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.)

MHB5
I have a rare skin condition that my vulva and vagina can be affected by. I was so bad at one stage that 2 GP' hadn't a clue what to do with me and prescribed steroid creams. I eventually saw a 3rd GP in a walk in clinic that was very understanding. She said it was the worst case she had seen. I could barely walk with it. She threw everything at it. Flagyl for bacterial vaginosis, Diflucan 150mg (3) one taken every 72 hrs for yeast infection, fluoxacillan for bacterial infection, canesten hc topically and dermovate ointment on top. Wash with something like silcocks base as it cleans and moisturisers. I'm not normally a fan of silcocks base but it worked for this problem.

Within days it was better. My problem never gets as bad since. I sweat a lot and it's crucial to stay dry down there and keep it clean. Sylk is great for just moisturising without to much moisture. I have started HRT pessaries which hopefully will help as well. The 3rd GP did mention going on HRT but as she was just in a walk in clinic advised me to discuss that with my GP. She said taking HRT can help with a lot of vaginal problems.

Sorry that was for MHB5

@Theblacksheepandme

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.

Doesn't the gel go on your thigh? Mine does.

I've got a coil, six years old. I can keep it to age 56 (8 years) for contraception. But yes, the progesterone is gone so no good for the estrogen offset, hence Ultragestan. I don't know about it being four years old. Ask them to point you to the section in the Nice guidelines they are using.

Sorry I should have mentioned that I'm in Ireland. The instructions in the HRT Gel states upper outside of arm but it does state thigh as well. I went with arm.

Well, you could read the Nice guidelines anyway, they'll give you a good understanding of how it works.

Annoying when you get two different reviews.

@Theblacksheepandme

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.

Okay here goes....

The Mirena is valid for 4 years as part of HRT. After that it needs changing. So the dr in the meno clinic is correct. Until itis changed you need to use Utrogestan. But don't use both when you fet your Mirena.

The gel is applied to either your upper arm or your thigh.

The vaginal pessary is not actually HRT, it's local, topical estrogen. I assume it's Vagifem? That's the UK version.

@VanGoghsDog Where to apply gel- all of this is on the massive leaflet in the pack .

@VanGoghsDog

Well, you could read the Nice guidelines anyway, they'll give you a good understanding of how it works.

Annoying when you get two different reviews.

NICE doesn't actually tell women how to use each type of HRT. It's general prescribing guidance only.

It's quite simple to search 'Mirena, part of HRT'

www.swbh.nhs.uk/wp-content/uploads/2012/06/Hormone-replacement-therapy-ML36061.pdf

Unfortunately, there is also a doc called GP Notebook which states it can be used for 5 years, but the majority of guidance says 4.

Thanks so much JinglingHellsBells and yes it's an estrogen pessary called Imvaggis. My mistake for saying HRT. It is the same as Vagifem but without an applicator. I completely know what I need to do now. I left the second GP's surgery completely stressed as now I need to find a GP that will replace my Mirena. I have an appointment with another GP next Friday to discuss this.

Where to apply gel- all of this is on the massive leaflet in the pack

I know where my gel goes thank you, it very clearly states outer thigh, so I was just checking for the poster.

And the Nice guidelines do cover the use of the merina coil for four or five years, here:

cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/#route-of-administration

[quote VanGoghsDog]Where to apply gel- all of this is on the massive leaflet in the pack

I know where my gel goes thank you, it very clearly states outer thigh, so I was just checking for the poster.

And the Nice guidelines do cover the use of the merina coil for four or five years, here:

cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/#route-of-administration[/quote]
Ah! You are using Sandrena!

There is also Oestrogel. (I use it.) No sachets. Big bottle.
Huge leaflet in box with instructions (it's a bit like a novel.)

The link you left is for clinicians, it's not the same as the one pinned on the forum.

Yes, so you agree I didn't post anything wrong. I just asked so the op checked.

And it doesn't matter who the guidelines are for, they are there, we can read them.

I'd quite like it if you stopped jumping down my throat please.

