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[dangermouse]

So, in a nutshell, for anyone new who's getting completely confused.

You can get bioidentical HRT on the NHS from your GP or via a referral to an NHS menopause clinic.

You can get bioidentical HRT from a private clinic (you may be offered extra tests such as blood tests for hormone levels, endometrial scans etc). The doctor can write to your GP for him/her to prescribe the recommended regime on the NHS. Or you can pay for prescriptions privately.

You can get compounded (bespoke) HRT from a private compounded BHRT clinic where you'll have to pay privately for your prescriptions which are made up in a specialist pharmacy. You should have regular reviews and at least annual follow up tests such as endometrial scanning.

Please feel free to correct if I've got anything wrong!

Just one thing, if a private doctor prescribes oestrogen patches or gel plus bespoke progesterone, they will also write to your GP for you to get the available meds on an NHS prescription (so cheaper) and the bespoke meds you get sent separately. They will also prescribe Utrogestan to save you money if you prefer it.

[CLKD]

Wonder where all this info suddenly springs from ............  :: do people really have acres of files in order to copy and paste .........  or ?

Except that some ladies have found that their GP simply won't prescribe if someone goes privately ......... even when written to by the Consultant.  What then?

[Hurdity]

I didn't ask for a Lecture though!

CLKD that's uncalled for - especially twice - and going too far. 

Wonder where all this info suddenly springs from ............  :: do people really have acres of files in order to copy and paste .........  or ?

Not sure what you mean here - the BMS publish loads of information - it's readily available - and yes of course it's kept as files...

[Tc]

Ladies. I  have found all the information and experiences very interesting.

The Progesterone issue is very important to me as I also felt suicidal on utrogestan.   I tried conti,  cycling,, taking vaginally, the lot.  I can never take it again I cant risk it.

On high dose eastrogen I was offered only one alternative under NHS and that was mirena.  I didnt want it. For various reasons But I felt it was constantly being pushed on me.   In the end I had to agree to it or I wouldnt have got the implant pellet.

I had it  fitted nearly 5 weeks ago. After 2 weeks  all the same side effects seemed to hit me as with utrogestan including very sudden onset of black dog depression
 
I was terrified.   

 It seemed to pass and the past week has been better  which I did not expect because with utro the only thing that helped was  stopping the tablets.   

But my point is I was so frightened of going downhill fast that I wanted it out of me there and then. And that's not possible to do.  I felt trapped. The  implant cant be removed so I must take progesterone for at least the next 6 months.  But if I have to have mirena removed which there is no question i  will  if i get like i did on utro with it, then I didn't think there was anywhere else  to go. 

So it is great to see these discussions and that there are other options. 

Xx

[CLKD]

Consultants are keen to do hysterectomy, many still think 'whip it out' without knowing how this major surgery affects ladies.  It shouldn't be viewed as an easy option to get women out of the Consultant Rooms!

It used to be the very last resort ...........

It also amazes me how some Members respond to certain threads but don't interact in others where their advice might be appropriate ....... 

[GypsyRoseLee]

Oh TC I do sympathise. Whatever the progesterone is in Femostan 1/10 made me feel suicidal. It was horrific. I vividly remember standing at the top of Mallen Cove thinking 'if I jump now all this will stop'.

To be honest I would happily drink radioactive rat pee if it stopped those thoughts. BHRT seems like drinking pure ambrosia in comparison!

[Mary G]

Tc, if I remember rightly, you went to the C&W in London so I'm very surprised they didn't offer you the low dose Jaydess coil.   I realise you have a high dose oestrogen implant but you are being monitored.

I completely understand how you feel, there are so few choices for women who can't tolerate progesterone and you might want to consider taking the bespoke progesterone route at some point.  It's an extreme measure I know but I wonder if the C&W might suggest a hysterectomy if the Mirena coil does not work out.  Obviously it's still early days and you might find the Mirena settles down after a while.

night_owl on here was also under the C&W.  She had the same problem as me with migraines that started at menopause.   She also reached the end of the road with progesterone but sadly, she has had to give up on HRT altogether.

You and I have Gilbert's syndrome in common too.  It runs in my family but only surfaced at menopause in my case.   

[GypsyRoseLee]

Jaydess coil??? I have never heard of this! You see, this is why we MUST encourage open debate and discussion as much as possible.

[Tc]

Mary thank you. the jaydess was never mentioned to me.  The doctor said it would be "unethical" of her to not ensure I had a "reliable" source of progesterone before implant.  Basically when she realised I was progesterone intolerant (her words)  she didnt trust me to take enough oral progesterone regularly to cover me.

