Please recommend the best HRT for me.

[RosieSun]

I’m a regular poster but have name changed as I have never started a thread and nervous about this. I’d be glad of advice.
I have my 2nd GP appointment the day after tomorrow for menopausal symptoms, where I am expecting to be prescribed HRT. I suspect I have been peri for 4 years, but I didn’t realize, as my symptoms accumulated gradually as follows:
20lb weight gain; hair thinning; tiredness; vertigo; mild hot flushes; stress incontinence ; back ache and stiffness; low mood; general rage and now high anxiety with frequent chest soreness and shortness of breath. The anxiety is dreadful and the worse symptom by far. I am on the mini-pill, married but no sex life to speak of, but I want this to change once I’ve sorted myself out.
I stopped the mini pill at the start of the year when I wanted to check if I was menopausal. I had no periods for 4 months, then the heaviest two of my life (could barely leave house some days) and so I went back on the mini pill.
I have read up on HRT and I think I would like gels/patches but I got the impression at my first appointment that they were going to give me a combined pill instead, which will be disappointing if true. I don’t want a mirena coil fitted as I had one before and encountered problems with its removal.
My bloods have been taken twice with FSH readings of 72 and 70.
Until all this my health was good. I am 47, a bit overweight (BMI 26/27), diet not bad. I don’t smoke and gave up alcohol in the summer as I was feeling so lousy. I had covid in Sept 2020 and I thought I had long covid before reading up on the menopause.

Sorry for the long post, just trying to jot down any significant factors. If anyone reading this is has experience of HRT and can recommend a prescription for me that would be great. (I have read many websites, including Louise Newson’s.)

Gel plus micronised progesterone tablet (also known as utrogestan). You need to have 2 weeks of just the gel, then 2 weeks with the progesterone tablet at night. I’m a GP and this is what I’ve decided I’m having!

My goodness thanks @PaddingtonsHat. That was quick. So are they allowed to prescribe what you suggest to peri women under 50 on the NHS? I just wish to go in fully prepared (I live in Scotland). Thanks I’m advance…

Yep.
Gel or patch have no risk of clot compared to tablets.
Micronised progesterone is the closest to ‘natural’ progesterone you can get

My GP had some ideas of what to prescribe, but has definitely listened to my own opinion on what I felt would suit me. I started on patches (combined - so 2 weeks e and then 2 weeks e +p. The patches were a bit fiddly and took a few months to get into (working out where best to put them, and how to apply them so they don't come off). But I still felt like I had good and bad days where anxiety/mood/rage were concerned and so I asked for gel to 'top up' on bad days. My gp was happy for me to try this and it's been working out well. I do tend to have the gel more days than not, because I feel so much better with it.

I'd advise you to think of it as a process, not a one time decision. Read all the information you can, speak to others about what their experiences are (but realise that you are unique and what suits one person won't necessarily suit you), have a proper dialogue with your GP and listen to their advice (if they are knowledgable on hrt - some GPs seem not to be up to date with current research it seems). Try something to start with and be mindful about how it's working (you can use a symptom tracking app like 'balance' to inform this), and tweak it over the next 6 months till you find something that suits. No decision is irreversible, it's just about finding that magic balance that works for you and your life.

Hrt is a case of taking medication every day for a good length of time and any type is going to have some drawbacks, but the physical and mental health benefits of finding the right one are immense.

So are they allowed to prescribe what you suggest to peri women under 50 on the NHS?

Afaik GPs can prescribe hrt to any woman, but if you're over 45 they can prescribe based on symptoms alone. Peri/menopause is so common over 45 that if you've got symptoms, it's likely. I am just over 45 and I did have a blood test just to rule out anything else the symptoms might have been indicating (frequent urination = diabetes? For example), but not to measure hormone levels. Hormones fluctuate so much during a normal cycle that one blood test isn't enough to diagnose menopause.

The gold standard for women who still have a womb, if you ask Louise Newson, is oestrogen transdermally (patches or a pump gel, the former intended to keep the dose quite constant) and Utrogestan, a form of progesterone taken orally for half your cycle.

The Mirena is a good option if a) you forget to take pills or b) you need contraception as it kills two birds with one stone. It's my sense that it's progesterone, which is required to ensure your womb lining does not get too thick as this is a cancer risk), which some women find hard to tolerate. I've read cases where women have ended up using the pills as a vaginal pessary. Personally I've had no issues with it at all.

@RosieSun I've been using HRT for many years and was put onto estrogen gel right from the start by my gynae consultant when very few women were using it. They are highly qualified and actually advised drs, like Dr Newson. I also use micronised progesterone.

You may find that in Scotland there are some licensing laws that will make it hard for you to get micronised progesterone. If you find this, it's worth contacting Dr Heather Currie who runs Menopause Matters and is the chief menopause gynae in Scotland. She will answer questions privately via an email (for £30) and the contact link is on the Home page of the website.

