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.)

Posted before I meant to...

So I'm reading other's experiences with interest - I am not due for a review until 3 months but it sounds like I need to track this week by week and then if still same, ask for increased estrogen?

The patches are ok - no problems with them sticking and I would prefer to stick with transdermal rather than pills from a perspective of no blood clot risks and easy to stop if I needed to.

There is gel if you prefer that over patches, I went for the gel.

Last week I took my soup off the stove, poured it out, ate it, went out for the afternoon, came back six hours later to the gas still on!
And left the heater on in the bedroom - I have a small space heater I use now and then, just while I get dressed or undressed, if the heating has gone off, so as not to heat the whole house - it was on for about five hours, urgh! At least that one's not unsafe, just costly.

Hi folks. Whilst we are sharing this weeks dippy moments- yesterday morning I put the lid from the coffee canister directly into the coffee pot instead of the coffee plunger - what a bloody mess that made. Today working from home, I was surprised how well the oven was warming the kitchen, until I realised I’d left a simmering pot on all afternoon from my lunch-time poached eggs. How spookily similar @putthehamsterbackinitscage and @VanGoghsDog!!!
Dread to think what I’ll do tomorrow. Im week 2.5 and feeling a bit better. Nerves, mood and joints- especially my permanently sore lower back- all improving. Some days much better than others. Off to sleep now.

Hi OP I’m on Evorel but the conti ones as I’ve not had a period for over a year. It took about a month for my symptoms to go. I’m just coming to the end of my first 3 months. Bloody marvellous it is and I wished I’d asked for HRT months ago!

Hi @Whattochoosenow. That’s great you are feeling much better. Long may it continue! Would you mind me asking what symptoms have been improved/relieved?

I’ve just had a phone appointment with GP to discuss menopause.

I’m 49 and had regular periods until the summer. Am having hot flushes and feel anxious and loss of libido.

Fortunately I did lots of reading on MN and the Newsome website so I knew what to ask them to consider for me.

I had a 5 minute conversation. It was a woman GP clearly in a hurry. I understand they are extremely pushed.

I was asked my symptoms and what was happening with periods. She asked if I had a history of blood clots or breast cancer in family. Told HRT would help.
Was offered some kind of tablets for the whole thing. I said I’d prefer the gel or spray. She said OK. She said I would have that with a Mirena coil. I said I’d prefer not to have Coil but Ustrogen capsules. I pointed out I have migraine with aura. Dr said I could probably have that but she was going to check her books and speak to pharmacist and I would then be texted and sent a prescription assuming it was okay.

She wanted to hang up, but I had a couple of extra questions - how often would I get the prescriptions, how long would I be on HRT etc. She answers me, but hadn’t been forthcoming with that info.

Within 5 mins I was off the call. Am now waiting for the text/prescription.

So, my feeling was that it wasn’t a terrible experience but not great. I was very glad I’d read up on it all, as the GP wasn’t very forthcoming and dint really explain how it works or the 2 parts to take etc. If I hadn’t known about transdermal applications, I’d have been given pills. If I hadn’t asked for ustrogen I wouldn’t have been offered it. If I hadn’t asked, I’d have no idea how long I might be on it etc. But that said, because I’d been proactive in reading and in saying what I would like them to consider and asking Qs, it looks like I will be getting what I thought looked best. I didn’t have to fight for it.

However, was this good enough? Is a 5 minute conversation from zero to prescribing enough? Is it good enough that women who simply ring with symptoms and don’t know anything about menopause or HRT possibilities probably wouldn’t have been offered the HRT which I am probably going to get? I get that if you go to a private clinic it will be more client focused and there will be time to discuss at greater length and you will be paying for your first prescriptions and also that ultimately the outcome for me is probably very similar at zero cost to myself. But should I have expected more….another appointment, being given options to consider and reflect on? A chance to ask Qs or some of the answers to the key Qs I did ask just being offered automatically? Once I get the prescription, the GP won’t be advising me about actually taking it or what to look for or about follow-up. I suspect I will need to call again and ask further questions - or am I being prissy and expecting too much?

@WombatChocolate I don't think that was anywhere near good enough.

I'm glad you got what you wanted, but not the way it was handled, and thank goodness for you being well-prepared, but it worries me how many women are out there suffering because they didn't have the preparation.

In another awful situation here - I'm a couple of weeks into the Evorel patches - when the young pharmacist gave them to me, I asked how to use them, because the GP hadn't given any specifics. She told me not to put them anywhere they might get rubbed off - like by your bra strap - but outer arm would be fine

I need to do something about this, from an education perspective if nothing else, don't I?

[quote Luckingfovely]@WombatChocolate I don't think that was anywhere near good enough.

I'm glad you got what you wanted, but not the way it was handled, and thank goodness for you being well-prepared, but it worries me how many women are out there suffering because they didn't have the preparation.

