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[Cathy]

  Hi I'm a new member and I'm so pleased to have found the forum - what a great resource. I am taking Utrogestan vaginal capsules 200mg (day 15-16) and Oestrogel - both bioidentical hormones as the synthetic ones gave me side effects. I saw a private doctor to start with as I was so desperate and had little joy with the NHS but now manage my own symptoms with the odd bit of help from my GP - meds through the NHS. They are reluctant to do bloodtests to check my hormone levels although had one about 18 months - two years ago which showed  I am not menopausal yet - FSH levels quite high. I have been on these meds for about 18 months but before that tried all sorts since starting peri-menopause symptoms aged 41 - I am now 49. As I have learnt...nothing stays the same for too long with my hormones and for the past three months I am sleeping really badly again, hot at night too and irritable, hormone-related IBS and hair shedding, sore breasts and migraines all symptoms for me that things aren't right with my hormones. Feel dreadful due to lack of decent sleep and even my usual off sleeping remedy isn't really cutting it. I generally sleep better once the Utrogestan has kicked in after a few days. I think I probably need Utrogesterone (progesterone) for more days during my cycle, which annoyingly is still regular as clockwork although now just last 3 days. Does anyone have any experience of this or advice please about what I could try?
Thanks so much
Cathy

[Dancinggirl]

Hi and welcome to MM
I had a premature meno so understand your dilemma. A high FSH indicates you are menopausal!!!
 I didn't get on well with Utrogestan - we are all different so it's trial and error finding the right HRT. Coping with poor sleep is difficult and HRT don't always help. I found Utrogestan gave me night sweats. Headaches and sore breasts are typical side effects of most HRTs.
You are using the Utro with Gel regime in a sequential way, so you will get regular periods.  The only way to tell whether you are truly post meno would be to come off the HRT for a few weeks and then have bloods tests.
You could move to the sequential version, so use Oestrogel daily with Utrogestan at 100mg daily - the standard recommendation for the Conti regime is to use Utro 100mg for 25 days with a 3 day break.  Here is the link on this site that tells you about the options:
https://www.menopausematters.co.uk/to_progestogens.php
Many women find using Utro vaginally every day can irritate the vaginal area and Utrogestan has a sedative effect that can also be a nuisance.
There are many women who use your regime very successfully and they will hopefully be along with advice.
DG x

[Cathy]

Thanks for your reply DG - perhaps I remembered my results wrongly - I will call the Doc's tomorrow and check them again but I remember her saying I wasn't close to menopause yet - but that was a while ago.
I'll see if anyone else can offer any suggestions - guess going 'cold turkey' is an option to get an accurate test result but I do worry that I'll feel really dreadful so would only want to do that if no other option.
Sleep well!
Cathy

[Freckles]

Hi there
If it's been 18 months since your last blood tests you probably need blood tests.
If you are getting your meds on the NHS seems sensible to me that they do them, as most likely you need a review and most likely menopausal (hence your recent symptoms). Seems illogical to me they don't.
I have a thyroid disease and have to have that checked via blood test on the NHS each year to get my prescription- seems bizarre they'll prescribe HRT for you but not monitor it via yearly blood tests
I get my hormones checked yearly on the NHS and fully prescribed on the NHS but see Prof Studd yearly as I was ( still am) disillusioned with the NHS, especially for effectively  treating the menopause.
Sounds like what worked for you before re Oestrogel isn't now and you may need a higher dose? The symptoms sound like lack of necessary oestrogen  levels (losing hair, anxiety, etc).
I use Ultrogestan vaginally (using a pessary dispenser) at 100mg a day for just 7 days each month, which I found more effective than talking it orally and with less side effects.  I get the necessary bleed that way
Hate taking progesterone  but needs must. 
No way could I handle the NHS guidelines of 200 mg for twice as long.  I'm progesterone sensitive/intolerant and it really affects my mood while I take it.
I'd suggest gong back to your GP and asking for blood tests.  Even being on HRT should give you indication of how you are re hormones levels.
I had to do that a couple of years ago- was on Femoston 1/10 tablets, realised I had all the classic symptoms of low oestrogen, asked GP for an increase, was refused  (too old at 55!) and offered anti-depressants instead. 
As I wasn't depressed, and my blood tests showed I had less oestrogen than most adult *males* (despite being on Femoston), declined AD's and got private help from Prof Studd.
Honestly do get your blood tests done and then research up to date information and make an informed decision about where to get help from.
Good luck xx

