Still 'tweaking' BHRT nearly a year later

[SandraCC]

Hi All

I could really do with some advice/guidance/reassurance in relation to this matter. Having been advised that I was in early menopause early in 2020 I was originally left to it by my GP until I sought private help in relation to managing my symptoms.

The symptoms I had/have are cramping, foggy brain, forgetfulness, irritability and some hot flushes and the most massive of all, weight gain of 10-12lbs. Having enlisted the help of a private integrated GP practitioner (IP) who helped me to get BHRT from my own GP, I was under the impression that it would be a short matter of time before I could get my hormones under control and then get a handle on the other symptoms and by following a tailored weight loss programme that the weight would come off albeit under stricter circumstances than I have been used to which I was prepared for.

Initially I was put on 2 pumps of Oestrogel and 1 Utrogestan orally 1-25/28 days. My symptoms went through the roof and the subsequent blood test showed >800 estradioal in the measurements! The IP told me to stop Oestrogel temporarily and continue with Utrogestan which I did for around 6 weeks and it was the first and only time this year I saw a small but steady decline in my weight and other symptoms. I presume this was because as the Oestrogen was leaving my body it was ending up at a more suitable levels for my body. But then it peaked and weight loss stopped. The IP told me to re-introduce Oestrogen, this time 1 pump and then build up to 2. My symptoms came back again in earnest and no weight loss, in fact fluctuations to gain.

She then told me to reduce to half a pump which I did. Very little respite. Then she asked me to use Utrogestan vaginally - there was a small improvement. Most recently she has told me to use 2 Utrogestan vaginally and again there has been another improvment.

But, I am still not sure that my hormones are balanced enough to enable me to lose weight. I did a 7 day detox last week the first day of which is an epsom salt cleanse. As is standard, I lost weight int he first 2 days - after all, I was only eating vegetables essentially. Thereafter the weight has steadily increased and although I havent put on all of the weight, considering I am following a strict programme, this shouldnt have happened. What may be muddying the waters is that during this time, I had the 3 day break from the Utrogestan and this is always accompanied by an impending feeling of PMS symptoms which I experienced this month. I am now back on the Utrogestan but even with re-introducing that after a break, there are a few days of re-adjustment before the symptoms reduce a bit more.

In the next day or so, I have a call with my IP. I am not sure that the BHRT are working or are going to work for me or something is wrong with the approach to me taking this. I look at other Functional/Integrated Medicine websites and they promise results within 3 months. I dont understand why it is taking so long for me to catch a break with this. I am looking at holistic supplements but I have been advised that if BHRT doesnt work, these might not either - is that true?

Can any one give me any pointers or questions that I should be posing to my practitioner having taken the journey this far?

Sorry for the long condensed post but I thank you in advance for taking the time to read.

[london81]

i’ve just started reading lara briden hormone repair manual. it’s a very easy to read, straightforward book, which covers e.g. using only progesterone vs oestrogen plus progesterone . i’m definitely not qualified to advise on what you have said except to say i’m experiencing rapid weight gain and urinary issues due to hormones plus autoimmune, and i sympathise this is a really hard problem to solve the book def helped me get my head round stuff

what are your thyroid levels like currently? ft4, ft3 and antibodies especially? recently i tested sex hormones plus thyroid and was shocked that 6 months into taking progesterone cream, my ft4 had crashed to 4 percent, despite being on 4.5 grains ndt. my oestrodil had declined, testosterone up and fsh plus shbg raised. still wading through the data and trying to learn how menopaose and thyroid interact . the book does help lay the foundations of knowledge

i saw on tanya borowski instagram that she’s due to start up a group which is for people experiencing peri/menopause plus thyroid issues. maybe contact her admin to ask to get a notification when this starts? i feel from looking that she is one of few who know about both issues, altho i’ve not got direct experience of working with her

also not sure if you are exercising but i had a private dexa scan last week which flagged up my abnormally high muscle mass. this partly explains why i’m 10 pounds heavier since going back to weight training , although some is definitely fat as i’m a bit fat too thought i would mention the muscle issue as so many of us women are given generic advice that lighter on the scales is always better but every body is unique !

good luck

[SandraCC in reply to london81]

Hi london81 and thank you for taking the time to reply. I will check out this Lara Biden book - it cant hurt to have more information, but I think I am still stuck and struck by the fact that surely, it cannot take this long to get the doseage of HRT right - can anyone else either confirm or refute this>?

