Thyroid UK
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Question only for women who are or have been on HRT successfully

I have read so much conflicting information on this topic.

Some experts claim that no woman still having periods should take estrogen, but should take progesterone only for the second half of her cycle. Only after twelve months without a period should estrogen be added.

Others claim that, as soon as the typical symptoms of (peri)menopause appear, women should be put on both E and P. But symptoms of perimenopause can appear years before periods stop...! Some even claim you can be menopausal and still have periods...

Therefore, it would be really interesting to find out how other members successfully dealt with symptoms such as excessive sweating, night sweats, sleep disturbances and moodiness. Did you start taking both estrogen and progesterone before you had not had a period for twelve consecutive months, or did you take progesterone only until that happened...?

Whatever worked for you, did you take synthetic or natural hormones?

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PS. I really liked this article, especially the fact that it quotes UK doctors and not US ones...I am so used to seeing US doctors quoted whenever there is a good article on peri- and menopause, and it's really encouraging to see that there are doctors in Europe as well not afraid to use HRT...I also like what the article says about perimenopause being much worse than menopause, but that those symptoms are often not recognised as hormone-related:

dailymail.co.uk/health/arti...

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anna,

Oestrogen & progesterone should be balanced and you should only replace what is missing.

In women with years of low thyroid hormone anything can happen but it is more usual for progesterone level to decline during the first phase of peri-menopause, leaving a state of oestrogen dominance. Systems might be bloating, cramps, mood swings, tender breasts ... all abit like constant PMS.

Higher oestrogen levels can increase the level of protein carrier to deliver the hormones but may also soak up thyroid hormones making them inactive, so hypothyroid symptoms may increase as well..

During the second phase of peri-menopause, oestrogen levels decline and this is when the hot flushes, memory problems & vaginal dryness may start.

GP's are useless on anything to do with hormones but ask for oestrogen, progesterone, FSH, etc to be tested. Be aware there are several substances that are referred to as oestrogens and all should be included in your test. I had to pay privately to get comprehensive testing.

I now take bio-identical HRT and NDT.

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Thank you for your detailed reply which I find really helpful!

My problems started in August which is pretty late given my age (I will turn 49 next month). All of a sudden, I started having hot flushes and terrible night sweats. My sleep was also affected; I have always been a good sleeper but, all of a sudden, I found it difficult to go to sleep and, once I had fallen asleep, I would wake up every hour or so, never getting a whole night's uninterrupted sleep. My periods, which have always been like clockwork, suddenly became erratic; they can now come every six or every three weeks, and they are much shorter and lighter than they used to (I have had to use OTC products such as tranexamic acid for years, but I no longer need to).

I have been seeing a so called Hertoghe doctor in Belgium for the past six years, and was put on both estradiol and progesterone at age 42...back then, I did not know as much as I do now, so I never questioned it. I never had any problems taking them but, when the first symptoms appeared a few months ago, I realised that estradiol was not doing anything for me, so I stopped using it but stayed on Utrogestan, 200 mg at bedtime from day 15 to 25 of cycle. Not sure how useful it's been, really...but I guess it couldn't hurt.

Since stopping estradiol, I have lost five kilograms and have been peeing like crazy. Not sure if there's a connection, though...but it's not like me to lose weight without considerable effort.

My OB-Gyn sent me to the lab last month, on day 23 of cycle (so luteal phase):

FSH 2.7 UI/L (ref luteal phase 1.4-5.5)

LH 2.7 UI/L (ref luteal phase 0.6-14)

estradiol 565 pg/mL (ref luteal phase 21-312) so above range

Progesterone not measured.

I will ask my Hertoghe doctor if I could have the other types of estrogen tested as well; I guess she is my best shot as most conventional doctors seem unwilling to do this. I have my next appointment with Hertoghe doc in April.

Lately, I have been using a product called Estroven Nighttime and have found it helpful. It contains black cohosh and 2 mg of melatonin per capsule. I worry about the effects of long-term use of melatonin, though...it's not supposed to be addictive, but I've read that it can shut your own melatonin production down. Last night, I felt really tired, so I thought I'd go to bed and try to fall asleep without taking anything. I did...but I must have woken up every hour. I now feel more exhausted than I did when I went to bed...

