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.)

Thanks for that @Runaround50. I will definitely give it 3 months to see how it goes. I’m trying not to view HRT as a potential miracle fix, but as part of a long term plan to really improve my overall health. (As I currently feel about 110!) As seems to be the case for many others, I’ve had all these issues building over time but didn’t realize it was menopause as I wasn’t getting bad hot flushes and thought I was too young. That’s good you have settled into a treatment that suits you.

@RosieSun Micronised progesterone - It IS a cost issue in some parts of Scotland (that's what I meant by licensing- not that it isn't approved, but that the cost isn't being met in some regions.) I don't know if, in those cases, you can ask for a private prescription and pay for it yourself? (It's about 50p per tablet.)

Thanks for that info @JinglingHellsBells. I will ask the GP tomorrow about licensing in my area/getting a private prescription if it comes to that. I live in Lanarkshire NHS Trust area. From the advice given on this thread and my reading I’m thinking oestrogen gel and micronised progesterone is what I would like to try (I particularly liked the thought of just putting more gel on for bad days!) but I will need to see what happens and keep an open mind if that request is panned! I will let you know how it goes.

Watching with interest. I've just started the patches at 45, and am wondering I should have pushed for the tablet progesterone (micronised). The gp suggested the oral version might not suit me as I am prone to adult acne and had real problems with the POP pill because of this (skin was dreadful on it).
I just started 2 weeks ago and rather naively hoped I'd feel a difference, but looks like I'll have to be patient then!

Hi @RavenT. Are you not feeling any improvement so far?

Perhaps sleeping a little better. But only 12 days in so it is very early days.

Update: I had my telephone GP appointment this morning. I’m to given combined sequential patches. My choice was this or pills. I wasn’t to be given gel as she said it needed to be a combined option. After @JinglingHellsBells useful post yesterday, I did some online reading and see utrogestan isn’t approved in Scotland so not an option and I didn’t feel bold enough to ask the GP about it this morning. Anyway I’m really looking forward to starting it, but disappointed it’s going to be a week before my prescription is ready (!?). I have been advised my long baths won’t interfere with the patch, as I was worried all my desperately needed hormones will end up down the plug hole! Anyway I can’t wait to start as I feel awful. My anxiety since Christmas Day is giving me a constant heavy sore chest and my nerves are shot.

I want to thank everyone who bothered to take time replying to my query.

@RosieSun

Update: I had my telephone GP appointment this morning. I’m to given combined sequential patches. My choice was this or pills. I wasn’t to be given gel as she said it needed to be a combined option. After *@JinglingHellsBells* useful post yesterday, I did some online reading and see utrogestan isn’t approved in Scotland so not an option and I didn’t feel bold enough to ask the GP about it this morning. Anyway I’m really looking forward to starting it, but disappointed it’s going to be a week before my prescription is ready (!?). I have been advised my long baths won’t interfere with the patch, as I was worried all my desperately needed hormones will end up down the plug hole! Anyway I can’t wait to start as I feel awful. My anxiety since Christmas Day is giving me a constant heavy sore chest and my nerves are shot. I want to thank everyone who bothered to take time replying to my query.

@RosieSun Utrogestan IS available in Scotland but not in some areas. I don't know which but there are women here and on other forums using it.

Dr Currie is actually quoted on the front page of The Times today, asking for 'menopause champions' in the workplace. She is a consultant at Dumfries & Galloway Infirmary and was awarded the MBE last year for her menopause work. If you want to know about Utrogestan in Scotland, she's the person to ask via Menopause matters Home page where there is a link.

Thanks @JinglingHellsBells. You are so helpful with all this. I guess I feel I sold myself short a little in my appointment today. I’m not good on the phone and have always had ‘white coat syndrome’. Also, at the moment I’ve turned into someone who bursts into tears if my family comments the mash is a little lumpy. I have no fight in me! I was just so glad to be getting a prescription that my warrior side fell silent. If the patches don’t work I will go back and fight the fight.

I'm on the evorel 50 patches and I love baths and swimming. The patches can do really well in water, but there are techniques and positions for applying that help, which differ for different people.

I've found the best way for me is to apply after a bath/shower, give my skin 15mins to cool down and dry, then I make sure the area is really clean by wiping with surgical spirits, then warm the patch in my hand so it's the same temp as my skin, then apply it slowly, pressing out all the creases. I also found the best spot for me is below my hip, on the outside of my upper thigh. I find this area doesn't get in the way of going to the loo (I forever caught the edges of my patch when lowering/pulling up underwear when I tried it where my pants would sit) and the skin there doesn't crease so much when I'm moving around. Have a bit of an experiment, and try to get a spare pack for when you lose a patch.

In terms of the prescription, I understand things are due to change soon, but currently the prescription is only month by month and double prescription charge because the estrogen only patches for first 2 weeks are counted as a separate prescription to the prog + estrogen ones. So I bought a pre payment certificate which is about £100 per year iirc, and all my prescriptions are now 'free' - I would otherwise have to pay twice for the patches and once for the gel every month.

