Help, HRT

[Shallysally]

I’m post menopausal, and am currently prescribed Evorel Conti patches. They come in a 50 mcg strength. After a few months it was identified that I need an increase, and GP (who is very uninformed re HRT) suggested I halve a patch to increase dose to 75mcg.

So I’ve been doing this for a couple of months. However, I’ve been having a bleed every other week. Also, I still don’t feel that the dose is right, still have some brain fog, insomnia, joint pain.

So GP was supposed to refer me to the menopause clinic for advice. Had a GP appointment yesterday and she told me that she has spoken with gynaecology who have said I have two choices, to either have a coil fitted and have tablets (presumably for oestrogen?) or to carry on as I am.

I was pretty disappointed, the cool
and tablet isn’t an option for me due to family history of DVT and breast cancer.

So before I consider paying for an appointment at a private meno clinic, I’m just wondering if those options are actually all I have?

No! You could. Get actual 75 patches which I have, or 100 patches or switch to eostrogel.

What are you using for the progesterone element?

@Moredarkchocolateplease the Conti is a combined patch.

Oh I see. Well you could change to the non combined patch and take utrogestan for the progesterone (it's a body identical progesterone) which you take 12 days of every cycle so from day 15-26.

There are other progesterones you can use also as a tablet.

And the patches still come in different strengths when it's not the conti.

Have you had a look at menopause matters? There is lots of info about the the risk profile of the different progesterones.

I have the Conti patches and it very clearly says not to cut them in half and it damages the membrane and can make the dosing to fluctuate.

Push for a referral to a menopause clinic. There are lots of different options.

@Moredarkchocolateplease when you talk about days of a cycle, does it matter that I don’t have periods please?

Thanks for the info, I’ll have a look on menopause matters.

@OhBeAFineGuyKissMe I did tell the GP that, she disregarded it 😕

Thanks, I’m going to ask for a referral.

Sorry OP i totally missed that you were post meno.

I think assuming you have a uterus still that you take the progesterone in tablet form for nearly every day each month.

But def push for a referral to meno clinic.

Sorry you are not having much luck with your GP.

TBH this is such a simple issue a GP ought to be able to sort it. No need for a meno clinic which is for more complicated issues.

I'm not sure how much you know, but ALL continuous combined HRT carries the side effects of bleeding for 6 months. This is how long it can take for the 2 hormones to work together to keep the womb lining thin. (This may be on the info on your box of patches.)

If there is a strong family history of breast cancer (and that means your mum and sister with it diagnosed early in life) then you should a) be tested for the BRACa gene and b) be using micronised progesterone (which has the lowest risk re. breast cancer.)

Many women think they have a high risk when they don't.
There is info here from Prof Michael Baum - bottom right of page.

https://thebms.org.uk/publications/bms-tv/

You should avoid Norethisterone which is in your patch IF there is a high risk.

If the breast cancer risk is more distant relatives like aunts or cousins, then specialists would not call that a risk.

The best options for you are

-Estrogen-only patch or gel or spray
-Micronised progesterone 100mgs daily (this is the continuous regime equivalent to the patch.)

If there is a strong family history of breast cancer, then it's safer to take progesterone on a cycle ( half a month) as it reduces the risk compared to continuous.

@JinglingSpringbells thank you! So after reading your reply, I don’t believe I am high risk of breast cancer as it was my maternal grandmother who had it.
I am increased risk of DVT though, I’ll do some reading around that.

This is why I’m unsure about the response from GP as she has always been so cautious in the past. My Mum had far reaching complications from clotting, and I definitely do not want to risk anything on that scale. I was taken off combined pill at age 30.

So if I go for the Estrogen plus the Micronised progesterone will this still carry the side effect of the bleeding please?

The evidence re. clotting is that transdermal estrogen does not increase your risk above what it already is. There is a small risk with tablet form but it's far lower than with the Pill as HRT estrogen is totally different form that.

If in your family there was a long line of women with ovarian and breast cancer, it would be a factor. But when it' s only one person, 2 generations back, the cause could be anything, including being overweight, inactive, diet, drinking, etc. BUT I can see how you want to take the least risk possible.

This is the page from Menopause Matters about combined continuous HRT.
The latest statement from the BMS on Utrogestan says it has no increased risk of breast cancer for at least 5 years so you can always reassess after then if you want to carry on.

[[https://www.menopausematters.co.uk/postmeno.php

Thank you. I agree with your understanding re breast cancer. For me, I’ve opted for HRT as quality of life outweighs the benefit of developing breast cancer.

Yes, I’m aware re the transdermal v tablet form, that’s why I’m surprised that I’ve been offered tablets. I’m more concerned re the clotting risk than I am re the breast cancer risk.

So given that my options for progesterone are current patch, tablet or coil, that I don’t particularly want, I guess I need to starch with the patch and accept that it’s not an optimum dose.