perimenopausal / about to start HRT

[pippydoo]

Hi, I' m 48 and have been feeling exhausted, poor sleep, irritable. forgetfull, low mood, less regular periods, panicky and anxious, hot flushes and night sweats. This has been getting steadily worse over the last year and I've finally been to my GP and asked for HRT. i Have been taking menopace for the last 6 months too. GP did some bloods to check and it looks like I'm perimeonopausal. My mother took HRT for 20 years post hysterectomy and loved it and I think I'm low risk and want to feel like myself again.

GP didn't know very much about HRT but was very willing to prescribe , so I researched it (really didn't want to take horse urine HRT) and have been reading alot on here and listening to womens hour on radio 4 and decided I would like to try bioidentical HRT which is what I think I have got... Oestrogel 0.06 and utrogestan 100mg capsules. I think this has a good safety profile and few side effects. Please correct me if I am wrong.

I was waiting for my period to come to start the oestrogel on d1.
My period has not yet arrived and I'm currently on d44 .
I am definately not pregnant!!!!
I have felt for the last 2 weeks like my period is coming. Last month was d27 but over the year it has been erratic and cycle ranges from 27-45 days.

I have a few questions to experienced HRT users if possible.

Is is ok to start oestrogel at a random point mid erratic cycle or will this cause me problems?

I am going to start with one pump per inner thigh daily. Do I have to rub this in or does it have to sink into the skin and dry on its own. Tips greatfully received. I have read the info leaflet but its not that clear to me..

Is am or pm a better time to apply?

I think I'm supposed to take the progesterone 200mgs ( 2x100mg capsules) on day 15-26 and will them have a withdrawal bleed. Is this the standard dose of utrogeston as the info leaflet says only take one capsule on these days. I am presuming that d1 of of cycle is when I start the oestrogel ( unless I decide to wait it out for another period). I am supposed to take the progesterone at night as it might make me sleepy.

A longer term question is how will I know when I am post menopausal if I am having regular withdrawal bleeds? I would like to know this so I could at some point in the future switch to bleed free hrt.

Please feel free to correct me if I am wrong as I have done most of this research myself and via internet and don't really have a good knowledgable GP to go and ask these questions to.

Many thanks in advance.

Pinkfrocks --I do hope you see this as I have been impressed with your all things menopausal knowledge and helpful answers to others on here.

[pinkfrocks]

Hi!
As far as I remember, you can start the oestrogen at any time. What you need to do though is record that as Day 1 so that on Day 15 you start the Utrogestan. If your periods have not stopped completely then you may have breakthrough bleeding at any time until the HRT regulates your cycle. so in some respects it would be better to start the gel on Day 1 of your cycle - ie when your period starts. If it doesn't come for ages and you want to start the gel then it should be ok but you may have your normal period before you get to the utrogestan stage. You will then have to count 15 days into that cycle before you take the Utrogestan. Is this making sense?

It does have a good safety profile and is what I was given by a consultant who thinks it's brilliant. Same for Utrogestan which has a good safety profile for breasts compared to synthetic progestogens.

Applying- do not rub in but smooth on your skin- bit like applying body lotion but not rubbing in, just smoothing over and allowing to dry. You can divide the 1 pump between 2 thighs if that makes it easier! I apply one pump to my upper arms, divided between both arms and another pump before bedtime. I found I felt nauseous at first with 2 pumps in the morning. Some drs say it's better to divide the dose but it doesn't really matter.

The correct dose of Utrogestan is 200mgs for a minimum of 10 days per cycle. I read somewhere else that the current leaflet is incorrect and they are changing it to say 200mgs per cycle. That is what I use.

You can take 100mgs for 25 days if you are on an almost bleed-free regime ( 1 year after no normal periods or age 54.) or 100mgs every day to ensure no bleed. It might make you a bit sleepy or dizzy so best to take it at bedtime.

To complicate things for you further, some women ( inc me) prefer not to take Utrogestan daily or almost daily and keep to a bleed sometimes on a longer cycle ( 6-8 weeks) but this is usually under a consultant who will suggest scans to ensure the lining does not thicken too much.

You won't know if you are menopausal if you use HRT this way- unless you have a break from it. You may have to continue with the bleeds up to age 54.

Does this answer your questions?

[pippydoo]

Wow, Thanks Pinkfrocks, super clear now. You have been really helpful.

I 'm going to start the oestrogel tomorrow....sick of waiting for a period that may or may not appear. So tomorrows d1 and if a period does happen to appear naturally before day 15 when I should be starting the progesterone I will then restart with that as a new day 1.

I thought the correct dose of ultogestan was 200mgs...strange that the leaflet inside says take only 100mgs. So Pleased I checked.

Great tips for applying the gel too. Why are these leaflets so unclear??? Drives me mad. Thank goodness for the internet!

Im sure i will be back with more questions as the weeks/ months go on.

Thanks so much for now.

[pinkfrocks]

I think the leaflet is wrong because they have recently discontinued the 200mgs capsule and only the 100 is available and for some weird reason they have messed up the dosage instructions but they are aware and it's being sorted.

When you apply the gel you need to rub it in lightly or it will be a gooey mess, but just don't go mad - think smoothing not rubbing.

Good luck!