As mentioned in Part 2, I’d collected my prescription for the Evorel 75 patch, the replacement for my Sandrena gel, at the end of June. I applied my first patch on the evening of Saturday 2 July. I felt completely out of sorts on the Sunday and Monday; had a migraine on both days. I even fell asleep on the Sunday afternoon, which is really unusual. I took the patch off on the Tuesday night as my Sandrena prescription had arrived, and this would have been the day that I would have changed it anyway. I did not, at the time, think that how I felt was in any way related to the application of the patch.
The following Monday I passed
a large blood clot. TMI? Maybe, but as I've said previously I'm wanting to be honest and hope that anyone reading this can take something from my experiences. I’d not had anything like that since the summer of
2019, so it was a complete shock to the system. I flooded my underwear and the shorts that I was wearing and had to go home to wash and change. Now, I wasn’t
overly concerned as I had a sneaky feeling that it had something to do with the
Evorel patch. My specialist appointment was the week later, and I knew that I
would discuss it there. Had I not been due to have this appointment I would
have sought medical counsel. Any bleeding that is not usual should be
investigated.
So, Tuesday 12 July arrived; my menopause specialist appointment. After
I’d received my blood test results, and as the day drew closer and closer, I was
getting more apprehensive. I’m an acknowledged overthinker and had already
decided that I might face the same response as I had from my GP. There are a
couple of differences between a GP and a menopause specialist; one is time and
the other knowledge. If you are lucky you get 10 minutes with a GP and if you
are even luckier they have a specialist knowledge on the menopause. A GP has basic
knowledge of so many conditions and just doesn’t have the time that someone
facing perimenopause and menopause needs, in my opinion. My first menopause specialist
appointment was for a guaranteed 50 minutes. If you know me, you will know that
we didn’t stick to this time but to be fair, I did have 10 years to discuss!! I
also established that Dr Glenys is an NHS GP and that she, and another
colleague, had attempted to get funding to set up an NHS menopause clinic in
the Peterborough and Cambridgeshire area but this had been declined. She had then
set up her own clinic. This also explains why her clinic is only open 2 days as
week. If I was one of her patients I’d be getting her knowledge and expertise
on the NHS. How lucky are her NHS patients!
I needn’t have been apprehensive. Dr Glenys was amazing. I’d documented
my period cycles for the last 10 years, highlighted some of my early
perimenopause symptoms, then later ones. Discussed the fact that I was
prescribed an SSRI (antidepressant) for those symptoms. She asked why? I had no
answer to that, as I didn’t know why I was ever really prescribed them, other
than that I’d been told that they would help with my hormonal imbalance?!
She then went on to discuss the results of my blood test. Although I had been applying the oestrogen gel for 7 months or so, I wasn't absorbing it properly, as my oestrogen levels were lower than they should be. This explained why I was still getting symptoms; night sweats, periods of being able to fall asleep fairly easily but waking anywhere between 1 and 3am, then staying awake for 2 plus hours, being moody and tearful, to name a few!
I’d been advised to apply the oestrogen gel on the outside of my thigh. Dr Glenys informed me that this was not the best place for absorption and then went on to show me where to apply it; it should be where the skin is thinner, so the inside of the thigh or even the inner forearm.
We discussed
my testosterone levels and the impact of my sex hormone binding globulin, one of the other tests that had been done. She agreed that adding testosterone to my HRT regimen would definately be beneficial for me. Yeh! I was so relieved!
After further discussion we agreed that I would change from the gel to a patch. I told her what had happened to me on the Evorel patch. She explained that although the dose of the patch was correct for the dose of Sandrena I was on, because I was not absorbing the Sandrena gel properly I’d hit myself with as huge dose of oestrogen all in one go. Hence the migraine, feeling odd and the blood clot a week later! There is another patch available, Estradot, which we agreed would be good for me as someone who has a history of migraines. The recommendation was to start on 50 micrograms, then a month later move to 75 micrograms, then a month after that move onto 100 micrograms. Basically, increasing my oestrogen levels at a steady pace. Once my oestrogen levels increased I could then start the testosterone.