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PS. I have found supplements such as black cohosh and sage to reduce hot flushes and night sweats but, if my symptoms are caused by a hormonal imbalance, I want it corrected. The problem is not even my hormone doctor seems to know how to achieve this...she just keeps renewing my prescriptions for Estrogel and Utrogestan. It was only a few months ago, when my first symptoms appeared, that I started to do some research and found out that you should not take estrogen if still having periods. I wish I had found this out years ago, before starting to take any hormones...the idea of having used estradiol for years for no reason is actually kind of appalling to me. My hormone doctor keeps saying that, since it's bio-identical, I have nothing to worry about and could use it for as long as I want, but it's still a powerful hormone...I'm no longer convinced by the "as long as it's bio-identical it's safe as only synthetic hormones can cause cancer" argument put forward by my hormone doctor...

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You should get a pelvic scan every year just to check uterine lining - quite cheap through a franchise in Mothercare shops and you can book online

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I'm not in the UK, and not sure it's done where I live...I've never heard about it before. But I'll look into it.

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anna,

Bio-identical hormones have the same structure as hormones found in your body so are safe to take when you are perimenopausal as used to simulate your natural menstrual cycle and rebalance hormones.

I can’t see from your previous posts if you have Hashimotos but it is the most common cause of hypothyroidism and many with Hashi have certain MTHFR mutations that can affect the methylation cycle and lead to hormone imbalances – such as oestrogen-dominance.

Put simply it means we have difficulty breaking down folate vitamins, which can cause high homocysteine which leads to poorly converted glutathione which is the chief antioxidant and detoxifier of hormones.

Methylation is required for the creation of every cell in your body including neurotransmitters like serotonin, epinephrine, norepinephrine and dopamine as well as immune cells and hormones like oestrogen. The liver processes by using countless enzyme pathways including methylation in order to convert nutrients, etc into usable forms.

I supplement glutathione as have an absent gene and have huge detoxification problems and medicate as little thyroid hormone replacement & HRT as I can get away with as can not afford to have it floating around my blood stream, as too much inactive hormone can block neurotransmitters required to receive the hormone and make it work..

I supplement DIM & Ca D-Glucarate, both of which help regulate both O & P, encouraging utilisation & detoxification of unused hormone from the body.

The oestrogens to have tested are estrone, estradiol & estriol. There are also other oestrogen metabolites that can be tested. …. it just depends on how deep you want to go.

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Thanks a lot!, very interesting post!!! Yes, I have Hashimotos, diagnosed 17 years ago.

Methylation sounds interesting, I will look into that!

With this disease, there is so much to learn...it never ends, does it...? Every time I think I have things under control, I realise there is so much I don't know...!

When I compare my recent symptoms with those of estrogen dominance, they all match.

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Sorry ... forgot to provide link.

mthfrsupport.com.au/mthfr-a...

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Thanks again!

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PS. Can I ask which product(s) you take?

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Glutathione is by Seeking Health.

Ca D-Glucarate is by Biotics Research Corp.

DIM is by Allergy Research Group.

All sups are through a nutritionist practitioner.

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I’d be interested to know if the bio identical HRT that you take is from soya or not?

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I personally have never wanted to take anything except natural products during peri, menopause & post menopause. Women are meant to go through the menopause and in most countries sail through it with no problems at all. I consider that UK & US make a big deal out of it in order to prescribe the wrong and possibly damaging hormone, to keep the pharmaceutical companies raking in the money. It's not good at all to mess around with 'fake hormones' in HRT. Estrogen and progesterone are 'antagonists' (I think that's the correct medical term) whereby if there is more estrogen in the body that's needed then progesterone reduces down; and vice versa. Women who have been on an estrogen dominant contraceptive Pill will be Estrogen Dominant - ie far too much estrogen in their body than is natural and more than needed. Your symptoms are possibly estrogen dominance.

