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[CathDog]

Hi,

I'm so grateful this forum is here and I could look through to try and find solutions to the symptoms and read other women experiences and not feel like I am imagining that my mind and body have been severely affected by this.
 
I thought id start here and introduce myself and the treatment history.

In a nutshell, not overweight, somewhat fit, healthy eating, working woman with demanding analytical job going through a brutal destructive menopause.

No periods for over a year, over 54, realised way too late that so many of the symptoms leading up to the no period stage were menopause related and visited the gp way too late, when I was crippled in bed with heart palpitations, Thankfully the gp put me on hrt immediately and we have tried various hrt. In addition I take a ton of supplements and have to eat way more red meat than id like to even just keep afloat.


Kliofem
2mg estradiol
1mg norethisterone
 (Not one day without constipation  that I thought was lactose related but was actually too much? progesterone slowing down my bowels)

Fem 7 Conti
1.5 mg Estradiol hemihydrate (50mcg/24hr)
0.525 levonorgestrel (7mcg/24hr)
   (Put a patch on on Mondays, but found mental health was not good at all, actual depression, I started supplementing with st johns wort and it did not get better in fact worse, and a constant daily regime of mindfulness and cbt just to keep me barely functioning, I wasn't able to take on anything other than the basics of staying barely alive.  Then I put an extra half patch on on the Thursdays and felt better within hours and days. It was amazing  , I spoke to the pharmacist and doctor and they said this wasnt allowed! I was gutted.  )

Evorel Conti
3.2 mg estradiol hemihydrate (50mcg/24hr)
11.2 mg norethisterone acetate (170mcg/24hr)
   (mental health just following treatment as prescribed was not good, crying over little things but not depressed perse, not able to think and concentrate well either)

Femoston conti + 1mg extra estradiol
(had to ask for the 1mg estradiol extra, only found out it was possible because Wiltshire council in their on-line hrt advice to gps https://www.gwh.nhs.uk/media/163808/wiltshire_hrt_guidance_2014.pdf allows the extra 1mg.  I actually break the rules and take an extra 1mg (on top of the Wiltshire Nhs advice, so 1mg in the Femoston conti+ 1mg (Nhs extra) + 1mg estradiol because I don't feel well enough with just 1mg.

On this treatment I am only barely hanging on by my nails, I can't remember things, can't learn new things, mental health is barely ok, have minimal stress resistance.. absolutely not good with a new job and driving again after many years of not driving.

I asked the gp if I could see a consultant and they sent me an electronic invite? There is nothing available, I had to put myself on a waiting list to go on a another waiting list for an actual appointment lol.. talk about women health being marginalised.

I have a small benefit with the company I work for, a 200£ voucher to see a doctor which id like to use to see a consultant to try to work out how to solve the mental problems associated with menopause.

So I have 2 questions?

1.
Has anyone done this? seen a private consultant or Nhs consultant for the south glos, Bristol, North Somerset region? How much would a consultation about something that will most likely need repeat visits cost and do the consultants liase with the Nhs gp? Can some of the cost be deferred to the Nhs.

2.
Has anyone else found that the prescribed level of hrt is just not enough and more is better, it might not be a case of not enough and maybe more a case of like carol vordeman, a case of unbalanced progesterone/oestrogen/testosterone and non bioidentical hormones that is causing the problem?

http://www.dailymail.co.uk/femail/article-4501426/Carol-Vorderman-says-NHS-offer-women-bespoke-HRT.html

thanks for your advice and x

Cath
   

[Tiddles]

Hi Cath

I'm afraid I'm not knowledgeable enough to answer your questions as the 2nd HRT I tried has, thankfully, alleviated all my symptoms both emotional and physical so my experience is very limited.  But other forum members will be along to help you. In the meantime I just wanted to say hello and welcome and take comfort from the fact that there are more success stories on here once the right treatment has been found than otherwise. Xx

[Wilks]

Hi,
I had awful depression and anxiety last year with menopause. I eventually saw a menopause specialist privately. She increased by dose of HRT and after my oestrogen levels stabilised, she also prescribed testosterone. Expect to pay about £200 to see a private menopause specialist. The one I saw does the follow-up appointments by phone which is a lot cheaper than the initial consultation.
By the way, you shouldn't take St John's Wort with HRT as the two interact which causes a reduction in the effectiveness of the HRT.

[CLKD]

 

[CathDog]

Thank you so much ladies for the encouragement and info.

I was surprised St Johns Wort would counteract hrt because its a bit of an SSRI, but I agree with you my experience is it did not make things better and I am pretty sure worse, when I googled it though it just says there is some sort of interaction so I could not tell from the internet if stj made things worse or better.

I am still plucking up the courage to see a consultant privately. Did you get a name from your GP or googled?

x

Cath

[Daisydot]

You can ask your gp to refer you to a meno consultant on the nhs or you can opt to go private.f you go to the very top of the page you will see a list just above the green coloured block and if you click it on specialist it will give you a drop down where you'd type in your postcode and this will give you some specialist names in your areas if there are any.good luck.

[Dancinggirl]

Hi CathDog and welcome to MM

You do not need to go privately - you just need to get clued up on the info from this site and ask your GP for it.  Print stuff off to show them.

Firstly, you have only tried continuous HRT regimes and it's usually better to start with a sequential HRT so you can gage whether a progesterone suits you or not. I suspect you are not tolerating progesterone that well and certainly not continously.  Clearly Femoston does suits you slightly better but I suspect that any progesterone all the time is giving you the low mood.
Please don't take St John's wort with HRT as it is contraindicative (I believe it will effect the absorption of the hormones!!!) so you should check with menopause specialist before taking anything alongside HRT.

