HRT options - which one?

[Magnificentbeast]

It's 8 years since I found out I was having an early menopause and I've decided to start HRT.

I have an appointment with the GP tomorrow and have been advised that I should have some idea about which method I would like to use. E.g. patches, tablets, or cream. I'm not sure how to decide.

Also, what are your experiences of visiting the GP about HRT? What should I expect?

How old are you now? Are your periods well and truly over?

How much do you know about HRT already?

Briefly, there are 2 types- sequential and continuous.

sequential mimics a cycle and gives a short 'period' each month, continuous doesn't.

In some ways it's best to start with sequential (though GP will prob offer continuous if your periods have stopped.)

This is because continuous is 2 hormones daily and means it's hard to tell which might be giving side effects or if the dose is suiting you.

The latest thinking is for patches or gel +separate progesterone for all women as this gives better absorption and has no added risk of blood clots compared to tablets.

(There is no 'cream'- it's estrogen gel.)

I'd recommend having a look through the Menopause Matters decision tree as it will depend on your circumstances and current symptoms. Many people use more than one option together.

A few examples:
If you're having vaginal or urinary issues, then you may benefit from local estrogen. There are a few different types, most I know use Vagifem and/or estrogen creams (which are different from the gels, creams are only for local estrogen while gels are for systemic HRT needs).

If having wider issues like hot flushes or mood swings or joint pain or dozens of others, systemic HRT may be of benefit. A lot of people prefer the transdermal options (patches or gels) and they're recommended particularly for people with blood pressure or other cardiovascular issues or other health problems which makes tablets more slightly risky due to how they're processed by the liver.

From what I've seen, a couple of the most common systemic combinations to start for those still having periods and having a uterus are a patch like Evorel Sequi with Oestrogel gel to top up or Oestrogel with Utrogestan (tablet) for progesterone part of the month (this is only entirely registered bio identical pair), with local estrogen like Vagifem as well if the pair doesn't control vaginal or bladder symptoms.

But everyone is different, it is common for there to be a bit of trial and tweaking, which is why I recommend looking through the Menopause Matters decision tree and website as a starting point.

Thanks @JinglingHellsBells. I am 45 now and I haven't had any periods for at least 5 years. I think this would mean that I would be given the continuous option. Is that right?

Originally I didn't accept that I was menopausal and I didn't like the thought of HRT. I was also breastfeeding for an extended period so it wasn't really an option.

I have done a little reading about HRT and I think the patches might suit me in theory. Although I wondered if I would be offered oestrogen only or combined patches?

Thank you @BiBabbles. I will check out the Menopause Matters website.

As an aside @MagnificentBeast, have you had a bone density scan? The purpose of HRT for early menopause is to prevent bone loss and prevent heart disease (as well as other things.)

It's quite important to have a baseline assessment of your bones because the greatest loss of bone ( up to 5% per year) occurs in the first 5 years post menopause. Also as you were breastfeeding, you may have lost a lot of calcium too so a DEXA scan is important- ask your GP because with an early meno you ought to qualify for the scan.

Depending on the state of your bones, you will have more information around what dose of estrogen you might need (bones are linked directly to amount of estrogen ) .

You could for example, find that the OCP ( Qlaira) is best as you are so young. This has a higher level of hormones and the estrogen is more body-identical ( like most HRT now.)

Qlaira is often recommended for younger post meno women.

You can have continuous HRT but you don't have to.

I still use sequential and I am in my 60s and 11 years post meno. I choose sequential as I don't like daily progesterone - makes me feel tired.

You can't have estrogen-only patches if you still have a womb. All women with a womb must also use progestogens to stop the lining getting thick (which rarely would become cancerous.)

Lots to think about.

Thanks @JinglingHellsBells.

I have recently had a DEXA scan and I am going to talk to the GP about the results tomorrow. I got the results over the phone from the receptionist who said they were ok. I said I would book an appointment to discuss the next step ASAP.

I think it was going for the scan and my DC2 finally being less interested in breastfeeding that has prompted me to ask for HRT. I was a worried after having the scan and waiting for the results.