Which HRT should I request?

[FrothAndBubble]

I am sure GP will give me options but which is good, current best first one to try?

She suggested HRT as I am 48 and perimenopausal. Asked me to reflect on the risks but I’ve decided it’s a definite yes when I go back tomorrow. I don’t fancy wearing patches and my biggest issues are lack of libedo and brain fog (poor memory).

How about a gel like divigel (oestrogen) and then utrogestan tablets for progestogen?

Or if gel seems messy then something like femoston is good.

These are ones, along with patches, that I tend to advise (GP).

Best of luck whatever you decide!

Thank you SO much for taking the trouble to reply. It couldn’t have been more useful. I am reading up on your suggestions now. I had no idea there was a gel instead of a patch. I like that idea much more. In my naivety I thought HRT gel had to be applied internally .

Is the divigel alongside utrogestan tablets safer than taking the Femoston? I don’t mind the gel idea at all - now I know it’s applied to the thigh! I could just do it after my shower, before getting dressed each morning.

Would you have a view on which is most effective for a non existent libedo and a total lack of information recall ability? I currently only get the hot flashes as night sweats in the week before my period is due. (Periods getting lighter and shorter each month now).

Thanks again.

No prob!

Transdermal preps seem to be preferred over oral from a side effect point of view.

The above combo can help with libido but you may also need a small dose of testosterone too. I haven’t much experience of using that as yet but definitely worth researching.

The brain fog seems to come in under the “generally shit things about the menopause” umbrella that HRT tackles so hopefully you’ll see an improvement there.

Just to note the utrogestan tabs can be taken orally or inserted vaginally to further minimize progesterone side effects.

Just had a look on a forum with one of my HRT gurus and she suggests 1/10th to 1/7th of a tube of testagel daily in addition to the O/P combo to help libido. Apparently it can be a bit messy to try to squeeze out the correct amount but I’m sure there are ways and means!

Oh and lastly if you go vaginal route with the utrogestan insert it at night so it doesn’t end up falling back out!

@FrothandBubble

I agree with the PP about using gel and Utrogestoan but I think she is not in the UK as some info she gave is incorrect.

@RedlemonadeYou can't be in the UK as Divigel doesn't exist here.
It's either Oestrogel, or Sandrena.

Also- you say you are a GP- but not in the UK as your info isn't correct for the Uk. Vaginal Utrogestan is not licensed here for that use.

Many women (me included) were told (by a private consultant) that it's fine to use it that way, but if you ask a UK GP you will be told it's not licensed for vaginal use.

OP- if you choose Utrogestan you can use it vaginally, but whichever way you do use it - orally or vaginally- both can have some side effects. some people love it, others hate it. It is sedating when used orally, and vaginally you will get seepage overnight (knickers in bed needed) and no sex when it's in there (unless you use a condom.)

GPs in the UK are again, not allowed to prescribe testosterone. You might get one who is willing to do this outside prescribing rules, but most women who use it have had to see a private consultant.

It's also NOT a good idea to use it right from the start with HRT- you need to give the estrogen time to work first for a few months, then reassess.

I am sure GP will give me options

Mine didn't. Straightforward bog standard tablets. 1mg oestrogen for 16 days then 1mg oestrogen and 1mg progesterone for 12. Elleste duet. Not sure if its available atm. I've found it very good.

I saw my GP yesterday. Brain fog was my main problem too, thought i was going mad, I'm early 40s.

She's prescribed the patches for 3 months, lower risk than tablets for stroke apparently. I'm a bit concerned about the progesterone as the contraceptive pill messed me up, but she has said there are other options if i don't get on with this.

Yep, not in the UK but use the FRSH guidelines etc. I prescribe utrogestan PV if wanted but explain it’s off licence. Same with testosterone but as I say I’ve not much experience with that so would def go the stabdard route first.

I didn’t realise divigel wasn’t available in UK. Somehow I thought our pharmacies got it from there but must be thinking of utrogestan!

