Too much oestrogen?

[Robinsegg]

I have been taking HRT for 3 years, it was prescribed by a gynaecologist who is regarded as being an expert in the field, I paid to go privately. I was 52 and hadn't had a period for 2 years. It's been great, no problems and I have felt well.
Recently I've seen a different gynaecologist because I have a very large ovarian cyst and enormous fibroids. He is shocked and alarmed at the amount of oestrogen I am taking and has said that it may well be putting me at risk of stroke and blood clots as well as having contributed to the fibroids growing so big. I feel so confused and also pretty stupid because I didn't really question my prescription, it worked well and I've been getting on with my busy life. I thought that I was getting the best possible advice.
I'll need surgery (poss hysterectomy/ oophrectomy) now for the cyst and fibroids but also have to consider stopping the HRT on his advice. I am use Evorel 50 patches, Femoston Continue 1/5 plus Vagimen twice a week. Is anyone else on a similar regime?

why don't you query it with the first gynae who prescribed it?

Have never heard of anyone using a patch AND pills.

why?

Normally you'd increase the patch. It sounds a bizarre regime because if you want transdermal oestrogen, and want to increase, you could swap to gel which you could use up to 3mgs a day.

I think your current gynae is overreacting because Evorel 50mcgs is roughly 1mg (roughly) and Femoston is 1mg = 2 mgs. This is a reasonable but high-ish dose for someone aged 55.

There is no added risk of stroke with patches or gel.

Not all fibroids grow- I'm on roughly 1.5mgs oestrogen and in 8 years my fibroid hasn't changed.

I think you need to find a THIRD gynae who can give a balanced perspective. Neither of them sounds completely right on this.
And after losing your ovaries you simply cannot go from 2+mgs a day to nothing.

It's so difficult when specialists can't agree Polly, I honestly don't know what to believe. I have moved to another part of the country which is why I am seeing a different gynaecologist at the moment. I could go back to see the previous one but guess that she will stand by her preferred regime. I'm not sure of the rationale in prescribing patches and tablets, I had no idea it was unusual until this week! My new GP confesses to having no real expertise regarding HRT so has been happy to carry on prescribing though did say it wasn't a regime he'd seen before.

I have heard of 1 other gynae doing this patch and pill stuff- on another forum- might be the same dr. Thought it was weird then!

Why did she do it? Was a 50mcg patch not enough? At what point did you double up with a pill too?

It's not bizarre to use 2mgs a day but it is bizarre to mix pills and transdermal because you are negating the benefit of transdermal (no blood clots) by taking pills too.

If you need 2mgs then go onto a combi patch of 75 or even 100 mcgs, or use gel.

The amount of progestogen in the Evorel is for the amount of oestrogen - 1mg. If you are also using a patch, it may not have been enough which could result in a lot of bleeding or maybe a bigger fibroid. she has been a bit negligent.

sorry - meant the Femoston- the progestogen in it is balanced with the oestrogen to give no bleeds. If you add in extra estrogen you ought in theory to increase the progestogens too.

Have dug out my original letters to see why I'm having patches plus pills. Right from the start I was prescribed Evorel 50 plus a daily Femoston, the reason given 'because the tiny amount of oestrogen in Femoston is of a different type due to it's oral administration. The progestogen in Femoston is one of the safest for cardio vascular risk'
That's what I've taken for 3 years plus Vagifem which I was assured acts on the pelvic floor mainly with only a negligible amount being taken up in the bloodstream.
Well, off for MRI scan next so will address HRT worries at a later date once I know what I have to get through in terms of surgery.
Thanks for your input!

That's a bit of a load of codswallop tbh.
There is no risk of CVD from progestogens or if there is it's too miniscule to be an issue.
Femoston is 1mg. The oestrogen in it is the same as the patch estrodiol.

Vagifem is not absorbed so that's fine.

No Dr would normally give Femoston - with dydrogesterone - along with a patch on the basis of the progestogen being 'safer' re CVD.
You'd be prescribed a combi patch or an estrogen only patch / gel with Norethisterone OR a Mirena coil ( that is considered the safest.)