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[Nikkisyard]

While I try not to over-complicate things perhaps I am... so I need some help.

Ive posted here and there and referred sometimes to my issues but I think i need to pop it all down in one place so that I can follow the great advice given on here.

I'm 51, post meno for 5+ years. Been living most of the time in Switzerland but return to the UK and Spain regularly. Im currently in Spain.
With menopause came terrible hot sweats, insomnia, weight gain, zero libido and depression for many years. Usually I am a happy positive person.

I started BHRT earlier this year, starting with 2 pumps of Oestrogel and Utrogestan200 sequentially. I only did sequentially as the Utrogestan was advised as too high a dose to do continuously.
WOW - this changed things significantly! Almost within a week I was sleeping, no hot sweats and felt happier. However, I didn't welcome the bleeds and felt the pessaries and gel was laborious and messy.

So when i saw my GP last month we changed to Evorel Conti. I quickly found that I was bloating, losing hair (!) and getting headaches - I didn't like that the progesterone element wasn't BHRT and I read that my symptoms were common with this type of P. So we swapped again, to Estradem MX50 patch and Utrogestan100 continuous. The Utrogestan100 pessaries were much smaller and not so messy - so this seemed to suit me. We discussed the possibility of Testosterone for the Libido but my blood test revealed that I was borderline so she didnt want to prescribe T to me... which is SO annoying. My poor long suffering partner and I have had sex once in around 3 years... I really feel like T is the missing piece of the puzzle.

Here are the issues I am now having.
MOODS
I am super moody! Snappy with my partner and can feel myself slipping into depression with negative dark thoughts. I read too much P can do this. But could it be i need more Estrogen? Is 1 Estroderm 50 patch equivalent to 2 pumps of Oestrogel??
ZERO LIBIDO
I am SOOOO unhappy about this...  as suggested before, I guess all I can do is ask for a referral or just push my GP to prescribe it!
However.... I am in Spain. Can this be bought OTC? Someone did say they knew a lady in Alicante that could help? @suziq99? Was that you?
BLEEDING
This has worried me... 2 weeks ago I started to bleed a very dark brown/black "old blood" and its not stopped. There is no odour and no pain, however today I seem to have "period pains". Again could this be an imbalance of the patch/pessary? I am a little clueless as what would cause this.

Currently I don't have a Doc here in Spain (tho if anyone has any suggestions for one on the Costa Blanca?), but I am planning on seeing my GP again for a checkup when I return to the UK late November.

Advice and thoughts on all or any of these things are welcome! 

[CLKD]

Why did you alter medication if it was working  ?

[Nikkisyard]

Why did you alter medication if it was working  ?

Starting HRT was fab... but as I think I explained I found using the 2 pumps of the gel and the huge pessaries really laborious and messy.  It was time consuming and the pessaries seemed to just come out as a big blob of cream!... also I really didnt want to have the bleeds after 5 years post meno.... thats why I changed.
i guess I thought a different method would be ok but hadn't realised quite how different the brands/methods can be...

I am not sure what, in my current regime, isn't working... 

[CLKD]

Having found out that you are now in a pickle, would it be wise to re-start the regime that you know actually works? 

[Nikkisyard]

Having found out that you are now in a pickle, would it be wise to re-start the regime that you know actually works? 

But thats the point CLKD - it didn't work... thats why I changed.

Yes starting HRT made a huge difference to most (but not all) of my symptoms, so I am super happy with that...  but the methods I have tried have not worked for me. Isn't this about finding a dosage and method that works for each of us?

I don't really want to go back to a method that was messy, time-consuming and had me return to the bane of periods every month... besides, travelling with a oestrogel proved a pain as I almost had it confiscated at the airport because it was over 100ml!

Evorel Conti had me lose hair and bloat... This current method sees my mood drop and I am constantly bleeding what looks like old blood...

So none of it actually worked.... hence my asking here for some help...

I am seeking advice to find a balance that works, and perhaps some possible explanations to why I am bleeding, and why my mood has dropped.

I could go back to using Gel if push came to shove (and I remember to carry the prescription with me when I travel... ugh) - but perhaps the estrogen only patches are working and I just need to up the dose?

[CLKD]

Now I'm confused, but that's probably connected to menopause?