[Dancinggirl]

Cathy
Were you on HRT when the blood tests done 18 months ago? If you were then I think this would give a normal FSH reading but I'm not sure on this. Anyway, blood tests are notoriously unreliable , particularly when you are in peri meno and GPs are not good at assessing meno symptoms. You are displaying classic low oestgen symptoms and it may also be worth getting thyroid function tested as well. If you are on 2 pumps if Oestrogel per day then you should get a level of around 400-600 on a blood test for oestrogen.  There are different types of oestrogen readings, pmol or pg/ml, so hopefully someone will come along to tell you the difference.
Adjusting dosage is often necessary to control symptoms but be careful not to chop and change things too much to quickly as the body need time to adjust to changes.  DG x

[Hurdity]

Hi Cathy

 

The reason your periods are still regular as clockwork is due to the HRT ( as well as your own cycle). Sequential HRT (half the month oestrogen only, half the month oestrogen and progesterone) is designed to mimic the natural cycle and give a withdrawal bleed every month.

What was your cycle doing in the year leading up to starting HRT ( was this 18 months ago?) - had the cycle started lengthening regularly and becoming very variable? As Dancinggirl says blood tests are unreliable and not usually given - except under specific circumstances ( eg women with no uterus) and FSH now in any case will be affected by the HRT.

I agree that it sounds from your symptoms like the dose is too low although from what I've read on here some women do seem to get return of symptoms even on a high dose of gel so not sure what's going on there if you are already on a high dose? I only ever used ( still use!) patches and they have always worked for me - but I started in my 50's in late peri-menopause.  My levels are probably somewhere in the low 200s (haven;t had them done for ages). Due to your age, it is important to replace oestrogen. I did read that the aim of HRT was to replace oestrogen to an average level over the menstrual cycle which was somewhere between 300 and 400 pmol/l. I know Prof Studd (I think - I read somewhere a year or two back)) recommended at least 300 pmol/l for the feel good factor (even though many woman have less and feel fine like me!). However oestrogen levels per se are not really an indication of how any particular woman will feel - which is also partly why tests are not usually carried out.

Most oestrogen readings are in pmol/l but the conversion is: multiply x 3.671 (for pg/ml to pmol/l).

Why don't you keep a record of all the symptoms you are experiencing and see if there is a cyclical basis for them - eg not sleeping ( as you have said) migraines, etc? I used to get migraines on the progesterone withdrawal part of HRT ( still do sometimes)  ie a couple of days after going back to oestrogen only but once it was out of my system I felt much better (until starting the prog again). If you are still peri-menopausal then your own cycle will also be confounding this to some extent.

Hurdity x

[Cathy]

Thanks so much everyone for your suggestions, comments and support. I now have an appointment with my GP tomorrow and am going to request some blood tests to see where I am at - the levels you posted are so helpful as I don't get any interpretation from the GP so I'm flying blind really. I thought I was Oestrogen deficient too as was only on two pumps of the gel so upped it to 2.5 but then my sleeping and other symptoms became dreadful so I have cut it down a bit so do two pumps each day and a extra half a pump every third day - I realise it takes time for your body to adjust so I may just have to wait longer!
I was on HRT previously but was taking the Utrogestan orally and it wasn't as effective for me so then I went all round the houses trying lots of different synthetic hormones,patches etc - which are so easy to use but resulted in so much hair shedding and other symptoms I knew they weren't right for me. So I eventually returned to the Utro and Oestrogel but now take it vaginally. I do feel fine on the Progesterone when I take it and tend to sleep better too. Let's see what the blood test result says and I will try and compare it to my previous result - I wondered if whe I upped my previous dose of Oestrogel I had made myself Progesterone deficient as was sleeping so badly so lowered the Oestrogel a bit. Constant balancing act and tweaking!!
Yes my periods had got further apart and variable before I started on HRT - very heavy at first, then as time went on further apart.
Thanks everyone.
Cathy x

