HRT advice please

[lurknolinger]

Hi,
Can anyone help me with advice please?
I’ve been on Oestrogel and Utrogestan for around 6 months now, which was prescribed by a private GP (I spent the previous 18 months trying out a variety of tablet and patch options for 3 months at a time prescribed by my NHS GP without success, so decided to go private) since then, having found the HRT that was working the best for me I have reverted to getting the prescription from my NHS GP and pay for the prescriptions.
In the last 2 or 3 months I have noticed some of my symptoms coming back again, which fluctuate in waves, the worst ones are brain fog, lack of concentration, low mood and motivation, with anxiety thrown in too, but not sure if the anxiety is as a result of the other symptoms affecting my ability to do my job.
Initially I wondered if I needed to adjust my dosage of the gel or tablet and if so how, so I read the information leaflets for the HRT to see if there was any advice on this (embarrassingly I hadn’t read them before) and saw that the progesterone tablet leaflet says its only to be taken for days 15-26 of each cycle. Neither GPs private or NHS told me this, so I’m not sure if in some cases people take it continuously?
So I have two questions firstly, am I taking my HRT the right way, and if I am, is there an adjustment I can make to help my symptoms?
I feel like I’m on the right version of HRT as, compared to the others I tried, I’ve had the best results with this combination, but I know the doses can be adjusted so am hoping I just need to tweak this to see some improvement.

My history is; I’m 53 now, infrequent periods since 42, no periods since the age of 45 - was still prescribed the contraceptive pill until I switched to taking HRT, my NHS GP knew I didn’t have periods but didn’t offer HRT) but I had no menopause symptoms until 51 (was probably a year before I realised I had built up a good number of them and they become bad enough for me to seek help).
I use 2 pumps of Oestrogel (one on each leg) in the morning and take one 100mg Utrogestan at night, and as I said I’ve been taking them both continuously. I still have my womb.

On advice from the private GP, due to not been given HRT from my mid forties, I requested a Dexa bone scan and fortunately my results were good, and slightly above average for my age.

And just to add, although I realise I should go back to my GP for advice, i don’t have confidence in my NHS one, and anyway, don’t think I shouldn’t be bothering them with this right now, I’m also trying to avoid going back to the private GP as I’m self employed and have had to close my business so need to be careful with money now.
Thanks for reading, apologies for the v long post, it’s probably a reflection of my muddled brain right now.

You are doing the right dose.

On the leaflet with Utrogestan, it ought to say that the dose can be EITHER 12 days a cycle or continuous (it might say 26 days which is the same as continuous, it just allows 3 days for any bleed if it happens.)

There are two ways round your symptoms (I use the same type.)
You can increase the gel to 3 or even 4 pumps a day.
When you say you apply to your leg, which part?
It's supposed to be inner thighs (OR upper arms.) So if you are applying down your entire leg, it might not be absorbed properly as it needs to be put on a fatty area!

The other option is to go to a sequential regime which is the 12 days per 28 days. You will have a false 'period' about 3 days after the last one. So depends if you can cope with that.

If you do that, the dose is 200 mgs daily, not 100.

Looks as if you will need to experiment and see what suits.

Hi,
thanks very much that's really useful.
I do apply the gel to my inner thighs, and they are definitely a fatty area so no problems there. I can't see anywhere on the leaflet that says it can be continuous, but it's reassuring to know that I was taking it correctly, albeit I need to adjust it slightly.
It dies say the does would be 200mg for 12 days rather than 100mg all the time.
I'll try doing as you suggest then, one last question please, is there any difference in the risk factors between increasing either of the 2 doses?

It says that you can use 100mgs daily on this website - see point 4.2
www.medicines.org.uk/emc/product/352/smpc

Risk factors- what did you mean? For Utrogestan?

You will be using the same amount per month (almost) whether you use 200mgs x 12 days or 100mgs x 30 days.

There is evidence that continuous types (both hormones daily) have something like an added 1% risk of breast cancer compared to the increased risk of sequential types. However, this may or may not apply to Utrogestan as not enough studies have been done on it. The stats apply more to the synthetic type of progestin.

No one knows if higher estrogen doses gives a higher cancer risk . This is research yet to be done but the advice I have been given by my consultant is to use the amount needed to give symptom relief.

It's pretty poor your own private dr didn't take time to discuss dose in more detail.

@JinglingHellsBells sorry for the very slow response, but just wanted to come back and say thank you so much for your advice. It's really appreciated. I acted on your advice and within a couple of days felt so much better, and am so relived the brain fog that I'd found so debilitating has lifted.
I went for the option of increasing the Oestrogel dose, mainly because that meant the regime would be the same everyday, and that seems to be working well for me.

Thanks again, I'm sure getting this resolved early on in lockdown made a massive difference to how I've coped as I found anxiety went hand in hand with the brain fog.