@PaddingtonsHat, I don’t think you are quite right in saying you take the gel for 2 weeks only, before switching to progesterone. I think you use the gel DAILY and either take the utrogestan progesterone sequentially ( if still having periods) or continuously at night ( 2 hours after food ( if you have been bleed free for 12 months plus).

You can take the utrogestan orally
( or vaginally).

The dose of gel must be consistent each day, either am or pm.

There is no ‘ best hrt’ OP.
Hrt either works for you or it doesn’t.

Gel, spray and patches are popular choices. But you can’t dismiss oral Hrt. The risk of clots is small and many women quite happily and safely take a tablet each day, so don’t be put off.

Be warned, Hrt can take a few weeks or even months to work its way into your system. There may be side effects along the way, but after 3 months, you should know if that regime is working for you.

Good luck.

Sorry completely correct, meant to say you take both for second half

@PaddingtonsHat what is your opinion on bioidentical hormones?
I need to see my GP re HRT.

I am nearly at the end of my 2nd month of oral hrt. I am 55 and still have periods. Brain fog and anxiety became too much for me and hrt does seem to be helping. I get off to sleep quicker as well which I so needed. Hope oral OK as so far, seems to be having a positive impact on my life. (Femoston 1/10).

[quote awonderfuladventure]@PaddingtonsHat what is your opinion on bioidentical hormones?
I need to see my GP re HRT. [/quote]
@awonderfuladventure Do you mean bio or body-identical? The 2 are confused often.

BIO are not licensed. Read the info on this on the website of the British Menopause Society website. thebms.org.uk/?s=bio+identical+hrt

What did 1st GP say? Have you been let down?

@JinglingHellsBells I meant Body identical, thanks for checking. I'll blame the brain fog.

@PaddingtonsHat

Sorry completely correct, meant to say you take both for second half

You did say that

Thanks so much for responding everyone. I have company this evening and (frustratingly) cannot disappear to my phone but am much looking forward to taking time to consider all responses at bedtime. It’s much appreciated (keep them coming! )

I’m free now to get stuck in here.
@spudjulia. thanks that’s all very useful. The GP I saw is young and sympathetic. Unfortunately she is also about to go off on mat leave.
I think I’d be better with gel than patches if that was a choice as I have a long bath every night and imagine that must be problematic for patches.
Btw I had two blood tests. The GP wasn’t doing them to diagnose menopause but I think to try and work out how far along I was due to being on the mini pill mucking up my periods.

Thanks @PaddingtonsHat. I have read that micronised is the better type so hoping for that.

Thanks @LiveFromNewYork. I had an awful experience with the Mirena coil. (They couldn’t get it back out of me and I found them trying a bit traumatic). I don’t know if I can keep taking the mini pill with HRT though or if I need to consider something else.

Thanks @ JinglingHellsBells. That’s useful info. I didn’t know there was an issue with licensing laws. I was assuming that if I was given pills instead of gel/patches it was maybe due to the cost to the NHS.

Thanks for that @Runaround50. Was HRT a success for you? Do you take the pills? I am hoping I don’t get bad side effects.

Hi @DinkyDaisy. That’s good to hear and I’m pleased it’s working out for you. Anxiety is terrible isn’t it? It comes over me often for days at a time. I can feel my nerves shaky and have such an uneasy feel, worry about everything and have had a couple of complete panic attacks. I want to be a strong woman for my teenage children. Not a nervy wreck they are scared to come to with their problems. I have lost my confidence doing the most basic things. Social interactions with people, driving, cooking a meal for guests. The most basic tasks are mountains to climb in my head.

Hi @Oblomov21. Sorry if my post was ambiguous. I have my second appointment with the same GP. She didn’t want to prescribe at my first appointment as she only had one set of my blood results and said she wanted a second lot taken. This was to work out if I was peri or full menopausal, but this doesn’t make much sense to me as I’ve had 2 periods in the summer so can’t be the latter. Perhaps I picked her up wrongly. I was rather tense at the appointment!

@RosieSun
I TOTALLY get what you mean re losing confidence over the most basic of tasks. For me it was driving and social interaction longer than 5 minutes! I got to the point where I just couldn’t drive for longer than 10 minutes. Couldn’t face long windy fast roads, in fear of crashing, god it was horrendous! These were roads I had driven for years, then suddenly, one day three years ago, bang, I just couldn’t do it!

I started on gel and utrogestan continuously as I’d been period free for a year. Then I switched to patches, which I’m on now. They haven’t been without problems and HRT can be a process, rather than a quick fix. What you have to remember is that hormone depletion happens over quite a long period of time. When/if you start HRT, the body need a period of adjustment. Different regimes suit different people.

Give your new regime 3 months to see how yet on.

🤞🤞🤞🤞