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[Henrietta]

Hi- Post Hysterectomy and Oopherectomy so no ovaries. Been on HRT Ellest Solo over 3 years but looking to change. Been advised Estrdiol is strongest sort of Estrogen but natural Estrogens incluse Estriol, Estrone and weaker Estrogens.
GP thinks I don't need Progesterone as no womb lining so won't entertain prescribing that. She gave me an alternative prescription todya for Hormonin which she said was Estriol and Estrone but no one stocks it anymore and no one can order it. She mentioned Prevarin (Sp) - horse wee based and think I have read bad things about that .
Can anyone recommend what to ask for in tomorrows new phone appointment with GP?
Symptoms- low B12 and Folate- started supplements, Thyroid tested and within their parameters although looking into further investigations on that front once I have trialled alternative HRT. Symptoms, always hot, rubbish at sleeping, too fat, achy muscles are the main long term issues.
Thanks for any suggestions

[Dancinggirl]

Hi Henrietta
I do think we can over think things when it comes to HRT.  Basically most oestrogen preparations available these days are bio identical and many of us swear by the patches or Oestrogel - both of these contain natural oestrogen and tend to be more effective than the pills. 
I have always liked the Oestrogel whilst others like the convenience of patches -  gel is applied to inner thighs either morning or evening and you can use between 1-4 pumps per day depending on the amount you need to control your symptoms or go for an Estradot patch as 50mg,75mg or 100mg  - usually within 2-4 weeks you will be feeling much, much better.
HAve you had your Vitamin D level tested?  Many of us are low in Vit D which results in aching joints and fatigue.  In the last few weeks I have been using a Magnesium spray every night and I'm sleeping much better.!!!!  DG x

[Henrietta]

Hi Dancing Girl, many thanks for reply. yes I had a Vitamin D blood test and the results were as follows
Total Vitamin D :
Status:

81.8 nmol/L
ADEQUATE
Interpretive Guide:
(25-hydroxyvitamin D 3 : 79.0 nmol/L, 25-hydroxyvitamin D 2 : 2.8 nmol/L)

Thanks fo r reminding me about Magnesium, haven't t aken any lately and I did find it helped with achiness.
Thanks for the names of Oestrogel and Estradot.  I've googled both these and they seem to be alternative ways of delivering the same hormone Estrdiol. Is this the only Estrogen available these days.  Is it more beneficial to have it slowly releasing from gel or patch rather than all at once in a tablet? I've never had anything but tablets.

[Dancinggirl]

I think the oestrogen available in most HRT preparations is basically what is deemed appropriate and effective by NICE and the health professionals. Using oestrogen transdermally by patch or gel is considered the best option as less is needed - taking pills means a higher dose is needed as absorption is impaired as it passes through the digestive system and liver -   one needs to use less oestrogen to get the best effect if delivered through the skin. We do store oestrogen in our bodies so the speed of absorption is not that relevant. If you are still getting some meno symptoms then I would assume you need a bigger dose - using transdermal oestrogen should help with this. DG x

[Henrietta]

Many thanks

[Hurdity]

Hi Henrietta

Just to add that as Dancinggirl says estradiol is as "natural" as estrone and estriol but it is the main oestrogen in terms of our oestrogen receptors (although estriol is also effective in vaginal tissues due to different oestrogen receptors there).

You haven't said how old you are but you mention "too fat"! As you suggest this could be due to thyroid problems - do you know what your results were for TSH and any other thyroid hormones measured? Do you have any other symptoms of underactive thyroid eg feeling cold (doesn't sound like you suffer from this?), fatigue, as well as weight gain?

If it is not thyroid then it could just be due to slower metabolism which is a feature of ageing so you will need to change your diet and exercise more in order to lose the weight. This in itself should make you feel better but of course does not replace HRT.

I quite agree with Dancinggirl that transdermal oestrogen will be better for you than tablet oestrogen - although you didn't say your dose of Elleste?

The other thing is you may also be lacking in Testosterone and having had ovaries and womb removed you should ask for a referral for testing and possilbe treatment with Testosterone,. Symptoms of T deficiency would be classically low or no libido, but also muscle pain especially after exercise and generalised fatigue, lethargy, lacking in energy - which is also true of underactive thyroid too!

Hurdity x

[Henrietta]

Hi Hurdity
Many thanks for reply. I'm on 2mg of Ellest Solo and have been looking into hypothyroidism on a couple of thyroid web sites and have had some blood tests done. I think I do have undiagnosed Hypothydroidism , mentioned this to GP but she glossed over it and I can't afford private appointment right now so thought I would tweek the HRT to start with .

I do have other hypo symptoms- crash fatigue especially after lunch when I often sleep for a couple of hours, rubbish at staying asleep at night and seldom get more than 2 hrs in a row, low basal body temp ave 36.1 early morning and late evening, feel hot all the time and don't do cold, aches and pains, acid reflux in the form of coughing with tickly throat so on Omniprazole,too fat, stressy so on citalopram and fibroids pre surgery- they are the main ones which do all tie in with hypothyroidism.

I've never had Testosterone tested.
The blood test results show I'm a bit low on Folic Acid and B12  and less than optimal vitamin D. GP has given me calcium and Vit D supplement plus Folic Acid but can't refer me for B12 injections as not low enough on their scale.
These are some of my results
CRP- low 9.6 indicating inflammation
B12 low at 209
Serum Folate low at 7.92
TSH 2.94    (0.27-4.20)
Total T4 123.4   (64.5-142)
Free T4   13.99
Free T3    4.01
Vitamin D 81.8 nmol/L

Trying to eat better including more fruit and veg and less rubbish.

Any more thoughts most welcome!

[Henrietta]

Hi Sparkle
Thanks for all that. Sorry I didn't mean to confuse you by talking about Fibroids- they were in the past and I had my hysterectomy and oopherectomy back in 2012.
Someone else advised me the Omniprazole would be contributing to low B12. I've just bought a Nutribullet and hope to improve my fruit and veg intake.
I've tried propping up on a pillow but really can't get comfy like that.
I try not to eat after 6.30PM . Will try and get off them if I can sort my diet out a bit.