Filed under: Hormonal. Tagged as: Hormonal.
There are different types of progestogen available, and various dosages within each type, so there is a good chance you will eventually find a combination of oestrogen and a progestogen that will give the advantages without the side-effects. Faced with a woman who has undesirable symptoms at the first attempt, many doctors still say, ‘Well, we’ve tried HRT, but it obviously isn’t going to work for you. Never mind’, and they just give up, without making any more attempts at finding an acceptable combination of the two hormones. If you feel that you need oestrogen (whether ID reduce menopausal symptoms, or to protect yourself from osteoporosis or artery disease), it would be a great shame if you gave it up after just a few months.
There are about 20 different combinations in which you can take HRT, so it’s highly likely one of them will be right for you. It just requires a little patience and perseverance from both you and your doctor. Usually, changing to a different progestogen will get rid of the unwanted side-effects, but if that doesn’t work, then reducing the dosage should work, or possibly taking it for fewer days each month. However, there is a minim urn dose needed to ensure the lining of the womb is shed each month, so you shouldn’t have too low a dose or for too short a time. Many women find that vitamin B6 or evening primrose oil helps reduce unpleasant pre-menstrual symptoms brought on by progestogen.
The good news is that research is being done into new and better progestogens. Until recently, this hormone could only be taken in the form of tablets by mouth. As much of the progestogen gets lost as it passes through the digestive system, quite a large dose has to be taken so that you end up with the amount you need, and this large dose is what causes most side-effects. Progestogen is now also available in a combined progestogen and oestrogen patch. It is called Estracombi, and is manufactured by Ciba-Geigy. In this- form, the two hormones are absorbed through the skin, and because the digestive system is avoided, a much lower dose can be given to achieve the desired effect, thereby reducing the side-effects. Before long, a completely new generation of progestogens will be available which produce fewer side-effects.
If progestogen in any form really doesn’t agree with you, under certain circumstances it may be possible to cut it out altogether. Your doctor would probably only suggest this if you already had osteoporosis and needed to take oestrogen but were finding the side-effects of progestogen so intolerable that you had to give up. The big disadvantage of doing this, however, is that you would have a small but definite risk of developing cancer or other disorders of the lining of the womb. You would need careful counselling about this, and your doctor would probably suggest that every one to two years you had a biopsy: a small piece of the lining of the womb would be removed and sent for examination to see whether there was any sign of cancer or other disorders. Nowadays, for women who have osteoporosis of the spine but who really cannot take progestogen, a new non-hormone drug called etidronate might be the solution.
If it is the ‘withdrawal bleed’ that is putting you off HRT, there is a third alternative, known as ‘no-bleed HRT’ (because the aim of it is that it should eliminate distressing menopausal symptoms without producing periods), or ‘continuous/combined HRT’ (because you take combined oestrogen and progestogen continuously). No-bleed HRT involves taking a small dose of progestogen every day, instead of for just 10-12 days a month. The theory is that this method eventually leads to amenorrhoea (a complete absence of periods).