Move from 0.5mg of estradiol to 2mg estradiol - timings?

[squibbitus]

HI there :-) , I have just turned 50 and been on HRT for 3 months just over. I am on progesterone only pill daily as I had a small endometriosis in my naval that was removed and none found elsewhere back in 2017 (the reason was to possibly stop any further endo - I find if I stop taking them I get a lot of headaches, so am happy to stay on them). I have been on Femoston conti for 3 months and initially my hot flushes, irritability and fatigue subsided a small amount, but they came back, so I spoke to my GP last Friday and he is happy to up my estrogen, hence the change to 2mg of estradiol (Elleste Duet 2mg) which I started on Saturday last. Has anyone else had an increased dose of the estrogen part of tablets and found a great result? Here's hoping xx

It would make a lot more sense to carry on with the brand you are on (which contains dydrogesterone as the progestogen) and use Femoston 1mgs. What's the idea behind such a bit increase all at once AND changing to another type with Norethisterone as the progestogen?
You won't be able to tell (if side effects) if it's the change in progestogen or the increase in estrogen.

You (and your dr) do realise that the POP can 'cancel out' the good effects of estrogen in HRT?

You are actually taking mainly progestogen if you add up the POP and the progestogen in Femoston (so it's not a surprise you are still getting flushes etc.)

If you are using continuous HRT, you ought not to need the POP as well- it's doubling up the progestogen.

Sounds like a re-think is needed. :)

Thank you JHB
I started taking the HRT through a nurse at the surgery, she looked up the best one for me to be on regarding my previous endometriosis, she has since left my surgery. So I am now discussing with my GP who is not an expert in this area. So I am guessing he is not aware of what you have described. I am thinking of visiting a private menopause specialist and having it all done properly by someone that this is their specialist area. I do find it hard in the 10 mins we get with our busy GPs to go into much of a discussion on these subjects, so privately I guess I cover a lot more. Thank you for pointing out all those differences I was not aware of. Kind regards :-)

I think it might be best if you saw an expert. If you go to the website Menopause matters on the Home page right at the top, there is a tab for Specialists.

You ought not to be doubling up with 2 kinds of progestogen (POP and HRT) because the POP is really redundant. I'm not sure TBH that a nurse was qualified to prescribe this for endo . All you were given was the lowest possible dose of 0.25mgs.

Your GP is dangerously out of touch. It's pretty disgraceful to be really honest that he is unaware of the very basics - ie that the risk is around blood clots (with Pills v patch/gel) and not cancer. I think many non-medical people are aware of that!

I will do that JHB, thank you. The nurse even said the GPs are not very up on HRT etc... I think she had lots of experience and had used evidence based practice, it was just nice that someone was willing to listen to my symptoms and look into it for me.
I think a specialist would be best.

Would you recommend I book an appt with the specialist after I have been on these new tablets for at least a couple of months - just wondering if I go sooner it will be time wasting (and money) if we need to see any good/bad effects from them. I have no others I can take in the meanwhile either. Can you just stop HRT or do you have to wean yourself off, do you know?

Thanks again.

It would be a good idea to see a menopause specialist if you can, mainly to avoid stimulating any endo again,but in the meantime it might be worth trying to stop the POP. It'd be a good idea to give the new HRT a try though to see how it feels.

Many women get a headache when their own (natural ) levels of progesterone fall each month ( either before menopause or when using HRT on a cycle.- I do! When I stop the progesterone I tend to get a mild migraine for a day or so as the level falls.) It could be a type of withdrawal you are getting but it could well go away once your body gets used to no POP.

You can just s top but you may get symptoms again. It's best to tail off by reducing the dose over a few months.

I use an app on my phone to track my headaches and I was getting headaches about 30-50% of the time when not taking the POP, so down to just 1 or none a month now, so a huge difference and I get migraines on rare occasions, so really don't want all that back again.

But I am definitely going to book to see a specialist and get this all sorted correctly, thanks for your support x

My private GP service is brilliant with HRT in the South Bucks area. They can give a lot more time per appt, are extremely knowledgeable and up to date.