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!

I’m 49 and have been on Femoston for 2 years now.
It stopped my night sweats and helped with my mood and emotions.
I used to get hormonal acne when younger and was worried it would come back but my skin looks amazing, someone told me I look ‘ so fresh’ the other day.
I haven’t lost weight but haven’t gained either ( apart from the odd pound on and off from over indulging)
You get a ‘ bleed’ at the end of the Packet cycle but mine is hardly anything so am having a blood test to see where I’m at hormonally.
Good luck OP

@JinglingHellsBells

I've put my name on the list with the Newson Clinic that someone linked to in the thread and checked the box for a doctor appointment.

I didn't spend too much time thinking about it because I am starting a new job soon and just want to get on with trying something. I'm also realising that my menopausal symptoms may have contributed to handing in my notice at my current job. Eek.

Have people been impressed or otherwise with the Newson clinic?

*JinglingHellsBells, my GP prescribed it that way. Since I've had the mirena (am on my second one), my periods would settle into a cycle, say of 38 days, for a few months. It would then change, to say 32 days for a few months, then down to 27 days. I'd been back to my GP about that previously, and they said it was a recognised side-effect that it may change the regularity of your periods. In the last year or so, though, it's been completely erratic (28 day cycle with 6 day bleed, 14 day cycle with 4 day bleed, 9 day cycle with 5 day bleed, 38 day cycle with 14 day bleed), etc.

[quote Aspergallus]@JinglingHellsBells

I've put my name on the list with the Newson Clinic that someone linked to in the thread and checked the box for a doctor appointment.

I didn't spend too much time thinking about it because I am starting a new job soon and just want to get on with trying something. I'm also realising that my menopausal symptoms may have contributed to handing in my notice at my current job. Eek.

Have people been impressed or otherwise with the Newson clinic?[/quote]
I'm very happy with the Newson Clinic, would highly recommend them.

@Chrestomanci3

*JinglingHellsBells, my GP prescribed it that way. Since I've had the mirena (am on my second one), my periods would settle into a cycle, say of 38 days, for a few months. It would then change, to say 32 days for a few months, then down to 27 days. I'd been back to my GP about that previously, and they said it was a recognised side-effect that it may change the regularity of your periods. In the last year or so, though, it's been completely erratic (28 day cycle with 6 day bleed, 14 day cycle with 4 day bleed, 9 day cycle with 5 day bleed, 38 day cycle with 14 day bleed), etc.

Your GP is wrong @Chrestomanci3

Have you read the link I left?

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

You don't need Utrogestan as well as the Mirena. The link above explains it.

The Mirena is the progestogen part of HRT. It thins the lining when you are adding estrogen. You don't need Utrogestan as well.

Your GP hasn't a clue.

Also, if the Mirena isn't working then you might consider ditching it. The point of the Mirena is either as birth control and to reduce blood loss and in many women to end bleeding altogether. If it's not doing that for you, what's the point having it?

You wont get the benefit of hrt if you are using an excessive amount of progestogens.

[quote Aspergallus]@JinglingHellsBells

I've put my name on the list with the Newson Clinic that someone linked to in the thread and checked the box for a doctor appointment.

I didn't spend too much time thinking about it because I am starting a new job soon and just want to get on with trying something. I'm also realising that my menopausal symptoms may have contributed to handing in my notice at my current job. Eek.

Have people been impressed or otherwise with the Newson clinic?[/quote]
I think Newson clinic are fab, very informed on the whole subject and also very good at myth busting-

BUT -

If you are someone like me who has multiple health difficulties (I have Addison’s, sjorgens syndrome, lupus, pituitary issues etc etc) then it all gets quite complicated because in my experience the NHS specialists you see won’t speak to Newson Health GPs and you end up stuck between the two of them with conflicting advice. This is what’s happened to me. I am torn between who to trust and consequently am currently having a break from the HRT (in my own situation the HRT was affecting my pituitary issue and my endocrinologist and rheumatologist advised me to stop taking it but Newson Health said it wasn’t causing the issues they said it was and it was fine to keep taking it…! They wrote to the endocrinologist asking to speak with them but the endocrinologist wouldn’t engage so I copied and pasted correspondence between them but it’s all ended up at a stand still).

I had elleste duo then when that had supply problems I moved to Novofem which I've been on for 4 years.

The Newson clinic annoys me. It's ridiculously expensive and therefore exclusionary.

@Bryonyshcmyony

The Newson clinic annoys me. It's ridiculously expensive and therefore exclusionary.

It is very expensive. My initial appointment was about £250 and I then paid privately for the HRT too which was couriered to me so the whole lot including the 3 months HRT was about £500 (I then got the HRT prescribed on the nhs through my GP). Newson health then like you to have regular follow ups - initially it’s every 3 months and then 6 months (might be different for different people I guess) and they cost about £200 for about 15 mins (phone consultations with me). I did this for a while because I felt I needed the reassurance but after a while I stopped and then just had the HRT prescribed through my Gp and then had issues as mentioned above.

The fees for most consultants is around £250-£300 for the first appt which can be up to an hour.
Although the clinic you mention is good, many of the drs there are GPs, with meno expertise, they are not consultants. That is all most women need, but they are charging top rates, in line with gynae consultants.

