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[Hurdity]

Hello -
Thanks for the advice here - I ended up going to both GP and consultant privately.  I've paid for bone scan and ultrasound just to make sure that nothing was wrong. 

Blood tests also ordered to see if I do have reduced FHS levels. 

My GP was not amenable to starting HT now - she ordered FSH levels to be tested now and in 6 weeks.  Based on the results she will prescribe (or not prescribe) hormones.  She wasn't interested in giving me a bone scan or a trans-vaginal ultrasound.    And she didn't seem to care that I am having horrendous symptoms and that 6 weeks feels like an eternity without some relief.

I am working hard to change diet and exercise lots and get sleep, etc to the best state.

Will go back to the consultant on Thursday to get prescription - Oestrogel & progesterone.  Does this sound like a good place to start? 

I am wondering if anyone saw relief straight away?!  My moods and irritability are now trumping the hot flushes and sweating and that's saying something!  I am really struggling to control my anger and irritability and I have never been like this before. 

I have read up and researched more but one thing I don't understand is where the mood swings come from - if oestrogen is declining, why the ups and downs and such terrible irritability - (I see from reading here that I am not alone.)

Thanks!

Just to reiterate what I said in my earlier post that your doctor is quite wrong not to agree to your starting HRT at your age based on your symptoms. Also she should let you have the HRT that you choose for the reasons that you give. I would recommend everyone to do their research before going to the doctor re HRT and especially the NICE Guidelines and the first two paragraphs on this site under Menopause diagnosis:

"The diagnosis of menopause and the menopausal transition should be made from a combination of factors with most emphasis being placed on the pattern of periods and presence of menopausal symptoms. Over the age of 45, the absence of periods or infrequent periods along with symptoms such as flushes and sweats can alone be used to diagnose the perimenopause or menopause. Blood or urine tests are unnecessary and are not recommended. [Ref 90]

Measurements of hormone levels are most useful when early or premature menopause is suspected, following hysterectomy with conservation of ovaries when there is no period pattern to observe, when unusual symptoms are present and when fertility appears to be reduced"

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

Your doctor is out of date here. Despite having been to a private consultant I would still go back to your GP and tell her what you want to do and your reasons (ie start HRT and which type). It is shocking that we have to educate our doctors (and great that we can educate ourselves), but I feel that those fortunate enough to have read about it, found this website and the information should if possible try to pass it on - for the benefit of other women after us. It's all going to take time so anything we can do to help ourselves and others - can only be of benefit! Even if you have got your prescription privately you will want to continue with the same prescription thereafter from your GP so you will want to have this discussion anyway.

I would still agree to general blood tests to test for everything as I mentioned before - as a baseline - and any good doctor should order these. No need to wait to start HRT though. Get the blood tests (and make sure your doc has ordered the whole range), get a prescription for HRT and then begin

You should begin to notice relief of flushes and sweats within a few days of using transdermal HRT - I certainly did using patches.

Oral progesterone isn't balanced by oestrogen - but can lead to side effects in some women. Like Mary G I have only ever used Utrogestan vaginally as I'm a nil-by-mouth gal when it comes to HRT!

Do keep us posted.

Hurdity x

[VerityDreamer]

Thank you - have only just seen this reply - not sure why I didn't get an email notice about it.

I agree re educating the GP - I had planned to do that when I went in but I could see that there was absolutely no point - she is an aggressive Mirena pusher and has very clear views on what to do from here. 

When I go back, I will see my usual GP who is more amenable to working with me.  The GP that I saw is the practice's "hormone specialist" so I assumed that seeing her would be best but it clearly isn't. 

My plan is to get settled on hormone therapy via the consultant and then go to my GP to get the regular prescription after a few months.  I think my regular GP will be better - I have a child with complex medical needs so am somewhat exhausted with medical management and 'advocacy' - I just want things to be easy for once and paying just made it easier. 