In another awful situation here - I'm a couple of weeks into the Evorel patches - when the young pharmacist gave them to me, I asked how to use them, because the GP hadn't given any specifics. She told me not to put them anywhere they might get rubbed off - like by your bra strap - but outer arm would be fine

I need to do something about this, from an education perspective if nothing else, don't I? [/quote]
Sigh. Did she think they were nicotine patches?

I had a ridiculous situation in the chemist today, not HRT related other than I was picking up the prescription.

There was a hand cream on the shelf said it was for eczema, psoriasis etc. I get a nasty rash on my hands that nothing so far has cured (including prescribed cream) so I had a look at this.

First thing - on the pack it says "prescription", so why is it on the shelf?
Second thing - I read the ingredients and couldn't work out how it was different to any old hand cream. Also it has dimethicone in which I know I'm not fond of.

So I asked - is this prescription only, and what is the active ingredient. They had no more idea than I did. She just said urea was the active ingredient because it was the second ingredient after aqua. Well, that's a pretty normal ingredient for hand and foot cream so why it's purporting to be for psoriasis I have no idea.
And she said it's not a prescription product - so why does it literally say prescription on the box?
It took her about ten minutes to look all this up and I got bored of the idea by the time she had done it, and got no additional information from her.

Yet we're supposed to go to the chemist as our first port of call for issues. That chemist sold me calamine for this rash on my hand when it started two years ago. It made it worse.

Another one confidently declared it was ring worm and sold me anti fungal. It clearly wasn't and I'd already tried anti fungal but she told me this was a "better" one for ringworm (it might be, but I obviously didn't have ringworm).
I feel more bloody knowledgeable than they are!

Hi @WombatChocolate. I agree the standard of care is low, I think because they are so rushed (and often totally demolished). You should expect and receive more - and you are paying for it through your taxes/NI! Thank goodness you were clued up and knew what to ask for. I had been disappointed with my experience too. I’m (thankfully) hardly ever at the doctors, so when they were running blood tests to check if I was peri or had other issues, I was disappointed that a cholesterol check wasn’t included and asked why not. The nurse told me ‘you only needs to get your cholesterol tested once’. She didn’t move from this position even when I pointed out that it had been taken 8 years ago! I was gobsmacked , (not least cause my appointment was at 2pm and I’d fasted since the night before for it!)

@VanGoghsDog. I daren’t ask them anything at our pharmacy, as the assistant talks in such a loud voice it’s as if she’s on stage. Mortifying! You should definitely say something about the patch advice. Is so clear from the instructions it’s not to go anywhere near the upper body/chest that her advice to you is horrifying.

Nice to find this. I'm in my 2nd week of patches, will be putting my first combined patch on on Sunday. Similar to the rest of you, weight gain (though I was always fat to be fair!), anxiety, horrible irregular clotty periods (which - to show that god has a sense of humour - have only come when I'm staying at my MIL's house for the last 2 years!). Dripping with sweat at night. And the rages! I nearly threw my fave mug across the kitchen one morning when the coffee machine was out of water. And I'm very attached to that mug! Was driving my poor dh up the wall.

I've had a couple of hormonal issues in the past, migraines and kidney stones, but gp agreed that hrt was worth a go, and my dh - Who is also a GP - was all for it.

Too early to tell how it's going so far, and I suspect that any general health issues will show up when I add in the progesterone, and possibly not in the first month. But it's got to be worth a go!

Also in Scotland (check username!).

I did my first vaginal estrogen last night. I did it wrong and got it everywhere. Bit idiotic of me really, but I put my finger on the end of the plunger to insert it, which obviously meant the plunger went in and the product exited but it wasn't actually in, so it was all at the opening instead of up inside.

Another go tonight.

Doctor did say to use it every day for two weeks to start with, plus apply some to the labia (I am a bit sore there) and then go down to three times a week but to basically use it as much as I feel the need and ignore the warnings in the leaflet.

I've currently also got very sore piles and fissures (I'm trying to diet which tends to mean I eat more protein which bungs things up, though I do eat plenty of fruit and veg too) and so I'm sticking thing up both orifices now, best just make sure I don't muddle them up!

Poor you @VanGoghsDog. that all sounds a bit of a faff downstairs. I hope it actually works and you managed to get everything in the correct erm…place tonight!
Welcome to @weegiemum. You are doing better than me. I’ve had such rage I wouldn’t trust myself to go and stay at MILs. I thought I was going to commit a murder at Christmas when she was here on my turf! I’m on week three and so first week of combined patch. No side effects so far.
That’s great your DH is a GP. You will be sorry you shared that info. Will try and keep questions to a minimum…lol.

@RosieSun

Hi *@Whattochoosenow*. That’s great you are feeling much better. Long may it continue! Would you mind me asking what symptoms have been improved/relieved?

