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.)

There have been days I felt I couldn't go on because of the pain. My GP told me she didn't know what to do. Steroids help but I can only use them for five days. Electon I use on the plaques. Most of the time I have to endure the pain. Lack of access to a gynaecologist is something I can't do anything about.

I was going to suggest a dermatologist but you've seen one

I agree the Ovestin would not be causing those symptoms. But I'm also not sure Ovestin is intended to, or likely to, treat psoriasis.

Lube (such as "Silk") is not a treatment. It's just a facilitator really. It's good that it helped but it has no active ingredients. And, as such, probably OK to use it as well as Ovestin. But check with GP.

I'm sorry this is so bad for you, it sounds awful and yes, at least the Ovestin should be preventing any further problems caused by the lower estrogen, but it's not going to treat the psoriasis, only relieve symptoms by a happy side effect of the general emollient action I should think.

I'd be pushing for a new derm appointment really.

@MHB5

There have been days I felt I couldn't go on because of the pain. My GP told me she didn't know what to do. Steroids help but I can only use them for five days. Electon I use on the plaques. Most of the time I have to endure the pain. Lack of access to a gynaecologist is something I can't do anything about.

@MHB5 I'm not an expert on this although I have had some skin conditions myself and so have my family. I did find this link that might help. www.psoriasis-association.org.uk/sensitive-areas?gclid=EAIaIQobChMInaza_qTN9QIVj-3tCh2BWAmzEAAYASAAEgKqTfD_BwE

You may not want to say, but I'm wondering if the psoriasis in on your vulva, not inside your vagina. Did you mean it was externally on your labia?

I have always understood that steroids can be used more than for 5 days as women with lichen sclerosis use them for much longer.

Depending where you are in the UK, it's usually possible to see a gynae privately within around 4 weeks, unless they are really very busy!

Also, depending on where you are in the UK, the best vulva specialist is Prof Wendy Reid who works in the NHS in north London. She also works privately, although she has taken on another role and I'm not sure of how available she is. Your GP can enquire for you if the location was possible for you, or she also has contact details for her private work (if they are up to date.)

It might be worth accessing support groups of psoriasis for more help.

Hi folks, do u mind if I join this discussion? I’m 47, been 2 years since last period, started evorel sequi patches today…..really hoping to feel an improvement soon… trying not to expect too much, but hope it is the answer I’ve been searching for….when should I expect to feel a difference, if at all? Xxxx. Nice to ‘meet’ you all, xxxx

@JinglingHellsBells, Many Thanks for your helpful post. I have to confess to you I'm not familiar with the names of that particular area !

I'm a grandmother who has been lucky with health mostly apart from MS. I live in Southern Ireland now but my husband who is English and I married and had our family whilst living in England. We had many happy years there before coming to live in Ireland for work reasons. This is the first time I have had a major problem. Due to Covid accessing a GP in the area we live is difficult . Because of skin cancer I saw my dermatologist who looked at the area. He prescribed Ovestin which does help but as I have a breast condition I hope it is safe. My breast Consultant died n May so next I have to find someone to look after that condition. GPs are very busy here right now. The Irish medical system is quite dfferent to Britain 's. One has to take responsibility one self for one.'s health unless one has a very helpful GP. I had up to last year when my GP retired . The worst part of my condition is the pain. There appears to be a shortage of gynaecologists
here. Just to make contact with others is helpful. Many thanks for taking time to write.

Welcome to the thread! @GinF1zz. Yes knowledge is power in the murky seas of meno! Do read all you can before your GP appointment so you are well prepared. Welcome too @MHB5 & @Goodlassie1
MHB5 I really feel for you. It sounds like you are suffering terribly with your skin condition and I really hope the advice so far gets you closer to effective treatment.

@Goodlassie. Great you are started on patches. I’m on week 4 now and I’m having more good days now I feel, things are improving. I am feeling a bit more positive and optimistic about life and not constantly wishing for a duvet day. I notice with little things, like I’m bothering to put on makeup and not dreading visiting people. I also feel certain my achey bones and sore lower back are improving. (I’m popping fewer paracetamol).
I am still getting days where my nerves are bad, I’m anxious and don’t sleep well. It’s as if it goes in waves of negative meno symptoms and the patches help with little ones but not the big breakers. The good thing is I’m on the combined bit of the cycle now and have no negative side effects. So, things are improving but not instant or mind blowing.

