Starting HRT when you still have periods -what types have people tried?

[Aspergallus]

I'm embarrassed to say I have just realised that I am perimenopausal. Embarrassed because I'm a doctor and have been tolerating strange things for about 4 years without realising that this was the answer. I'm 45 and I think this all started when I was 41.

I'd had my second child at 38. It took about 2 years for my periods to come back (was only breast feeding for 6 months). While I waited for my period to return, I felt hellish. It was like permanent PMT and the night sweats drenched my bed and mattress. If I sat up at night I had a river running down my chest. Then my periods came back and were pretty regular (28 days) but sometimes lasted 10 days, sometimes 1 day. And my PMT was more like the whole second fortnight rather than a few days. I remember meeting an old friend and when she asked how I was I blurted out "ANGRY. All the fucking time."

Then at 41 I fell pregnant with my third child. Pregnancy was a blessed relief. I felt like me again -the world was crystal clear and I was content. But I knew I was different, better, and started to dread the end of the pregnancy and returning to what had been going on. I actually thought it was just PMT worsening with age and started researching ways to deal with PMT in preparation.

Delivered my third when I was 42. Got my periods back 18 months after she was born. Same experience as before while waiting. Night sweats were insane. Settled when my periods returned. But gradually, the anger, volatile moods and random period duration has returned. Instead of just being in the second half, it's solidly the second half with random spikes at other times when I am just in the red fog. My husband looks like me like I've gone mad and says "why are you so angry about this now, you've never been angry about this before?".

What else...

I'm tired all the time
My weight "set point" is about 20lbs higher than it has been. I can lose with a huge amount of effort, gain easily but generally sit at the same place, just in the overweight BMI cat.
I feel hungry most of the time.
I wake a lot at night having been a very deep sleeper my whole life
Occasional night sweats but nothing like when I had no period at all
My tolerance for normal behaviour from the kids is very low, and out of keeping with who I think I really am (if that makes sense)

Last month I had a frightening experience when I lost my central vision in one eye. I had an emergency appointment. GP/optician assumption was that I had a retinal detachment (I'm very short sighted and this is a known risk). Turns out it was my first ever migraine. I realised then, that on reflection I had been having visual aura for a while.

I asked the eye dr why I'd have migraine for the first time at 45 and they said, "menopause". And that's when the penny dropped.

I definitely don't want another baby just to escape this for 9 months...so I do think I'd like HRT...for me, for household harmony, to get my energy back...

Wondering what experiences other women have had with HRT at my age, while still having periods. Would love to hear thoughts on specific types.

A big issue for me is acne. I have had lifelong issues with hormonal acne and my skin is actually pretty good right now. I wonder if this would play a part in any choice here.

Grateful to you if you read this and can offer some thoughts!

Following as I am in very similar position

45 here. Unlike you I had awful pregnancies, put on loads of weight and didn't feel like myself
Started night sweats soon after birth (last at 35) but assumed it was because I had started exercising more
For the past few years (5) and with hindsight I had;

• night sweats getting worse
• period reduced to 26 day cycle
• uncontrollable binge eating 10 days before period
• rages in work 10 days before also to the point t I would put a post it note on my screen to say don't say anything that day !
• hormonal acne on chin when I had clear skin all my life to that point

Started oestrogel and ulstrogestan after reading the wonderful posts here from jinglebells, am on my third cycle.
Changes have been ;

• beautiful skin - like when I was 20
• hair is lush and has grown thicker
• less emotional ups and downs / irrational thinking
• more public hair! Hadn't noticed that I had t needed to shave underarm for years - this was a surprise even though it's obvious now
• can drink alcohol as don't have debilitating hangover next day

Downsides:

• had some very low mood days
• breasts enlarged but hoping will go down soon
• still some uncontrollable eating but half what it was

I think the progesterone side doesn't sit well with me as I feel worse on those 12 days than rest of month
All in all it's been brilliant
Oh periods are lighter and a bit shorter
Hope that helps

Also following as similar experiences, babies also in late 30s and early 40s.

In fact was struggling with cfs / joint type issues after first child which I now wonder was hormonal.

Though I've noticed improvements to mood with b6 and magnesium, also bvits complex and higher dose of omega 3 than boots' versions.

But the joint and body aches and waking up with pounding heart and very hot is still there. Occasional anger but not as bad. I don't know if it's all enough to warrant medication?

Still bf toddler a little bit so may have to stop that to see if helps and also before I try anything.

Hi I’m 43 and still have periods. Been on HRT for over a year. Started on combined oral but could only take that at a low dose due to blood clot risks. Worked for about 6 months and then needed an increase. On everol sequi 50 now but starting to get symptoms again so going to ask to increase dose further.

Periods are more regular now and less heavy which is good.

Writing this super quickly whilst trying to deal with children but basically I am 40 and I take the mini pill as it stops my periods completely and I like that and then I have 4 pumps of oestrogel and take 100mg utrogestan every single night. Works for me!