Also would obviously go into a lot more detail in terms of risk assessment/counseling etc if this were someone I was actually prescribing for but just wanted to give OP some jumping off points to discuss with her own GP. No substitute for that.

I think that you can choose after trying some types of hrt. For me tablets is a preferable way cause I find it easier and more convenient with my lifestyle. Femoston is ok for me after trying 2 more types.

Thanks for replies all. I will read them carefully, noting names of recommended meds in a bit.

Came on to update on my GP appt which I was too upset to do yesterday.

I decided that I didn’t want patches so asked for a gel like divigel (oestrogen) and then utrogestan tablets for progestogen as suggested by PP (thank you!). I was really helpful to have a starting point and to have been able to read up before going. She would definitely have prescribed patches without me saying this.

We then got two problems; the gel was fine (although I think it would be a different one) but she couldn’t find a separate progestogen tablet to prescribe with it on her allowable list. She did look through her book etc. What should she have found that was suitable? I got the impression she normally prescribes gel to those who don’t need the progestogen element. This sent her heading straight back to the patches route and I’m really put off the whole idea by patches.

Secondly she took my blood pressure and it was one hundred and fifty over something (80 maybe?) which she said was high so she took it twice more and high each time. On that basis she couldn’t prescribe anything and has said I need to borrow a monitor from the surgery and monitor at home and she’s booked me back in for a months time.

Left feeling very low afterwards and had a cry to a friend later in the day.

Surgery didn’t call about the monitor but my DH ordered one online which should come today.

The BP delay did allow her to say to me to ask friends what they have had prescribed etc (i.e do more research) which I am sort of glad about as I would have been pushed into patches otherwise.

I am confident BP will be fine. My period started last night and I know I was top level stressed and anxious when i went for my appt yesterday as my symptoms are at their worst the 7-10 days before period due.

So helpful people what can a UK GP prescribe alongside gel for the progesterone element? Suggestions/recommendations please

OP thanks for starting thread. Can I ask a related question please? I am on Evorel continuous estrogen and progresterone patches for my peri-menopause symptoms (terrible migraines) which have worked fantastically. But apparently this is not ideal for people still getting periods like me (51), because of a small risk of endometrial cancer. I don't want to change to the non- continuous patches as they probably will make migraine worse. But I would like to find out what the actual increased risk is. Thanks for any comments or experience.

@RedLemonade In the UK most GPs are unaware of what Utrogestan is, let alone different modes of delivery. They are also not allowed to prescribe testosterone- it is not available for women and women have to be prescribed the ones men use, but 'trial' a dose.
Which country are you in?

Utrogestan is not made in the UK- the company is Besins and they are based in France/ Belgium.

Same company makes Oestrogel/ Estrodose.

@BusyBusyBusy1

I suppose there is a TINY risk because you are adding in your own estrogen to a controlled balance (via HRT) of estrogen + progestogen.

Most women will get erratic bleeding if they use conti HRT in peri. Your normal periods would break through.

One option which you might want to talk through with your GP is to use long cycle HRT- there is an option called Tridestra- which gives a bleed once every 12 weeks - and for 10 of those weeks it's estrogen only.
You can also use any type of estrogen plus a progestogen to create long cycle. I have been on long cycle for 10 years under a consultant, with cycles from 8-10 weeks.

I doubt your GP would agree to this or have the wherewithall to manage it.

Your other option is the Mirena coil- it's the most obvious answer- and it will keep the lining thin regardless of your own hormones plus estrogen only HRT.

@FrothandBubble

Utrogestan is micronised progesterone if your GP isn't able to find the name in her book of drugs! Amazing how they know so damned little about mainstream HRT. FGS!

Your BP is likely to be white coat syndrome.

HRT does not increase BP. This is an outdated myth. There was some evidence that the old types of HRT- Prempak- (used donkeys' years ago and in the US) which contained a synthetic oestrogen may have.

