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.

Just thought I'd update.
Doctor prescribed the Estradot patches, that I apply twice a week. And Utrogestan (progesterone) that I am to take from days 1 - 25 of cycle, which was yesterday.
I always find with doctors that you need to be direct about what you want ( not always possible because you don't know what's wrong with you) but I said I wanted to try HRT and read out a list of my symptoms. I was expecting a battle after reading some of these threads, but mine was very straightforward.
She did say I may find it the best thing ever, or it might have minimal effect on me, but will give it a go for a few months.

Yes, housemouse19, you do need to be direct. I had researched around HRT so knew what I wanted, but many women may not have so maybe would have accepted ADs as a first step.

I'm not saying it as a criticism of anyone, just as advice to anyone that may read this thread.
Some doctors are awful and ill informed, but most are just time limited. Majority of doctors at my practise are female, so maybe that helps too.

@Whycantthisbeeasy
You mention getting used to side effects, my experience of side effects from transdermal HRT is that there were non! The only side effects were positive, my sleep improved within a week of starting and gradually got better and better going from a couple of hours a night to a solid 7-8 hours which I have been enjoying now for 4 years.
With Transdermal not going through your digestive system and liver side effects will be far less than pill form.
The only negative I get is very occasionally get tender breasts but no more than when I had a natural cycle.

My advice would be don't be afraid to try it, if it doesn't suit you you can always try another type, maybe a gel or pill.

Thanks Rosie. The sleep is a major main problem and don't want to use sleeping tablets, so good to know the hrt has helped you.

Would you happen to have any experience of the best way to take magnesium for sleep? I take it before bed, wake up at 3/4am for about an hour, then go into a deep sleep until my husband wakes me up! I feel I should be taking it earlier in the evening. Still, it's much better with the magnesium, however, as without I would wake up at 3/4 and then not be able to get back to sleep ...

Sorry I’ve never taken magnesium hopefully someone with some experience will be along soon

I have taken magnesium for years. I just take it before bed. Get the glycinate one, its easier on your stomach, whereas citrate can have a laxative effect.
I have found it helps a bit, but if I am over stressed , or period due then I will not sleep.
Exercise helps, but too much puts stress on my body and will keep me awake, so its working out what's right for you.
Can't comment on HRT as I have only just started it, but did sleep very well last night after 1 day of it, but would usually anyway in that part of my cycle anyway.

Thanks housemouse. Yes, my sleep
Is linked to my cycle too. Hopefully the HRT will work to help.

Hello again.

I spoke to my GP again today and asked her again about 3 weeks on / 1 week off. She said they advise to take hRt cyclically if you have had a period within 12 months and you are still having them, albeit irregularly. She says that I could choose to take it for 3 months then have a break (I think she said a month). I asked if this was the case even if I had the Mirena Coil. She said yes. Very confused !

@Whycantthisbeeasy

Hello again.

I spoke to my GP again today and asked her again about 3 weeks on / 1 week off. She said they advise to take hRt cyclically if you have had a period within 12 months and you are still having them, albeit irregularly. She says that I could choose to take it for 3 months then have a break (I think she said a month). I asked if this was the case even if I had the Mirena Coil. She said yes. Very confused !

This is really SO bad!

Yes, it's cyclical regime ( correct term is 'sequential') but it still means you use estrogen every day.

I've used a sequential regime for 12 years and was told on day 1 of being given it by a consultant 'You use estrogen EVERY day and progesterone X days per cycle.'

You can do a 3-month cycle but that means using progesterone for 14 days in every 3 months but that's 'off licence' unless you are using the HRT called Tridestra, which is a 3-monthly type.

Women who use the Mirena still use estrogen daily.

I'd find another GP TBH.

And 'd like to flag up your post to @Iceskatingfan a dr who asked last night why GPs were being criticised on this forum. Is it any wonder?

Sorry- do you mean she suggested stopping and starting HRT every 3 months with a break for a month in between?

If this is what she meant she's not got a clue what she's talking about.

That’s still wrong I’m afraid it doesn’t matter if you’re having periods or not evorel 50 is to be used continuously. Can you speak to a different doctor?

Yes, I will speak to another doctor.

iceskatingfan. Do you have any views?

On day 10 of HRT and feel awful.
Have had a headache for duration, low mood and anxiety, feel dizzy, tired and spaced out. Much worse than before starting it.
I'm not sure if I should just stop taking the progesterone (Utrogestan), which seems to be the likely culprit, or try to ride it out a bit longer.
Do these side effects ease off over time, or should they not feel this bad?
I will probably try and get an appointment with my doc, but just wondered what other experiences are and do you feel worse before you feel better.

Sorry you feel bad @housemouse19

Ride it out. I had mirena long before peri started so I just added gel but it hasn't solved my issues and so I'm now on a totally different regime (zoladex and tibolone) to see if I'm better suited to a hysterectomy.

