HRT 3 Months update ...

[tass1960]

After lots of deliberation and lots of good advice and discussion on this site I thought I would write an update.

My GP prescribed Evoril Conti patches. These have helped with most of my symptoms. However my libido is still absent and my breasts are very tender and definitely larger (think pregnant boobs) I had a review with my GP recently and she asked me if I would like to try an alternative HRT. I said not at the moment because I thought it might be a frying pan to fire scenario. I am happy to change but not just clutching at straws. Am going to see the doc again in 3 weeks and it would be great to hear if anyone has been though a similar experience and if so what did you do about it ?

The only pointers I can give you are you don't HAVE to use conti HRT when you are post meno.

Many Gps follow the 'rules' religiously for conti ( ie aged over 54 or no period for a year)but it's really personal preference (on your part.)

Most of the side effects with HRT are from the progestogens - especially low libido and feeling bloated /fat/ sore boobs- so swapping to a sequi type of HRT may be better. You can only try!

I am years past meno but have never used conti HRT mainly because my consultant believes (and the research shows) a slightly higher risk of breast cancer with conti where the progestogens are synthetic. This has been known for many years.

So- if you can put up with the monthly bleed (or not if you used a Mirena along with estrogen) you may well get on better with sequi types.

Thanks Polly - you have been a great help throughout this (short) journey for me. I went to the doc fully armed with the info you guided me towards but got too confused with all her arguments - can you please come to my next appointment with me :)

I am going to write it all down - tell her I've been on online forums and ask for what suits me best. I've got 3 weeks to get my act together. I'm really bad now at processing information (and retaining it) but if it's in black and white I'll be OK.

If I could!

Your dr may be a bit iffy about using sequi as it's not so common post meno but plenty women I know of (on forums ) do it.

I think you just need to say that you feel using 2 hormones daily is possibly giving you too many side effects so you'd like to use HRT as a cycle, where you only use the progestogens for 12 days each month.

If you have an oestrogen-only patch then you will need either Utrogestan (micronised progesterone) for 12 days each month, or Norethisterone. One is natural (bioidentical) and the other synthetic.

Good luck and report back!

Thank you - I will 😳

Dear Polly,
Do you think an oestrogen only patch with micgrogenised progesterone pill is safer/better than a synthetic progesterone/oestrogen patch? I wondered if the breast cancer risks were higher with the latter. The gp gave me a very rushed consultation, has prescribed me the sequi patches - but I'm too scared to use them...

Yes!

It seems that this is perhaps the safest. There is no consensus yet but the research seems to point in that direction.

UPDATE-: following.a week of full blown PMT like symptoms - exploding boobs. PV bleeding (more like spotting) and very low mood ie snapping at my husband and crying at the drop of a hat I went back to to the docs this morning. It was a different doctor and I was explaining my situation from the beginning whilst sobbing constantly. She was very good. She has referred me to a post meno bleed clinic and meantime I have to stop the HRT. Am happy enough with this. Going forward and after listening to me, she is suggesting a combination therapy which sounds a bit like what Polly has recommended. Am very tearful today but this is what it was like for me when I had PMT. ie once I started crying it could last for days :(

Hi Tass I'm sorry you have felt a bit rubbish.

Your GP is a bit off kilter here, I'm afraid. She should know that bleeding in the first 6 months of conti HRT is normal. Unless she has other reasons for referring you, there is no need. (I expect they will sigh and wonder why a GP doesn't know this.)

Investigations for post meno bleeds are not for women who are using conti HRT and are only 3 months in - unless they have other worrying symptoms that are not connected to HRT.

To be honest, I'd print this off the web and go and see her again because it going to waste your time.
see here

www.menopausematters.co.uk/sideeffects.php

I read the leaflets and I knew this. I had taken a print of the comments from this post with me and I did try to discuss it with her but I don't think she is very knowledgeable and I was just too upset to push it to be honest. I am happy enough to be referred - I know the gynae doctors at the hospital from working there as a midwife previously and I am hoping that doctor will have more of an idea of what HRT will be suitable for me without just reading it from the BNF. It might a good thing ultimately although I know it is unnecessary - thanks once again Polly.

This is from the leaflet.

"Important information about Evorel conti patches

This medicine will not usually cause a monthly menstrual bleed. However, you may experience spotting or breakthrough bleeding during the first few months of treatment. Spotting or breakthrough bleeding is more likely if you forget to change a patch on schedule. If any bleeding continues after a few months of using the medicine, or after stopping treatment, you should consult your doctor."

I give up at times with GPs! Anyway- hope you get on okay.

Thanks Polly - I know you are right and once I am in a better frame of mind ie less tearful I'll get my act together and go back armed with the info. I did have the info with me today but I really struggled to get my point over because I was so upset. Bloody hormones (or lack thereof) ...

This is from the Women's Health Concern- the patient arm of the British Menopause Society

Show your GP (and maybe suggest she goes on one of the BMS training workshops on HRT!!!)

www.womens-health-concern.org/help-and-advice/factsheets/hrt/

Side effects associated with HRT

As with any drug, there are known short-term and usually mild side effects from HRT which may trouble some women, especially in the first few months of use. These may include breast tenderness, leg cramps, nausea, bloatedness, irritability and depression. These side effects are related to oestrogen or progestogen, and may be overcome by a change of dosage, ingredients or route in the HRT prescribed.

Irregular bleeding or spotting can occur during the first 4-6 months of taking continuous combined HRT or Tibolone, and is not a cause for alarm. However, you should consult your doctor if you get heavy (rather than light) bleeding, if it lasts for more than six months, or if bleeding starts suddenly after some time without bleeding. Irregular bleeding may sometimes be improved by changing the type or route of HRT