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[Ladybt28]

I am new to the forum and I have a few questions about the types of treatment, what each does, what problems it works best for and I would like information about some ladies experiences but I don't know where to put them on the forum so I have started a thread - sorry if it is the wrong thing to do, please tell me where I should move stuff.

Can any of you help me get some stuff straight in my head?

I want to know (a) if you suffer badly from hormonal depression are you better having patches, gels or tablets to get the right dose?
(b) If your problems are all over the place, does having hrt in gel form make the treatment more flexible or does it make it more patchy?
(c) I know testosterone is important but what does it do and how does it make treatment better?

(d) what side effects or weird feelings have ladies had when they have been on premarin versus bio identicals.

Suppose those will do for starters if you can help ladies and I'm probably going to ask questions about your answers!

I have a womb, am 56 GP says I am post menopausal but I was off my hrt 4.5 months and am now back on.  Before for 18 months everything was haywire and there was a lot of chopping and changing.  Before that I was on prempak c but now I am on premarin/provera and its not working right.

[Dotty]

Hi

Patches or gel are best as they are transdermal.  However, a lot of ladies do very well on tablet form of hrt.

Everyone is different so it's hard to say if gel "makes things more patchy."  It is more flexible, but again it suits some ladies and not others.

Testosterone is useful for libido and exhaustion and muscle strength.

Prempak and premarin are old forms of hrt made from the urine of pregnant mares.  You would be better on body identical oestrogen in newer hrts.  But a lot of ladies do well on premarin.

There is no right or wrong in hrt.  It's what suits you.  Sorry, I don't think I've been much help x

[Mary G]

Oestrogel is easily absorbed which is why specialists like Dr Louise Newson and Professor John Studd like working with it.   It is also very dose flexible meaning you can quickly and easily increase the dose if necessary.

Testosterone helps as long as your oestrogen levels are fairly high.

I can't comment on conjugated oestrogen but a lot of women really like it

The key to success with HRT is getting the dose right.   This may sound blindingly obvious but it can be difficult to achieve and a lot of women end up ditching HRT altogether because they don't get adequate symptom relief and/or they fall over on the progesterone component i. e. have dreadful side effects.

From my experience, a very dose flexible regime will give you a far greater chance of success.

[Ladybt28]

Because I was off the hrt for 4 months I have managed to work out - I think - side effects of the Premarin/provera regime as I have something to measure against.
I am on 1.25 Premarin and 5mg provera continuous.  I've been back on 3 weeks - I know that's not a long time yet but because I was on prempak for 7 years and it was discontinued and then on a few others and then off hrt altogether I have things to measure against.  There was an underlying health issue in the meantime which resulted in a stay in hospital for sepsis that the doctors couldn't get to the bottom of - I think it clouded what was going on when they gave me the 3 other forms of hrt in the 18 month period after the prempak.  GP put me back on Premarin because I had been on prempak 7 years but I think a lot has changed for me in that time.
At the moment the sweats have nearly gone and so had the really bad insomnia I had.  My joints hurt and that stopped when I was off hrt altogether.  My ears are muffled and my nose is running which are symptoms which stopped when I was off hrt altogether.

The joint thing , the nose and ears were are all things I had when I was on prempak.  I have a dull ache in my left calf and I feel like my breathing is ever so slightly restricted.  Still have no energy - no sex drive - I couldn't raise a sexy thought if my life depended on it (I don't like being touched at all) - I feel a bit weak and feeble and I am mega depressed (I have always suffered from depression and would stake my life it is hormonal).

Have any ladies had conjuncted horse oestrogen and had any of these side effects?

[Ladybt28]

I think I have some idea what might be wrong but I need more info to try and work out what would be best to ask for - I defo couldn't take femoston - I felt really ill on that. 

I really want to hear peoples experiences.

