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[NickyLD]

Hi All,

A bit of background. I'm 44 and have been on HRT for the past year. Tablets initially, which worked literally instantly, and I felt so so much better. Gradually I was finding the emotional imbalance returning - all other peri menopause symptoms much better.  The GP's initially suggested I needed an anti depressant and prescribed a 20mg tablet, which made me feel really very ill after just one dose.

I then tried the Evorel Combination patch as the docs thought this would be absorbed better by my body. This also had an adverse reaction (low mood, anxiety, etc almost instantly). So I asked the doctors to put me back on the original HRT (combination pill 2mg) that I was on before.  I've felt my moods and anxiety dip again - usually in the progesterone phase of the tablets. Again the docs prescribed an anti depressant but a much lower dose 10mg and they said I wouldn't have any adverse reactions.  Again after one dose, dreadful symptoms again and I literally will never take an anti depressant again.  So now I'm left trying to understand what to do now.  I asked the doctors for a bio identical HRT instead and was told that it wouldn't make any difference and to not put too much emphasis on the HRT instead.  Frustrated I then said what about a Mirena coil instead and that seems to be the latest advice to try that first.  Looking at the number of women who have had issues with the Mirena, I don't know if I'm walking into yet another unstable period.  I want to feel better not worse.  Any advice? Should I push for bio identical HRT first or try the Mirena and gamble on having to have a period of instability until things settle down? I just don't think my doctors understand the implications of all this swapping and changing around. I don't appear to just have minor symptoms, these changes can literally be really very unsettling and scary. Any advice out there?

[Dancinggirl]

Hi and welcome to MM

You haven't told us which HRT you are on now?  If you are on one that has Norithesterone then it is common to get low mood with this type of progesterone. It could be worth trying Femoston as this has a kinder progesterone.  There are many different types and most now have bio identical oestrogen but there are quite a few different progesterones you could try.
Do look under TREATMENTS on this site to see your options.
There is a bioidentical progesterone called Utrogestan (micronised progesterone) and some women do well with this but if you are very sensitive to progesterone then even this one can cause side effects.

If you struggle with the progesterone phase then do stick with a sequential HRT regime.
 You could ask for oestrogen as gel or patch used all the time and then use Utrogestan (micronised progesterone) vaginally for 12 days each month - this is the bioidentical hrt regime you are wanting to try and by using the Utrogestan vaginally this might reduce some of the side effects you are experiencing. Unfortunately using Utrogestan vaginally isn't licensed here in the UK but many women still use it this way as it's normal in most other countries - your doctors may not sanction this or may advice against this because it's going against the standard treatment here on the NHS.
If you print off the info from this site your GP should be able to find the right things to prescribe. 
The Mirena might be worth considering if the Utrogestan doesn't suit you; less progesterone is absorbed systemically with the Mirena so this can mean fewer progesterine side effects.
It is trial and error I'm afraid. I had a premature menopause and used HRT from my mid 30s. The best HRT regime I ever used was the Mirena with Oestrogel applied to inner thighs each day. Don't take Ny notice if the scares over the Mirena - I believe 95% of women do really well with the Mirena.
Try the oestrogen patch ( Estrodot 50mcg) and Utrogestan first, to see if that is better for you. DG x

[NickyLD]

Hi DG,

Thank you so much for your response.

Apologies brain fog!! I couldn't remember the name of the tablets! It's Elleste Duet 2mg tablets.  The doctors wouldn't prescribe the bio identical HRT in the format you have suggested below as he said it would make not difference to how I was feeling. The Mirena was basically the only option that was offered.  Frankly though, after a horrendous month this month with the build up to a bleed this month I'm willing to try anything! Perhaps have a light bleed would be a blessing in itself. It's just the introduction of progesterone into my body in a way that I'm not able to control that I find worrying. I have a feeling that I may react badly to the progesterone and it's not exactly something that I can just whip out! Which is why I'm not sure why he didn't just suggest a different make up of HRT first?!

[Dancinggirl]

Ask to try Femosron 1/10 next as this has a kinder progesterone. The GP is completely wrong about progesterones all being the same in terms of side effects - I'm afraid GPs are rarely clued up about hrt.
Sequential would be better for you even though you do have to put up with a monthly bleed.
DG x

[NickyLD]

Hi DG,

I've just spoken to the doctor again and I've been told Utrogestan isn't available to prescribe on the NHS and there is no bi-identical progestin available on the NHS either, so suggested I continue on the regime that I was on and persevere with the CBD oil (which I suggested would possibly make me calmer but would not tackle the menopausal symptoms much).  I've asked her to review the options and I've got an appointment at 4.30pm to discuss the options available to me.

I'm scared stiff that due to my sensitivity to hormones generally that the mirena coil 'option' is stressing me because if there are bad side effects like I've suffered for the past year then if I have issues I won't be able to simply take it out easily!

This all feels like a trek through treacle at the moment.

