Everol Conti - what next

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Hi all. I have been on Everol Conti for 14 weeks and must admit defeat. My principal reason for HRT has been low mood (sadness), brain fog and neck pain. Unfortunately my mood has been so much worse and I have just returned from a family holiday that was ruined by my tears and mood. It is like unrelenting PMT. My sister and daughter can’t tolerate progesterone and I wonder if that is what is making me like this. I have waited 12 weeks in the hope it would settle but no luck. I’m 51 and had an ablation for heavy periods 18 months ago hence the Conti. My question is - what could I request from GP that might be less catastrophic on my mood. I think I am a classic sandwich woman, worrying about ageing parents and growing children and an empty nest but I can usually rationalise this as life, rather than crying as if the world is ending. Please mumsnetters offer me a solution! Will also look into CBT but hoping a HRT might also be available. Strong breast cancer risk in family and see genetics for this if relevant. Thanks!

This would indicate that menopause isn’t the cause of your unhappiness OP

Thanks for your reply. I definitely feel like the hrt has made me worse. I was low before but now I’m devastated at times. Maybe you are right though.

Sounds like you're right to be suspicious of progesterone intolerance.

If you haven't had a period for 12 months, you might want to discuss Tibolone with your doc. Its a different kind of HRT, and gives your body a synthetic mother hormone, which breaks down to oestrogen/progesterone/testosterone - like products.

Its the best I've ever felt on HRT, and I always thought it was because my body was in charge of making what it needed, rather than getting a predetermined dose of the end products. Even better, its just a daily pill so no patches and gels to faff with. Sadly I was switched off it onto oestrogel and progesterone as thats the body-identical gold standard, but I still think wistfully about the niceness of T!

This is very interesting and I am off to research! Thank you

You should consider changing the type of progesterone.
Norethisterone (in patches) is one of the worst for causing side effects.

There are several other options, and also the option of using HRT on a cycle.
Women who are genuinely intolerant can be prescribed less progesterone (with medical supervision and monitoring.) eg you can use it on alternate months or fewer days per cycle.

There is also the Mirena coil which might suit you.

I see a PP has mentioned Tibolone. There are pros and cons to this with risks etc so it's really worth doing your own research on this as it's not always the better option.

What is the b cancer risk in your family? You mention genetics- do you mean you have been tested for the Braca gene? Or should be?

Hello. Thanks for replying. Due to dm
and dgm having breast cancer my sisters and I attend a family history clinic annually at our cancer hospital due to our elevated risk. My consultant recommended two years maximum for hrt so I have tried to choose my two-year window carefully - basically was at the end of my tether.

The criteria is 2 first degree relatives, so that would be your mum and sister at an early age (ie not 70s or 80s.) Your grandmother doesn't count.
This is in all the info about hereditary risk.

There is also a range of risks according to which sort of progesterone.

GP should be offering micronised progesterone (not synthetic Norethisterone in the patch) which has the lowest risk of BC. The research shows no added risk with at least 5 years use.

https://www.balance-menopause.com/menopause-library/family-history-of-breast-cancer-should-i-take-hrt-factsheet/

There is a BMS video on exactly this- family history and genetic tests. .https://thebms.org.uk/publications/bms-tv/

OP, I couldn’t tolerate it either. The second half would make me almost suicidal and when I took norethisterone it was similar.
I also had an episode recently where I was taking ashwagandha which was fine until I stopped and then I had the same symptoms.
I think some of us react severely and extremely emotionally to these things.

And I’m also in the sandwich generation situation. I’m sorry I’ve not been much help! I’ve given up too 😩

Please speak to a menopause specialist about this. Newsom clinic have been very helpful with my partner when the GP fobbed her off.

I will definitely ask about micronised progesterone. I had hoped three
months in I would have been feeling the benefits. I’m not sure about that conflicting advice regarding the breast cancer risk I have been given. We were advised moderate risk as my mum and her mum were post-menopausal albeit in 50s. I will raise this at next appointment however we have been given the best care and attention for 20 years so would not like that to stop!

Your GP doesn't seem up to date and neither do your specialists- sorry.
It's not estrogen that causes BC- it's the combination of estrogen+progesterone.
Women who use only estrogen (if they have no womb) have less BC than women not on HRT.

Your grandmother will count but it's more of an issue if they were younger.

Do you have annual mammograms?

You should discuss Norethisterone.
There is a scale of risk with progesterone- (highest first.)

MPA
Norethisterone
Levenorgestrel (mirena and some patches)
Dydrogesterone
Micronised progesterone.

It's also safer to use sequential not combined continuous.