[Mustard1]

HI LadyBT - I think it is really a case of trail & error.  I was on Kliofem successfully for 9 years and was very fortunate that I had never suffered anxiety or depression in my life.  The Kliofem stopped working and wham I was in the middle of madness.  My only symptoms now are bad anxiety on some days and bad depression on other days.  I believe it is hormonal but am trying other things as well as HRT to help such as meditation, exercise, breathing bla bla bla.  I still don't know what each day will bring when I go to sleep the night before.  I think we just have to hope the our GP or Menopause specialist can work with us to find a solution.  I have been at this now for 8 months and am beginning to wonder if I should try coming off HRT all together al though i would have to say the beginning without HRT when i was put in Citalopram and given diazepam was worse than now although the anxiety seemed slightly less.  There are some very knowledgeable ladies on this forum who really do help during this horrid period.  Thinking of you.  Mustard x

[Mary G]

Ladybt28, it sounds like you could be falling over on the progesterone part of your HRT.   The Provera could be drowning out the positive effects of the oestrogen.   I doubt the symptoms you describe are anything to do with the oestrogen component.

You could stop the Provera immediately, this will invoke a bleed and then you could do a good few weeks on oestrogen only and see if you get any improvement.   This would at least give you some indication as to why you feel so flat.   My money is on the progesterone.   

If you do this experiment and feel significantly better then you could switch to a cyclical regime permanently.

I should mention that I had a constant runny nose on the contraceptive pill and Angeliq HRT, it was a type of allergy. 

[Ladybt28]

Thanks Mary G - I thought it was some sort of allergy.  It's a good description you used - "flat" - to be honest that's an understatement
Happy to try dropping the Provera - I'll try anything to get this right.  I know I asked the pharmacist about it being 5mg and continuous and he told me there wasn't a lower dose.
 
How many weeks would you go on the oestrogen only - 4 weeks?  less or more?
Then when you put back the Provera - how many days do you think?
I'm a bit new to all this since it all went wrong and my gp's rubbish.
What are the side effects of too much progesterone?  I'm not headaches just like my whole system is on go slow.

[Mary G]

I would have a good run on oestrogen only to get the feel good factor and a much needed lift.   You have taken a lot of progesterone so I think you can afford to do a four week oestrogen only stint - Professor Studd told me to do this because he wanted me to get off to the best possible start.

Regarding the progesterone dose, again, if it was me, I would do 5mg Provera for 7 days each month but the NHS dose is 12 days I think.   So it depends on how well you tolerate progesterone.   If you opt for the low dose progesterone then it is sensible to have regular uterine scans to make sure everything is OK and you are getting proper womb lining clearance.   You could also do a long cycle (6 weeks) if you are post menopause but you would need to take Provera for slightly longer, probably 10 days.

The symptoms of progesterone intolerance are wide ranging but include constant flat mood, depression,  headaches, migraines, brain fog, bad dreams, tiredness.

[Lisa1966]

Hi I was on 2.5mg of provera as a sequential regime 14 days a month,I think you are on too high dose,my private consultant gave it to me, I think maybe cut them in half and try that.
        Lisa xx

[Hurdity]

Hi Ladybt28

Did you feel OK when you were on the Prempak C? As it's been discontinued I'm not sure what the dose and type of progestogen was in that one  but the main difference between these two is that one is cyclical (Prempak C) and the regime you are on now is continuous combined which means you are now taking a progestogen every day whereas before you weren't.

In your position I would go back to taking it cyclically and see how you feel - but I would strongly advise you start with the licensed regime. Many women are OK with progestogens cyclically but not continuously as there is no let up in the pms type side effects. The licensed dose is 14 days per 28 day cycle. You are on the highest dose of Premarin and until you have evidence to the contrary you may well need this for adequate endometrial protection. Please don't experiment without medical supervision especially until you know how your uterus behaves and what sort of bleed you get when taking this dose. Endometrial protection is the primary objective when taking a progestogen and should be the first consideration. Women who are severely progesterone intolerant - like Mary G - are closely supervised by specialist gynaes, in their very much reduced regime (in terms of dose and duration). The licensed dose is found here which is 10 mg for 14 days per 28 day cycle.
https://www.menopausematters.co.uk/to_progestogens.php As Lisa1966 says - the continuous combined dose you can see is either 2.5 or 5 mg but for a sequential regime you would need medical supervision.

