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[Tc]

 I'm off to gynae on Monday and trying to get my ducks in a row before.

My E isnt high enough and the return of flushes since I started the eastrogel might be an indicator of that. But all my major symptoms are not even controlled. On 4 pumps.eastrogel.

Depression and anxiety is major and all my symptoms seem so severe.

After 37 days straight on utrogestan I'm literally sick of it. Naturally progesterone isn't high for 37 days straight, is it?

I've come to a conclusion, anyway, any thoughts/advice please here goes:..

Being as I was not in meno prior to BSO surgery I think I need a regime that more closely matches my previous cycle. The continuous one is too much of a big change. I think if I went on a bleed regime at least for a few months or couple of years it might more closely reflect what my body was doing naturally and make the transition easier on my body.

I have also wondered if a switch back to patch might suit better. Our own natural hormones "pulse. The patches release through 24 hours whereas the gel doesn't.

I'm also going to ask for T as oopherectomy removes all the T that a woman in natural meno would still have.

I think the huge immediate change post surgery if you were not menopausal before  is too much for the body to take. They put you on a post meno regime with post meno doses There is no transitional phase and the body and brain go into shock. It's then an uphill battle.

So an initial post surgery regime which  as close as possible mimics the natural cycle and at higher than typical natural post meno doses  would seem kinder to the system.

As time passes it can then be tailored to reflect post meno.

Does my thinking make sense or am I way off the mark here?
Any thoughts /advice please.

[Hurdity]

Hi Tc

Yes as you say surgical menopause that takes place before you have reached menopause naturally is extremely challenging and shocks the body which takes some time to adjust.

Also true that your oestrogen levels would be cycling - although some maintain that this is not our natural state as we would naturally either be pregnant (very high oestrogen and progesterone levels) or breastfeeding (low hormones). But it is the actual state for most of us (the cycling) for most of our reporductive life.

However whichever is true naturally, post-menopausal oestrogen doses for those who have reached meno at the average age - tend to be lower ie a medium dose and I agree I would want my levels to be higher in your position - not yet at the average age of menopause (can't remember you age?) or at least not at meno before your op.

Also though - adding hormones exogenously (from outside the body) is only a crude approximation of our own enodgenous (internal) hormone production - so is not ideal - as you say there are pulses of hormone production. I don't either form of oestrogen replacement can actually replace this though - but do try patches if you think they will help you feel better?

Interestingly also with most HRT types apart from a couple of tabs maybe, the level is designed to be contstant - which minimises or avoids ( when post-meno) the dramatic fluctuations of peri-menopause - that is the aim. So - if you try to vary it - in this crude way ( the only way ) we have - it may have the reverse effect. For example if you try to cycle to very high oestrogen levels as they would be at ovulation, and then dramatically reduce them eg as they would be just before the natural bleed - maybe this would negatively affect your mood even more?

Some gynaes therefore aim to mainatain a very high oestrogen level (for women eg in your position) - which is only natural in pregnancy ( although the levels are not nearly as high).

Not sure what the answer is but sounds like it is definitely  a plan to try to take your levels up a notch - or at least increase the dose until you feel good - irrespective of what the blood results say - but just better to take it steady..

The tricky thing for you though is having to take the prog to protect the womb - and more has to be taken with higher doses of oestrogen - but yes there are quite a few of us who prefer a cycle - even those who have gone through menopause naturally, as continuous progesterone has a sedative and often depressive effect.

Re testosterone - this declines naturally with age but still continues after BSO to some extent as T precursors (eg DHEA) are still produced by the adrenal glands and  converted into testosterone in other tissues in the body - but a major source of production is removed at one fell swoop with BSO.

These are just a few thoughts in response to yours and hope it helps a bit

Hurdity x

[Tc]

Thank you hurdity. Very well thought out and interesting reply. Thank you for taking the time.

I think the highest patch is 100 so That's roughly equivalent to 4 pumps so if I wanted to increase I would either have to stick with the gel or maybe use a patch and add gel as well

'Re the progesterone. If I increase from 4 pumps does that mean I would need more P than 12 days x 200?
Hopefully I will get vagifem so I can start using the P vaginally.

My T has been tested so I guess we'll see what my adrenals are putting out.  do wonder wether BSO puts a strain on the adrenals.
 
I think I've got a clear plan in my head now of what I want to try. So we shall see.

[Katymac]

It's really interesting to read that both of you - I am struggling with this too

I think I run out on my patch before I 'should' replace it - so I was hoping to use the patch more often rather than have a bigger dose....I also run out on my Vagifem before the GP thinks I should take it again



I'm also interested in Testosterone

But I will probably sit and do nothing as I hate going to see the GP

[Tc]

Katy.yes.the docs think twice a week with the VA treatments is enough. You only have to read this forum to realise that for many women it's not enough.
How often are you supposed to change your patch? Do you mean you feel the effect lessens and so you have to replace it sooner?

[Katymac]

Twice a week so (say Friday am and Monday evening) but tbh I had brought it forward to 3 days not 3.5 and I'm not sure that is enough

Vagifem would work every other day I think and maybe 2.5 days for the patch? but I dunno how that would work with the progesterone

After day 2 I start to get ratty, my sleep is affected and I get my flushes back

[Tc]

Yes. I want to go back to patch but think I need more E than the 4 pumps Is giving and I think patch only goes to 100.dont know what I can do about that.
I m also going to switch to 12 x 200 utrogestan. I realy feel like I've had too much Progesterone taking it continously but not sure if 12 x200 would be enough if I up my E.

[Hurdity]

The standard patch change time of rmost of them is 3.5 days although apparently I read that actually they can last a week -but obviously giving out a declining amount of estradiol. If the change is too soon then maybe counterproductive so probably better to increase the dose than to go down to every two days for example? Not sure if any stats on this? yes good idea that you could use patch and gel Tc - that way you would be mximising absorption with teo different methods but yes if your levels become high you might find that the utro at the standard dose is less effective - although if you use it vaginally, likely to be more so ( ie effective).

Hurdity x

[Tc]

Thanks hurdity appt this pm.
Am I right in thinking a 100 patch would not be a drop (al5hough they're not m3asured the same) from 4 pumps gel.i don't want a drop switching over in fact I want to up.my E.
 I'm pretty sure I would have a fight on my hands to get patch and gel.together. if she won't do that then do you think i could I ask for 100 patches and 25 patches and use 125  overall in patches?

I'm realy gonna have to justify it I think because she has in her mind what post meno level should be and even Dr Newsome chart doesn't go above 100. Am I going into dangerous territory trying to go higher.

I'm ready to stand up for myself in there today just wanna get my facts straight and be ready with a comeback if she puts obstacles in the way.
Thanks for any advice

[Katymac]

hope yesterday went ok

[Tc]

Thanks Katy I have posted an update. X