Have a look for Dr Louise Newson, she and her colleagues will change your life. She has a fantastic website with lots of information

www.newsonhealth.co.uk/

Here's the link. There are some really great items to read under the resources tab

@Whatisgoingdown

https://www.newsonhealth.co.uk/

Here's the link. There are some really great items to read under the resources tab

Yep. This is where I go privately. Fantastic. They do tend to always prescribe oestrogel and utrogestan rather than the patches / tablets which is a good thing as they have less side effects etc.

If you suffer from acne, OP, the best types to avoid are those with Norethisterone. (That's all patches and most tablet form, except Femoston.)

Norethisterone is a type of progesterone called 'androgenic' which means it's more likely to give side effects like acne and weight gain.
The same applies to the Mirena coil which has another androgenic hormone in it.

You'd be better off trying micronised progesterone (Utrogestan) or Femoston.

Bear in mind that NO HRT is perfect. Sometimes we expect perfection when in reality something that does the job 80% ok is the best we get.

I've been on sequential HRT for over 12 years. It's not perfect as I don't like the progesterone part of the cycle or the inconvenience of a withdrawal bleed, but choose that as it's slightly lower risk for long term users.

Also, be prepared to give whatever you try a good 3 months and if it's not working, change to a different type.

Am 44 and have just started on oestrogel and Utrogestan, so it's a bit too soon to say if/how they are working. My periods had been variable for about four years, becoming completely erratic in the last year. Had been getting some night sweats, getting irritable over everything, have put on weight around my tummy (despite cutting out snacks, eating more healthily than ever and increasing the exercise I do). I had brain fog, forgetting things/could not find the right words. Thinking back, that part started about 4 years ago too, I was vaguely concerned it could be signs of early-onset dementia, but put it down to work-related stress. I only started HRT recently, but so far haven't had a period whilst taking the Utrogestan and I feel a bit brighter/ a bit more connected with my life. It hasn't affected the irritability yet, though. I think I'm on a low dose of gel (1 pump a day), and 14 days on/14 days off progesterone (also have the Mirena). It will be reviewed after 3 months.

I’m just 40 and am wondering how soon is too soon to start HRT.

Periods are still normal and not too bad, but ovulation is becoming unbearable (pain and the worst bloating ever, lasting several days). I also have terrible insomnia - I just cannot go to sleep and even when I do I wake at 5am.

EVERYTHING makes me angry and/or depressed.

Will I get laughed out of the doctor’s office at my age?

@Chrestomanci3

Am 44 and have just started on oestrogel and Utrogestan, so it's a bit too soon to say if/how they are working. My periods had been variable for about four years, becoming completely erratic in the last year. Had been getting some night sweats, getting irritable over everything, have put on weight around my tummy (despite cutting out snacks, eating more healthily than ever and increasing the exercise I do). I had brain fog, forgetting things/could not find the right words. Thinking back, that part started about 4 years ago too, I was vaguely concerned it could be signs of early-onset dementia, but put it down to work-related stress. I only started HRT recently, but so far haven't had a period whilst taking the Utrogestan and I feel a bit brighter/ a bit more connected with my life. It hasn't affected the irritability yet, though. I think I'm on a low dose of gel (1 pump a day), and 14 days on/14 days off progesterone (also have the Mirena). It will be reviewed after 3 months.

Who has put you on this regime? It's wrong.

The Mirena is licensed as the progesterone part of HRT. You do not need Utrogestan as well! It's one or the other.

You are being completely overloaded with progesterone (which will 'negate' the benefits of estrogen) and also the starting dose for gel is 2 pumps, and as a younger woman you may need even more.

Does anyone know if there’s a check list of all peri menopause symptoms ?
I ask because some things I wonder if they’re getting older or peri.

Has anyone managed to reduce migraines with HRT?

I’m watching with interest as I was diagnosed with POF about 5 years ago (aged 36) and for the past 18 months have had disabling migraines for 9+ days in the first half of every menstrual cycle.

No other symptoms really, except my menstrual cycle getting shorter and hair thinner! I definitely do have to work harder to keep my weight down now, and no longer have any tolerance for processed foods and refined carbs, but I’m ok so long as I avoid them. I suspect age or insulin resistance is the culprit with that one!

The neurologist I saw in January recommended trying the combined pill (usually off the table for my type of migraine, but apparently I’m super healthy in every other way). My GP says she is not comfortable with prescribing it but will give me the mini pill.

I am skeptical and debating whether a private menopause consultant and some sort of HRT would be a better idea.

@BoPeeple

I’m just 40 and am wondering how soon is too soon to start HRT.

Periods are still normal and not too bad, but ovulation is becoming unbearable (pain and the worst bloating ever, lasting several days). I also have terrible insomnia - I just cannot go to sleep and even when I do I wake at 5am.

EVERYTHING makes me angry and/or depressed.

Will I get laughed out of the doctor’s office at my age?

You shouldn’t be. You shouldn’t even need blood tests to start HRT if you have all the symptoms- NICE guidelines state you should only have blood tests to rule out other things as it’s often impossible to “diagnose” menopause because hormone levels fluctuate so much anyway.

@DinosaurDiana

Does anyone know if there’s a check list of all peri menopause symptoms ? I ask because some things I wonder if they’re getting older or peri.