Dr Currie (gynaecologist and founder/manager of this website) herself made a post on progesterone and the Studd regime of 7 days per month of low dose progesterone:

Just to confirm, while Professor Studd is very experienced and extremely knowledgeable, his regimens are not always in line with current recommendations, particularly around use of progesterone.
As always with providing menopause advice, this should be individualised and flexibility should be applied, as long as there is a clear understanding of national and international recommendations. Some women are intolerant of progestogen and progesterone and so it is appropriate to adjust the regimens, as long as it has been fully explained and discussed.
Best wishes
Heather

You may well be fine but do try the licensed dose first.

In terms of your other questions - I am a patch girl - I love them! Different women absorb different amounts using the different methods - some do better on patches some on gel, and sometimes it is just down to personal preference. Gel has to be applied every day and close skin-skin contact with others must be avoided for at least an hour. Patches have to be changed twice a week but leave marks where applied (although these can be removed with baby oil!). Both can be adjusted for dosage although patches need a bit of snipping which is what I do!

Testosterone - lots of threads on this but have a look at the long-running one in Private Lives - "Testosterone Here We Go" - hopefully that will answer some of your questions.

Also re libido - conjugated equine oestrogens increase a compound in the body called SHBG which binds free testosterone and will therefore be more likely to have a negative effect on libido. Therefore before even thinking about T, I would change to a transdermal oestrogen - patch or gel - and you could use the same progestogen.

Some medications also dampen libido eg some anti-depressants and some others I think?

Hope this helps . Sorry it's long!

Hurdity x

[Ladybt28]

Hi Hurdity,
Prempak c was ok - to be honest I didn't know any different - I have always had problems with joints and lethargy and depression and as I explained in my posts with CLKD under effects of depression I have only become aware lately how hormonal related my health problems have been.  I just learned to live with them get on with it and not make a fuss.

Prempak c was 1.25 oestrogen (2 strengths available,I had the higher one) + norgestrel.  I know it's cyclical but GP reckons my periods stopped altogether during the 18 months after prempak c.  Since the 4 month break a meno doctor at the meno clinic put me on the Premarin/provera which is medroyprogesterone continuously.

I have to say I wasn't impressed at the clinic - she was in a hurry - she went through what had happened to me - opened her book (that bothered me a bit because she didn't seem confident - said well "its still trial and error - try premarin -  you had that oestrogen before and take this progesterone and take continuously)- whole thing done and dusted max 20 minutes - come back in 3 months!

Can I run what you wrote back passed you so I have it straight?
You agree that I should change my current regime from continuous to cyclically as suggested by Mary G (because 5mg provera continuously is causing the "flatness" and wiping out the benefits of oestrogen was what she said) but that I should take 10mg of provera instead of 5mg (because 5 is not enough for womb protection) for 14 days out of 28 because that is the licensed dose?

I understand I should be supervised because of thickening of the uterus but as I understand it if you use the provera cyclically you will bleed.  I'd have thought that the regime they gave me continuously is more dangerous for thickening?

I thought I might have had a problem with progesterone headaches but I think that when my body went competely haywire over 18 months culminating in the sepsis - the headaches I suffered from could have been a red herring and nothing to do with the changes in hrt.  I have been on the 5mg for 3 weeks continuously and not had a headache which if I was really progesterone intolerant I probably would have had by now i reckon.  I suppose different people react to different types of progesterone? - all I can say is that there are no headaches yet on the medroxyprogesterone.

3 weeks in on the continuous hrt - I'm feeling rubbish and not sure I can until the 3 months is up continuing on 5mg Provera before anything gets tweaked - anyway having read what Mary said I wonder what state I'd be in on 3mths 5mg Provera continuously anyway.   I'm not at all convinced either that the women I saw at the meno clinic knows a fraction of what you ladies know on here - she most cetainly didnt fill me with confidence!  I'd feel far safer running things past you guys each day as I went along than waiting 2 weeks to get 5 minutes at the doctor (my gps not brilliant either she has only just been on a hrt traininng course!) or waiting the whole 3 months until I have to go back to clinic.

Do you think I should try the licensed dose and see if I feel better - I can report the bleed bit as we go?