Did you take The Pill at any time in your life? That would have messed your hormones up as, again, fake hormones are used in it in order for it to be patented.

Only when I was getting hot flushes at night did I successfully use Natural Progesterone Cream by Wellsprings

wellsprings-health.com/page...

All the women I recommended this company and cream to, loved it and swore by it.

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Yes, I have ordered and received Wellsprings progesterone cream after a member here (maybe it was you?) gave it a glowing review...however, I was diagnosed with an ovarian cyst three weeks ago and put on Duphaston for twelve days. Yesterday, I had a check-up with my OB-Gyn who said the cyst has gone from 7.5 cm to 2.5 cm, but that I need to stay on Duphaston for another three months, taking it twelve days per cycle. I am not too happy about having to take synthetic progesterone, even for such a short period of time, and wonder if natural progesterone (such as the one found in Wellsprings) would achieve the same results...I admit knowing nothing about the treatment of ovarian cysts.

Anyway, as soon as I'm rid of this damned cyst, I am starting Wellsprings (if not sooner)!

I did take the pill for a very brief period of time in my early 20s (for about six months), but not for birth control purposes. Instead, I was going to study abroad for a while, and wanted to make sure I would not bleed through everything, including the bedsheets...my periods have always been very heavy. So I took the pill to bleed less every month; very successfully, I might add...but it just felt wrong to continue taking it for that purpose. About the same time, tranexamic acid started to be sold OTC, and it reduced the bleeding pretty much the same way the pill did...so no, I have not been on the pill for a decade or more as many women in my generation have...

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There wouldn't be enough in Wellsprings to do anything (you'd need a whole jar a day pretty much), but fake progesterone (which acts more like testosterone apparently) is one of the worst fake hormones out there, but I don't know what the alternatives are. Can you ask for a prescription bioidentical progesterone?

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I have Utrogestan 200 mg, prescribed by my Hertoghe doctor. I have in fact been wondering if I could take that instead of Duphaston...

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Sorry, just to understand this statement about Wellsprings: do you mean it's too weak in general, or too weak to make a cyst go away? I am asking as it seems to be popular among some members who are very pleased with it.

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Anna,

Wellsprings is good if you just need to top up but if you have a huge deficiency it will not contain enough hormone to replace that missing.

Utrogestan is a bio-identical progesterone.

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Too weak to make a cyst go away, and just too weak altogether for me. Depends how deficient you are. I take 175 mg of progesterone a day, to put it in perspective.

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That’s fine for anyone who can sail through it. After 6 years of hell, I cracked. I wish i’d taken HRT sooner.

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I went through menopause 20 years ago and any symptoms I experienced can be laid at the door of the thyroid which was diagnosed 12 years ago. At the time I read the book - Womens Bodies - Womens Wisdom - by Christian Northrupp - I felt confident in leaving well alone :-)

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I am on biohrt and my doctor takes the opposite view to the Hertoghe doctors and so I take the same dose every day of progesterone, oestrogen and DHEA. I did not start until 5+ years after menopause. I tried every natural remedy there is for symptoms (including OTC creams) and none of them worked. Agnus Castus and meditation helped a little, but basically I didn't sleep properly for 7 years and had to change my clothes several times a day, I managed not to rip my skin off! Really, I think you need to know what you are deficient in and supplement that with bioidentical hormones - just like thyroid. For some that would be just progesterone, for others oestrogen, progesterone and testosterone

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Yes, you are right...as I'm almost 49, I think it's safe to conclude that I would most certainly be progesterone deficient as P levels are said to drop drastically in a woman's mid-30s...but I will make sure it's decided once and for all what I'm lacking and therefore should supplement.

So you take the same amounts of hormones every day? Interesting. It seems to be working for you as well...? Are you taking natural or synthetic hormones?

I think it's different once you're postmenopausal, though...

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Bioidentical compounded for me. Works - got my life back.

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I am not sure that's available in Belgium...might be worth asking my doctor, though.

