Confused

[DietingAgain]

I'm afraid this may be a long one - I started hrt around October 2017 age 49, I was still having regular periods but was suffering from other symptoms and was deemed peri menopausal and started on oestrogen gel and progesterone tablets. I took these for a few months and did feel a bit better but the dr was concerned that I wasn't having a decent amount of blood loss - still had periods but brown discharge really as opposed to red blood.

I was then put on elleste tabs for a few months which didn't seem to alleviate any symptoms so upped the dosage to the elleste 2mg which again didn't nothing for symptoms but both these treatments gave me a proper period. As they were not helping with symptoms dr suggested patches so I was on fem seven sequi and quite liked these and for the few first months had normal periods which did reduce to not much blood loss and again reverted to dark spotting really. Since unable to get hold of any sequi patches the dr has now prescribed me evorel conti patches. I've never not had periods and now have been on hrt for around 18 months. I'm now 51 and have no idea whether or not I would still be having periods had I not started hrt.

When I asked the doc about these patches being for post menopausal she said that they have the most up to date guidelines which are changing all the time, and that currently are advising if a person has been on hrt for 12 months they are now allowed to prescribe conti as opposed to sequi and that the latest report says that the gel/utrogestan combination may be more risky in terms of thickening of the lining of the womb and that's under further investigation! I'm so confused - does anything if this sound right and am I ok to start a conti patch at this point.

Thanks so much if you made it to the end, a bit rambly trying to fit enough info in without writing war and peace

There is no evidence that I know of that utrogestan is under investigation. That sounds like bollocks to me. I've used it for years and I am sure my consultant - world meno expert- would advise if this was so. In fact the opposite it true- more women are being advised to use it as it's less risky re. breast cancer it seems.

There is a slightly higher risk of the endometrium by using ANY type of sequi HRT but that has to be balanced against the more serious risks of continuous HRT which is KNOWN to have a higher risk of breast cancer.

Your dr was wrong firstly to query no blood loss- something like 15-20% of women do not bleed on sequi. Often this is because they don't absorb much estrogen or need a higher dose.

I appreciate you don't know if you are still having periods of your own. You are just at the age of average menopause at 51 so possibly you are.

I'd be really interested to see the report she talks about re higher risks of Utrogestan and suggest you ask her for a link to the paper or guidelines.

You might l ike to ask her if she knows that continuous HRT using synthetic progestogen is the highest risk for breast cancer- so ask her which is the better choice!?

In your shoes I'd push for sequi on the basis you may not yet be post meno. Endometrial cancer is very rare in any woman using HRT. She is rather silly I think to be refusing you a regime which is mainstream and advocated by consultants- many of them including minefavour it over all the other options.

Thanks so much for your reply, it really is a minefield but something about what she was saying didn't feel right. She never mentioned the breast cancer risk just the thickening of the lining. I've only got one months supply of this new patch and am due to start it on Sunday, I think after that I'll go back and ask further about the gel/utrogestan - thanks again

@Dietingagain

I think your GP sounds confused :)

Maybe she is conflating two things?

Sequential HRT (all types) carries a tiny risk of endometrial thickening compared to continuous combined HRT. Utrogestan is not as 'powerful' as say Norethisterone, but if used correctly it should not pose a risk which makes it unprescribable. (Otherwise it would not be licensed!)

There has been a lot of publicity around body-identical products - like Utrogestan (micronised progesterone) - with many 'slebs' saying how wonderful it it- think Carol Vorderman, Mariella Frostup, and more, as well as menopause drs, such as Dr Louise Newson (pretty sure she says she uses it.)

If it was so dangerous would all these people be using it???

www.menopausedoctor.co.uk/menopause/breast-cancer-hrt

This paper is useful and if you read the Results just a few paragraphs down, it shows what I was saying.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3815310/