Cyclical HRT treatment

[housemouse19]

I have asked doctor for HRT. I am still getting periods, but horrible PMT and menopausal symptoms.
Doctors has recommended cyclical hrt and send me a link to nhs website and let them know if I want to proceed with request and what treatment option I prefer. I am not sure if I have misunderstood the last part - do doctors normally ask you what kind of treatment you prefer.
I understand what cyclical HRT is, but are there different ways of administering it I think I would prefer patches, or gel as this seems to have the least incidence of cancers etc, but is it available in that format for cyclical hrt.
Sorry if this is a stupid question, its just not clear from the NHS site and a further scroll through the internet.

The simple answer is yes transdermal HRT can be cyclical. The easiest way in in the form of evorel sequi patches which deliver oestrogen in every patch (you need a continuous supply of oestrogen regardless of which type you decide on) but only have progesterone for a certain number of days in your cycle which should give you a bleed. You can also go for oestrogen gel with a progesterone pill again taken for a portion of your cycle.
Alternatively you don't have to go cyclical you could have a mirena coil for progesterone and patch or gel for oestrogen.

Thank you. I think I will try the transdermal for estrogen and pill for progesterone, as don't really fancy getting a coil fitted at the moment.

As you are still having periods, you ought to be on cyclical anyway- that's the basic rule!

Continuous HRT with no withdrawal bleed is for women 12 months past their last period or over 54.

There is no difference in cancer risks with transdermal- there is a lower risk of blood clots.

There is a difference in cancer risks with different progesterone and most drs now who are meno experts prescribe Utrogestan.

There is also a very small reduced risk of cancer with cyclical HRT anyway.

Continuous with Mirena is fine, but not with tablets taken daily because you are likely to get odd bleeds as your own periods may well continue.

If you have mirena for progesterone, do you take oestrogen every day?

The doctor told me cyclical because still having periods, but I have not started taking anything yet.
I am slightly confused by the different options being presented to me and the NHS website is not very clear. My understanding is that transdermal has even lower risk of clots and cancer, than pill form - even if its minute.
I have asked the doctor for patches or gel and progesterone tablets , its all done by email at the moment, so I am sure the doctor will correct me if I am wrong ?

There is no difference in cancer risk between the different types of estrogen.

I have a mirena and evorel patches which is continuous oestrogen, just change the patch twice a week . I’m 51 and peri

Rosie, is it everol 50? And you just keep them on without a break?

Yes Evorel 50 continuously I change my patch on Monday evening and Friday morning.

Thanks Rosie did you start the patches straight after mirena was put in place or wait until the bleeding stopped?

Sorry for all these questions but I just got one ... and they said I could use oestrogen only patch but didnt tell me when to start!

House mouse make sure you get a proper consultation and blood tests before you start anything else.

@Goinghome20

House mouse make sure you get a proper consultation and blood tests before you start anything else.

Blood tests aren't done for menopause unless women are under 45- it's all in the NICE guidance pinned here at top.

I got the mirena for heavy peri bleeding and fibroids, I did spot for about 4 months but then no bleeding at all and it's been in for 4 years... best decision I ever made! I started to get hot flushes and terrible insomnia and brain fog about 18 months after I had the mirena, luckily I have a really good gp who is clued up about all things meno and HRT and didn't hesitate to prescribe the patches.
I know HRT isn't fo everyone but personally for me it's been amazing it's given me my life back.

rosie39forever. Your story sounds very much like me. Approaching 50. Had the mirena coil fitted 2 years ago due to extremely heave periods. I'm now experiencing peri menopausal symptoms. Insomnia, anxiety, brain fog (forgetting the simplest of words and what I'm about to say). No hot flushes yet. My periods are irregular and light, but I still get them. I've been prescribed Evorel 50. The doctor said to take twice a week for 3 weeks then a week off for a bleed, I think she said does this sound right to you?
Thank you

@Whycantthisbeeasy The instructions for the patches will be on the patient leaflet.

You use estrogen daily so there will be no days when you do not have a patch of some sort on.

Absolutely not right at all, you don’t have a break for a bleed with evorel patches and mirena it completely defeates the object of having the oestrogen. Even with cyclical HRT the oestrogen component is taken continuously its the progesterone that you take a break from. You change your patch twice a week every week. You need to either go back to your doctor and tell them they are wrong or find a new one, if you can’t find a new doc then ask for a referral to a mono pause specialist.

@rosie39forever I read it that she was confused ( the poster) as she said she 'thought' that's what the dr had said.

@JinglingHellsBells
I have friends and colleagues who've been given the same advice about having a break for a bleed, it's quite maddening how many GPS don't even know the basics of the things they're prescribing. Lots of women will take the advice of their doctor over instructions in the packet.

[quote rosie39forever]@JinglingHellsBells
I have friends and colleagues who've been given the same advice about having a break for a bleed, it's quite maddening how many GPS don't even know the basics of the things they're prescribing. Lots of women will take the advice of their doctor over instructions in the packet.[/quote]
Oh it's diabolical, for sure.

GPs get half a day's training on meno at med school. If they are drunk and miss the lecture, then none.

Unless they have taken an interest in it and treatment, they are downright useless.

I have been lucky to have had private meno specialist for a long while and I am just gobsmacked at the mistakes GPs make compared to the top experts.

@JinglingHellsBells
Thankfully I’ve been lucky too I have a gp who has a special interest in women’s reproductive health and keeps up to speed on the latest research but it seems I’m definitely in the minority, I’ve heard so many horror stories from friends about mistreatment and more worryingly lack of treatment.

[quote rosie39forever]@JinglingHellsBells
Thankfully I’ve been lucky too I have a gp who has a special interest in women’s reproductive health and keeps up to speed on the latest research but it seems I’m definitely in the minority, I’ve heard so many horror stories from friends about mistreatment and more worryingly lack of treatment.[/quote]
I know some people cannot afford it, but for around £250 you can get an appt with a specialist and get sorted.

I don't have to make this choice, but if I had, I'd forgo holidays and other things to get the right health care.

@JinglingHellsBells
Absolutely me too, the quality of life that I get from HRT is worth far more to me than a holiday!

Thank you both, Rosie and Jingling.

My GP definitely said to take a week break and I think she said the reason was to have a bleed. I'm not going to follow this. I'm going to have another appointment in a month so will speak to her then about it. She was very nice, but did try to prescribe anti depressants for my insomnia and anxiety and said that's would they "usually recommend". I'm not going to do this either. I'm quite nervous about the side effects of getting used to the HRT as I have two children and the is a lot of pressure of work so I need to be as on the ball as possible.

I did try to book an appointment with a private menopause doctor but there was a long waitlist (maybe Covid + demand). I thought I'd stick with the GP and do my research so I can let them know what I want! The next thing is testosterone (I've read it can really improve brain fog and concentration).

In terms of insomnia, I use magnesium spray and baths, which help a bit. I tried to take magnesium tablets before bed but they seem to do the opposite.

She was very nice, but did try to prescribe anti depressants for my insomnia and anxiety and said that's would they "usually recommend"

Oh FGS! Has she not even read the NICE guide from 2015?

It says in words of 1 syllable that ADs are NOT to be prescribed as first line treatment, but HRT is.

This level of ignorance is terrible.