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I started taking Angelique four years ago, a combined synthetic HRT which was recommended by a friend. Her sister's a gynaecologist, & uses it herself, with that being a strong selling point. I wish I'd taken it sooner, rather than go through 6 years of unnecessary hormone hell! I think it was worse as I had untreated hypothyroidism.

After chatting to someone on here about bioidentical hormones, I swapped to using a progesterone tablet & oestrogen gel. The night flushes started again at bedtime, rather than the previous all day & night, though these have diminished since using a higher dose of oestrogen for the past two weeks. The GP I've seen said the transdermal oestrogen is better as it doesn't need to be processed by the liver, not that I have any known liver issues. I find it a nuisance to fit this in with eating & taking magnesium at bedtime, so have been increasing my transdermal magnesium use, but not applying it where I use the oestrogen gel. I'm sure everything will fall in to place soon! ;)

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OK, thanks! Sorry, I am not sure I follow you...you did great on Angeliq but are no longer taking it, is that it...? If so, will you be going back on Angeliq...?

The thing is that once my peri-menopausal problems started, about four months ago, totally out of the blue, I had the impression the bio-identical hormones I've been taking (Oestrogel and Utrogestan) no longer made a difference...but I told myself I must be crazy as "everyone" is doing much better on natural hormones...right?!

Anyway, my OB-Gyn said yesterday, when she prescribed Duphaston to shrink an ovarian cyst, that we will discuss HRT treatment at our next appointment in late January...she prescribes synthetic hormones. Maybe I should not be afraid of that...?

It's really confusing...I know menopause is a normal thing, but some symptoms can be quite debilitating...I just hate it when I start sweating or wake up 7-8 times every night drenched in sweat. It seems that for most, but not all women, the symptoms more or less disappear after their last period but, for some, they can continue well into their 70s...I cannot imagine 20-25 more years like this...!

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Mine got worse, especially the vaginal atrophy and memory loss.

But the hot flushes didn't improve either.

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Sorry, worse on what...? Synthetic hormones? Or just after your last period?

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Worse after menopause/last period. No hormones at that time

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Angelique worked well. Bio-identical did not, until I used the higher dose of oestrogen. If the increased dose of oestrogen doesn’t continue t work, & so far it seems fine, I’ll swap back to synthetic HRT.

I waited 6 years expecting it to stop after 2. No point in anyone suffering unnecessarily!

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Couldn't agree more:-)

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I have been reading about Angeliq and found a way to order it. I am terrified at the idea of taking synthetic HRT as it's so often said to cause cancer...especially progestin seems problematic in this context. However, many seem to do fine on synthetic HRT. I don't know how much of a problem it is to take oral estrogen (as in Angeliq) as that needs to be processed by the liver...? Anyway, I have not found bio-identical HRT (Oestrogel and Utrogestan) very effective lately, and have been wondering if I should give synthetic HRT a try...anything to get rid of these horrible night sweats...!

I'd appreciate any input from members having successfully used synthetic HRT. be it Angeliq or something else!

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PS. I also read that some women's bodies use up bio-identical hormones too quickly, while synthetic hormones provide more stable levels...

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How much estrogen are you currently using?

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1mcg. I had hot flushes in the lower 0.5mcg dose.

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I’m on my second month of bio-identical HRT, & far prefer synthetic Angelique. I’ve stopoed having hot flushes in the past weeks that i’ve been on the higher dose of oestrogen, but my sleep patterns are worse, & I feel as though my hormones are fluctuating. The effect on my skin has not been good, as a month ago, I had to use hand cream for the first time, also on my peeling arms. Whatever’s going on, I don’t like it. 🤢

I was at my wits end, & decided if a gynaecologist is happy to take synthetic hormones, the newer forms being safer than early HRT, then it was ok for me to use. I have a higher risk of cancer, but couldn’t carry on feeling so unwell, unnecessarily. All medication acts as a life enhancer, & all carry risks.

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Interesting! Sorry, I cannot remember your medical history: why did you switch from synthetic to bio-identical HRT?

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I thought it would be better for me as it's natural. :-/

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I started with transdermal but it just wouldn't work for me. Now have sublingual. I think transdermal works for most people.