VanGoghsDog
Crikey VanGoghsDog I really think JinglingHellsBells was only being helpful. In all fairness what you gave me as a link was not clear at all. It was still confusing in relation to saying 4 yrs and 5 yrs. The link JinglingHellsBells gave was completely clear and said 4yrs which is what the meno specialist said. I also didn't give the name of the HRT gel I was using and you assumed it was used in the same way as your one which is the thigh. My HRT gel can be used in a number of places. Also I wasn't asking how I use my HRT gel as there was a huge leaflet with instructions. My question was - Is the Mirena 4 or 5 Years and do I take everything all at once which JinglingHellsBells answered. I am grateful for your help but there is no need to be getting cross with JinglingHellsBells.

Hi folks, evening. This thread has been successful helping a lot of women for 5 weeks now, which is fabulous. It’s about us helping each other and pitching in with useful advice and our time.
It would be great if we were all in a room with nice cake n coffee, we could pick up on people’s tone, body language, facial expressions. It’s not always easy communicating to our best anonymously over keyboards with busy days behind us. But we are here to help each other.

Love to all on wet windy night while we rage against our hormones!

Also….. @ChocolateHelps still has an issue on how to tweak her HRT to get better sleep.(I’d be interested to hear this too). @JinglingHellsBells and @VanGoghsDog and all others, sound advice would be very much appreciated. We are all girls together in this ❤️.

@RosieSun

Hi folks, evening. This thread has been successful helping a lot of women for 5 weeks now, which is fabulous. It’s about us helping each other and pitching in with useful advice and our time. It would be great if we were all in a room with nice cake n coffee, we could pick up on people’s tone, body language, facial expressions. It’s not always easy communicating to our best anonymously over keyboards with busy days behind us. But we are here to help each other. Love to all on wet windy night while we rage against our hormones!

Also….. @ChocolateHelps still has an issue on how to tweak her HRT to get better sleep.(I’d be interested to hear this too). @JinglingHellsBells and @VanGoghsDog and all others, sound advice would be very much appreciated. We are all girls together in this ❤️.

Thank you!!

Yes please, any advice / info on possible options when I speak to GP on Tuesday morning would be great

@ChocolateHelps hi! The most obvious thing that comes to mind is your estrogen dose is too low. After 3 months your body may have got used to it and it's helped a bit, but you need more!

what dose patch are you on? And it is JUST estrogen isn't it? (Your dr hasn't given you a combined one by mistake?)

Estrogen only patches come in 25, 37, 50 , 75 and 100mcgs depending on brand.

Have a look at this list here- scroll down to NON TABLET

www.menopausematters.co.uk/treatafter.php

[quote JinglingHellsBells]@ChocolateHelps hi! The most obvious thing that comes to mind is your estrogen dose is too low. After 3 months your body may have got used to it and it's helped a bit, but you need more!

what dose patch are you on? And it is JUST estrogen isn't it? (Your dr hasn't given you a combined one by mistake?)

Estrogen only patches come in 25, 37, 50 , 75 and 100mcgs depending on brand.

Have a look at this list here- scroll down to NON TABLET

www.menopausematters.co.uk/treatafter.php[/quote]
Thank you!

I'm on 50. Had the mixed pack to start with (half e only then e&p) but moved to utrogestan tablets after just one month of the e&p patches as felt terrible with PMT and the tablets have been much better

A friend takes the utrogestan every day, just the one tablet, instead of 2 tablets for 12 days. Any thoughts?

I'll make sure to ask GP about dose of e being enough. Thank you

A friend takes the utrogestan every day, just the one tablet, instead of 2 tablets for 12 days. Any thoughts?

@ChocolateHelps I assume your friend is post menopause (no periods for at least 12 months) as she is on the continuous regime, not sequential. Continuous is also called the 'no bleed ' type (no withdrawal bleed each month.)

The only reason to use progesterone is to stop the womb lining growing too much when using estrogen. Using 1 capsule daily will control this in women who have little estrogen of their own (post meno) and who are aren't having natural cycles.