I have just had my first result back from the blood test that the GP ordered (I can see that the NICE guidelines are that she can diagnose menopause based on 2 low FSH tests 4 to 6 weeks apart) - My first Serum FSH level was 72iu/L.  There are no laboratory specific ranges on the test results (I see them online so probably the GP has the ranges on their information). This is postmenopausal levels as far as I can tell. 

However, I am worried that I have been using the Progesterone cream when I had the bloods taken and I see now that the guidelines are no hormone therapy when establishing FSH levels - does anyone know if the Progesterone cream would skew the results? 

I will ask the consultant tomorrow as I go back to see him then but I just want to make sure that I haven't messed things up. 

Also, Hurdity - can you explain what you mean by "Oral progesterone isn't balanced by oestrogen"? 

I understand the need for progesterone is to protect the womb but not sure what this means? 

I am seeing the consultant tomorrow and I will ask for transdermal in both progeserone and oestrogen as I have had recent elevated liver markers and am worried about straining my liver further.

I can't wait to start the therapy - I am so moody and hot and sweaty. 

Thanks so much for your replies - it's been an absolute lifeline for me. 

[Dancinggirl]

Hi VerityDreamer
Hurdity is definitely the one to answer most of your questions. However, you are right that progesterone is there to protect the womb lining from building up but the amount of progesterone used needs to be balanced against the oestrogen being used - so in the pill or patch form of combined HRT this will have been formulated correctly.
When using progesterone and oestrogen separately the balance needs to be taken into account so the right amounts of both are used - the lining can become thickened and problematic bleeding is often the result if the balance isn't right.  I wouldn't rule out having the Mirena as this can be a ‘no hassle' way to protect the womb and allows as little or as much oestrogen to be used alongside - it will shrink fibroids and polyps (if they are present) and often results in no bleeding at all which can be a big plus.
Here on MM we tend to advocate using HRT in a sequential regime to start off with so you can gage whether a particularly type of progesterone suits you. Whilst many on MM are very keen on Oestrogel or oestrogen patches with Utrogestan (micronised progesterone), your consultant may suggest you try a normal combined HRT patch first and these can be very good. Finding an HRT that suits you is trial and error and we are all different - so what works for one women may not suit another. I had a premature meno so have used HRT on and off for the last 25 years - I've tried just about everything and some HRT combos were successful and some were not - Utrogestan was the most problematic for me.
I doubt very much that the progesterone cream would have influenced the FSH test as it is very low dose - it might have influenced a test for progesterone if that had been tested. Your reading for FSH was high, so clearly indicating menopause.
I would follow the consultants advice, see how it goes and enjoy getting your life back on track.  DG x

[VerityDreamer]

Thank you, Dancinggirl - that is very helpful information and reassuring about the progesterone cream - especially as I am paying for one set of tests, I didn't want to skew them in any way and have to repeat them. 

I wish the Mirena suited me in all ways but I saw a noticeable improvement in a few things when I had it removed but I wonder if the improvement was because I was having progesterone (through the Mirena) with NO oestrogen - as I hadn't realised that I was menopausal.  I am worried that I may have been menopausal for 5 years and not known it - especially in regard to bone thinning.  I will get the bone density results tomorrow. 

I also just checked my Oestradiol levels on my blood tests - it is 18 pmol/L!  That is really really low as far as I can tell - right? 

I hope there is not too much trial and error for me in getting the hormones correct, as I am practically homicidal when I get "hormonally" angry and I've never been this way - am trying to take it out on the treadmill rather than the people around me. 

Thanks for your support. 