@VanGoghsDo

[quote MHB5]@VanGoghsDo[/quote]
This is useful to show what all the bits are called. What the medical stuff, it helps to be precise.

You don't need to tell us, but just for your own knowledge.

@VanGoghsDog
Thank you for your encouraging words. It is strange that having shared my problem somehow I feel less stressed. Then my GP phoned this evening to say she is putting me on a course of fungicide called Fluconazole followed by Canesten. I had to travel to another part of the country - two and a half hours away (my home town) to get an appointment. The GP is kind and that too helps. This is the fifth month of what I call The Agony. Compared to many I have been fortunate being able to manage health but this time the pain seemed to numb my brain and I could barely function. I appreciate your kind help. Many thanks.

[quote MHB5]@VanGoghsDog
Thank you for your encouraging words. It is strange that having shared my problem somehow I feel less stressed. Then my GP phoned this evening to say she is putting me on a course of fungicide called Fluconazole followed by Canesten. I had to travel to another part of the country - two and a half hours away (my home town) to get an appointment. The GP is kind and that too helps. This is the fifth month of what I call The Agony. Compared to many I have been fortunate being able to manage health but this time the pain seemed to numb my brain and I could barely function. I appreciate your kind help. Many thanks.[/quote]
I don't know how much you pay there but Fluconazole can be bought over the counter here, and online it's really cheap. I guess it depends how many she prescribes.

It's the active ingredient in Canestan tablet anyway. So maybe she means tablet and cream.

www.chemist-4-u.com/fluconazole-thrush-relief-150mg-single-dose-capsule-trio-pack-p?gclid=CjwKCAiA3L6PBhBvEiwAINlJ9DKAdl1kzjF6n6XQ-om977rq-JUZC5kHP1AAcIWoqsJ9MlY5zz321BoCqZcQAvD_BwE

@VanGoghsDog
You are kind to educate me (It is never too late.) on basic physiology.
I do appreciate it. I saw my dermatologist last August for my skin (skin cancer) check up. He told me I had Psoriasis in the area. He prescribed Steroids for five days and Elocon cream . All was well for a couple of weeks and then it came back. In October my GP put me on another course of steroids and all was well again for a week until the infection returned. Now there was an odour too which I had up to a few days ago.

The GP told me she had never seen a Vagina as inflamed as mine. I found this comforting as One wonders if one’s pain threshold is low. Last week a swab was taken and that showed I have an infection also.
There is a very long waiting list here to see a gynaecologist.(Privately) My GP wrote to eight and no response. Remember here we pay for everything and a visit costs up to € 200 plus. The GP has prescribed a course of Fluconazole. My immune system has never been very good. As a child I has Polio but managing MS is easy compared to this infection. Prior to this I never had a problem. Finally I don’t want to keep whinging about my problem but I do appreciate your kindness and others who have made helpful comments. I may miss some comments as my vision is dodgy due to MS. It breaks the isolation that pain creates. Please accept my appreciation.

The odor could be BV, in the UK you can buy tests kits for that over the counter. Might be worth checking, it's a really easy fix though the antibiotics for it are a bit heavy and would probably give you thrush (catch 22!)

Anyway, I've had that a few times.

I'm on some anti fungals at the moment for a toenail fungus, have to have liver function tests throughout the course 🙄

I really feel for you, hope the new regime sorts it out.

Popping back to see how you are doing @RosieSun?

I've had a pretty crappy week compared to previous ones. Have the mother of all periods, not had once since end Oct so not surprising. But awful stomach cramps and my god I just wanted to chop my boobs off they have been so swollen and tender.

My mood has bee quite low as well, I could not summon any enthusiasm for work for most of this week and have felt really anxious.

Patch change day today so we will see what they brings.

My estrogen increase started yesterday and I have had a two day headache. More or less gone now, so hopefully won't come back.

It's a bit harder to rub in because there's more of it.

Just another mini rant about the stupid 28 day estrogen packs. GP orders 84 because it's 28*3. Last time I got three packs of 28. This time, I got one big box. A box of 91. Which is three actual real months. Yay!
Except the bloody pharmacist took out seven to make it 84!

I mean, I know they have to because 84 were ordered, but why can't my GP order the box of 91? And what the hell is the chemist going to do with seven loose estrogen gel sachets??

