Calling HRT experts

[M0stlyBowlingHedgehog]

My current meds, Prempak C 1.25 mg/progesterone, has been discontinued. I think the 0.625mg version may still be available but I swapped to the higher dose about 2 years ago (the lower dose didn't touch the hot flushes or insomnia). Anyone got any recommendations/things to avoid for when I go to the doctor tomorrow to sort out an alternative? (Have been on HRT for about 3 years, just into my 50s so should have another 2 years on HRT - more if I get my way!)

[M0stlyBowlingHedgehog]

All the alternatives (medium dose, so not as high dose as what I was on), on the Menopause matters site, have 2mg estradiol. Progesterone part varies - norethisterone, norgestrel (same as in prempak) or dydrogesterone - any thoughts on these?

[PollyPerky]

Personally I think it's a good thing you are off Prempak- it's synthetic oestrogen which may give more side effects and not be so safe.

There is NO time limit for HRT now (see NICE meno guidelines and BMS statements.) the '5 year rule' has gone so don't let any dr tell you otherwise. (I've been on HRT for 8 years.)

In terms of safety (breast cancer risk) MPA has the highest risk, Norethisterone the 2nd, and dydrogesterone the 3rd.

Many of us are going 'a la carte' and using a separate estrogen with a separate progesterone. If you intend to stay on it long term (I'm over 60) then transdermal (patches or gel) are safer than pills.

Many specialists think that Utrogestan (micronised progesterone capsules) are safest and are taken @ 100mgs daily for conti or 1 days @ 200mgs for sequi regimes. Alongside you can use an oestrogen patch or oestrogen gel.

Depends on how wedded you are to pills or if you fancy trying other things.

Femoston gets good reviews amongst pill takers.

[PollyPerky]

200mgs x 14 days for sequi.

[M0stlyBowlingHedgehog]

Thanks - that's just the sort of information I needed! I have checked out the NICE pages. Hoping for a constructive chat with the GP (old GP was utterly lovely but has now retired, new GP is "old school as short a time as possible" - despite being 30 years younger than old GP, but just to complicate things further, am seeing someone different again tomorrow due to it being a rush job prior to going on hols - oh the brilliant timing of not being able to fill my repeat prescription).

I am going in armed with notes (and the fact that I have no family history of cancer, but a serious family history of osteoarthritis and other skeletal problems - I personally think I fall in the "take it as long as possible" category).

[PollyPerky]

This from the BMS is very helpful especially the points about it's the woman's choice how long to use HRT(as long as no medical reasons to stop) and no set length of time on it.

thebms.org.uk/publications/consensus-statements/hormone-replacement-therapy/

[M0stlyBowlingHedgehog]

Just to report back - GP was lovely. Going to try Femoston for 3 months (largely so as not to disrupt things too much as I'm going on holiday) then review - maybe gel/patches plus utrogestan. Thanks for the advice.

[PollyPerky]

Great! Hope it helps.