[Dancinggirl]

VerityDreamer - I am certainly no expert but your readings do sound very low so you are probably post meno.
I don't think you have told us your age?  Have you had any periods since having the Mirena removed? 
If you had the Mirena while you were peri meno, without any oestrogen, then it may well have given you some side effects.  The Mirena with oestrogen may well be a good option for you if you don't want to have the bother of monthly bleeds.  If progesterone gives you PMT type symptoms or low mood, then taking any progesterone, either orally or transdermally, on a continuous basis can make these symptoms worse - this is why we always suggest you try a sequi HRt regime first. The Mirena gives you transdermal and more local absorption of progesterone but in much lower doses than any other form of HRT progesterone, usually results in no bleed at all after the first few weeks and allows you to use as little or as much oestrogen as you need. 
I am not suggesting you should go for a Mirena at this stage - I actually think you need to try a combined sequi combined patch or possibly Oestrogel/oestrogen patch with separate progesterone in a sequi regime first to see how you get on.  It is about finding the right progesterone that protects you womb lining whilst giving the least side effects.
Just keep an open mind and see how it goes.  DG x

[VerityDreamer]

Thanks, Dancinggirl - I haven't had a period since having the coil removed. 

The consultant started me on Estraderm MX 50 patches 2 x a week.  I started today.  I also have days 1 to 10 to take Utrogestan 2 x 100mgs per day.  So I will be taking that for 10 days out of the month starting 1 October.  I am really hoping that I don't have a bleed!  I haven't had one in 5 years and it's been the only positive of all this!

I am 45.  I haven't had a bleed since I had the coil put in over 5 years ago.  My bloods from both the GP and the Consultant show that I am menopausal.  I clearly went through peri-menopause without knowing it due to the coil. 

The coil did not suit me at all, I had terrible bladder problems that I'd attributed to "getting old" and when I had the coil removed the bladder problems stopped.  Maybe it was because I had no oestrogen though.

I am having daily migraines and hot flushes, profuse sweating (yay) and very irritable, the worst in my life.  I really hope that this regime helps with something.  I am so desperate as I can see that many here are too. 

Ok, now to go lay down in a dark room so I don't commit homicide due to the ragey hormone / migraine combo. 

HOpe you are well. 

[Hurdity]

Hi VerityDreamer

Just to say you are likely to get a bleed when you use utrogestan in this way (first 10 days of the month) - as it is necessary to shed the womb lining. If you are post-menopausal then you can take progesterone all the time but best to start cyclically so that you can see how you get on with the oestrogen on its own. If you are happy on both parts of the HRT ( ie oestrogen alone and when you add progesterone) then you could try taking it all the time. However many of us continue with a cycle even into our 60's because we don't like taking prog all the time due to side effects. I'm sure many women are fine though.

It is probably a good idea also to use vaginal oestrogen to prevent further bladder problems and vaginal atrophy - such as Vagifem or estriol cream.

I hope you see an improvement soon - especially in your headaches. I presume you've had these checked out separately to rule out other causes?

Hurdity x

[VerityDreamer]

Hello,
Thanks, Hurdity for the reply - yes, the migraines are primarily hormonal as I've had them off and on my whole life depending on what type of hormone/birth control I've been on - I can and do have other known triggers but usually hormones.

I'm now 5 days into wearing the patch - it's a nightmare to keep on!  It stuck on my abdomen for about 2 hours so I put a Tegaderm patch over it to keep it on (fortunately had some at home that I use for my son) - then the next one I tried on my upper thigh and it fell off immediately too so I have had to buy Tegaderm to stick over it. 

The consultant said it would take time to build up oestrogen levels - I am already feeling relief from the hot flushes, (still having small tolerable flushes) massive sweats (I didn't realise how little I sweat until it stopped - I was like a water spout sweating so much!) and the homicidal rage that I have never ever had in my life has passed without jail time which is great. The racing heart and night waking is gone too. 

However, I am weepy, sad, hungry, and feeling anxious which I was not feeling before. 

I guess I just want some reassurance that things may settle? It's early days, right?

I read about the patch not sticking for lots of women and got the Tegaderm idea here so feel ok about that issue but the emotional stuff is a bit tricky and I can't seem to find more info here about that. 

I'm not sure about the extra vaginal oestrogen for bladder - the bladder problems seemed to have been caused by the Mirena as they are much better now that it is out (it's been 3 months now).  Maybe I should mention this to the consultant next time I see him though.

I hope the Progesterone helps with the negative symptoms that the Oestrogen is causing.

Thanks for the help, this has been a lifeline. 