Hi @IDidntFloatUpTheLaganInABubble. Sorry I forgot to check thread yesterday and didn’t see notification as I am usually logged in under my other username (that wasn’t well thought out!)
I’m sorry to hear you have had a bad week. Hormones are the devil. Do you think you might ask for a stronger HRT dose next time?
I’m doing quite well. HRT is lessoning symptoms. I am on the mini pill too still so I don’t usually get any periods. When I came off them this time last year, I had nothing for 4 months and then the worst period of my life. Yikes @VanGoghsDog. I get you, but I had a wee chuckle at you wondering where all the spare sachets go too!
Have a good day.

Long time lurker...I spoke to my GP this morning and she was really helpful. Explained my symptoms and she is very willing to get me on gel and tablets as soon as I have blood tests, BP check and weight recorded. It was a phone consultation hence taking a week for tests etc.
Hopefully in a week I'll get the medication.

The Nice guidelines say you do not need blood tests, why does the GP say you need a test? What is being tested for?

@VanGoghsDog She wanted to test for cholesterol and blood sugar. Purely because I haven't had them checked for a long time.

[quote PeriPeri11]@VanGoghsDog She wanted to test for cholesterol and blood sugar. Purely because I haven't had them checked for a long time.[/quote]
Ah, OK, well I guess that's a separate thing and doesn't impact on HRT.

Welcome @PeriPeri11. Best of luck for your tests and consultation. My blood pressure and cholesterol were fine and they gave me patches. I know they tested me for other things but frustratingly they didn’t tell me and everything is so rushed I didn’t like to press for a list. I didn’t even get a cholesterol breakdown, just the overall (when I finally got my cholesterol test..lol).

Do you know what kind of HRT you are hoping to try?

@RosieSun Thank you for your warm welcome. GP mentioned patches and tablets, I had read this thread and suggested gel plus micronised progesterone and she agreed. Shall update once I have them.

@PeriPeri11. That’s great, you are getting the A1 stuff!! That’s what I was hoping for but the GP said I needed to have something combined, not gel, and so I got confused and flustered and came away with the patches instead. I was just so pleased not to be given pills as I was worried I’d get nausea! Do let us all know how you get on with it.

I'm on month 3 of patches and progesterone tablets. The combined patches gave me awful pmt and sore boobs. GP agreed to change to utrogestan straight away.

Sleep is my major problem. I'm tracking it and it seems I get better quality sleep when on the utrogestan. But that's only 12 days. And then the few days after being on patches only my sleep is awful. I had to cancel meetings and go back to bed today. Was not safe to drive. I have a phone appointment with GP on Tuesday (I book the appointment pre-emptively as they are at least 3 weeks wait to get the same GP (who is brilliant)

Can anyone suggest the possible tweaks to HRT to get better sleep? I'm 49 and peri for at least 4 years. Anxiety is better, except for the few days straight after the utrogestan has finished. On the days when I have slept I feel I could conquer the world...no sleep and I want to give up on everything. I feel very bleak.

You can take Ultragestan for up to fourteen days, so that's two extra days of sleep! (Or nights)

I put mine down as it makes my skin bad. But my twelve days ended a week ago and I have eleven spots. And I'm having a sort of grungy mucky brown spotting period having not had anything since July. And I had a migraine Sat and Sun. I'm hoping this is actually a reaction to the higher estrogen dose, which will settle down and not be my life for ever on HRT.
I hate being so spotty at 53 :(

I had a video call with a private menopause clinic as my GP was useless. I'm 46 and reckon I have been perimenopausal for a number of years. I have been prescribed HRT gel and HRT vaginal pessaries. I have the Mirena coil but the GP in the clinic said as it is 4 years old to go and get a new one.

The clinic is not near me to for them to do it. My GP said they don't fit the Mirena. I finally found a GP that does it and she won't fit a new one. She said it is good for 5 years. The GP in the specialist clinic said after 4 years I wouldn't be getting enough progesterone while on HRT. The second GP disagreed with her and arrogantly told me she was an expert on menopause.

I rang the clinic back and they gave me a prescription for utrogestan 200mg. They told me to take this and use the HRT Gel and HRT Pessary. I am to do this until I get my existing Mirena out and a new one fitted.

Is the second doctor wrong? I think she is as I have been trying to get information and it does say 4 years. The doctor in the specialist clinic also came across like she really knew her stuff. Also I took the Utrogestan orally, put the HRT vaginal pessary in and rubbed the HRT gel on my arm last night for the first time. Am I right doing all of that nightly until I get a new Mirena fitted? I forgot to ask the doctor if I take the Utrogestan every night. The pessaries are for 3 weeks every night and then 2 nights a week. The pessaries are called Imvaggis.