You may well be needing a higher dose of oestrogen but you could try Femoston 2/10 sequential and put up with the monthly bleed( many women stick with sequi HRT in post meno to avoid more extreme progesterone side effects)  - this would help you see if this will improve your mood during the oestrogen only phase.

A good alternative HRT regime is to try is Oestrogel or oestrogen only patches, at the strength you need, and use either Utrogestan or Provera for just 12 days each month. This would result in monthly bleeds. You can use Utrogestan vaginally to help reduce side effects.
Here is the info on this: https://www.menopausematters.co.uk/to_progestogens.php

Another good alternative is to have a Mirena fitted as you could then use as much oestrogen as you need as gel or patch and this usually does not give a bleed.

Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

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.

I had a Mirnea in post menopause for 4 years and used 2 pumps of Oestrogel daily alongside and this was the best HRT regime I ever had - and I have tried almost every HRT type over the 25 years of my meno journey ( I had a premature menopause).  Keep us posted.  DG x

[Wilks]

St John's Wort induces an enzyme that metabolises estradiol, so if you take both
St John's Wort and HRT, the HRT will be less effective (because it will be metabolised more quickly). That's why the patient info leaflets for both of these products say not to take them together.

[Dancinggirl]

Thank you Wilks DGx

[CathDog]

Hi,
Thank you for the stJ info

and the advice to show my doctor (I did it once with the Wiltshire Nhs info and he went a little pink and then said he had to consult with his colleagues to see if it was allowed bcs South Glos is a different Nhs region and he'd never heard of giving an extra mg of estradiol, He is pretty awesome tho but I don't really know what to tell him, the Nhs standard response is ssri if you are depressed even if its obviously your hormonal imbalance causing this, they aren't really bothered that your brain isn't functioning as well as it was, I wonder sometimes if the dose level of hrt is for 1950's women when they thought women only need enough brain power to make jam, not to run businesses etc..  I will read what you wrote again and see if it is something I can use that will help restore my brain power.

I looked in the specialist tab and there is no-one in the Bristol Bath and a little further west area, is this correct? I'm a bit gutted, I recently started a new job and don't think its politic to take time off for a medical appointment (let alone one that will take nearly a day of traveling there and back), I was hoping I could just come in a little later or leave a little earlier. :/

[Wilks]

Yes, there is a dire shortage of menopause experts, even amongst private ones. My nearest one is an hour's drive away so I had to take half a day out of my holiday allowance (which is stingy anyway!)

[Dancinggirl]

CathDog - do read my post again.  You haven't explored the sequential HRT route or the possibility of the Mirena and one of these options may well help you. You should not need to pay for a specialist.  Until you have tried an HRT that gives some time with oestrogen alone, to see if it's the progesterone that is giving you the low mood, then it's pointless seeing specialist.

Do get you Vitamin D level checked as well, as vitamin D deficiency can give low mood, aching joints etc.

GPs are rarely up to speed on treating the menopause and you are not alone in struggling like this. You simply need to ask for the treatment you need to try - it is going to be trial and error and I'm afraid some women do need HRT and an SSRI alongside.  DG x

[Wilks]

Hi, I guess I also meant that there seems to be a shortage of GPs who are fully clued up on managing the menopause too, which is leading women into searching for specialists (of which there are very few).
I was already on a low dose of hrt when I started feeling so awful (mentally and physically) last year but neither my GP nor I realised that it was partly because my oestrogen had plummeted and I needed a higher dose.

[CathDog]

Just thought id update  , getting small things done every day though slow as molasses basically because I'm not feeling well so just taking things one step at a time.

I eventually felt well enough to go on line again to check if any of the hospitals I could have access to had had an update and appointments were available, - it still said no appointments (all three Bristol hospitals you are on a waiting list for an appointment)

so called the hospital I was on a waiting list for (which they said online I should do if I hadn't heard from them in a month and I hadn't) and confirmed I was on the list so thats good, but the earliest appointment would be October ish  (this was in June and is a Bristol gynae dept in a hospital so if you are based in Bristol you can look at almost a 5? month wait to see someone). 

I then wondered what to do and called my gp for a renewal prescription of the old fem seven patches that worked the best and told him about the suggestions on here and that I couldn't find a local specialist here and he renewed the prescription and suggested its better for me to see the specialist and not change the hrt until I have seen what they have to say, as we had tried quite a few things and he gave me a referral to private female (which I am grateful its a female) doctor in Bristol.

I picked up the prescription and referral this Saturday and the plan is to call this week for an appointment.

Brain is still a train-wreck though.

If its any help to others the combination of Menopace, Fish Oil, l-theanine and gingko are having a positive effect.  But I have to take them religiously and eat absolutely regularly or the walls start crumbling, its a very fragile balance and I can't push myself either physically, emotionally or mentally, I have to take things slowly and methodically and build up tolerance to new things!    I started swimming in the local open air pool before work and I look forward to it and it makes me happy and I am doing it consistently so that is giving me confidence that some of the old me is still there and importantly my driving is better which is improving my confidence, I'm not worried I'll kill someone before breakfast anymore (even my driving was affected by the menopause, has anyone else found that?)

anyway, hope everyone else is finding ways to cope too.

[Dancinggirl]

Pleased things are progressing. Do keep us posted. DG x