Hi Ladybt,
thanks so much for detailing your HRT history
. Great that at last you have a regime that suits you - but sorry you had to go through a long period of trial & error, in common with many women posting here.
I had been kinda wondering whether the regime that fixed your dry eyes included one of the more androgenic progestogens, given what I've read recently about androgens being important for DES & what I said above about the surprise of Evorel Conti increasing my saliva production.
Unfortunately I can't seem to tolerate Utrogestan whatever the route. Evorel Conti didn't give me bad progestogenic side effects but maybe only as I absorbed it poorly! Probably for same reason, it didn't resolve my meno symptoms completely, though I stuck with it, as better with than without (sound like an optician!) because every alternative regime I tried was worse. T was prescribed by a specialist gynae from the outset but I never got around to trying it as we were still trying to get my basic HRT right. Because my dry eye problem has worsened post-BSO & I've noticed other unwelcome changes I suspect may be due to losing the T the ovaries are said to go on producing postmenopause, I'm intending to ask about T again if I stay on HRT. I also want to try it for energy, stamina, muscle loss, bones (oesteopenia) & libido. Sorry - that's rather off topic.
Yes agreed - oestrogen is always said to be good for increasing moisture throughout the body, which is why I thought that optician was a
dickhead mistaken
, for saying HRT makes DES worse. I didn't question him at the time because I'd had the DES 25+ years, thought I was managing it OK & at that point it was no worse than it had ever been. It was just a routine eye test - I hadn't gone asking for help with DES, so what he said didn't seem significant at the time & I continued to assume the oestrogen component of any HRT regime would only help the condition.
A couple of years on (earlier this year) I was referred to Ophthalmology for checks on visual field - which turned out to be fine, but the Cons was instead pretty animated about the dryness & inflammation (which have recently got much worse), prescribed 2 other sorts of drops on top of those I already use & referred me to another Cons Ophthalmologist at the "anterior segment" clinic. I saw him a few months ago - he too was pretty interested in the dryness & has referred me on to Rheumatology for investigation for the Sjogren's they both suspect.
As when I was referred to Ophthalmology I'd just gone back on HRT after 18 months without, I wanted to reassure myself that the oestrogen would only help the DES condition. To, my surprise when I started reading up, what I found indicated that it's a deficiency of
androgens they think more important in DES. I printed out a long article & sent it to my Endo (who prescribed my latest HRT) to discuss at last appt, but somehow it got missed. Now can't find the same article, which I thought I'd bookmarked, but have managed to turn up other, shorter ones, saying much the same. The link below from Review of Ophthalmology (2006) is interesting, but may not be the best - I have a pile of articles but no time to go back through them this morning.
Relevant meaty bits include:-
"Recent studies have suggested that androgen deficiency may be the main cause of the meibomian gland dysfunction, tear-film instability & evaporative dry eye that are characteristic of Sjogren's syndrome, which occurs almost exclusively in women."
". . . other studies suggest that HRT worsens dry-eye symptoms . . . & oestrogen only HRT seems to be worse than combined oestrogen & progesterone therapy."
"Given what we now know about androgen deficiencies in Sjogren's syndrome & other dry-eye disorders, it seems plausible that rectifying endocrine imbalances may prove beneficial for patients with lacrimal & meibomian gland dysfunction and associated dry eye. It has been shown that testosterone levels correlate positively with tear function in postmenopausal women . . . suggesting that postmenopausal women with DES may benefit from testosterone replacement."
https://www.reviewofophthalmology.com/article/hormones-in-dry-eye-a-delicate-balancePhew - sorry another epic - but I hope perhaps interesting to anyone struggling with dry eye.
Wx