The advice now is treat the high BP but do not refuse HRT in the meantime.

Sounds like she needs to go on one of the BMS HRT training courses!

Just push for Utrogestan- plenty of patient info leaflets on the web on this product if you look and print off for her.

Alternatively you can use Norethisterone tablets but she won't know how much to give you! (It's 1mg daily.)

Thanks @Jingling. Very helpful. Makes sense - some of the 'periods' I get are completely painless, some are normal periods. So I suppose the painless ones are due to HRT rather than 'real' periods iyswm. Yes I was wondering about trying out the Mirena as another option, thanks for the suggestion. Just a tiny bit wary as have read that some people found it made them more headachey initially so wanted to find a good time window to try it. (Almost anything can tip migraine off for me so I end up being very cautious with any tweaks to medication). Will certainly consider it. Thank you

Can elevated blood pressure cause anxiety?

@BusyBusyBusy1

I'm confused now. If you are using continuous HRT you ought not to have any bleeding at all.

You might have some erratic bleeding which is when your own hormones 'overtake' the conti HRT.

This is called breakthrough bleeding and shouldn't be happening too much.

However....anyone using conti is 'warned' it can take 6 months for it to fully suppress bleeding, even in post meno women. This is because it takes time for the lining to thin enough not to bleed at all.

I can't in all honestly see the point in your using conti because it won't suppress ovulation and you will still get the ups and downs of a cycle.

You may find that sequi controls your migraines - have you tried it?

Jingling I’m in Ireland. I had no idea Utrogestan was a relative unknown in UK. Fascinating how different the licensing is between near neighbors.

GPs here are getting more and more on board and upskilled about HRT though we’re still not all there yet. Great to see progress and good info being shared among women too.

Thanks Jingling. Have only been on it for 3 mths so far. Very helpful thread!

I'm in Ireland & considering HRT so I'm finding this thread really interesting & useful. I'm lucky enough to have a GP who has an interest in menopause treatments & knows her stuff, so I'm taking notes for my next visit.

Some excellent advice here OP. Definitely consider an Oestrogen gel and micronised progesterone (Utrogestan). Check out Dr Louise Newton online and read Liz Earle's the Truth About HRT.

Thanks (again) to those who have taken the time to post. It’s so helpful.

Are there any UK GPs (or indeed well informed UK patients!) who can give me generic names or brand names (and dosage?) of either the best or a good Oestrogen gel that can be willingly prescribed by NHS GPs and the same for micronised progesterone please?

I’ve been monitoring my BP all weekend and it has been completely normal each time so I’m going to call the GP in the morning and ask her to reconsider waiting almost a month for another appt as I really want to get started with a prescription. If I can actually suggest something she can prescribe at the same time that sounds like constructive way forward...

Are there any UK GPs (or indeed well informed UK patients!) who can give me generic names or brand names (and dosage?) of either the best or a good Oestrogen gel that can be willingly prescribed by NHS GPs and the same for micronised progesterone please?

There are no generic types. ALL of the above are and can be easily prescribed by a GP- there are thousands of women using these. Have a good read of the website by Dr Louise Newson.

Oestrogel is sold as Oestrogel or Oestrodose, both made by Besins in Brussels.
There is also Sandrena Gel which is slightly different; it's in daily sachets and some people (not myself) say it's stickier to apply. It's also harder to adjust the dose as it's a sachet rather than a pump/ aerosol type of packaging.

Micronised progesterone is old sold as Utrogestan, made by Besins.

It comes in 100mgs capsules.
Dose is 200mgs for 12 days in peri, once very 4 weeks. Most women either start the 12 days on Day 1 of each month or Day 15.

Oestrogel - the dose is 2 pumps ( 1.5mgs estradiol) or you can start with 1 pump, and increase up to 4 (daily) for symptom control.

Ask me anything else if you like- have used it for 10 years although did use Norethisterone for a few years.