I received the clinic letter, by email, late afternoon on the day of the appointment. Wow! This summarised everything that we had discussed and she had also supplied me with a prescription for the Estradot, to discuss with my GP. I pay for an NHS prescription prepayment plan, and as this is available on the NHS there was no point in paying for a private prescription. In October 2021, the Government announced that women in England would only have to pay one charge of £18.70 for up to a 12-month supply of HRT. It was recently confirmed that the move would not be enacted till April 2023! It may be the case that I can have a 3-month supply on one prescription, when my levels have settled down, but for the moment it's a monthly prescription for me.
Dr Glenys discussed 3 different forms of testesterone with me; 2 types of male testosterone and 1 type of female. I opted to go with one of the male types, partly due to how little is used therefore how long they last (approx 300 days) and also cost! The female form, AndroFeme, is licensed in Australia and comes as a 3-month supply costing almost double what the male form costs for 3 times less supply! She had sent the prescription to a pharmacy, I then received an email from them to pay, and two days later the testosterone (Testim) had arrived. Because of how little I will be applying I then had to source a very small syringe to measure the dosage correctly! Amazon was great for this! They are sitting in the bottom of my wardrobe waiting for the day that I can start applying it!
During my weekend spa break with my best friend, we'd had time to talk! One of the many topics was weight loss, or lack of it. On Saturday 16 July I stood on my bathroom scales, yet again! Weight not quite back to where it was last November when I wrote A moment in time but only 2 pounds off...... The holiday booked then was now only 15 weeks away. I set a plan. As I have said, repeatedly, I am always better with a plan. Whether that is food planning, exercise or even with a target in mind. 15 weeks allowed a healthy weight loss of between 14 and 28 pounds. The top end of the possible weight loss would be lovely, but as I've got older the weight has not been as easy to lose. With all this in mind I set about meal planning and food management started. 'Food management' is the phrase my hubbie came up with. It's not a diet, as it is a way of life. I just need to manage what I am eating! oh, and maybe think about exercise too!
I'd had to have some repeat blood tests for my GP for something unrelated. Although, as I am writing this my thoughts are that I when I went in May and discussed testosterone with the GP I also discussed how easily I bruise with her, which led to the original blood tests. I've read something recently suggesting that bumping into things and therefore bruising are another perimenopause/menopause symptom! I had scheduled an appointment for a week after seeing Dr Glenys, to discuss those tests and also update her on my private appointment. I took a copy of the clinic notes so that she could put them with my NHS notes. I continued to use the Sandrena gel, before this appointment, but changed to applying it to my inner forearm, as had been suggested by Dr Glenys.
My GP raised the prescription for the three doses of Estradot and sent them to our local pharmacy, which is a village Boots store. Eager to start the patches as soon as possible, I went to the pharmacy that afternoon. I was greeted with supply issues of this particular patch. The advice given was to call other pharmacies to find out whether they had stock. Should this really have been down to me to do? Anyway, I did! I found out that a larger Boots store not to far away had stock of the 50 and 100 patches and that they could order the 75. I arranged to have my prescription put back into the system?! This meant that as I had my NHS number any other pharmacy could then pull that prescription and fulfil it for me.
So, I applied the first Estradot patch on Wednesday 20 July. This patch was much smaller than the Evorel patch and 'stuck' more easily than the Evorel patch had. I put that first patch on my upper thigh. Subsequent patches I have applied around my hip area, alternating the side that it is on.
Whilst on this dose I was GRUMPY! I'm sure that the 'long suffering husband' could use other words to describe me but that's my interpretation! I was still having night sweats, periods of broken sleep and therefore tired, grumpy and with little energy. I suppose some of that is possibly because I had been applying the 1.5mg Sandrena gel in the correct place for about a week, so I had therefore increased my oestrogen levels; I had then dropped them back down when applying the patch.
