Peri-menopause and HRT after oestrogen positive breast cancer

[MoverOfPaper]

I’ve been dithering for ages about just what to do about my peri-menopausal symptoms.

I have been suffering from extreme rage at some points during my cycle. It’s been debilitating and has almost cost me my family and job.

I’ve other symptoms but that And brain fog, feeling stupid, not knowing words, are the worst.

I’m 47 and was diagnosed with oestrogen positive breast cancer in 2009.

I am on SSRI and have had a double mastectomy.

My GP ( eventually and when pushed) followed NICE guidelines and referred me to a menopause clinic. I’ts been such a positive experience. I’ve been referred back to cancer specialists and it’s okay for me to take HRT.

Now I’ve always reacted very badly to hormonal contraception so I’ve dithered. Instead I tried acupuncture and changing my diet, a bit. The acupuncture has actually moderated my symptoms but it’s not quite enough.

My period started, possibly thanks to acupuncture, and I’m seeing the cancer specialist and menopause clinic in three months. I thought this would be the perfect time to try the HRT. My specialist saiid they would try me for 3 months and monitor after.

I’m on ONE pump of Oestrogel daily and the two utogesteron (sp) from day 14 to day 26.

By day 4 I had awful bloating and stomach cramps so I didn’t take day 5. I’m actually petrified despite reassurances. Anyhow I pulled myself together and took again on day 6.

I suppose I’m posting here to keep me on track.

So far positives have been a short and light period. They’ve been going on for two weeks and I’ve been flooding. I had a difficult conversation yesterday that would have left me fuming or in tears. It passed by unremarkably.

So that’s me. I just need to break the news to my acupuncturist although I’m sure she can still work with me.

That's really interesting and hope you carry on feeling better.

Has anyone suggested you use Utrogestan vaginally?

This can eradicate all the bloating etc.

It's the common practise in Europe and my consultant prefers women to use it that way if they can (I am in the UK) as there can be fewer side effects.

You just use the same capsule and push it up as far as you can at bedtime for those 12 days.

There is also some research showing that it's twice as effective used vaginally and some women use only 100mgs ( 1 capsule) under medical supervision.

Your other option (which I use) is long cycle HRT which means not having a 4 week cycle, but a longer one which can be up to 6-8 weeks which reduces the number of times per year you use utrogestan.

Again, I am doing this under medical supervision as it's off licence, but my gynae consultant is a world renowned meno consultant.

It might be worth you asking about a) reducing the dose to 100mgs used vaginally if you stay on 1 pump of gel (low dose) and b) also long cycle.

Thanks so much @JinglingHellsBells

I did ask about the long cycle. I probably read about it on here and by you! It was knocked back as off licence.

I do wonder if I’m somehow intolerant to progesterone but I’ve not started taking the progesterone yet. The bloating seems to be linked to the oestrogen gel. Is that probable?

I’m interested in one capsul taken vaginally and I can always ask...

The doctor said patches would be best for me but they aren’t reliably available...

Sorry I misunderstood your post . When you wrote Utrogestan on day 14-26 and said in the next line you were up to day 4, I assumed it was Utrogestan.

I think it would be unlikely that the gel is causing bloating.

It's a shame your dr is not familiar with the long cycle regime. Yes, it's off licence, but the idea is that if there is erratic bleeding, it would be investigated. It's well known that it's the progesterone side of HRT that may increase cancer risk, so the idea of long cycle is to reduce use of it as much as possible.

Likewise, Utrogestan is possibly the safest form of progesterone and you can't get it as a patch.

Maybe your dr isn't that clued up? Is this the menopause clinic?

You can always reduce the gel to a tiny amount- half a pump- and see how that goes, then build up.

So sorry to confuse. It’s confusing enough inside my head.

The regime was first suggested as standard by consultant at the menopause clinic. I decided not to take the HRT. it’s on my notes that I can take it.

The HRT was dispensed from my GP surgery.

It’s been slightly complicated dealing with it as it’s been Lockdown.

I’d rather take the least amount of progesterone as possible. When the GP asked where I’d heard about the 6-8 week cycle and I said on a forum she was slightly miffed.

I’m confused about my cancer now. I try not to think about it but I’m pretty sure it was oestrogen positive and that’s a good type. Can it be oestrogen positive if caused by progesterone?

I’m confused about my cancer now. I try not to think about it but I’m pretty sure it was oestrogen positive and that’s a good type. Can it be oestrogen positive if caused by progesterone?

Most meno specialists agree that estrogen does not cause cancer.
What they think is that estrogen may help an existing cancer cell(s) to grow.

The reason they think it doesn't cause cancer is that women using estrogen-only hrt (that's women with no uterus) have less breast cancer than women not on HRT ( at all.)

It's more complicated than just estrogen or progesterone causing cancer. Most progesterones (apart from Utrogestan) are synthetic not natural. It's thought that the combination of estrogen and some types of progesterone combined can trigger growth of existing cancer cells.

I'd not expect a GP necessarily to know about longer cycle HRT BUT there is a type of HRT ( tablet form) called Tridestra which is a 3-monthly type and is mainstream treatment for women in peri (so not as weird as your GP might think!)