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[helenmelon]

Hi again,

I've been on Evorel Sequi for 14 weeks, the first few weeks felt like I had morning sickness and s bit dizzy, but hallelujah the hot drenching sweats stopped after about 4 days.

Since then when I'm on the estrogen patch I feel fine, but starting to dread the progesterone as it make my skin very itchy and my boobs feel like to rock hard melons.

Now the bad news !! The last 2 weeks have seen some of my symptoms return; hot sweats (although not as severe as without HRT) my anxiety and mood which had improved massively seems worse now and the past 2
Periods have been after 25 days and come when I've gone back on the oestrogen patches but now I'm having one after 17 days and I'm still on the progesterone 😳 what's going on ? Has it stopped working already???

I'm seeing Meno specialist on Friday and am wondering if anyone else has experienced this and what I should do next.

I have now realised just how bad my symptoms were before I started HRT and defo don't want to go back to being a complete mad woman !!

Any suggestions would be fabulous
Thanks

[Dancinggirl]

helenmelon - I think you are having problems with absorption.  This can happen with the patches.

You could try HRT pills e.g. Femoston 2/10, is a good one - it has a kinder progesterone so can suit many women very well.
Others options to try:  Oestrogel (which you apply daily to inner thighs) and separate progesterone as pills e.g. Provera or Utrogestan, for 10-12 days each month.  This allows better absorption, better control over your cycle and hopefully less progesterone side effects.  The other, no hassle, HRT option would be to have a Mirena fitted (usually results in no bleeding at all after the first few weeks) and use Oestrogel daily alongside.  The Mirena + Oestrogel was my best HRT experience.

Print off the sections under TREATMENTS on this site - particularly the Perimenopause,  Progesterone and Oestrogen sections -  to show the specialist so you can discuss these options more in depth.   DG x

[helenmelon]

Thank you dancinggirl for your reply, it's a flaming minefield this menopause lark 

I've had the mirena coil before and hated it unfortunately and had it removed. My GP had suggested the coil as I had fibroids which I had the coil to try to help, in the end had UFE which worked and they are still ok. When I needed HRT she suggested we try it again, but I don't like the thought of something permanently and I could feel it all the time  Not put in by my current GP though.

Do you know if the patches are absorbed differently depending on where you put them???

Thanks for your help dancinggirl xx

[helenmelon]

Also dancinggirl, forgot this question

Do you know if you get the same amount of estrogen in both the Evorel 50 and the Evorel Conti with the northisterone Or do I feel worse on the second patch purely because of the progesterone???

I had taken northisterone many times to delay my periods as they used to be terrible when my fibroids were a 5 month pregnancy size and I had always be fine with it, but it seems the more regularly I take it ie)2 weeks every month is not the best idea.

[Samade]

I'm on evorel sequi and I had a similar experience. In December my symptoms returned bad night sweats and increased low mood and anxiety but a few weeks later it passed and my symptoms were under control once more.
I asked my consultant about this and she said it was possible my own cycle may occasionally 'breakthrough and cause trouble'. As DG said absorption issues is also a possibility.

[Dancinggirl]

It is usually the progesterone and/or the withdrawal from progesterone, that causes the problems with HRT.

Why did you hate the Mirena? You shouldn't be able to feel it!!!!! Gynaes like to give women the Mirena if they have fibroids or problematic bleeding because it will often shrink fibroids and keep the lining thin - thereby reducing and often eliminating erratic and problematic bleeding.  It is a safe and easy way to protect the womb lining with fewer progesterone side effects.  I fear Utrogestan may not be strong enough to prevent your breakthrough bleeding, so the Gel + Utro would probably not be a good option for you.

The amount of oestrogen you need will depend on a variety of things e.g. used orally or transdermally or the amount you personally need etc.  We are all different so there are various HRT options to try to cater for this.  Unfortunately, if you are prone to fibroids, HRT will often trigger their growth and this may be why you are getting this problematic bleeding - therefore the Mirena would be your best option. You probably need a scan to check what is going on ( see if fibroids are back) and then move forward from there.  DG x

[helenmelon]

Thanks Samade, that gives me hope that it might just be a blip xx

Dancinggirl I could definitely feel the mirena and even the GP said it was positioned in a weird place ? I just wanted rid of it.