Really interested in what you have to say about the horse oestrogen and libido - i dont have a libido any more at all. My only saving grace is that vaginal dryess has not managed to take hold but I cant persuade myself into sex even though I'm upset in my head that I dont want to - just being touched feels weird. My poor husband is being brilliant and could not be more understanding My libido's never been very good although it was rampant when I was pregnant, both times, - with boys interestingly enough!  I often wondered if it was because there was testosterone floating about?

My only other medication is blood pressure meds so it has to be the hormones, lack of them or the wrong sort that has wiped it out completely!

[Ladybt28]

HELP - will one of the experienced ladies come back on here and tell me how to change my continuous Premarin/provera to a cyclical regime.  I am currently 18 days from starting as the doctor prescribed 1.25 Premarin+5mg provera daily.  I am practically suicidal, can't be bothered with anything, a simple trip to the shops is beyond me and my joints are constantly sore, I cant stop crying and I am dangerously depressed.   I think I need to stop the progesterone continuously - could someone put down an "idiots guide" for timing as to which tablets I take on what days from now on please.  I don't mind bleeding.  I haven't had any spotting or bleeding since I started at all and the dr said their might be but no.

It seems like I don't have any side effects from the medroxyprogesterone its self - no headaches -  just from the quantity from what the Mary G has to say.  I think I have to give this a try before going back to the GP and changing everything but something has to be done now because I am beyond desperate, I wont be able to get an appointment with my own GP for 2 or more weeks anyway!  Any GP yes but my own the wait is ages.
Any other suggestions, or comments or observations - please send them on over I feel like I'm drowning - sounds dramatic but there is no way of controlling how you feel where hormones are concerned.

[Hurdity]

Very quickly Ladybt - as I'm not really on here but just saw your question!

You can stop the Provera RIGHT NOW!!!! You will continue with the oestrogen only tablets and will count tomorrow as Day 1. If there has been any womb thickening you may get a withdrawal bleed . Also you may get some pms symptoms as you come off the prog. (possibly headache, tensionm anxiety etc) but this will pass - after a few days you should feel much better! When you get to Day 15 start the Provera again and take it for the next 14 days. This should be at 10 mg - I wonder if you can cope with this for 14 days?

Do try to get an appointment with doc - make that appt tomorrow. If you are not yet post-menopausal then you may get a bleed at other times but hopefully this regime will regulate your bleeds. Maybe you will be better off with a different prog. Take it easy and take it one step at a time - firstly by stopping the prog.(Provera). You must talk to the doc about using a reduced dose/duration of progesterone if taking it continuously is making you feel like this, and get them to either refer you to menopause clinic and/ore agree to give you scans to monitor your uterus if they are letting you do a reduced dose.

Have I or anyone suggested Mirena coil ( haven't time to read all through the posts now)? This means you could take hihg oestrogen dose without bleeding (hopefully - eventually).

Please find someone to talk to about your feelings if you are feeling dangerously depressed - there is always Samaritans. Do you have a partner or close friend you can talk to? Go to the doc for emergency medication if you feel you cannot cope - please do not suffer alone. I know it's Sunday but if you have no-one and need help ring 111.

Take care and hope you feel better soon 

Hurdity x

[Mary G]

Ladybt, you can stop the progesterone now but continue with the Premarin which you must always take every day.   This will invoke a bleed and I would not touch progesterone again for about 4 weeks to give yourself the best chance of a lift.

I think you need a proper review and with someone who knows what they are taking about, not a GP who just prescribes the first thing that comes into their head to get rid of you.  Can you afford private treatment?   Professor Studd and his two colleagues specialise in this field and would definitely be able to help you.

I read your post on CLKD's thread and she has given you some good advice.   I think you are suffering from reproductive depression but you need to get it properly diagnosed and treated.  A history of PMS, PND, feeling good when pregnant and ADs not working are an indication.    Please read Professor Studd's website where he discusses it in more detail.   It needs specific and targeted treatment and usually involves a high dose of oestrogen, a low dose of progesterone, testosterone and often an AD but you need to get the hormones right first and then filter in other medication as required.

GypsyRoseLee on here had a similar problem to yourself but is doing brilliantly now.   Why not read her posts and send her a PM, she is very kind and very approachable.

I do hope that helps.