We are all so different it's hard to advise you. Push on through. I'd say 3 months is the minimum - which what I have to try this type for.

If you are on day 10 @housemouse19 how has your dr advised you to take the HRT?

It's sometimes better to have a long run of estrogen only (14 days) to see how that feels, before using Utrogestan as well.

You can take Utrogestan from day 15 and if you find 14 days too much, you can use 12 days (I think that is on the leaflet, but check.)

Thanks. I think I will try to the end of the 25 day cycle, but if its gets much worse I will stop.
NHS website seems to say takes couple of weeks for body to get used to them, up to 6 - 8 weeks. Taking it day by day at the moment.

@housemouse19

Thanks. I think I will try to the end of the 25 day cycle, but if its gets much worse I will stop. NHS website seems to say takes couple of weeks for body to get used to them, up to 6 - 8 weeks. Taking it day by day at the moment.

The way to use it @housemouse19 is either from Day 1 for 14 days (or 12) or from Day 15.

Nothing 'bad' will happen if you use estrogen alone for a month, BUT that's not the licensed dose.

Most women set a day on the calendar and take it on the same day - ie 1st Feb, 1st March, or 15th Feb, 15 march etc etc

. How to take Utrogestan

(from the leaflet- online.)

Always take this medicine exactly as your doctor has told you. Always read the label. Check with your doctor or pharmacist if you are not sure.

Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough.

The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on Day 15 of the cycle and ending on Day 26).

Alternatively, 100 mg can be given at bedtime from Day 1 to Day 25 of each therapeutic cycle.

Taking this medicine

Take this medicine by mouth.
Swallow the capsule whole with a glass of water.
Take this medicine at bedtime.
Do not take this medicine with food.
Take your estrogen HRT at the same time as Utrogestan.
How much to take

Take two capsules at bedtime on days 15 to 26 of your 28- day cycle.
You will usually have a few days withdrawal bleeding (like a period) after this time.
Continue to take your estrogen HRT every day.
If you have any problems with the withdrawal bleed, your doctor may change the way that you take Utrogestan. This will help to reduce the amount of withdrawal bleeding.

Cross posted with you.
Doctor said to take progesterone from day one of cycle, which I did.
Started with patches at the same time.
I am thinking that perhaps I would have been better to have just started on the patches first to see how they felt, like you have just advised. Doctor wasn't very clear and its all telephone appointments at the moment.
I am just going to try and speak to my doctor tomorrow and see what they say.
I expected a few side effects, but not quite like this and do feel quite awful at the moment.

I am taking the 100 mg before bed, on a 25 day cycle. I have the instructions and it does say that on the packet.
The estradot patch I have been applying twice weekly. Monday and Thursday.

I'm sorry you are feeling bad, housemouse. Selfishly, I have to say your post is putting me off starting HRT. I'm having a really stressful time at work so cannot have horrid side effects. I don't have any advise but I hope you start to feel better.

rosie39forever. Just reading back through your posts. If you haven't had period for 4 years, then maybe that is why you take hrt continuously I am still having periods, however. Could that be why the doctor had recommended I have weeks/months on/off.? Thanks

@Whycantthisbeeasy
I haven’t had a period for 4 years because I have a mirena which completely stopped them though I do still have some cyclical symptoms so at 51 I would say I’m still peri rather than menopausal.
All patches weather they be sequi, conti or oestrogen only are to be used constantly as per the manufacturer’s instructions. To be honest I have never heard of anyone recommending patches be used with a break, it totally defeats the object of replacing your declining oestrogen.
Even using combined pills for contraception the oestrogen component is a constant, with the progesterone added for 12-15 days to give a bleed.
I would really be questioning your GP.

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.

@housemouse19 Going back right to the start and your 1st post- above.

You are not using cyclical HRT!

Using 100mgs for 25 days is actually the combined, continuous way.

Although you are using it for 25 out of 28 days (with a 3 day break) that short gap is to allow for a tiny bleed if it were to happen (and it usually doesn't.) A lot of women who use the '25 days' are told by consultants to carry on taking it every day just to make the whole counting thing easier. Whether it's 25 days or every day, it's still continuous , not cyclical.

Cyclical is the type where you would have a bleed (each month).
That regime is 12 days of Utrogestan each month.
The way that works is to take it on the same day each cycle for 12 days - so, like I said earlier, (an example) 15 Jan, 15 Feb, etc.

Your GP ought to have explained this clearly.

I use a cyclical regime and when I tried continuous ( taking it daily) I felt awful and gave up after 3 weeks on that and swapped back to 200mgs x a few days per cycle (as directed by my dr.)

I stopped taking the progesterone last night and have woke up feeling much better.
Will leave the estradol patch on for moment and I am waiting for an appointment with doctor.
Thanks for everyone's input. Will keep you updated.