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.)

Hi @RosieSun - good to hear from you.

I have a review appt booked for tomorrow as I'm now half way through my 3rd pack of Sequi.

Had a few issues with the Conti patches not sticking as well as the oestrogen only ones, and that led to a bleed much earlier in my last pack rather than at the start of this one.

Overall I'd say they are helping but I think I need more oestrogen as still have symptoms a lot of the time. But there have been no negative side effects for me so far.

I've also been suffering with hamstring/glutes tendinopathy for a while and it's got better since hrt but not fully resolved . I found a scientific article about a possible link of tendiopathy and peri so I want to discuss that with the Gp too.

So fingers crossed that I can have a good discussion and get a new prescription including either higher strength patches or a gel top up.

Quick question anybody....

Gp appt today, Gp said she'd prescribe some stronger patches but then text me back to say use 2 x current patches instead... is this ok?

Evorel Sequi so that would mean 100mg estrogen for 2 weeks and then 2x Conti patches as well... so Doubling up progesterone as well....?

Update - called my surgery as it was bugging me and Gp says absolutely fine as minimal dose of progesterone...

Will give it a try and see...

Hi, may I join please? I had an appointment with my GP a few months ago and had 'the chat' about HRT. As a fellow woman of 'a certain age', she is very open to it, so that is great. She also did my bloods to make sure no other causes of bone-tiredness.

I wanted to go and think about things before going ahead, as I didn't get on with the pill years ago.

It's now come to the time to go back to her and ask for HRT. My tiredness hasn't been too bad lately, my insomnia manageable. My periods are getting more widely spaced (70 days, after going down to 21, and now about 30 but really light). I think (from my family's reaction) that my temper is getting worse. I accepted that my libido disappeared years ago. The kicker for me is that my hair is thinning so quickly. It's like frigging autumn on the top of my head, and I'm terrified I'm going to end up looking like Andy Pipkin from Little Britain.

So... what would be your HRT suggestions for me to ask my GP for? My boobs are already ginormous, and do get tender before periods, and I'm prone to hormonal spots in the run-up to my period. Is there some combination of HRT in particular I should be asking for in order to minimise these effects? (I also don't want to put on weight, but maybe that's too much to ask!)

Sorry for the essay. Any pointers that you could give me would be gratefully received.

Hi @putthehamsterbackinitscage. Sorry I missed your posts as I’m rarely logged into this account to get the notifications-doh!! Weirdly I’m just seen it tonight as I’m in the same position and actually started a thread asking if anyone upped doses on the patch! What are the chances of all that! How are you doing , have you started your double dose yet?

Welcome @Ringsender2. Sorry I don’t have the answer for you. I think people just vary widely in how the react to different HRT. I’m in combined patches, and whilst they aren’t working a miracle I’m better than I was and I don’t have any negative side effects which I’m very relieved about.

Well. I had my telephone GP appointment and all went well. GP immediately agreed it seemed reasonable to up my estrogen dose. I’m being moved from Evorel Sequi 50 to Evorel 75. With separate progesterone, and I’m sure she said Utrogestan !! I’m stunned as it’s not approved in Scotland and difficult to get. I hope it’s not a mistake. My prescription will be ready in a few days and I will report back then.

That sounds like an excellent result @RosieSun ... fingers crossed it is utrogestan as Ned the increased dose works for you.

I picked up my new supplies yesterday so am now on Evorel Sequi plus an extra Evorel 50 patch alongside ...

Will see how that goes - sleep is still hit and miss but I'm hoping that will improve further and similarly brain fog ... the number of times I cannot remember something but then eventually I do, plus totally inability to focus/concentrate for longer periods.

I do think I have less rage now - DH and DS haven't said anything so that's a positive, and the aches n pains that I put down to running injuries have improved since starting HRT.