Id read about putting a wound covering on top of the patch to keep it there - forgot the name of them now, (tags seem??) but like a clear sticky patch that they use in hospitals to cover wounds while they heal. My GP told me that they were probably sucking half the hormones up, they shouldn't be used if they are sticky all the way over the patch. You can get some that have non-adhesive 'windows' if you want to try, but I've found that my patches are quite reliable now in terms of staying stuck on.

@RosieSun
You have done very well today.
Talking HRT can be a tough conversation to have on the phone.
Let’s hope that she patches work for you soon!

Totally get that lumpy mash thing. Think I have cried at over cooking my morning porridge!

God alone knows how to cope with work again next week!

@JinglingHellsBells is that MN guru of all things menopause.
There’s not much she doesn’t know 🙂

@RosieSun If you decide that you want to explore Utrogestan, or even just know what's what, this is the link to the form to ask a question.

As Dr C is in Scotland, she is perfect for advising on the situation.

www.menopausematters.co.uk/contact-the-doctor.php

I have long baths every night and my patches are totally fine. Best of luck OP. Try not to worry too much about which HRT system, best to try and see what works for you.

Hi all. What a lovely helpful bunch you are .
@spudjulia. the tips on applying the patches are super useful. That’s a shame you need to pay upfront for your prescription. They abolished that years ago in Scotland (though we do pay some higher taxes for it).

Thanks for your kind post today @Runaround50. I know from your words you know exactly how I feel, it’s lovely to be in the company of the likeminded (even the wobbly minded with dodgy mash n porridge!) .
@JinglingHellsBells. I’m going to check out your link now for more info.
And thanks @bluejelly. Yes, I’m feeling better in myself today a little knowing I’m getting the patches soon. And the bath thing is a relief. I think the GP might have thought I sounded a bit flaky asking about baths. But my bath is my sanctuary for my sanity!
Have a lovely evening all.

Just wanted to say I hope they help.

After a phone consultation with a really helpful doctor yesterday & blood pressure and weight check today I have just applied my first patch!

Good luck @IDidntFloatUpTheLaganInABubble!! What type did they give you? What are you hoping for from them if you don’t mind my asking?
I got a text from pharmacy an hour ago to say my script was ready. So I have just been and collected. It’s cute little pink boxes of ‘Everol Sequi’ I can’t wait to get started. I also bought surgical spirit after recommendation on this thread, for application. I will slap the first one on after tonight’s bath. So excited and happy it didn’t take a week as expected.

I have been given the same as you.

I am 46 and been in peri for a while. Brain fog, joint/muscle ache, itching, stress, exhaustion, incontinence, hot flushes, nightsweats, insomnia, anxiety, hair thinning, weight gain and just generally feeling awful all going on here.

I will be grateful for any improvement I can get tbh I just feel old and tired and want to feel a bit like my old self.

I have been given a months worth and the doctor is going to call the week before I run out to see how I am getting on.

I have to say the doctor who I have never seen before was brilliant, I'm very grateful for that.

Crikey @IDidntFloatUpTheLaganInABubble. Your situation with all this is near identical to mine. It will be interesting to see how we get on. I’ve been given 12 weeks worth to start with. ‘Old and tired’ sums up how I feel most of the time too. I’m going to keep a diary to chart progress.

I am going to do the same. My doctor says some people start to see improvements as soon as a week after starting treatment so we shall see.

Let's catch up next Thursday!!

@IDidntFloatUpTheLaganInABubble. Good idea, let’s do that.

Have you been prescribed Evorel Sequi patches? Would also find it useful to share experiences!

I started gel and Ultragestan two months ago.

Only side effects - headaches and one migraine the first week on e only (migraines are one of my hormonal issues anyway) and I do get a spot or two in the two week p window.

But the e immediately cleared up my flaky scaly skin, hot flushes have stopped I think. And no more migraines, I was getting a few each month.

But sleeping, mood and anxiety are no better so at my review I'm going to ask for the higher strength e.

As for prescription charges - my GP prescribed 3m at once. So it would have been £18.70. I have another unrelated monthly script currently, and was also prescribed extra migraine tablets jic. So I bought a 3m pre payment cert for c£30 and that has so far covered five prescriptions, but will be eight by the time it ends.

In theory, if you buy a 3m cert twice a year and time it carefully, you'll get two lots of HRT on it. The pre payment certs generally work out better if you have anything more than one script per month. (I did a spreadsheet to work out when best to buy it!).

I don't like that the Ultra comes in packs of 30 but you have to take it for twelve to fourteen days (my GP said fourteen is easier, but I'm going to ask her if I can do twelve to reduce the impact on my skin a bit), so the most you need is 28, and I have packs with two left in them now!

Conversely, you use the e gel every day, it's supposed to be a 3m script, but the box has 28 in, so actually it runs out before the end of a real month. Why they can't match up I have no idea!

But, yes, it's changing soon so we will get a 12m prescription and it will be £18.70 for the whole year then (13 boxes of e, 11 of p - ).

Yes @RavenT. Evorel Sequi Patches it is, so please keep posting how you are doing and we can all compare! @ VanGoghsDog. I hope they sort your prescription so it helps more. Good on you with your prescription cost strategy! I like your thinking.