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!

Thanks
I'll get my blood pressure down a bit then push for gel

@Akire You might find it helpful to read the information on The Migraine Trust website- google HRT/ search etc for the right section on the site.

They state clearly that migraine is not a contraindication to HRT.

I have migraine (from age 12) although they are infrequent. It's never been an issue re. HRT and I've used it for over 12 years.

Sadly, there are still a lot of myths and misunderstanding around who can use or not use HRT.

The newest types of HRT such as Oestrogen gel and micronised progesterone are the exact same molecular structure as our onw natural hormones (and they are made from yams.) They are replacing our hormones with an identical formula.

They are very different to the old types of HRT and completely different to the Pill.

I don't believe they will work very hard to change the NHS though, why would they? They'd have no business!

Most drs working privately have had a long history in the NHS (or combine it with private work) and they leave because they often are held back from offering women what they want and need. They are usually at a stage of their career once they offer private appts, when money is not the driver. I don't think anyone becomes a dr for the money.

I do believe they have an important role to play through a domino effect. Women who pay to see a dr pass on their experiences to friends who can then use that information when they see their NHS dr. So I think it's empowering because it creates a dialogue.

@Suzi888

I’ll think I may have difficulty though and if a blood test can ‘prove’ it I’ll have a better chance of obtaining treatment. My GP isn’t the best. My main symptoms are being very irritable (angry!) and a terrible memory, periods are heavy, bloating and insomnia. Not sure my GP will take it seriously so I tend not to go anymore.

My gp refused to prescribe anything - I had to have blood tests which showed my oestrogen levels to be very good, and I was (and still am) having regular periods. No matter that I was 50 and suffering exhaustion, insomnia and aching joints. I didn't need Davina to tell me I was perimenopausal, but it still wasn't sufficient to get me HRT. I have gone private, but I hugely resent it and can't really afford it.

@JinglingHellsBells sorry to @ you and to hijack the thread, but you asked me a question about my POF diagnosis earlier on in this thread. You seem really knowledgeable about this stuff and I was wondering if you felt I’d been misdiagnosed or fobbed off? I didn’t ask many questions at the time and my current GP does not think it is related to my migraines because I have good estrogen levels and no hot flushes. I’d really appreciate your opinion on it (if you have one!)

TIA

I’ve just been prescribed oesteogel and Utrogestan by my wonderful GP, although I forgot to ask when to start taking it as I still have periods. I’m assuming I need to wait until my next period begins and start then with the gel and then add in the Utrogestan 14 days after that? Anyone with advice please?
I have many symptoms but the worst for me is IBS type symptoms and diarrhoea after alcohol!!! Hoping the HRT means I can resume one gin or two!

@TheSockMonster That's ok :)
It might be worth reading info on the Daisy Network site and My Menopause Dr (POF info). What I know from the Daisy Network is that in some women, normal fertility (ish) can resume after a time even if they have POF/POI.

So although you had a diagnosis, maybe there were other reasons at the time for it, and now you are okay?
Sorry, your other posts are a little way back now and I've not re-read them.

Thank you JinglingHellsBells

I have another question for everyone...

Since my period returned post partum, as I mentioned it has been very variable in duration, from 1 day to 10, from extremely heavy to very light. But one thing that happens month after month is pre-period spotting on and off.

Usually this:
Very obvious day 1 with cramps etc and flow that needs san pro followed by variable length period
Day 11-14 ovulation type pain
Day 17 ish PMS type symptoms start
Day 20 start intermittent spotting on and off until Day 1

I know that abnormal bleeding usually needs medical review, but this has just become a totally recognisable part of my cycle. Does anyone know why?

Thanks.

I know that abnormal bleeding usually needs medical review, but this has just become a totally recognisable part of my cycle. Does anyone know why?

I'm pretty sure that what you describe is normal for peri menopause. The spotting after mid-cycle is usually down to low /no progesterone, sometimes as cycles can be anovular (no ovulation.) It can be controlled with the progesterone only pill. (Or HRT.)

I don't think abnormal cycles which are part of the whole peri scenario need investigations, especially as it's a pattern each month rather than odd bleeding at different times.

@JinglingHellsBells

Thanks, that's reassuring. It's not random so probably part of the whole hormonal decline.

Just an update...

So while waiting for my appointment with the Newson Clinic, I thought I'd give my GP a try.

Had a very good appointment, I think!

-Agreed that diagnosis and treatment should be clinical, regardless of bloods, so didn't offer to do any
-Agreed with me that I may get on better with Utrogestan than other progesterones
-Agreed that transdermal is lowest risk

What was nice is that he knows that I am under a lot of stress at home (children with special needs) and with a high pressure job, and he brought up the need to get this right "treatment can be life changing for some women".

He is prescribing Oestrogel + Utrogestan for me, to start with next cycle. Review in 3 months to see if Oestrogel dose is sufficient.

I think that is a good start and feel like I could cancel my Newson Clinic appointment for now?

What do people think (@JinglingHellsBells)?

@JinglingHellsBells

tagging again, after my fail above...

I think I'd keep your appointment with the Newson clinic, they're running at 3 months from registering to being allowed to book and then 3 months from booking to appointment - so it's 6 months from when you first decide to see someone to when you actually will see someone.

The reason I'd keep your appointment is because if you don't get on with the progesterone orally, you can take it vaginally but I'm not sure a GP will agree to this, whereas the private menopause doctors do. Also, if you need testosterone you'll need the Newson clinic.

It would seem that Dr Newson has been brought back in to the NHS to consult on menopause and what women need from their GP's, so hopefully things are changing, let's just hope it's quickly.

@Aspergallus Hmmm..I think if I were you I'd probably go with the GP for the moment and see how you get on.