[VerityDreamer]

Hello,
I am just following this up - I started feeling better over time but then got too fatigued  - I mean zombie level fatigue, not able to undertake daily tasks fatigue.   

I stopped the Utrogestan 100mgs per day and then still didn't feel better so I cut the 50mcg Ustrogen patch in half and felt a little better.

I'm now just on the 25mcg Utrogestan patch and don't have any symptoms except completely debilitating fatigue!  I cannot function at all although my mood, migraines, vertigo, hot flushes, sweats, - everything has stopped.

The consultant wants me to hold steady here for a few weeks as I stopped Utrogestan and Progesterone at the same time. 

I'm wondering if anyone else has intolerable levels of fatigue even on low doses? 

I haven't noticed any return of negative symptoms with the reduction from 50 to 25 and I'm wondering if I shouldn't just quit the HT altogether.

Also, can anyone tell me, what is the lowest dose Progesterone that you can take and still have womb protection?  I can't seem to tolerate the 100mgs but it looks like on the information here that that is the lowest dose in capsule form. 

Thanks for any replies!

Verity

[Dancinggirl]

The fatigue may have nothing to do with HRT.  HAve you had your thyroid function checked recently?? 
Also chronic fatigue can be an issue for many - sometimes triggered by a virus, the fatigue can last some time.
Also, maybe diet issues? Are you low in vitamin D or iron or B12?

I'm sure your specialist is the best one to advice about appropriate dosage of HRT - from what you are saying I think you are on the lowest dose.  Unfortunately Utrogestan can make one feel sedated and you are still taking this every day - you might do better to use Utrogestan sequentially (so just 10-12 days each month) and possibly vaginally but you then have to put up with a withdrawal bleed each month.   The 25mg oestrogen dose is very low and at the moment you may be taking too high a dose of progesterone in relation to the oestrogen.  DG x

[CLKD]

What support do you have with regards child care?  Is there a support group or support organisation?

Crashing fatigue bothered me during my menstruating years and I remember my Mum sitting down and dropping straight to sleep …. didn't know at the time why 

[VerityDreamer]

Thanks for the replies!  I've had thyroid function, and other things checked because I had a sudden onset of lots of symptoms all at once after having the coil removed.  I've had MRI scan and masses of blood work.  I'm on Vit D and other supplements including B12 because I was having migraines almost every day after having the coil removed. 

So right now I am just on the 25mcg Estraderm Patch and nothing else and still feeling the severe fatigue.  It's only been 12 days since I halved the Estraderm and quit taking the Utrogestan so maybe I'll give it more time and hope the fatigue passes.  It's so nice not having any other symptoms though - I'm so glad that it's helped all the other symptoms.   

I'm ok for childcare, thank you for asking.  It's a struggle but I just take 4 caffeine tablets at a time when I need to move around for a while.  I'm sleeping about 12 hours at night and 2 to 3 hours during the day which is difficult but I'm managing to keep everyone fed and clothed right now.  Ironically I've had difficulty sleeping my entire life and now I can lay down and go to sleep in a few minutes and sleep for hours - I've never had this in my life. 

I guess there is nothing more to do but wait and hope more Estrogen clears my body and some energy returns. 

Thanks, Verity

[Hurdity]

Hi VerityDreamer

Sorry to hear about your fatigue.

Can I just clear something up for you. It is not the oestrogen causing your fatigue (it doesn't work like this in any way at all!) - it would be more likely to be lack of it or too much progesterone, or malfunctioning thyroid or low testosterone, if not a severe vitamin deficiency - but this is unlikely if you are taking supplements although maybe you are taking too many or too high a dose? It is very important to get most of the nutrients you need from your diet.

Also to clarify - you were talking about utrogestan patch - but utrogestan is the progesterone capsule. I presume you were talking about the oestrogen patch?

