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Menopause

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Night sweats returned

7 replies

abracadabra1980 · 09/09/2024 07:52

I've been switched from Evorel 50 and Progrsterone 100mg to Evorel Conti only; 1 1/2 patches twice a week. My night sweats have returned. Is this normal when switching HRT? Also had a period for about 10 days. I was switched by a Consultant after having a hysteroscopy-womb lining level fine.

OP posts:
Apileofballyhoo · 09/09/2024 08:03

Your womb lining is fine? What were the reasons for the switch? Body identical progesterone can help some women with night sweats but I don't know if the non body identical progestin in the conti patches would do the same job, probably not. It might also be that the 1.5 patches is too much oestrogen for you.

JinglingSpringbells · 09/09/2024 08:27

Why did you have a hysteroscopy?
Did you mean you're using 1 and a half patches a week? If that's right, why?

Return of symptoms usually means not enough estrogen OR the balance between estrogen and progestin is not suiting you.

It's very normal to have bleeding when switching types of HRT.
But did you ask to change?
Why did you swap from the safer body identical type (Utrogestan) to synthetic type in a combined patch?

I assume you mean you were using estrogen daily and 100mg Utrogestan every day? You could have carried on with an estrogen patch and your 100mg Utrogestan.

Can you explain the reason for changing?

Usually, if women are bleeding on 100mgs a day of Utrogestan, the advice is to increase it to 200mgs.

Are you post menopausal or in peri?

abracadabra1980 · 09/09/2024 22:08

Hi thanks for the replies.
I was originally sent for an US pelvic and trans vaginal scan for bleeding whilst on Evorel 75 patches (plus 100mg Progesterone 25 out of 28 days per month).
The Ultrasound result was borderline and it showed a small echogenic foci within the endometrium which my GP said needed further investigation hence the Hysteroscopy. I had diazepam and gas and air for the procedure and can't remember much about it, apart from the Consultant was happy with my womb thickness but questioned the medication I was on and changed it to Evorel Conti 1.5 patches, twice a week.
I can't find the letter from the Consultant within my online GP notes but will have a look in the morning for the paper version.
Hope that makes sense. I'm beyond tired as I type!

OP posts:
abracadabra1980 · 09/09/2024 22:09

Oh and in answer to the other question, I'm post menopausal-age 57

OP posts:
JinglingSpringbells · 09/09/2024 22:48

@abracadabra1980 There is something a little odd here.

The 25 days of Utrogestan has now been replaced by taking it every day.

I know the leaflet says 25 days but if you read info online (medical info not anecdotes) it will say that. I'm pretty sure that the info on Menopause Matters website makes this point.

The 3-day break (between days 25-28) is actually intended to be there to give a withdrawal bleed if there is any lining to come away.

It's only when you're using progesterone every day that any post meno spotting is an issue.

On top of that is the newer guidance to use 200mgs Utrogestan with high estrogen doses. A moderately high dose is 75mcgs patch and a 100mcg patch.

This info is all online in a guide from the British Menopause Society. I've left a link to it as a post several times. It's called Progesterone use with HRT.

So, referring to that guidance, there is no need to swap to different products. You could either use Utrogestan every day to start with and also increase to 200mgs a day.

I'm slightly surprised this wasn't discussed as it's mainstream guidance.

Are you able to get another appt and discuss?

abracadabra1980 · 10/09/2024 07:04

@JinglingSpringbells I'm a little confused as to why you think it's odd. Do you mean you feel it's odd that I've been switched by the consultant, or odd that I've been taking the Utrogestan for 25 days out of the 28? Would you be kind enough to clarify and yes I'm sure I can make another appointment- again do you mean with my GP, or the Consultant? Thank you

OP posts:
JinglingSpringbells · 10/09/2024 08:15

abracadabra1980 · 10/09/2024 07:04

@JinglingSpringbells I'm a little confused as to why you think it's odd. Do you mean you feel it's odd that I've been switched by the consultant, or odd that I've been taking the Utrogestan for 25 days out of the 28? Would you be kind enough to clarify and yes I'm sure I can make another appointment- again do you mean with my GP, or the Consultant? Thank you

Of course! Please bear in mind that what I'm posting is medical guidance and not opinion.

Your agreement to swap to a new form of HRT should always be discussed with reasons given with the pros and cons so you are actively involved in the decision.

You've been swapped from a (safer) body-identical type to a synthetic type of progesterone with no explanation (from what you've said.)

The previous 25 days on Utrogestan is a bit outdated but maybe your GP wasn't aware? The 'risk' of 25 days is that it allows a 'window' for a bleed which may happen as it's not being taken every day.

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

UTROGESTAN
Micronised progesterone
100mg at bedtime from day 1 to 25 of each 28 day cycle (licensed regimen), though taken every day is usually recommended

I wonder why you've been advised to halve a patch. Swapping doses within the week is more likely to give side effects as your estrogen and progesterone levels will be varying. It's the same as if someone was told to use 2 pumps of gel for 4 days and 1 pump for 3 days (and reduce the Utrogestan on those days as well.) On the days of 1 pump they may find flushes , sweats or mood changes occur.

Here is the link from the BMS guidance. The points I made earlier were about adding more Utrogestan if there is spotting or bleeding.

https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

Page 3
The dose of the progestogen should be proportionate to the dose of estrogen. While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens).

This applies mainly to women on high doses like a 75 or 100 mcg patch.

Page 6
For the majority of women with unscheduled bleeding on HRT, modifying progestogen intake often controls the bleeding especially in women who experience unscheduled bleeding in the first few months after commencing HRT.

Progestogen intake could be modified as follows:

For cyclical HRT regimens, the dose of progestogen could be increased (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg, or switch to a different progestogen) or increase duration of progestogen intake (can take progestogen for 14 days a month or for 21 days out of a 28- day HRT intake cycle).

For continuous combined HRT regimens, the dose of progestogen could be increased (e.g. increase micronised progesterone daily dose from 100 mg to 200 mg daily on continuous basis, or switch to a different progestogen), particularly when combined with higher dose estrogenic regimens.

If breakthrough bleeding occurs following the switch to continuous combined HRT and does not settle after three to six months, then the woman can be switched back to a sequential regimen for at least another year.

Sorry this is so long but it's important you have the info if you're going to query it.

Are you happy about dropping Utrogestan for the Norethisterone in the patch?
What were the reasons for suggesting that?
What was shown on the scan? Was it endometrial proliferation but regular/ benign and not a problem?
And are you having night sweats because your dose is changing mid-week?

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