If Estrogel & Utrogestan don't work...

[NickyNora]

What other HRTs can I try?
Dr wants to put me on The Pill. I'm really not happy at the prospect of The Pill

Been on Femoston, was awful. Im struggling with tbe Utrogestan.
Any other good HRTs to try?

Thanks

Thankyou for all your advice.

Are you saying there is still a supply problem with Oestrogel? I understood there was from another forum. There was a supply issue in March and a short delay in getting mine. let's hope it doesn't go on too long. Your other option is Sandrena gel, or even an estrogen-only patch in the meantime.

Sorry your gynae is so useless- sounds as if her people skills are not quite where they ought to be care.

I think it's important you keep on open mind on it and don't anticipate problems before you have tried something based on your 'hunches' if that makes sense. HRT is not the Pill, it's body identical and in tiny doses compared to the pill. I don't think there is any single type that is perfect, it's always a compromise. I can't predict my bleed using Utrogestan (sometimes it's 2-3 days early), sometimes I get really bad period pains with it, but I'd rather put up with these than be without the benefits of estrogen , so the alternative isn't great either!

Yes there is a manufacturer issue with Estrogel. I've called 27 chemists today. Only one outvog 27 could give me part of my prescription.

I know HRT isn't the Pill. The Gynecologist wants to put me on the The Pill.

I get severe bloating from the Utrogestan. PMT type symptons. Mood swings, depressed & irritable. Exhausted. Sore breasts I lose at least 12 days of the month where I feel so irritated & annoyef by everyone. Really struggled this month.
I wish I had symptons like you QueenoftheNights.

Nicky- why don't you try using it vaginally before you give up on it? Lots of women find this really makes a difference. In Europe this is the normal way of using it- all French women do. In the UK it's not licensed for this but many women are using it this way. OR you find a private gynae who is happy for you to use it for 7 days a month and you will have access to a private scan once in a while. Again, there are many women doing this. Maybe post on the Menopause Matters forum where there is lots of discussion on this ?

Well I had my appointment today with a very well respected Gynecologist in London.

He strongly recommended the Mirena... to the point he spoke of no other HRT. He offered to give me a general anaesthetic when I said I hated all medical procedures. I explained I experience severe anxiety even to have a smear.

I've never even discussed periods with a doctor, i avoid all medical things so the whole HRT thing is driving me crazy!

When i didn't agree to the Mirena, he suggested I stop HRT 'and see how I go..'

What's others experienced the Mirena if they struggled to tolerate Utrogestan?

Any advice?

It's a bit disheartening that he could only offer the Mirena . Did he not talk about long cycle HRT (bi monthly cycles for example?) Or use of Utrogestan vaginally? If you have not tried Utrogestan vaginally, is there a medical reason why? Have you considered it?

No he talked about nothing but the Mirena was so weird!

So weird as i just wanted a diffetent HRT combination.

Mainly taking Utrogestan orally for convenience & has hoped I could rescue my relationship...

I will try using the Utrogestan vaginally this month. Can i get away with using it for less days?

It would be remiss if him not to press the mirena when it is such a low dose of progestogen and that is the hormone that is causing you a problem. All the same pv progesterone is a good idea so try it and see how you go.

You really do need to continue with HRT if you can!

You also can vary progestogen duration and dose and cycle length on NHS provided your doc approves. I have done so for many years. Like QueenoftheNights I take utrogestan (vaginally) very 6-8 weeks (local GP practice). I would not take Loestrin - especially if you are progesterone intolerant - it contains norethisterone, notorious for causing side effects.

When utrogestan is used vaginally there is limited research to show that approx half the dose can be used compared with oral intake to give the same protection to the uterus. Systemic absoprtion is actually greater but with oral intake there are a large number of metabolic by-products which are thought to be responsible for some of the worse side effects of utrogestan. However it is also dose dependent - on the amount of oestrogen - so larger doses of oestrogen would need correspondingly larger doses of progesterone so you would need to make sure you took sufficient.

There is systemic absorption of the progestogen from the Mirena which starts off much higher and very gradually declines over the 4-5 years. It is very approx the same amount as would be obtained from a Femseven patch ( containing the same prog) - but far far less than contraceptive pills containing the same prog. It also has the advantage of being able to take as much oestrogen as you want and the womb is protected.