[Dancinggirl]

Here are the links on this site you need to print out to show the GP:

https://www.menopausematters.co.uk/perimeno.php

https://www.menopausematters.co.uk/to_progestogens.php

https://www.menopausematters.co.uk/treatafter.php

Explain to the GP, “calmly' - This site was set up by Dr Heather Currie who was part of the professional team that put together the latest NICE guidelines.
She would not put something on this site that wasn't available on the NHS.

You could do an email consultation with DR Currie ( costs £25) and you could then show her advice to the GP.  You could also ask for a referral to a specialist gynaecologist or menopause clinic.

The Mirena can be easily removed if it doesnt suit you but it could be a good option for you but I wouldn't rush to this yet.

I am staggered that your GP can't offer alternative HRT options for you - I would ask to try Femoston 1/10 next if they really won't give you oestrogen patches with Utrogestan.

We are here to support you - keep positive andproactive - I'm afraid it can be trial and error and a battle.  All you've had trouble with so far is with this type of HRt because it has Norithisterone. 
Perhaps say to your GP “ AS I'm sure you know, Norethisterone is known to be a difficult progesterone to tolerate (many women struggle with this) and I'm sure you can find me a better alternative”. “ There are many women on this reputable website who are on Utrogestan with separate oestrogen and doing extremely well”. 
Utrogestan is under ‘Micronised Progesterone' in their drug book - so perhaps suggest nicely that they look this up. I believe it is used in fertility treatment but is now widely used as part of HRT as it is considered ‘breasts friendly', safer and better tolerated by many women!!!!!!

Good luck. Dg x

[NickyLD]

Thank you DG. I've printed all that off.  I'll be very diplomatic

[SueLW]

Good God! 

I have my Utrogestan prescribed by my NHS GP, as does everyone else using it on here!  If she simply can't find it on her computer under HRT products, tell her to look for it under the "fertility" section.  It will be in there.  Don't tell her you intend to use it vaginally (if you would like to try that) she'll have a fit.

You can most certainly get it on the NHS.  I use it continuously vaginally.  It's good.  No side effects.  I couple that with the gel, but she seems happy with patches, so stick with a patch to keep her happy if you want to try sequential with Utrogestan.

[NickyLD]

Hi all,
I didn't get very far. I printed out all the guidelines and asked again why I couldn't have the Utrogestan (sorry can't spell it), and she said she can't prescribe it as an NHS patient and it would have to be a private prescription.

I've ended up with Tridestra. I have absolutely no idea what this will do to my moods, but I didn't appreciate that 7 days of a 3 month cycle would be a placebo to induce a bleed. So assume I'll have to go completely cold turkey in this week?  She was lovely and trying to help but I'm not sure if I've emded up with the right product (again). Time will tell!

Nicky

[Dancinggirl]

Oh dear! Another GP who doesn't know what she is talking about. Does Tridestra have Norethesterone in it?
Trudesta may be worth trying but if you are still peri menopause you might get some erratic bleeding.
Give it a go and see if you can cope with the progesterone phase and the 7 days without Oestrogen.
She is wrong about Utrogestan.
If Tridesta isn't good then try Femoston next. DG x

[NickyLD]

Hi DG,

It doesn't have that stuff briginnong with n in it (sorry I literally have no brain to remember the name), which is why she prescribed it.

I am interested to see how much Utrogestan is as a private script though because Lloyd's Pharmacy has it currently on their website as 51p as opposed to the NHS £8.81 for a NHS prescription. How is Utrogestan normally taken in a pill form?  She was referring to the NICE guidelines when she was looking at NHS products and I asked a few times and she said it wasn't there! Really odd. I think I'm going to have breakthrough bleeding (I'm only 44) and a lack of oestrogen at the placebo week. I literally feel like I've walked into another problem

[Dancinggirl]

I think Tridesta may have Medroxyprogesterone which you may find is OK actually - it dies suit many women very well.
Don't look for problems - give it a go and you never know it could suit you. At least you have a much longer time on oestrogen alone. DG x

[NickyLD]

You are right I was looking for problems before I'd even tried it!

Thank you for making me see that xx

[MIS71MUM]

Hi
Just a quick reply - I had the same problems progesterone wise as you.

Just a thought, as you're under 50 you could try a contraceptive pill. 

You might find that HRT isn't enough to control your systems as it won't override any existing cycle that you have.

Qlaria is meant to be good for peri menopausal ladies. It's been mentioned on this site before.

[NickyLD]

Hi all,

Will a contraceptive pill have enough oestrogen in it to control the hot sweats, palpitations and myriad of other symptoms?

I went to pick up the prescription today, trying to be positive about it and thinking I should just try it. I was told there was a supply problem and they didn't know when it was going to be available, as a result I could “ring around” all the local chemists to see if they have stock. No ideal for something I didn't want in the first place. She also said it was x 3 times for the prescription (1 each for oestrogen, progesterone and placebo week), so £28! On this basis I'm wondering if anyone knows how much a private prescription is and I will go with the Utrogestan combo I wanted in the first place.

I'm still smiling (just)!