The licensing rules around HRT are an annual (at least) review.
This means that after the 1st 3-month check up, you could go for 6 more months at least unless there is a problem.

Thanks @BatshitCrazyWoman and @Bagelsandbrie.

I think a GP with expertise should be enough for me. My major health condition thru my life has been my hormones/menstrual cycle. I do have a spinal condition too but it is degenerative rather than rheumatoid or immunological. I also know (from experience) that my GP will be happy to act on and take over from a private recommendation so not expecting it to be a long term ongoing cost.

@Bryonyshcmyony I totally agree with you. Healthcare is becoming two tier in every sphere. My son has very severe ADHD and we had the choice of waiting for the NHS referral (3 years of suffering) or private treatment (£1750 for assessment alone). I don't want to feed the private sector and allow the NHS (that I work for) fall apart. I don't want there to be haves and have nots...but as an individual parent I wanted my son to have treatment and get back to school and back to some quality of life, and now I want all 3 to have a mum who isn't losing the plot. (I have complained vociferously about the situation with ADHD btw, I'm very aware of the suffering and poor outcomes for kids who have parents who couldn't afford this).

@Bryonyshcmyony

The Newson clinic annoys me. It's ridiculously expensive and therefore exclusionary.

I agree.,I have signed up for the waiting list but then looked at the price list £275. I really can afford that..Will have to take my chances with gp. recently did the got consultation thing and I suggested a specialist in women's health be at every gp.

And she never gives advice on her Instagram page, obviously advice is only for those who can afford it

I just had my initial appointment at the Newson Clinic this past Weds (yes, eye-wateringly expensive, with the Rx), and started HRT on Thursday: Estrodot 50 mg and Imvaggis, and then Utrogestan next month on a two-week cycle.

While my periods are still regular and I still ovulate (I'm 50 next month), I've been experiencing weight-gain round the middle; having to look up words in the thesaurus several times a day (hugely annoying when writing is part of my work!); terrible mood swings; poor sleep; tinnitus; ectopic heart beats; worsening of my fibromyalgia symptoms; sweats (thought more like being in an oven for hours at a time); and hair loss.

Two days in, and my breasts are tender, but the tinnitus has eased significantly, and I am feeling more "here" - even with a head cold. I am curious as to how many things I've been going through have been caused or exacerbated by peri-menopause, and I only realised when speaking to the doctor just how long it has been coming on for (maybe over 10 years).

So we'll see!

Why can't you go to the gp? Why pay that? 500 is mad!!

Some of us are sadly forced to go privately @Bryonyshcmyony because our GP's refuse to prescribe tailor made HRT. My GP would only prescribe Femoston tablets and the progesterone part was just dreadful for me. When I asked to try estrogel and ultrogestan, because I'd watched and read everything I possibly could on menopause and HRT, and knew that this was what menopause docs were prescribing, my GP (a menopausal woman) told me to go privately! For the first time in my life, other than having my children, I really needed the NHS and it just wasn't there for me.

I didn't get on with femoston but elleste or Novofem were fine.

@WhatMattersMost that is really good to read. Not being able to find the right word, or using an "approximate" word instead has been another thing for me.

All of the 'menopause specialists' are very reluctant to prescribe HRT in tablet form now - I think it's because it has a higher risk of clots? The transdermal route is much safer and easier to tailor to specific requirements, you can have more estrogen than progesterone, whereas the tablet form are 1mg or 2mg of estrogen with the standard quantity of progesterone. Also for those of us that are progesterone intolerant, you can use ultragestan vaginally, so the side effects are lower.

Novofem only has 12? days a month of progesterone.

I am sure the clot advice is correct but I'm suspicious that menopause experts play up those dangers to get middle class women to pay their ridiculous fees.

[quote Aspergallus]@WhatMattersMost that is really good to read. Not being able to find the right word, or using an "approximate" word instead has been another thing for me.[/quote]
I only realised it was a "thing" when I watched that (fabulous, imo!) movie "Wine Country" where I think it's Amy Poehler's character who wakes up, walks into the kitchen, and can't remember the word for "kettle".

GP's are paid £155 per patient registered with them per year - whether you go to see the doctor or not. Private doctors only get paid per patient they see, so I suppose they have to charge enough to make their practises commercially viable. The likes of Dr Newson and Dr Potter do try to get as much free information out there as possible, including details of what they prescribe and how to encourage your GP to do the same. Sadly, menopause is not high on the NHS agenda, even though we now know that so many health issues, present and future, could be alleviated with HRT and whilst this remains the case there will always be a need for private menopause healthcare.

I'm lucky then as I have a cheaper form of HRT that works really well. I have considered asking for the gel but it all sounds very confusing.

Can't have any at the moment as BP. Too high anyway

@Aspergallus try asking your GP practice if they have a doctor with a menopause interest. Newson health have recently offered an online menopause course free of charge to one doctor in every GP practice - not all practices will have someone who has the time to do it but lots of GPs learning a lot more about menopause (DOI GP who is doing said course and it’s really helping me care for women better)