@ Bellaciao
Thankyou.

I agree I think I need to stay on HRT but i need to find a way to tolerate HRT. However that maybe

From your last paragraph, do you think I need to be more open minded & consider a Mirena?

Entirely up to you! I have chosen not to have one, in favour of long cycle vag utro!

Why not Mirena? I had 2 over 12 years......brilliant.

The reason i don't want a Mirena is partially that I'm really struggling with dealing with Drs, clinics etc.

I've never had any gyne problems so never discussed periods or anything personal with a doctor.

I don't trust doctors. Even a smear causes me massive anxiety. I have put them off for years in the past.

If i react to the Mirena, I can't remove it-without involving doctors & being exaimined. The menopause has caused my anxiety to go through the roof.

Why won't I react to the progesterone in the Mirena? I can't risk feeling worse then i do & no-one seems to be able to answer my question!

I'm not having issues with bleeding. Never had heavy periods. Even on HRT i only bleed for about 3 days & very lightly.

I think I will alter how I use the Utrogestan differently.

I'm also going to start anti depressants as i can't go on feeling as i do. I feel increasingly depressed. If i didn't have young children, I literally would just give up...

I had no idea the menopause would be this bad. It's horrendous & I've already lost a year to it. My youngest is very affected by how I am now. She can't remember the 'normal' me.

I wanted a hysterectomy but was offered the Mirena. Not entirely happy with it but that plus Oestrogel works reasonably for me. I had the Mirena put in under GA. (A previous procedure resulted in scarred cervix and severe pain.)
Anyway, you could try the Mirena. If you are progesterone intolerant, it’s at least a smaller dose. I think I get joint and muscle pain from it, but not too badly. And yes, there is still an issue with the gel supply, according to Boots anyway. My local independent pharmacist was far more helpful, my scripts are going to them from now on.

@nickynora

Would you think about counselling or CBT as part of all of this?
A lot of people don't like drs, but to allow those feelings to get in the way of finding a treatment that works is another level.
Are you embarrassed by being examined (I don't think any women enjoy it!) or do you feel everything is out of your control rather than being an equal in your care? At the moment you seem 'stuck' due to worrying about things that may never happen ( ie bad reactions to types of HRT) when you have't tried it. This is a psychological issue (it's call catastrophising!) and CBT could help.

Thanks. I've just finished CBT it helped, it helped so i can actually go to appointments.
I think antidepressants will be the next step.

I'm embarressed by state of my body, which has changed so much in the last year.
I don't trust the doctors, they don't listen to me or trivialize what I'm describing.

I fully thought I'd start HRT, pick it up from the chemist & have a yearly check at the doctors. Yet here I am getting worse mentally & physically.

My reaction when on Femoston was scary, really scary. I actually at one point consideted running someone over because they crossed the road too slowly! It was like extreme severe PMT. Plus lots of physical side effects.

The doctor on Tuesday wasn't listening & offered me no alternative HRT. He offeted to book me in to have the Mirena put in under general but i can't stand the thought of it even being unconscious!

Joint & muscle pain is getting worse. Still having hot flushes, though reduced. Dry eyes & mouth. Severly fatigued. No labido whst so ever.

I don't feel the Utrogestan is just the issue. The Estrogel doesn't seem to be working anymore. This week I go up to 4 pumps daily.

Maybe it's time to chuck money at this & go private

Thankyou for responding.

I need to belt up & stop whinging. I wish I could get back to normal.

Well I had my appointment today with a very well respected Gynecologist in London. [pm me if you want with a name because I use a London gynae.]

I misunderstood; thought you'd already seen someone privately.

If you see someone privately what you will get if it's the right person, is time and consideration and treating you like a person.

They won't be able to offer any different types of HRT but they could be happy to use what is available as a different dose (eg long cycle so 6-8 weeks not every 4) . You could also try the Mirena and have it removed after 2 months if it wasn't any good.

I seen a very well known Gynecologist but luckily through the NHS.

I hoped he would recommend an alternative but he spoke about the Mirena for the majority of the consultation.

Mr Panay? Only one I can think of in London who does NHS and private.