"
I started BHRT earlier this year, starting with 2 pumps of Oestrogel and Utrogestan200 sequentially. I only did sequentially as the Utrogestan was advised as too high a dose to do continuously.
WOW - this changed things significantly! Almost within a week I was sleeping, no hot sweats and felt happier. However, I didn't welcome the bleeds and felt the pessaries and gel was laborious and messy. "

Maybe send an e-mail to Dr Curry on here and ask?  There is a charge.

[Nikkisyard]

Is 1 Estroderm 50 patch equivalent to 2 pumps of Oestrogel??

I am going to attempt to answer one of my own questions here... I have been doing some digging but need to check this with you all... and in a way this is checking to see if my original dose was what worked despite the method itself not working... (which is why I asked the Q)

Apparently 2 pumps of Oestrogel contains 0.75mg of oestradiol - so my daily does was 1.5mg.
One EstrodermMX 50 patch releases 50 micrograms of oestradiol a day...

If I convert 1.5mg to micrograms this equates to 1500 micrograms?! So the 50 micrograms a day from the patch is woefully inadequate??

If I am not getting enough Oestrogen would this contribute to low moods and bleeding?

Have I got this right? Or dreadfully wrong?? 

[CLKD]

 . that's sums and I don't do sums ........... maybe someone else will be along who knows more about HRT regimes which will help.

Or put the medications into the search box on here? See what pops up?

[Nikkisyard]

Now I'm confused, but that's probably connected to menopause?

"
I started BHRT earlier this year, starting with 2 pumps of Oestrogel and Utrogestan200 sequentially. I only did sequentially as the Utrogestan was advised as too high a dose to do continuously.
WOW - this changed things significantly! Almost within a week I was sleeping, no hot sweats and felt happier. However, I didn't welcome the bleeds and felt the pessaries and gel was laborious and messy. "

Maybe send an e-mail to Dr Curry on here and ask?  There is a charge.

Yes perhaps I should ask Dr Currie... good plan.  Im sure she will know re the dosages too...

And perhaps I complicated things myself (nothing new there!) by not explaining adequately that the first method didnt work for. me.. the dose seemed to as it dealt with the symptoms - but the method didnt...

[CLKD]

Clear as mud, probably an age thing 

Let us know how you get on.

[Hurdity]

Hi Nikkisyard

Your post was perfectly clear to HRT users! You explained what you had been using and your reasons for changing...

You can't equate the gel dose with patches though! The gel dose is what you actually put on your skin. The patch dose is the assumed average daily release into bloodstream. You have to go approx by low medium or high doses (see Treatments menu) and then adjust if you are someone who absorbs better by one method than another.

I understand what you are saying about the gel. I changed to it briefly for a few weeks and it's such a faff (I find) although regular devotees swear by it - we have to do what works for us. If you can get Estradot patches (or similar in Spain - Vivelle Dot or something) - these are the tiny ones that work on a dot system - then I suggest changing to them and increasing the dose say to 75 mcg ( starting with 62.5 for a few weeks - cutting a bit off the 75 mcg) and see how you feel.

That leaves the prog. I take it cyclically so put up with 12 days of a little bit of goo (of 200 mg) - I really don't find it that messy - if you sitck it up far enough - and wear a thin daily panti-liner anyway. There is no way I would take prog every day as it is a sedative and maybe also helps to reduce libido. Taking it cyclically also means a bleed - could you go on a long cycle under medical supervision and have a bleed every 6-8 weeks as I do?

Have you thought of a Mriena ( not bio-identical though...)

As you have been changing hRT then the spotting could be your body settling down -after 6 months it should settle especially if you are using it vaginally. Also I can't see how daily vaginal use of anything would help one's sex life especially with seminal fluid sloshing about - maybe affecting the absorption of the prog, although if this is a rare occurrence then it's more academic.

My regime is brilliant - 62.5 mcg Estradot patch. 200 mg Utrogestan vaginally for 12 days every 6-8 weeks. Tiny blob of Tesosterone 1 % gel daily. Vagifem twice weekly. Yes I do have a bleed and feel rough sometimes on the prog and the come-down from it but the rest of the time I feel great - well - I'm tired sometimes but I am mid 60's!

Does this help at all?