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PS. Another thing that is interesting is that, last month, I took Duphaston (synthetic progesterone) for twelve days after the ovarian cyst was discovered, and a lot of my symptoms resolved during that time. But I told myself I could not possibly stay on it as it's synthetic...

So, I have been wondering: if synthetic hormones seem to work better for me than bio-identical ones, for whatever reason, and I have regular check-ups, would I really have to worry that much about cancer...? After all, millions of women all over the world are on synthetic HRT and doing very well on it...

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The contraindications are listed (probably on PIL) and include:

"Treatment with dydrogesterone has infrequently been associated with alterations in liver function, sometimes accompanied by clinical symptoms. Thus, dydrogesterone should be used with caution in patients with acute liver disease or a history of liver disease as long as liver function tests have failed to return to normal. In cases of severe hepatic impairment treatment should be discontinued.

Break-through bleeding and spotting may occur during the first months of treatment. If break-through bleeding or spotting appears after some time on therapy, or continues after treatment has been discontinued, the reason should be investigated, which may include endometrial biopsy to exclude endometrial malignancy."

Duphaston may cause the following side effects:

nausea,

vomiting,

headache,

dizziness,

weight gain,

swelling of the breasts,

anemia,

depression,

lethargy,

liver damage (loss of appetite, pain in the right upper abdomen, jaundice),

allergy and others.

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There is a link between ovarian cysts and thyroid - google both you'll find plenty and healthunlocked.com/thyroidu...

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Thanks, interesting info!

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I just stumbled upon this very well-written and interesting article...I wish I had read it before going on estrogen six years ago. Combined with progesterone, true, but still...if it can be at all avoided, I'm never going to use estrogen again, not even so called natural estrogen.

thedoctorwithin.com/women/e...

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Since going off estradiol, six weeks ago, I have been taking black cohosh and it has definitely made a difference. I find it quite effective, really, when it comes to minimising hot flushes and night sweats. However, yesterday, I stumbled upon several articles stating that long-term use of black cohosh can lead to severe liver damage, and therefore should not be used for more than six months...so now I am in the process of looking for an alternative. It seems hops can be quite effective as it, like black cohosh, has estrogenic properties, but without the potential side effects. I am going to give it a try and see what happens. Hopefully, it works just as well...

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Today, I decided to restart Estrogel and see what happened...I honestly expected it to make a difference for the better.

But it didn't. I cannot remember last time I felt this uncomfortable or sweated this much...I then stumbled upon this article which I think explains the difference between perimenopause and menopause very well:

cemcor.ubc.ca/resources/pro...

I am staying off estrogen from now on, but will go back on Utrogestan once I have taken Duphaston (for an ovarian cyst) for the next three months.

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Those of you who have successfully been on synthetic HRT, what have your doctors told you about the potential risks associated with it? The Hertoghe doctors will only prescribe bio-identical HRT, but I know many doctors prescribe synthetic HRT and many patients seem happy with it. I wonder if the risks have been exaggerated, and are more applicable to older generations of synthetic drugs...?

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I tried doing the menopause naturally for three years and failed miserably. I have Hashimoto’s so cant have anything with soya in. I was really at a low ebb so started on HRT for about 18 months. My GP has now withdrawn it! It wasn’t perfect but much better than doing natural stuff. My mother in law was on HRT into her late 70s when they made her come off it. It’s not for everyone, but was a life saver for me. I think you have to way up with how much you are suffering as to wether you take it or not and also wether there is breast cancer in your family. It’s a difficult decision to make.

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I have been reading about Angeliq. It seems it’s only intended for women who have not had a period for at least a year...I’m still having regular periods...?

Also, I’d appreciate input from anyone having tried synthetic HRT as the Hertoghe doctors in Belgium always tell patients natural hormones are preferable...I’d like to hear from members having successfully taken at least synthetic estrogen or, even better, both synthetic estrogen and progesterone.... as I really like the idea of being able to take one pill and get both hormones. But since we are always told to take E day 5-25 of cycle, and P day 15-25, how does that work with a pill containing both hormones...?

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