I previously mentioned in my Jan to March post that I hadn't read the book that was suggested by Oprah but in July I read another. Natural Hormone Balance for Women by Uzzi Reiss. This book was published in 2002 and is written by an American Obstetrician-gynaecologist. I don't know where or when I bought this book, probably years ago BUT what I do know is that I should have read it earlier! I hadn't even finished reading the foreword before I'd messaged my best friend and told her I was ordering her a copy. There are many points raised that I could relate to. Parts I read made me have 'lightbulb' moments. I've been looking at the last 10 years of my life and totally 'get it'. I have been so impressed that I discovered that he wrote another book in 2020, The Good News About Estrogen, that I ordered this too! This book is really an updated version of the first book but does have some added information relevant to the 2020's.
In August 2016 I wrote the blog post Post Moonwalk Blues. What I have realised since reading the aforementioned books is that I almost definately had a hormone crash at this time. I sort of knew this due to food that I started to crave and was then eating. Sweets! I'd never really been a sweet or chocolate eater but I would binge on handy packs; Haribo's, Maltesers, anything really! I fell out of love with walking. Again, looking back, I know that some of this was due to the ever increasing aches and pains which I couldn't face after doing even a 3 to 4 mile, 1 hour walk. My periods were still averaging 25 days but with increasingly heavy first days. By the end of that year I had my first 'missed' cycle. I wonder if I'd read the first book earlier if I'd have had a better understanding? For me, there is nothing I can do about that. This series of blogs is to get someone who is reading to look at themselves. I was just shy of my 43rd birthday when I noticed my first perimenopause symptoms and I didn't even know that that's what it was! Knowledge is power and if this gives someone a little bit more knowledge then I've achieved something! Look to my blog post Trust me! if you want to see the list of 40 possible perimenopause symptoms; either to refresh you or to help you to look for signals.
Four weeks after applying the Estradot 50mcg patch I started the next box, so up to 75 micrograms. I'd lost 7 pounds (lbs) in weight and also managed to maintain some kind of exercise programme! I am still keeping track of any symptoms on my WellWoman app. Within 2 weeks of starting this patch the night sweats had completely stopped. The broken sleep was down to a couple of times a week rather than only having a couple of nights uninterrupted sleep a week! This all adds up to feeling, a little, more energetic and taking an interest in things. That is very vague as I can't quite put my finger on what I mean here. I suppose it's a little bit more 'get up and go', rather then wanting to spend a weekend morning in bed!
On Wednesday 14 September I applied the 100mg patch. I change my patch on a Wednesday and a Saturday. It works for me to be in this kind of routine. When I looked at what the recommendations were for patch changing, this one was the one that I felt suited my lifestyle best. I generally have a bath every evening. So I remove the patch before I get in the bath. I use copious amounts of soap to remove the 'glue' residue that is left from the surrounding area. If that doesn't work then I have found that baby oil removes the last little bit; a tip gleaned from a live Instagram with Lisa Snowden and Dr Naomi Potter!
The day after applying the second 100mg Estradot patch I had spotting. Having had the bleeding that I have had this year I knew that this was down to the increase in oestrogen; probably why Dr Glenys didn't just prescribe me it straight off! Remember that I had not been absorbing the ostrogen from the Sandrena gel properly and I'd passed that blood clot whem I'd 'overdosed' on the Evorel 75 patch. The spotting lasted 3 days and then settled. I was now on countdown! Two weeks on the 100mg patch and I could start applying the testosterone.
By the end of September I could most definately say that I was starting to feel more like me! That's a really difficult one to quantify. The easiest way to describe it is this; imagine a birthday balloon that slowly loses air. There's still some in it but it's not as full as it was. You are then somehow able to refill the balloon. Pump it up a bit! That's the easiest way to say how I feel. Still got some saggy, crinkly bits like that deflated balloon but with some air pumped back in I'm feeling much better. About myself. About my well-being. About my relationships. About my life.
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