Hurdity x

[suziq99]

Hi Nikkisyard, sorry just seem this. Yes I know a lovely lady in Alicante.
She speaks perfect English as well I can pm you her number if you like.
How's your Spanish ? You need to speak to the receptionist for an appointment.
Yes you can get testogel OTC.
Generally speaking gp, s in Spain are not that keen on hrt. So you are much better off seeing a gyne directly.

[Nikkisyard]

Hi Nikkisyard, sorry just seem this. Yes I know a lovely lady in Alicante.
She speaks perfect English as well I can pm you her number if you like.
How's your Spanish ? You need to speak to the receptionist for an appointment.
Yes you can get testogel OTC.

Thank you Suziq99!! I have received your PM so kind of you.
I was considering taking the T into my own hands.. but I feel, under the circumstances, I should be seen by a specialist! Great to know there is one not toooo far away. I will be in touch!

Does this help at all?

Hurdity thank you!!... Yes it does help Glad I was understood.. I didn't consider that non HRT users wouldn't get it but of course none can assume... and for a moment I assumed we were all on HRT! Duh!

I actually spoke to a duty Doc at my regular practice in the UK today, on the phone.. we discussed things as they stand and we decided I should up to TWO of the  '50' patches each time and see how I go... it may or may not help with the bleed but examination isn't an easy thing to organise when I travel so much - however with Suziqs help this may change! I would like to see if my general mood is lifted though - because I am sure I need more Oestrogen. Then perhaps I can begin to understand how these hormones are working for me, and also if patches are the way to go. I will check out the "dot system" as I wasnt aware of that... I thought patches were patches! 

If the current bleed (and it is a bleed... not spotting) doesn't stop we spoke of stopping HRT all together but I cant bare the thought of that... perhaps as was suggested before somewhere I stop only the Prog, to see if Prog is the prob - but I cant see why it would be as Utrogestan is what I have pretty much always used aside for a short time on Evorel. I can however understand my body is probably still in freak out mode after so may changes.. this whole HRT thing is far more complex than I imagined and I hadn't realised that just changing the 'method' would affect everything... now, of course, I am learning...
 
I wont rule out the possibility of putting up with a cyclical bleed if it helps with the long term balance and wellbeing...

As for the T... well, with regards to my UK Doc I am still a bit stuck as even talking to the duty Doc today she said my regular Doc was very reluctant to prescribe it... because my levels were 'normal' (well - 'borderline' was what I was told before).  They are also waiting for advice from the Meno Clinic still.
No idea if the lady in Alicante would help me on this point but its worth a try... in any case I have an appointment to talk with my regular Doc on the 31st Oct so we shall see what happens then!

Thanks ladies!

[Nikkisyard]

So.... here's my update...

Suzieq99 has been so kind in offering to meet.me.in Alicante and take me to her Gynae there... and it coukd still be a possibility but I woke the other day with sharp pains in my uterus.. the kind that causes a sharp.intake.of breath... so, what with the constant bleeding I was worried. I quickly found a Gynae closer to me and now have an appointment for next week - private - but I dont have much choice as my EHIC doesnt cover me at this clinic and I havent yet set up Health Care here in Spain.
Anyways... as explained, following advice from my UK Doc a few days ago I had upped my Oestrogen to double what I had been taking, and, having missed a dose of Prog and read lots about Prog making one tired/low plus the pro's of taking cyclicly I thought perhaps I should give the Prog a break... so its been 2 days off Prog now...

The bleeding appears to be subsiding and today no pain.

I think the increase in Oestrogen has lifted my mood.

Yesterday I was able to buy T from the local pharmacy (they know Im on HRT) and I have been reading numerous medical research papers about giving T to post menopausal women so am now convinced this is my next step...

I need a health check by this Gynae local to me in Spain (he is Dutch)and will see what he is like... if, as I have read, he is as good as they say and is open to the idea of monitoring me with T included I will stick with him... if not I shall be hooking up with Suzieq99 in Alicante as well as pushing my UK Doc to open her eyes.....I think she will...

[paisley]

Hi Honeystar
I live in the north of Spain near Dénia. I have private insurance here & so have a private Gynae. I don't find her that much use & she isn't really keen on HRT after a certain age but I insist.
You can get most things here. They do have estradot but it is more expensive because it is imported. I use a patch called Evopad, it is similar to the Evorel that you get in the UK. That costs €2.50 for a box of 8 patches. Don't take progesterone as have had a total hysterectomy 7 years ago.