That oestrogen dose is far too low as Dancinggirl says - if you have reached menopause - but as you say you don't know where you are. As I/we said earlier unless you had gone several months since having the coil removed you don't know whether you are post-menopause or not so on this basis and because of the sedating nature of the progesterone I strongly recommend ( as I/we did before) that you take the progesterone cyclically and increase your oestrogen dose. Sleeping that much is not normal and has to be due to some sort of deficiency/malfunction - unless you've had a serious virus recently (so could be post-viral fatigue) or are very depressed - which can also cause fatigue.

Are you seeing a GP or menopause specialist? Please go back and ask for a referral and especially in relation to your fatigue. If you like patches I would recommend Estradot which are very small and stick well ( I probably mentioned these before) and at least a 50 mcg dose. Then you can take Utrogestan for 12 days per month - initially at 2 x 100 mg per day but if you want to take it vaginally may be able to reduce (either dose or days) with your doc's permission and depending on your withdrawal bleeds.

There is no other way - ie if you don't want a bleed then it has to be the Mirena, and taking progestogen all the time at your age is really not recommended. I didn't realise you changed to taking 100 mg per day?

Please do have another think and read more about the role of progesterone and oestrogen - and not from cranky US sites that want you to buy progesterone cream as they will make you believe that you are deficient and it will solve all your problems!!!

Also if you have reached or are near menopause - I am sure we will have said earlier that you need a decent amount of oestrogen to help protect bones and heart - and the licesned dose for this is  50 mcg minimum.

Hope this helps and let us know how you get on - and hope you manage to sort out your fatigue very soon!

Hurdity x

[VerityDreamer]

Hi Hurdity,
Thank you for your reply, it's very helpful.  The problem that I have is that I had a huge crash all at once and unravelling what is what is very difficult.

In the past oestrogen has caused me severe fatigue so I had thought that maybe the Estraderm could be contributing to the fatigue.  I understand that Estraderm generally is energising rather than sedating but I have always been very sensitive to hormones with fatigue and migraine being symptoms throughout my life. 

I am still seeing Mr. Dooley so he is prescribing what I am taking.

Although I did take only half of the prescribed Utrogestan (he prescribed 200mgs for 10 days) and I took 100 mgs for 18 days. I did not take it as he prescribed it - I had a reason for this but it's convoluted and I won't go against what he says again.  He has said to hold off on the Utrogestan for now, settle on an Estraderm dose and then we will sort out the Utrogestan dose. 

"Also to clarify - you were talking about utrogestan patch - but utrogestan is the progesterone capsule. I presume you were talking about the oestrogen patch?"  Sorry, Hurdity, I get these names confused all the time  - I now have them in front of me so I won't conflate them!  Yes, I was talking about the Estraderm Patch! 

Mr. Dooley said categorically based on my hormone tests that I am menopausal, not peri-menopausal.  I am going tomorrow to have the 2nd blood test though (for my NHS GP) so she will eventually agree to prescribe the HRT regime that I settle on with Mr. D on the NHS.  I know I am now on Oestrogen so that will cause my bloods to change but all I can do is what she said for me to do and hope she then agrees to follow Mr. D's prescriptions. 

I will have to review the 25mcg vs 50mcg in regards to bones and heart with Mr. D.   I am not having hot flushes or any other meno symptoms - my mood is good, I am not sweating, I don't have migraines on the 25mcg.   The only symptom I have is continuous fatigue - I should say that it isn't crashing fatigue, my fatigue is not lessened by sleeping and is constant. 

Today I had a 3 hour nap and had to take caffeine to wake up, I don't feel better after sleeping.  Mr. D has prescribed the Estraderm 25 so I would assume that he thinks it's not too low.  However, he said to try it for 3 weeks and then we are reviewing. 

I am confused about the fatigue and will keep looking for causes and try to find anything that helps.  It's very frustrating as I was an active, exercising, healthy person until I had the coil removed and then everything fell abruptly apart.

Anyway, sorry for the confusion in my posts.  I am so tired, posting here is a huge effort which sounds whiny and exaggerating but I promise it isn't.  Will try to query things with my Dr. again. 

Thank you all for your replies.