I dont know what my levels are like - I had bloods done last year but presume they will be irrelevant now. I am due to have a DUTCH test in the next couple of weeks, but even this has been a long time coming. I am confused and befuddled as I see some of the well known clinics offering a simple procedure of consultation, blood tests, review and results meeting and then offer the (usually) made up combined progesterone/oestrogen combination and 'results in 8 weeks' - for those of you who have been on this journey yourselves is this an accurate reflection of what you went through?

Re the muscle vs fat debate - I wish I was in this position but again, this is just not applicable to me at this moment. I have been advised by a nutritionist that I am working with that I need to go on a high protein diet which will help increase metabolism and should help with weight loss. But I have only just re-introduced strength training after several months of walking.

I have also been disappointed with the number of so called 'specialists' out there who apparently are dedicated to womens health and hormones. They promise much but deliver little.

Can anyone inbox me recommendations for credible integrated/functional medicine specialists who do online appointments. I am particularly interested in those who support peri menopause, can also look at nutrition and can do online.

[london81 in reply to SandraCC]

you could try tanya borowski? google her name as can’t post links, she’s based in lewes but does offer video call consults

if you increase protein and have started strength training you are likely to see benefits in terms of muscle, good for bones and metabolism, but might look like extra weight on scale. take photos and measurements to track fat loss once strength training

[london81 in reply to SandraCC]

PS my perception ( with only preliminary knowledge) is clinics promising an easy ride with hrt don’t have a grasp of thyroid or autoimmune as it’s still very early days in terms of the science and research

for example when i’ve done questionnaires on alva menopaose site it just asks “ is your thyroid condition medicated/under control”, so i guess they don’t really grasp the complex overlap. there was a study posted yesterday by someone about symptomatic thyroid patients and autoimmune factors, are you hashimotos? if so i’ll send you the post

i would say if you are getting dutch test and can get full thyroid panel including ft3 and antibodies you should have a good over view of what’s happening

[SandraCC in reply to london81]

I have had a full panel done last November and my doseage were apparently tweaked based on that. I seem unable to tolerate oestrogen well and I wonder if I need to have one last ditch try with compound BHRT instead which is much more individualised. But yes, many promise much but in my small amount of experience have not delivered. I do understand that it is a complex area and I really didnt expect necessarily to get it right first try but nearly a year later - that seems excessive when I see some companies promising results within 8 weeks!

[london81 in reply to SandraCC]

maybe you could post your thyroid results and dutch results on here? i got some good help from members who seemed to understand both

i don’t think we can rely on promises of 8week results until we know the underlying issues causing us problems

definitely look up tanya borowski i thinks he was starting a group too for thyroid and menopause

[SandraCC in reply to london81]

Thanks london81 having spoken to the IP just now I am not hopeful and feel she has all but given up on me. she is asking me what I want to do but that is the reason I am going to her - because I need advice and guidance. She is now saying lets wait and see what the DUTCH test says and I will do this next week - fingers crossed it provides some much needed answers.

[london81 in reply to SandraCC]

good luck and keep us updated. i have heard the dutch covers a lot of ground! is it across a day or the whole month?

i heard a consultant endo on menopause podcast just now who has written a book on menopause: her name is annice mukherjee , you could have a listen and see what you think?

t

[SandraCC in reply to london81]

Brilliant @london81, thanks so much for this. In the meantime I have been trying to do research on whether anyone takes BHRT progesterone only or whether there is any reason why this shouldnt be considered long term for those who cant tolerate oestrogen. I have not been formally told that I cant tolerate it but every time I try to raise above half, oestrogen dominant symptoms are exacerbated. Interesting there is very little out there about this 🤔

[london81 in reply to SandraCC]

it’s covered in lara briden’s book screen shot attached maybe google her name and “progesterone only” to bring up relevant info?

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[london81 in reply to SandraCC]

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[SandraCC in reply to london81]

Ok so I have purchased the book and just read the relevant sections in relation to this. This has opened up a new possibility for me, one which I didnt even consider to be a feasible option. The current IP that I am working with said that she would usually start clients off on Progesterone then gradually introduce Oestrogen but I had been with a practitioner previously who insisted I use both as did my GP who I had to obtain it from. Having spoken to my IP just now, she is proposing that after I have the Dutch test, I pause the oestrogen - but she doesnt seem to be suggesting this indefinitely. I hope the results paint the final picture but in this case I think symptoms may override as to not feel much improvement with both progesterone and oestrogen, even the tiny amount of oestrogen I am using, its worth a try to suspend it for now.

But thank you for pointing out this important text - its reassuring that this is something that can and is being done - even if its not common or the norm.

[london81 in reply to SandraCC]

PPS alva menopause offerHRT and a free consultation for a non profit price ( around £80 for three months hrt and no cost to talk to a doctor)

[SandraCC]

Thank you london81