why not a lower dose of oestradiol?

[llama74]

Hi, I’m 45 and noticed perimenopause symptoms since age 40. My cycles went from 28 days to 20 or shorter, weight gain, brain fog, tiredness and PMT. I tried natural progesterone cream and had real improvement, cycles back to 26 days, weight became manageable, brain fog eased. However, I was concerned that I wasn’t able to control the dosage applied very well, and I still had huge mood swings around the end of my bleeding/’ovulation’. I went to see a GP with an interest in women’s health, and she put me on HRT 50/140 oestradiol/norethisterone transdermal patches (oestradiol for weeks 1-2, then combo for weeks 3-4).
This seems like a high dose of oestrogen, as the patches are classed as medium rather than low dose. I am not using the patches for contraception (husband had the snip). Why would she not have put me on a lower dose of oestrogen please? it's early days of using them, but I'm 2kg up already (I'm still in 'normal' BMI) though not feeling hungry. I appreciate that I'll need to settle down on oestrogen but I can't help feeling I should be on lower dose. I hated the combo pill in my younger years, always gave me weight gain, acne or horrendous PMT.

@llama74 Look, I've got more to do than get into spats with you. If anyone owes anyone an apology, it's you. You came along with your sarcy comments about 'self appointed expert'.

You are incredibly rude and you ought to retract your comments about me that are personal and completely out of order, I am going to report you. I have stuck to medical facts. I have NOT made personal comments about your intelligence or ability to read.

I am an expert in that I write on these issues and I speak to all the top UK menopause specialists who provide content for the articles. Argue with them maybe? Would you like their names?

I am NOT using progesterone cream. It is a TABLET. So your entire post here is incorrect and based on your own inability to read and understand.

Micronised progesterone which I and thousands of women use ( it's not a cream!) is a licensed product available on the NHS as part of a combined HRT regime. It is not licensed for use alone other than a fertility drug. My consultant is a world expert in the use of micronised progesterone. I have been with him for 10+ years.

That's all I have to say to you.

llama your posts are offensive and incorrect and jingling, out of the goodness of her PROFESSIONAL heart, has helped hundreds on here get proper treatment from their GP's.

Me included, all for the better.

GP's know very little about menopause, once I got the info from here, I researched and researched and then got my HRT.

Your estrogen dose sounds like a good call to me (but what do I know?) you are young and need more estrogen. Sounds lucky you were prescribed that dose.

Do some research yourself and stop talking about progesterone creams and arguing with a very knowledgeable and helpful poster for the sake of it.

You are rude.

Hi Billie, thank you for your personal attacks and lack of factual information.

1. I have done some research myself. Have you? Research is literally my job, I teach research methods (Cambridge Uni, currently on loan to Sydney Uni). I teach undergrads and post-doctoral researchers how to research and how to use research methodologies.

1. Your opinion of GPs may be justified in your experience and that of others. I was prescribed progesterone originally by a consultant at Addenbrookes hospital.

1. It is worrying and frankly ludicrous to continue denying that my progesterone doesn't work. It is endorsed by NICE and on the NHS list. Crinone 8% is a standard preparation in the treatment of fertility challenges. Crinone 4% has been widely prescribe (by consultants worldwide) for non-fertility related issues, including management of perimenopausal symptoms around cycle / luteal phase. It may well not be on the NICE list, but I suggest that could be a matter of cost. It is not, to my knowledge, available over the counter but then I've not tried as I've always had it prescribed by consultants (then repeat and monitoring from GP).

1. I also find you rude. In addition, I have received a number of messages indicating others have shared my experience here with one person who has left them feeling shut down, put down and afraid to participate.

1. I can see no reason to continue this conversation. I've been trying to shut it down for a while, as I have made clear. However, having been through the horrendousness that is fertility issues and treatment I am not going to walk way while someone is saying, here or anywhere, that their consultant-prescribed, NICE-endorsed, NHS approved progesterone preparation does not work. You perhaps can only imagine the damage.

Feel free to not comment back. I think we would all prefer for this to have stopped already.

I hope you sort it. You were certainly rude. I'm sorry you find that fact rude.

There is a lot of confusion on this thread by some posters over progesterone used for HRT as combined HRT and progesterone used as treatment for shorter cycles in peri, (and for fertility.)

In peri, it's quite usual to give women progestins if they spot so soon in their cycles.