I wont have a hysterectomy. Ovaries removal has had a terrible effect on me. So I cant see myself agreeing to it.

Gilbert's yes. You saw my post on the other thread. Menopause is thought to  trigger symptoms.

Xxxx

[KBallinger]

My gynaecologist who has seen me over the past few years refused me the Jaydess as he believed I would react the same as I did with Mirena - maybe he was right! I suggested coming of Oestrogen but he believed without it I would become too depressed and I need protection for my bones as I already have osteopenia. Hence the suggestion for hysterectomy.

I went to a female gynaecologist who works privately as well as the C&W hospital  to get a female perspective and second opinion.  Her advice was that hysterectomy was not a bad option but as I'm in no state to proceed or make a decision she would  be willing to try the Jaydess as she has had some success. I would need 3 monthly scans. My lining was measured on day 7 of Utrogestan and it was 3.8mm . She would like me to try 6 weeks to see if it settles. Today I'm struggling and am not sure I can but I will take each day as it comes.

I realise I am fortunate that I have been able to go private. Don't know where I would be if I wasn't.

Mary I know you are unwilling to say who you saw for your bespoke progesterone. Are you willing to say yes or no if it was someone at the Marion Gluck clinic? This seems to be the one that keeps coming up on google. X

[Ladybt28]

Posted a comment about what the lozenges contain (comes up around page 3) and Mary G answered and Stellajane I think - coming back to this, it has moved on somewhat (sorry ladies otherwise seriously occupied but miss my daily menopause matters visit    Ref why BHRT lozenges might be better, it appears to me that it is the combo of dose but possibly the other ingredients and the delivery method.  MaryG mentions some ladies need 1 x 50 mg lozenge every 12 hours which would be the equivalent of 100mg but all at once??  Just my thoughts on that bit.

Ref reactions - at the beginning I had side effects and the depressive reaction but it lessened considerably at 7 months and last 3 cycles (I'm now at 20 months) I have had only a very slight depressive reaction. in other words just a tiny bit lower than when I am on the oestrogen part only. The thing about that is that most people can't/don't hang on that long.  As you all know there is no choice for me giving up would be an even more dangerous option xx

Even at my worst no one ever suggested a hsyterectomy to me nor if they had would I have considered one. It does appear from what has been posted and what i have read that women on lozenges and BHRT regimes do appear to get better monitoring.  No one is monitoring me despite repeated requests for a womb lining scan.  I have had none since starting hrt.  Apparently they say "you dont need it as you are having no problems and no intermitent spotting.  Come back to us if you do we will consider it then).  The list of monitoring and bloods and other investigations and tests which MaryG lists is most comprehensive despite it being "unregulated".  To be honest it is better "regulated" than I am at the moment

[Perinowpost]

Re the Jaydess and my much publicised failed attempt to have one fitted (on here), I was told it may not work also. I wouldn't have known until I had tried it.

Re hysterectomy as an option, surely part of why it's not offered is because of the cost.

Re scans I have always had to pay for mine.

Summary if you?re at all progesterone intolerant/sensitive it's all such a lottery - which is precisely why we?re having this debate x

[CLKD]

Many Surgeons offer hysterectomy because it gets the woman out of his Clinic! and because they don't have much of a clue of the long-term after effects.  My friend had 'enough wind to fly a kite' for weeks after  .  Some of course really benefit from the operation.  But as with many things, they won't know until it's gone. 

[Mary G]

KBallinger, I would love to be able to reveal the identity of my clinic but believe me, it would be more than my membership is worth!  Send me a PM and I will give you all the details. 

There are quite a few clinics in London that offer bespoke hormones and plenty of others around the UK.  I should mention cost.  Most clinics charge ?300 for the initial consultation and about ?140 for the annual follow up.  I have a yearly prescription and the actual lozenges work out at ?1.00 per day.   

You should be able to have your annual blood tests via the NHS but the uterine scan will probably cost about ?100.  Even when you add up the overall cost per year (roughly ?600) it's still less than some people spend on holidays each year. 

Not ideal I know but the great unanswered question has to be - apart from a hysterectomy - what is the alternative for women who (like me) categorically cannot tolerate any form of progesterone offered by the NHS? 

I'm still waiting for an answer.

[GypsyRoseLee]

MaryG and Lady - same her. Virtually zero monitoring in my 3 years ping ponging between GPs and Menopause Clinics.