Re. using it vaginally if you want to- it's only in the UK it's not (yet) licensed that way for HRT although it's used in the UK as part of fertility vaginally. Your Dr won't know - unless you were to tell him.

My dr told me it's been used vaginally as part of HRT in Europe (mainly France) for a very long time.

Also @Aspergallus bear in mind that if you wait for your appt at the Newson Clinic, you won't necessarily have your apt with her. She has a team. They are GPs. I don't know the set-up- maybe it's something for you to query? Are they also working in the NHS or purely private GPs?

Dr Newson is great but she is not a consultant. She is a GP with menopause training beyond most GPs.

The point I am making is even if you pay for an appt, are you going to get anything beyond what your own (enlightened) GP can offer?

A consultant working privately takes full responsibility for anything off-label. I'm not sure how this works with GPs (privately).

I do though know of other women using Utrogestan vaginally and their NHS GPs know and are happy about it.

@JinglingHellsBells

Thanks, that's my thinking too. He seems to be pretty clear on all the initial steps -good choice of treatment, reviewing in 3 months.

I appreciate further steps might be necessary but it feels like I have a reasonable plan for the next 6 months that any reasonable Dr would want me to follow first in any case.

I also agree about expertise -if my GP is as up to date as he seemed today, I may not do much better with the Newson Clinic anyway.

@Aspergallus I'm sending you a PM.

Any advice please, I have been on evorel sequi for 5 months now, first 3 months had withdrawal bleed 2 days after applying last patch of cycle which I believe is normal but last 2 months have been spot bleeding after 1st week of new cycle so whilst on only 3rd patch of cycle( evorel 50 patch) rang my gp and although lovely had to refer to guidelines to get advice. I have been given extra progesterone capsules to take the first 14 days of my cycle along with the evorel 50 patch and then to put just the evorel conti patches on for the next 14 days in the hope it will stop the spot bleeding. Seems like a lot of progesterone and my doctors knowledge didn’t seem that great. Has anybody else had to do this?

@Proudnana3 I just thought I'd tell you my 'regime' which might help you to calculate your own as I'm assuming you were still having periods hence the sequi regime.

I use a 50mg patch with 1 pump of estrogel continuously - so 75mg of estrogen every day.
I then also for 10 days of every calendar month, so10th to the 24th, use 200 mg of utrogestan.

So every month I'm taking 2000mg of progesterone spread over 10 days. Usually 2 to 3 days after I stop the utrogestan I get a bleed.

How much progesterone are you taking in total per month?

Rina66 At the moment I’m just using the sequi patches 50mg as yes I still have periods. The new regime will be an extra 100mg of progesterone for the first 14days with the everol 50 patch each month. Hope that makes sense

@Proudnana3 so how I see it is your doctor wants you to take 14 days of 100mg Utrogestan by mouth = 1400mg

Then the sequi patches are 170g (I think) progesterone per day x 14 days = 2380g

So your total is 3780mg per month, whereas mine is 2000mg, so you're nearly double. Mine is quite a minimal dose as I'm not tolerant of progesterone, can you cope with progesterone? Lots of women (post meno) do take 100mg Utrogestan capsule per day on a continuous regime which would give you approx 3000mg per month, you're still 25% higher than that though.

Just picked up my prescription and actually says to take for 25 days of cycle not 14 I imagine the 3 days of not taking it is when I should get a bleed. Seems an awful lot, I don’t seem to have a problem at the moment on the dose I’m on except for the spot bleeding of course, it’s all so confusing

Hi everyone, just an update on how I am getting on...

So I started oestrogel -2 pumps every morning which GP says I can increased to 4 pumps if necessary in a month. Utrogestan 2 capsules at night days 15-26.

I have to say, I feel amazing. I feel more like me than I have for absolute years.

The things that are definitely different:

I have more energy. I can actually do things in the evening when the kids go to bed rather than collapsing on the sofa immobile, thankful to have survived another day of work/kids/dinner, bath and bed routine.

I am sleeping much more soundly, less wakefulness through the night.

The rate of my hairloss has slowed, judging by what comes out in the shower.

I am much more even tempered and somehow capable of being more kind and patient with the kids. I am just more tolerant all round.

I feel more optimistic -life was such a drudge, I often wondered if death would be a relief (not joking).

My insatiable appetite has decreased. I feel satisfied by the food I am eating and don't feel the need to snack to keep my energy up. This has been a huge change -I lost 2lbs in the first week without any other changes.

Skin is looking fine, perhaps a bit better than usual. Oiliness and acne certainly not worsened anyway, even in the utrogestan phase.

No headaches or migraine symptoms since I started.

I am cold. All the time. This used to be normal for me. Then I was hot all the time. So I guess my temperature regulation is back to my normal!

Less sweaty. In particular I don't have the big flash sweats that were coming on when I was under pressure with something.

No pre-menstrual spotting which I'd been having for 1 to 2 weeks before each period, extending the whole inconvenience of having periods.

Improved fitness performance. I took a cycling fitness test (peloton) that showed a big increase. I had plateaued and been stuck at the same level for the 6 months prior to treatment despite training 4x a week to a program.

My GP had said to me, when the diagnosis is right and it works, it can be life changing. He was absolutely right. I spent a lot of time reading and fretting about the risks, and though they are smaller than used to be thought, they are still there. But I'll take how I feel now as being absolutely worth it, versus another 5-10 years (or more, who knows?) of being how I was and the impact of that on everyone around me, especially my kids.

My only regret is that really, with reflection, I've been struggling with this since I was late 30s -maybe 38, and should have done something sooner. Apart from the 9 months I was pregnant with a late surprise baby when I was 41/42, it's been really very hard.