[Hurdity]

Hi Cathy

Thanks for the more detailed info.

HRT doesn't really work like that ie increasing oestrogen doesn't make you deficient in progesterone - but the more oestrogen you take as part of HRT the more progesterone you need to thin the womb lining because it acts in a dose-dependent manner.

From what I've read on here gel can have an immediate effect - which may be negative ( maybe because the levels spike too quickly?) but any adverse effects should stabilise provided the level doesn't go higher than is usual physiologically - in which case sometimes it ceases to have an effect. I doubt this would happen in your case though? If you also have a cycle sometimes superimposed on the HRT (because the oestrogen dose is not high enough to fully suppress it) then it would be difficult to interpret readings from blood tests although if oestrogen was very low it would indicate insufficient (absorption) - whatever stage of the cycle.

If you do get blood tests done be sure not to get the sample taken from the same arm that you apply gel to ( if you apply to arms) and also preferably not very soon after your daily application - as you could get a false reading.

Women vary enormously in how well they absorb oestrogen from the different methods so it is possible that you might do better on patches if things don't settle for you?

Hurdity x

[dangermouse]

I think the issue with balancing oestrogen and progesterone is that progesterone is an antagonist to oestrogen and acts to control levels from going too high and causing over-stimulation of the womb and the nervous system.

So it may be that your oestrogen HRT is too high rather than your progesterone being too low, even though I know it then equates to progesterone being too low if looking at purely from that perspective!

Hormone balancing is, indeed, a complex task!

[Cathy]

Hi thanks everyone for the helpful comments previously,
today I got my blood test results back:
FSH - 29
LH - 12
Estrodial - 164 (quite low I think even though I was taking my Oestrogen pump at the time)
The blood tests were done during my monthly bleed so no progesterone being taken at the time.
The doc has suggested switching me to continuous HRT - 1mg Estrogen Femoston Conti - I start later today. A little nervous as it took me an age to find HRT my body tolerated but I have read on the forum it is 'kinder' than some of the others so I hope it will help symptoms. My doc did try to see if she could keep me on my current HRT (bio-identical) Utrogestan and Oestrogel but she had to reduce the Utrogestan to 100mg on a continuous cycle and I know from my previous use that orally I didn't absorb it well and vaginally those can't be inserted (it has to be 200mg because of the pointy shape - the 100mg is a ball and doesn't get ejected from the applicator! So if I went down that route I would be forced to take 100mg orally which didn't cut it 7 years ago I had to take 300mg orally to get any effect or 200mg vaginally - was seeing a private doc at the time. So I am hopeful but slightly nervous as my hair sheds if my body doesn't tolerate the progesterone (Mirena, Evorel, Premarin and others).
Any comments very welcome.
Thanks
Cathy



 

[Dancinggirl]

Cathy - good luck with the Femoston - it suits many women very well.  Don't look for problems as you may find it's perfect.
It can take at least 3 months for any HRt to settle and erratic bleeding is normal at first. 
Women do use the 100mg Utro capsules as pessaries in the vagina  - you simply push is up with your finger as there is no need for an applicator - so you could go back to that as an option.  Keep us posted.  Dg x

[Cathy]

That's great thanks DG - if it doesn't work out I'll go back to that then but a tablet is obviously easier. Fingers crossed the Femoston will work!
BW Cathy