Anyone else finding HRT isn't helping?!

[QueenRefusenik]

The thread title is a bit misleading I guess as it IS helping a bit... Just not as much as I thought it might. I'm 44 and started HRT last year on Elleste solo 1mg everyday and Utrogestan 200mg for the second half of the cycle. It helped a bit but not enormously so I had the estradiol dose raised to 2mg. Slight improvement but still...

Should I ask to change the drugs? Higher dose? Alternative pill? Transdermal gel or patch? My GP is very nice but she's about 12 (ok slight exaggeration) and just looks what I suggest up in the BNF and then prescribes. Which is useful in some ways, not so much in others!

Or am I being unrealistic in my expectations? I hear so much 'oh, I'm a new woman' and even when my GP wrote the first prescription she said that although it can take 3 months to feel the full benefit, I would probably feel the difference within a few days... Nope. Nor with the higher dose (been on that over three months now too). Given I have a young DS (4yrs) and a demanding full-time job as well as a full-time working partner who does his share but tends towards the 'you should have said' style, is this just how it is till I come out of the other side of menopause?! I don't think I'm depressed but maybe I do need ADs as well as HRT?!

Any advice very welcome, I'm going a bit bonkers here!

Sorry, there were paragraphs in there when I typed it!

I've tried a few now and the patches suited me far better than the tablets - which kind of worked but weren't pulling me completely out the fog I've found myself in ages 47! Like you I have two young boys and job to hold down so being a short tempered hot mess isn't at all helpful quite frankly.

I feel robbed, no one warned me this would happen when my hormones dwindled! The patches I have have been helping but in short supply .. apparently now the issues are resolving themselves.

The gel helps me. That’s oestrogel.

So maybe switching to transdermal will help then? It's got to be worth a try, I just don't think I can keep slogging on like this!

It must be worth trying!

Are your bad symptoms mostly mental health ones, OP?

Oh the full gamut of symptoms, I took a shopping list to my first GP appointment - alongside the homicidal rage/crying/brain fog there's the fatigue, the aches and pains, the random and bizarre nausea, the insomnia and a bunch of others I can't immediately bring to mind. The only things missing are the classic hot flushes and my periods are still (reasonably) regular. But given the symptoms and the fact they more or less started around the time I had.one ovary removed a couple of years ago HRT seemed like the obvious option. But maybe it isn't? Or maybe not the only option? I should add I'm seeing a counsellor too, just not convinced that's helping much either!

I didn't get much relief from elleste. I took another tablet hrt (now discontinued) and that helped more, bit even then it was mainly the physical symptoms that improved, not the psychological ones.

I went private last july and have been on estrogel/utrogestan/testosterone since. The physical symptoms went almost instantly but the psychological ones took six months and an increase in estrogel (at three months) to kick in. I feel lot lot better. Wish I'd gone private years ago. I am 42 and my chn are 11 and 10. I crashed into early peri after my youngest was born. I had a horrific time with young chn, God were really unhelpful. But costs of going private seemed so big. If I knew now what I'd known then, i would have just found the money. Those early years with kids were so hard and only get one shot.

Gps not God

This is really helpful, thank you everyone, I think I'm going to go and ask for the gel and the largest recommended dosage. What's the worst that can happen! (Rhetorical question, please don't answer that!). It seems as though it's mainly the patches affected by shortages and not the gel, is that right?

I haven’t found it hard to get the gel. I like it because it’s easy to tweak the doses.

For me it was beneficial but it takes time. I have tried 3 different types before the hrt I am on.
And 1 mg is too small dose I think according your age. I don’t feel like a new woman, I feel just normal without all the menopause symptoms, aches, insomnia and so on. And with better skin! :)

I'll settle for that Emerald!

@QueenRefusenik I suspect it's something as simple as too low a dose.
You are in early menopause so your need for estrogen is going to be way more than a woman of 60 using HRT.

2mgs is in tablet form. You won't be getting 2mgs because a lot is lost through digestion.

I use between 1 and a half and two pumps of gel- that's around 1mg or 1.25mgs estrogen. I'm mid 60s. If I go less than that, I get night sweats back.

Many specialists are trying to phase out the use of tablet form- it's less safe re blood clots for a start and can raise lipids in the blood. You don't get that with transdermal.

I found the patches worked v well but there’s no stock in my county now! I’m on gel next.