This is not usually a cream but the mini Pill.

Utrogestan is the brand of micronised progesterone.

It's used in doses of 600mg a day for fertility but much lower doses for HRT.

I hope if anyone reads this and is confused, they understand the differences :)

@llama74 After your lengthy post late yesterday I hope you can appreciate why your original post was misleading and downright confusing. Rather than rant and be rude because I questioned this, (and for good reason) it was down to a lack of accuracy.

Let me explain where I was coming from on this and let's put an end to this spat once and for all, for the sake of other women reading who do not need this aggression (and neither do I quite frankly. It's upsetting. I give back here - whereas I could be earning £££ writing stuff.)

For the information of you and others, CRINONE is a standardised product. Unless you had something different, it is a GEL not a cream and is not actually listed as 'natural progesterone cream' on the product information.

It is normally used for fertility treatment.
Using it for peri menopause - for PMS and short cycles- is perhaps slightly off label. Usually women are given the mini Pill (progestogen only) for this.

Your own history may well be unique- I'm guessing here- in so much as you were or had already used Crinone and felt it helped in some way. Again, that would have been helpful to know.

The reason I questioned your use of natural progesterone cream is- and you said you were not aware of this as you are perhaps too young to have come across it (yet) is that there was a US Dr (J Lee) who promoted a natural progesterone cream which was an alternative to HRT.

His theory was it counteracted 'estrogen dominance' - something which reputable drs do not believe in.

He built a whole 'empire' on this - books and products.
The cream called 'Serenity' was available by mail but not within the UK. It was made from yams, and natural progesterone is made from yams, but the actual product was not subject to pharma QA, and therefore it was not advisable to use it. There is also evidence that the product could not be converted to a form of progesterone the body could actually absorb.

There are still many online 'menopause sites' that promote this product but they are doing exactly that- selling it and women are being duped.

The fact you wrote about varying absorption levels and being unable to get an accurate delivery of the product compounded my opinion that this was Serenity which you used.

Just because you were unaware of all of this isn't an excuse to fire off personal attacks.

I am quite capable of reading thanks, but I can only read what is there. It was many posts in when you mentioned Crinone.

I object very much to being spoken to as you did, and have my professional work questioned. I don't need to prove to you or anyone here what I do. The many personal messages I get asking me for advice prove most posters value the information I put out .

Good luck with your treatment.

Jing. First up, you were rude, patronising and dismissive in your first post me. You even said, "sorry to sound harsh". You were rude first. You. You told me my cream didn't work and etc. and then doubled down again and again. That is rude. That is patronising. That is dismissive. The personal attacks came from you first. I asked a question about oestrogen. You went off on a really offensive personal bugbear that included suggesting I was buying drugs from overseas by mail order and that my doctor was no good. That was what you said, before I said anything back. Own it. I object very much to how you spoke to me and having my personal integrity questioned.

Cream, gel whatever. My doctors generally referred to them as creams or preparations, or just as progesterone or by their brand name. They work. They are available on the NHS. They are prescribed by reputable consultants.

Crinone 4% is used for non-fertility related. I'm sure it will come up in a google search, like Crinone 8% did.

If you want to know doctors who prescribe it, start with Anne MacGregor. I believe she's in private practice, but she used to be at Barts. Dr Simpson (can't remember first name) was at Addenbrookes, not sure now.

Good luck with your writing.

I have spent half my adult life being told that I don't know my body, making up symptoms, don't understand the facts, can't have experienced what I said I felt. We know from research that it's actually very common for women to experience that, especially around 'women's issues'. We are alienated from our bodies and told that are wrong, we have our experiences and our bodily knowledge erased. I, and many other women, have had to fight, argue and become difficult people in order be taken seriously by medical practitioners, only to have our claims validated in the end. It is incredibly upsetting, and actually very triggering, to be causally told that 'no, you're wrong, that didn't happen to you just because you think it did'. I really hope that you are never so quick again to tell a woman she's making things up about her body, her health, or her experience. I can only speak for myself, but I assure you it is distressing, especially when it is encountered unexpectedly.

@llama74

You're not 'listening'.

I explained in my last post that what you perceived as rude and dismissive was based on lack of information from you about the actual product.

Everything you wrote- about inaccurate dosing, the type of product and so on- pointed to Serenity cream.