I've already had scans and a Hysteroscopy before starting HRT, my fibroids are on the muscle walls of the uterus and are still at the same size as after my Embolisation. The bleeding I'm having isn't heavey now on HRT, infact the periods are the best I've every had and only lasts about 4/5 days whereas last year I had one lasting 34 days and had flooding on the way to my first appointment with Julie Ayers at the meno clinic which wasn't good given that the chairs were white leather and I had reams of that blue paper towel stuff in my knickers!! It all adds to the rich tapestry of life   

I'll report back on Friday after my visit to the Meno guru xx

[dangermouse]

You may do better on continuous Norethisterone if you don't have the intolerance issue.

When you withdraw progesterone, because it has suppressed your own progesterone to some degree, you have a few days where you feel much worse until your own kicks in again. Post menopause, like men, your adrenal glands produce it instead of your ovaries.

[Hurdity]

Progesterone withdrawal symptoms occur whether you are stopping progesterone or synthetic progestogens - it;s nothing to do with your own progesterone which is only produced in large quantities in the corpus luteum during the menstural cycle and pregnancy. Even after menopause the small amounts needed by the body and produced by the adrenals continues - like in the first part of the menstrual cycle. The withdrawal symptoms are to do with the reversal of the changes in the body caused by progestogens - and involve some changes at cellular level. You feel bad until the changes have taken place and the excess progestogens have left the system! Some women feel fine on progesterone all the time but equally OK on oestrogen all the time - but will still feel the changes from one to the other and the initial rise and fall in progesterone.

If you feel worse during the second phase of Evorel sequi (ie the conti part) then it's defo the norethisterone - but maybe your sensitivity to it has changed over the years?

Absorption of oestrogen from patches does vary - dpeending on application site on body. I recall reading that it is highest on this thin skin of front lower abdomen ie tum. However I never put it there as not convenient - I always apply to butt cheek. As long as you keep to the same part of the body and adjust the dose to what is right for you you should be OK. However you can't adjust the dose of combi patches hence Dancgingrils suggestion of separate oestrogen and progestogen ( eg Mirena) as you can then increase or decrease the oestrogen until you arrive at a dose (over a few weeks) that suits you.

Hurdity x

[dangermouse]

I've never had progesterone withdrawal from Norethisterone. I've started and stopped that when I tinkered about with the minipill for a while and had absolutely no symptoms. I find natural progesterone much more potent (perhaps as it's more fitting to our bodies) and it does cause withdrawal until my own progesterone kicks back in, which is after a couple of days of low dose and about a week if high dose. Perhaps it does something different if combined with estradiol?

[helenmelon]

Thank you all for your replies, I'll let
You know what happens on Friday xx

[helenmelon]

Update.

Went to see the menopause guru on Friday. She thought I should give the patches a little longer as thinks I may have been out of sync with them and my own cycle and that this period although early may be a the correct time as it's whilst taking the progesterone phase.

She also suggested trying the mirena with a separate estrogen as suggested by some of you lovely ladies. I'm not keen but decided to give the patches another 3 months and then if the progesterone is still a problem try the mirena.

One question though, is the progesterone in the Evorel patches different to the mirena?? And if I'm susceptible to progesterone problems won't I get them which ever one I use

Thanks all again xx

[Dancinggirl]

Hi helenmelon

The progesterone in the Mirena is different to the one in Evorel.  Evorel has one of the toughest progesterones to tolerate.

Here is a quote from this site about the Mirena and why it is so useful as part of HRT :

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.

Here is the link for all the information about the Mirena - go to the bottom part of this page : https://www.menopausematters.co.uk/to_progestogens.php

DG x

[helenmelon]

Thanks DancingGirl

My GP and Julie Ayers who I see in Leeds both championed the Mirena but after my last experience I'm still not keen, but I fear that the progesterone in Evorel is not the best for me just when I felt better I know seem to have some hot flushes back!

Thanks DG x