Lots of factsheets here -

www.menopausedoctor.co.uk/resources/booklets-fact-sheets

@Chrestomanci3

This explains progestogens and you will see it's either Utrogestan OR the Mirena.

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/488/HRT%20the%20basics%20v21-02.pdf

I’m starting to wonder if I’m peri menopausal and have thought about a visit to the go to discuss hrt. But what happens when you stop taking the hrt? Does it just postpone the inevitable symptoms?

@TheSockMonster

Has anyone managed to reduce migraines with HRT?

I’m watching with interest as I was diagnosed with POF about 5 years ago (aged 36) and for the past 18 months have had disabling migraines for 9+ days in the first half of every menstrual cycle.

No other symptoms really, except my menstrual cycle getting shorter and hair thinner! I definitely do have to work harder to keep my weight down now, and no longer have any tolerance for processed foods and refined carbs, but I’m ok so long as I avoid them. I suspect age or insulin resistance is the culprit with that one!

The neurologist I saw in January recommended trying the combined pill (usually off the table for my type of migraine, but apparently I’m super healthy in every other way). My GP says she is not comfortable with prescribing it but will give me the mini pill.

I am skeptical and debating whether a private menopause consultant and some sort of HRT would be a better idea.

POF would usually mean premature menopause, so are you having periods or not? Sorry but I'm confused as women with prem ovarian failure have no periods or hardly ever.

POF is usually treated with HRT because there are serious long term risks to your health without estrogen.

Most women would use HRT for POF but in very young women the CCP is sometimes given- Qlaira is one that has a more natural estrogen in it.

There is a charity- the Daisy Network- which is run by menopause consultants and they have a lot of info on their website.

You don't necessarily need to see anyone privately unless your GP is clueless, but you do need medical support for POF.

How was this diagnosed if you are still having periods?

@JinglingHellsBells

My periods very suddenly went all weird (regular 37 day cycle down to 25-28 days and much heavier) so I went to the GP who sent me off for loads of blood tests and a scan. She said that the blood tests showed I wasn’t ovulating any more and that I had POF. I didn’t want any more children anyway, had no other symptoms and my estrogen levels were still ok, so she sent me off with instructions to watch for signs of low estrogen and get myself back and go on some sort of hormone replacement if/when that happened (she recommended the pill for younger women who still have periods)

In any event, my periods then stopped completely for 3 months, then came back at a very regular 31 days which they’ve stuck at ever since. I’ve had my estrogen tested a couple of times since and always normal. No idea if I started ovulating again?

All was great until November 2019 when the migraines started!

Op you sound similar to me, I'm 43 and been experiencing night sweats, weight gain, extreme bloating especially at ovulation, anger, acne, huge tiredness.

I've spent 2 months trying to get hrt from my GP, but without some serious self education and bloodymindedness on my part I would not have been successful. She just was not going to suggest it. Basically it was a case 'there's nothing that will help' this is despite all the symptoms and loads of blood tests to rule out other things.

I have 3 month trial of everol sequi which is the combined Oestrogen/progesterone patch for women who still have periods. I just hope it helps but the frustration of trying to get it almost tipped me over the edge

Thank you everyone.

@Whatisgoingdown I have put my name on the waiting list for a private consultation. Waiting list is about 7 weeks apparently, thanks to Davina! Thank you for the suggestion. I don't want to waste time trying to persuade or convince a GP that isn't on board with this, and even after I wrote this I realised more things that I've been dealing with -like my hair has become so thin I don't tie it up, it actually feels like too much tension on the roots, and I am so aware of every aspect of my cycle in a way I never used to be -ovulation is so symptomatic too now.

@JinglingHellsBells thanks for the advice regarding acne. Another reason for taking that private route. I have more faith that they will listen to all my concerns. When I was a medical student my terrible PMT was really disrupting my life and I spoke to a GP about going on the pill. They didnt pay any attention to my oily skin type, or many previous treatments for acne and prescribed Ovranette. That caused a huge issue with my skin that took 10 years to resolve (they "fixed" the problem with Dianette, but tried to take me off it every 6 months, causing a rebound flare every time...until someone sensible gave me Yasmin as a step down from Dianette).

It's interesting that so many people here find the progesterone aspect so difficult.

I'm generally at my happiest and most content when pregnant -when progesterone is high?

But my PMT has been off the scale my whole life (with rage, oily skin, increased acne), which is also progesterone, isn't it?

Hormones are strange.

But I understand that there's no avoiding some combination of progesterone, not if I want to stick with it long term...

@Aspergallus Interesting about Ovranette. I used it for around 6 months only and had terrible acne spots- never having had acne ever. Each month I'd get a whopper on my chin. I stopped it ( not just for that reason) and later used Trinordial which was perfect.

I'd not overthink the exact cause of PMT or how this might translate into an HRT prescription. It's thought it gets worse for most women in peri and often through anovulation . In pregnancy you have huge levels of both hormones.

Also, choose carefully if you go privately. You need a menopause specialist, not 'just' a gynaecologist though the best are both.
I have a private meno specialist and it's worth every penny but some women come back here saying they have paid a lot of money and got no further than with the NHS.