempest, please don't allow yourself to be taken off HRT by anyone and if necessary, find a doctor who will prescribe it for you.  I know Professor Studd would happily prescribe it for you and your experience explains why so many women still have to go to him for help. 

[CLKD]

Maybe the whole of the NHS has been advised to save money?

[babyjane]

I don't want to get into the whole HRT question because we have differing opinions.  However when I had my hysterectomy there was a lady on the ward who had everything removed (including her ovaries).  I can remember that she could  not be discharged and had to wait until the consultant had signed off the prescription for her HRT patches.  It was an undisputed matter of course because she had her ovaries removed.  My neighbour also had everything removed shortly after her son was born and was automatically given oral HRT tablets before she was discharged from hospital.

It seems odd to me that nowadays women are having this surgery without the necessary HRT replacement being given.  Without ovaries where are they supposed to get it from? 

I only lost my womb and kept my ovaries so I did not expect to require it.

[CLKD]

Wouldn't it be lovely if, at the initial Consultant, that the Surgeon/Registrar talked to the patient about what follow-up treatments may be required - regardless of speciality?  This to be discussed prior to the surgery? so that any questions that have arisen between the initial consult and admission can be talked through?  Regardless of who will eventually pay for on-going treatment?  What held up patient discharge in many instances was the need for notes to be written, prescriptions to be signed by the SHO/Registrar and the time it took for Pharmacy to dispense  .

Of even further back than that: when a patient goes to the GP *they* discuss possible on-going treatments?

[babyjane]

Ha, when I went to my GP she said 'would you like a hysterectomy?'  my reply was 'yes please'.  6 weeks later I saw the consultant who repeated the question and I repeated my answer.  Job done.

Sorry Tempest, I have digressed this thread 

[Tempest]

Hi ladies! Thank you all so much for your help and support. Today has kinda been ok. I can tell my dose is needed though now at nearly tea time. I'm glad I dropped to 1 pump last night as I was fast turning into a gibbering wreck and I have been calmer today.

I have been discussing this with Hubby. We are going to insist on tests being done to check my levels. This guessing is just nuts! Apparently, this particular Consultant is a bit notorious for not putting ladies who have had everything removed on HRT. He doesn't like it at all! He actually told me if I walk enough, this should be sufficient to protect my bone density when I saw him in clinic at my 3 month review. I was rather dumbfounded to say the least.

When I had my surgery, it was all such a rush. I had the scan, and had the surgery 3 weeks later. To top it all, I had just buried my Dad a few days prior to getting the scan and was feeling really vulnerable emotionally. It all came as a huge shock all at once!  I did have the presence of mind to ask both the Consultant and clinic nurse at that time about what would happen after surgery regarding HRT. The nurse I remember said 'ohhh, you probably won't need it'! I have no idea what kind of racket their running at that particular Gynaecology department but all I can say is that I had to self refer to the menopause clinic as the Consultant wasn't going to help, and my GP didn't have a clue about HRT - the lady GP I saw said she wasn't 'clued up' on starting doses in someone 'in my position. To say it's been a hellish year is an understatement!

MaryG, I think you're right about the dose you suggested every 12 hours. This is going to be my next step once ive had a few days to 'wash out' and calm myself a bit. I got the feeling that I was getting a big surge from doing 2 pumps at night, and then it was running out. The feeling was like being on a rollercoaster! I agree with you and Hurdity that 1 is very probably not enough to protect my bones etc.

I must admit, both Hubby and I are getting a bit emotional about all this now. He is seriously wanting to kick someone's backside, I can tell you! He's been brilliant the last year, but I know it's been tough on him too. He worries when he is at work if I am doing ok, and I've really been trying my hardest to cope and he says that he knows I have. He also says that he feels I have been made so anxious about going on HRT, that this might be a factor in how I'm feeling right now and I think he's right. When the 'expert' keeps telling you no, you wonder if you're going against them and it's a bad idea. I've been under this Consultant for 10 years, seeing him approximately every 6 months as I had a complex Gynae history due to previous surgeries, multiple complex cysts, extensive adhesions etc. I thought he 'had my back', but it doesn't feel that way now I must admit!

[babyjane]

Of course I don't know the full story but it sounds to me as though you have been let down quite badly 

[Lizab]

That does sound awful. I had to leave my gynecologist group in the midst of all my issues, and I was hesitant because they knew my history, had already done some testing, and I didn't want to backtrack and have to go through the same tests all over again. And I had really likw my doctors there, but they weren't addressing my problems. I dealt with "This is what women have to go through. It's normal" for two years before I desperation and frustration drove me to my gp. Thank heavens I did. I can't imagine where I would be now if I had stuck with the gyne group. Maybe you should consider changing providers? I know that is scary when you are in the middle of an issue, but if they aren't helping, maybe another provider with a fresh perspective could help.

[Mary G]

Tempest, that all sounds pretty dreadful.  You have been very badly treated by people who do not know what they are talking about and have very outdated methods.  To tell someone of your age who has had their ovaries removed that they do not need HRT is a complete nonsense. 

Why don't you email Dr. Currie and get her opinion?

I'm not surprised that you and your husband are finding this very difficult to cope with and on the back of losing your father too.  You really must get some help from a sympathetic doctor who is up to date with the current thinking on HRT and please don't leave it too long.  If all else fails, why not book a proper appointment with Professor Studd, I know he will disagree with your consultant.  Perhaps you will hear from him next week via email?

In the meantime, I would try to do the split gel dose of 1 pump every 12 hours.  I have to do this to keep my levels up but other women find that if they use too much gel in one go, it leaves them feeling wired and restless and they find it difficult to get to sleep. 

Sorry you have been put through this hell. 

[CLKD]

If a Consultant doesn't believe in the after care why is he/she in the job  and why are the GPs local to that Consultant referring patients ………… 

[Tempest]

Thank you all so very much for your kind words. It really does mean a lot. 

Just a wee update of what has been happening today. Well, for sure I know 1 pump isn't enough as I said today with sweats again and the brain fog and joint pain has returned. At least now I know for sure!

Also, today I attended the appointment my GP referred me for at the CMHT for assessment for CBT. This was before I started HRT, and before I self referred to the menopause clinic. The CPN I saw was very helpful and listened to my 'story'. After which she snapped her notebook shut and said 'you are a very well balanced lady who has been through a lot and needed help which you hadn't received with your hormonal needs. I really don't think you need to be here, but perhaps counselling might help after all you've been through'.

Hoorah! Affirmation at last that I'm not actually losing my mind. I'd had my doubts this last year, I can tell you! She has given me details of a private counselling service which isn't 'time limited' as it is in the NHS, and which charges a very reasonable fee. 'When you're ready', is what she said. I am pleased with this outcome!

[CLKD]

EEEMMM …….. you have been listened to, however, you should  not have to pay for counselling services.  There is a wait and your GP should have an idea as to how long that list is likely to be for someone recommending that you should pay for initial services  .  I have no problems with paying for treatments but if she had a client unable to pay?

I would tend to go for the NHS version first and if necessary, pay for any extra if I felt it was helping, although it is nice to build up a working relationship too with a regular counsellor ……..