With patches I found the improvement evident within a month - better sleep being the main one which has helped mood etc

With the life you hold, it is very possible that it is not all down to the perimenopause. Stress and poor sleep quality can bring an array of symptoms, of which some that you describe.

Also HRT doesn't work for everyone. I have tried three different types, on three different occasions, 3 months at least each time, and it just made me feel much worse each time. It just isn't the miracle cure that some shout about for everyone.

I’m taking oestrogel every day - 1mg. I was prescribed Utrogestan as I still have a womb and regular periods but I suffered from really bad PMT and research suggests I have an intolerance to progesterone so I’ve reduced the Utrogestan dose. That has helped hugely with the mood swings. I was incredibly low - to the point of suicidal ideation - at Christmas but feel so much better since independently reducing utro.
I’d recommend seeing a specialist, I found mine via Dr Louise Newson. GPs in general don’t seem to be very clued up on peri or menopausal symptoms and treatments.
But the one thing I would say categorically is, you don’t have to live with these symptoms. There is help out there, you just have to find it

I was told by a gp that they don’t have training at uni about menopause. There is a huge amount of misdiagnosis and we do sadly need to do a lot of research ourselves. I agree on a holistic approach / sleep, nourishing yourself, exercise, low alcohol etc of course, but sometimes you do need help with the falling oestrogen as we can’t get that from diet and supplements. Good luck out there!

This is bonkers really, isn't it? I mean, I'm incredibly grateful for all the advice people have given here but given that 50% of people are going to go through the menopause at some point in their life, why on earth are GPs not being educated about it? Why do we have to rely on word of mouth and bitter experience?!

Based on all this I'm going to ask for gel and look at reducing the Utrogestan as there does seem to be an element of PMT in there... Other than that I already try and eat healthily, drink very little etc. Not much I can do about the stressful job other than try and chill a bit! We'll see what happens.

Thanks everyone!

If you get the gel you may find it helps to increase your oestrogen when you’re in the progesterone phase or from ovulation to mitigate some of the progesterone side effects.

Progesterone is the hormone that makes us feel crap/mood swings/hormonal acne etc and oestrogen is the feel good one.

@QueenRefusenik Meno specialists know there is this huge gap in GPs' knowledge and the British menopause Society is always holding training days but GPs are not made to go.

Have you heard of the petition #makemenopausematter? Sign it? it's to make MPs aware of the issue and make GPs have to undertake meno training.

By the way, you can't fiddle with the dose of Utrogestan.
200 mgs for 12 days is the licensed amount. You could drop back to 10 days if you feel terrible on 12 but this is 'off licence' as they say.

I use less than that- have more estrogen-only weeks- but this is under the supervision of a private meno consultant.

I’m progesterone intolerant but can manage the Mirena coil.
I use that for the progesterone and transdermal gel, 2 squirts. (In my 60s.)

Sorry you are going through this op, it sounds miserable. I am suffering with aching joints post hysterectomy. And wierd sleep patterns. Nausea and other stomach issues have totally gone since op; yay! Sorry, not much help because I am currently trying to work out if the gel is helping or not. I agree the amount of information from health practitioners is ridiculously small.

Progesterone is the hormone that makes us feel crap/mood swings/hormonal acne etc and oestrogen is the feel good one

I am hugely ignorant about all of this but, as far as I understand it, I am the opposite and felt hugely better when pregnant, when (if I have this right) progesterone levels are usually high. Doubt this is significant post hysterectomy but anyway ... .

Anyone know if taking progesterone in hrt is to

1. help with symptoms?
2. to keep balance with estrogen?
3. or is it just slimy taken to prevent cancer?

I'm just trying to work out if my symptoms may be caused by low prog or prog being imbalanced to estrogen?
Or are symptoms basically caused by low estrogen?

Thanks

I have just swapped from utrogeston for 12 days a month to Mirena coil which dispenses a localised lower amount of progesterone throughout the month. I didn’t tolerate the 12 day utrogestron well and my scan showed thickened lining so couldn’t reduce progesterone to 10 days. I thought it was worth a try as want to stay on hrt amd can only do this with progesterone. My understanding is that it’s the oestrogen that helps meno symptoms the progesterone is just required to keep lining from thickening and therefore keep cells there healthy. I may well be wrong though !