questions about patches and bioidentical progesterone...

[slowandfrumpy]

So, after a two minute consultation, I have been given HRT patches, evorel sequiri (the one that gives a period once a month)

I have questions, that I should have asked the GP but didn't as she had an eye on her watch (ten minute slot and the first eight minutes were taken up with other matters, like repeat prescriptions...).

I had regular periods until September last year, then a rogue period after two weeks, and then nothing until this March (six months gap) when I had two periods a month apart. Since april nothing at all (five months).

The patches will give me a period every month, but I understand that there is an option for a long cycle of a period every three months. Given that my periods are so far between does this make sense? And is it only possible with pills? Or can this be achieved with patches? And is it risky/ possible?

1. I have googled Evorel S. and it seems that the synthetic progesterone used in it has been associated with higher risk of breast cancer. Are 'bio identical' progresterones better/safer? Are they available on the NHS? Are they available in patch form? Or if I want this do I need to go on pills?

1. Is it worth paying to go to a menopause specialist privately? What would they do differently, if anything? How does their evaluation differ? What kind of costs am I looking at?

Thank you for your wisdom...

Frustrating you have had a rushed appt.

Okay- here's what you need to know :)

1. Yes, synthetic progestogens (note: not 'progesterone' which is the natural type) are shown to have a higher risk of BC. There is some research showing that natural progesterone has a 'neutral' risk factor and some research showing it may even reduce BC risk (compared with non-HRT users.)

1. You can't get any combined (pack) pill or patch with natural progesterone and oestrogen. The only source that is effective is a capsule which is micronised progesterone, trade name Utrogestan.

1. It's too soon for you to have continuous HRT (no period type) as you are still peri. Your own cycle may override continuous HRT so you'd get 'odd' bleeding. The 'rule' is 12 months with no period at all before no-bleed types.

1. To get what you'd like you need to use two types of hormones- oestrogen as a pill, patch or gel and then Utrogestan for 10-12 days each month (that's the licensed dose.)

1. You CAN have 'long cycle' HRT BUT this is not usually ever prescribed by a GP. (There is only 1 type of packaged HRT for this- Tridestra- which is synthetic progestogen- which they'd prescribe.) A private consultant can do what they want and prescribe long cycle using any of the kinds of HRT available - so 'a la carte'- where you use any oestrogen and any progestogen/ progesterone.

6 The 'downside' of long cycle is your endometrial lining should be monitored if you use long cycle for any length of time (by U/S scans) as there is a risk of build-up (hyperplasia.) Your GP won't offer this as it's not part of the NHS 'regime'. You will get this privately but the cost of s can (maybe annually) can be from £100- £250 depending on where you live. ie Harley St is top end of price.)

7 Going privately means you get time to talk, full range of products, more regular reviews (though you will pay) and - hopefully- a really clued up specialist.

I've had private meno care for almost 10 years. Saw my gynae for non-meno issue then stayed as meno arrived. I'm happy to share costs by PM but every consultant is different. Initial appts can be around £200 with review appts half of that or thereabouts (maybe twice a year) .

In theory you ought to be able to get the same HRT from your GP on the NHS- some women do. The problem is asking for anything outside the box (literally!) as GPs lack knowledge and confidence to prescribe.

Just to add, there are women using oestrogen and Utrogestan (many seem to like Estradot as the oestrogen patch) from their GP. But you will have to go along and say 'I want to try X and Y' because many / most GPs haven't heard of Utrogestan. (It's in the BP and is mainstream, often used in larger doses for fertility treatment) But the prescribing dose in easily found online for your GP and is in the leaflet in the box. (I've used it for 3 years now.)

It's not without its downsides- one side effect is sleepiness and dizzyness so it's advised you take it at bedtime and on an empty stomach. The dizzyness is short term; I once took it an hour before bedtime and felt really dizzy when I stood up.

Hope this helps.