If you are having periods now and then, you may find that 100mgs Utrogestan daily isn't enough to offset the estrogen in HRT and your own estrogen. So you might get a period at odd times on it.

You also might not feel great on it daily. I didn't but some women are fine and like the way it can help them sleep better.

I've been applying Oestrogel to my inner thigh for a couple of years now.

Is that wrong?

Upthread someone said it goes on the outer thigh.

Better go & read the instructions!

@Tulipomania

I've been applying Oestrogel to my inner thigh for a couple of years now.

Is that wrong?

Upthread someone said it goes on the outer thigh.

Better go & read the instructions!

It's inner thighs. It's absorbed by fat and outer thigh tends to be more muscle.

Thank you Jingling

I have been on Divigel HRT, Imvaggis estrogen pessary and Ultrogestan just over a week. I am waiting to get my Mirena replaced as it is over 4 years. Anyway I started getting really bad period cramps today. I have not had period cramps since I was a teenager. Even then they have never been this bad. Is this normal? I have no bleeding and I haven't had a period in 9 years because of the Mirena. I am bent over with cramps.

Hi Blacksheep - you have my sympathies on the cramps.

I'm just coming to the 4th patch in my second pack of Evorel Sequi.

I had only very light random periods before starting HRT... last one was around 3-4 months prior.

The withdrawal bleed started immediately at the start of week 1 of this pack and I too had not had cramps as bad in years.

I also found out that my moon cup no longer fits and it leaks so it was back to the inconvenience of pads as that was what my DD had left in her room (she's away at Uni). I'm guessing the fit issues are due to some degree of atrophy so that's in my list of things to discuss at my review.

If you take the utrogestan vagi ally look at what dose you need - the normal does taken orally will take into account that the tablet needs to go through your digestive system first.

So a month later (after blood tests and waiting for an appointment) I finally have a prescription in my hand but can I get Oestrogel...nooooooo! Been to 7 Boots and 3 private pharmacies, all out of stock with no delivery date. All is not lost, a Boots in Central London has finally called back and has last two boxes which I can pick up tomorrow.....phew!

GP has put me on Utrogestan 100mg, one to be taken daily on days 1-25 of cycle. I am peri, does this seem right? I know there are two options so maybe she's just picked one.
Also, do I wait until period has ended and then start HRT?

Any help would be really appreciated as I am very confused.

@RosieSun How are you getting on?

Hello everyone. How are folk on HRT (or not!) doing?

Hi @PeriPeri11. That’s good news you have your prescription at last and well done on your perseverance checking out so many chemists!! Hopefully someone knowledgeable will reply to you soon, but I thought people in peri usually only got the progesterone dose in the second half of a 4 week cycle?

I’m doing ok thanks. I actually emailed the GP surgery today to get my next prescription lined up. I’m nearly 3 months into the evorel sequi 50. It’s helped my but not as much as I thought it might. I should perhaps have more patience and try another 3 months. What I’ve done is ask the GP in my letter (if anyone reads it!) for a higher dose of estrogen, by extra patches, or preferably by gel and utrogestan. I don’t think I will get that in this NHS area but no harm trying.
I’m still pretty anxious (eg. got stressed out over nothing and burst into tears in the office this week 😳 ).
The one thing I don’t want is them giving me a 6 month+ prescription of the same.
It may be petty and ungrateful, but I’m also fed up with the practical application of the patches and would much prefer to try gel: It’s very hard getting the gluey lint squares off the skin; I bathe a lot and so put them on front of my thighs which is unsightly; They often give me a red rash. It’s not painful just unsightly, so perhaps I should just put up!

I don’t know if my expectations are just too high, but in the past 6 months I’ve given up alcohol, started HRT, finally lost 10lbs and am eating more healthily. I thought I’d feel like superwoman, but often I feel I am just a slightly less stiff, slightly less grumpy me 😞.

Be sure to let us know how you get on with your HRT, good of bad (hoping for good for you!)
If anyone else is still about it would be great to hear how your HRT is going?!