As I feel very strongly about women being duped by products that have no efficacy, that is why I queried it.

Had you said from the start that you had been given Crinone, none of this would have happened.

I appreciate you don't like being told your post was ambiguous and misleading, as was your comment about not needing HRT as contraception (? It's never contraception or relevant) but your reaction was way out of order.

Clearly you wish to take no 'blame' for the way this thread has developed but that's your choice.

You are clearly one very angry woman who can't bear to be called out on anything but hey ho, that's forums eh?

Bye :)

I find this thread very confusing.....

I started to read it and your posts @llama74 about natural progesterone cream – and I agree with everything that has been said about it - ie the criticisms etc due to non-standardisation, lack of evidence as to efficacy when used as part of HRT both wrt symptoms and lack of endometrial protection.

However I was somewhat puzzled that a long way into the thread and the discussion you suddenly refer to Crinone gel as an example of a progesterone that is used to lengthen the luteal phase and then later proceed to talk in detail about Crinone gels and their prescription on NHS, and that this is the product you have been using for your treatment. I can totally see that the reason the misunderstanding developed was because of the lack of clarity over the product used, as @JinglingHellsBells said. In fact I read the thread exactly as the others did from your description of using “natural progesterone cream” until you said you were using Crinone gel, and then said “Cream, gel whatever”. You will appreciate that as someone who lectures others in research methods, it’s all in the detail and precision - especially in terms of nomenclature – is key to clarity and understanding, so there is a huge difference between cream and gel and especially in this context of progesterone and HRT as Jingling has pointed out.

Another thing that puzzled me was early on you said you went to see an GP with interest in women’s health (NHS or private or menopause clinic?) who prescribed you the Evorel sequi patches, and reported the doctor (this same one) as saying there were concerns over ensuring the quality of ingredients and the method of synthesis. This would have applied to natural progesterone cream which you first referred to, but any doctor would know that Crinone is a licensed product available on NHS as you yourself pointed out later on?

So all in all – I am just a bit puzzled as to the course of the discussion in that you are discussing something comletely different later on in the discussion than in the beginning?

For your info and as Jingling said progesterone can prescribed (off-licence?) in various (licensed) preparations to regulate ovulation and hence the cycle, as well as for luteal support (Utrogestan, Lutigest, Cyclogest, Crinone, amongst others); there is also plenty of evidence and papers out there of Crinone being used as part of HRT off-licence for endometrial protection off-licence – but this was never the issue. Natural progesterone cream, a completely different product was the medication originally under discussion.

Incidentally if your cycle had shortened from the standard 25-28 days to much shorter than this, then you were not actually yet (officially) peri-menopausal according to the medical definition, but in the late reproductive stage - when ovulation is still regular and shorter cycles are characteristic. Hormones begin to go awry at this point ( there are studies into this saying which) and women often experience worsening pms. The unlucky ones even get hot flushes at this point and adding oestrogen as part of HRT can work for some women but not always and some benefit more from the contraceptive pill – if not too old, until mid to late peri - to regulate the cycle and prevent mood swings.

There is so much in this thread that is confusing, Bellaciao.

What is confusing is that llama goes to enormous lengths - leaving links to quality research about Crinone and fertility- then appears to contradict herself as to its quality control and efficacy.

She says her Drs had these concerns:

• these preparations have not been tested for quality, safety or negative side effects [They have been]
• there is no way to know if these creams are contaminated with other additives [Untrue The ingedients are listed to a pharma standard]
• they are not regulated and standardised like pharmaceutical-grade prescriptions {Crinone- not regulated?}
• dosage varies on application and with each batch made [The product comes with a syringe/ applicator and a controlled dose}

This is quite odd because the products she describes are all regulated pharma products with full QA. The dose of Crinone for example is 4% or 8% and as she says they are used for fertility (or perhaps part of combined HRT.)

The list of 'concerns' would apply to over the counter natural progesterone cream but not to Crinone gel.

I'm at a loss to understand why her drs felt these pharma products were 'not tested for quality'.

And, if this progesterone history was not relevant to her question about the dose of hrt, why mention it at all in the opening post?

I am slightly puzzled why a GP (in the UK?) would prescribe HRT for someone currently in Australia on a transfer,unless they are coming back to the UK for check ups often, because most HRT is given on an initial 3 months trial to see if the dose is right, or they will follow up with their local dr.