It sorted out my hot flushes, night sweats, insomnia mainly. Im not so uptight and I don’t have so much brain fog but I wonder if that’s because I,’m sleeping better. I have gained weight, but that was on an upward slide anyway. I just need to come to terms with eating less for the rest of my life .

@Whattochoosenow. That’s great you are able to get a better night’s sleep. I have the weight issues too. I gained about 20lb very quickly and thought it was because I went from part to full-time work and I just wasn’t as active. It was only when I looked back i realized lots of my peri-menopausal symptoms started then too (I thought they were just due to the job being bloody stressful, and me drinking wine too often.) Also the weight is largely round my middle. I’ve just started going to a diet club but it’s hard. I pretty much gain weight if I ever go over 1600 cals a day, so reducing this enough to actually lose weight is brutal!

Hello all, I'm so glad to have found this thread. I'm 45 and have fairly regular periods, although my cycle has shortened to 3 weeks since I was about 42ish. I was freaking myself out for a while thinking I might have early onset dementia so reading about brain fog has been an incredible light bulb moment for me!

Another unwelcome addition in my 40s has been absolutely crippling menstrual migraines, and my pelvic floor (which was already pretty dodgy thanks to my birth experiences) is worse than ever. Not helped by the fact that I've recently taken up running again, but then again it's the only exercise I know I can stick to so I suppose the benefits outweigh the downsides. I also feel exceptionally tired at certain times of my cycle.

Anyway, you've all given me the motivation I need to start to explore hrt and get in touch with the Gp.

@GinF1zz the thing that hugely helped my headaches was therapeutic massage. I’ve now decided to go every month as a maintenance thing. I had masses of tension in my neck and having it worked on brought such relief.
Also I self referred to womens health physio. I though I was doing my pelvic floor exercises properly but in reality I was nowhere near it. The physio was lovely and she said if only more women sought help at an earlier age they could delay the need for surgery.

The estrogen seems to have cured my migraines.

Thanks, @Whattochoosenow and @vangoghsdog, that's good to know.

Interesting re the women's physio - I had that thought the other day. I saw a lady when youngest DD was a baby and it occurred to me that I could ask for a referral again now. I've worked really hard over the past few months on pf exercises to no avail, so probably need the help of a professional if only just to tell me what I'm doing wrong.

@GinF1zz you can self refer without seeing your GP

Recently I was prescribed Ovestin by GP for a very painful dry vagina as over the counter products no longer worked. To my horror I have put on weight, my breasts ache and at times I feel like I'm pregnant. I have developed Psoriasis in the vagina so I have to stay with the Ovestin. I'm trying to make an appointment with a gynaecologist but most have very long waiting lists. It would be helpful to hear from others experiencing similar problems.

@MHB5

Recently I was prescribed Ovestin by GP for a very painful dry vagina as over the counter products no longer worked. To my horror I have put on weight, my breasts ache and at times I feel like I'm pregnant. I have developed Psoriasis in the vagina so I have to stay with the Ovestin. I'm trying to make an appointment with a gynaecologist but most have very long waiting lists. It would be helpful to hear from others experiencing similar problems.

How long have you been using it? I'm on my fourth day.

Are you taking other HRT as well, or just that?

@VanGoghsDog
Thank you for comment. My problem began with the Psoriasis in the vagina hence prescribed Ovestin which does bring relief but I didn't expect to feet pregnant at my age! However I'm grateful for relief. It is the Psoriasis that cause the chief difficulty / pain. I didn't realise how lucky I was in the past.
Hope things work out for you.

@MHB5 it sounds awful but I've never heard of psoriasis in the vagina.
Do you have it elsewhere on your body?
Who diagnosed you with it there?

By the way @MHB5, it won't be the Ovestin that is causing your other symptoms. It's only absorbed in the vagina. To put it into perspective, if you used it twice a week for a whole year, the estrogen used is equivalent to ONE estrogen tablet ( 1 milligram), which is a low daily dose of HRT.

Your weight gain and other symptoms are probably part of the whole peri menopause thing.

When you say your vagina is dry, has your Dr told you it's psoriasis? Have they examined you and found what they think is psoriasis?
Or are they just calling dryness 'psoriasis'?

Normally, this would be diagnosed by a consultant either a dermatologist (many deal with skin issues of the vulva) or a gynaecologist.

Thank you for your helpful cmments. I too had never heard of Psoriasis in the vagina ! A dermatologist made the diagnosis. I have a twice Yearly check up for skin cancer. I have Psoriasis on my arms and legs but it is manageable. Dryness in the vagina has been a problem during the menopause and post menopause and I have used over the counter treatments. The last one was Silk from Booths which worked fine for couple of years. I have MS and I suspect the problem may be autoimmune. Now I must go for physio. Where I live long waiting list for gynaecologist. Trying to go privately but also long waiting list. Such a comfort to find you girls !