I have been on HRT for 6 weeks now. My husband asked me tonight when it will start working. That just said it all for me. The rage is still as bad and so is my anxiety. So far I don't see any improvement. I never had a problem with sleep and now since taking HRT it is quite poor. My skin is very itchy also since starting HRT. I am on Divigel and I have a Mirena fitted. I had to stop the Imvaggis estrogen pessaries for a while as my vulva and vagina became very sore. I had swabs pre Mirena fitting and they came back with a staph infection. I was on 2 weeks antibiotics for that. It is back to normal now and I have started using the pessaries again. I'm hoping they aren't the cause of the irritation. I started using Multi Gyn Actigel in the mornings and find that helps. I read somewhere on Mumsnet about this and find it really good. I also started taking probiotics specifically for vaginal health. I have my Menopause Clinic review around Easter so I'll see what the doctor says.

Hi.... I was taken off Kliovance ,( been on them for about 6yrs ! Brilliant !..)
Went into hospital with gall stone pain & Dr there said not to take them, sent home & had OP to remove gall bladder last month , so off HRT for 5 months & been awful ! ... My GP said to try patches , as get absorbed through blood stream rather than put a strain on the liver now gall bladder gone !...
But not working after 6 weeks, leg cramps , aching , hot flushes etc etc , so bottom line , anyone on oral HRT without a gall bladder ??
Thanks

Thanks @putthehamsterbackinitscage. Good luck on the double dose! I have some improvement with rage but anxiety still an issue. My joint and especially lower back pain is much improved on HRT.
Welcome @Theblacksheepandme. My goodness your DH needs to be kinder - it sounds like you’ve been through an awful time. Perhaps if you are not improving they will change your HRT at your review. You have my sympathies. I’ve thankfully not had issues down below to date, but it all sounds very upsetting and debilitating.
Hi @Bev00. Sorry I have no experience of this to advise you, but hopefully someone else might have advice, or you could try starting a thread with it in the title to pique interest. 😊

Thankyou , appointment with GP near impossible, even a phone appointment ! Popped into local chemist, pharmacist brilliant, more knowledgeable than GP , so OK to go back on oral !! Brilliant!!.... x

Thanks RosieSun for the kind words. My husband is actually very good to be honest. I had a dreadful time getting my Mirena replaced the other week and he made a real fuss of me afterwards. Sorry to hear your anxiety is still a problem. It can be so delibating at times. It's good to hear there is an improvement with your joints and rage. Sometimes my rage goes completely nuclear. It will be interesting to hear what will be done at my review.

That’s a relief for you @Bev00. I think we all read so many stories of bad outcomes and women not getting the HRT they need, that when a health prof agrees with us and prescribes it feels like a mini miracle!
I’m glad your DH is a good one @Theblacksheepandme. Sorry if I jumped the judgment gun there!
My rage is definitely a bit better. I also think that now I know it’s hormonal I do try to keep it under control, just in case I’m, erm… in the wrong about whatever I’m raging about😳 .
I feel for you with regard Mirena. They struggled to get the last one I had back out and it put me off somewhat. It’s mainly the anxiety I need to tackle. It just makes me feel so weak and pathetic. I used to think I was a strong ‘bring it on’ type. Now i get anxious about the most ridiculous things. Even pleasant things I should look forward to. Working on it!!

I've got some packets but I'm scared to start taking it in case there's a shortage. I can't bear the fact it may be stop/ start.
My legs ache and I'm so tired. I don't know what to do 😓

The packets are patches btw.

@DoctorMarten whilst there are some shortages being talked about, it's not a given that you won't be able to get more patches.

I am in the midlands and have had no issues at all with supplies and patches are making a difference for me - I started in January and this week have increased my dosage. So far they have made a real difference and I'm hoping the increase will go further....

You f go ace nothing to lose... stick a patch in n and get started 👍

Hi @DoctorMarten. What did you decide to do in the end?
How is everyone doing. Good week@putthehamsterbackinitscage? @Theblacksheepandme? 😊
I’m about to start my new HRT regime. I have Estraderm MX 75 patches and Utrogestan tablets (yippee, I really did get them - alarmingly big pills, I’m on mini pill already so assumed they too would still be small).
The Estraderm patches are gigantic! I know if I’d been given Evorel 75 they would have been bigger than my previous 50s but my goodness! Think cheese single size (ok, I exaggerate slightly 😁). I put my final Evorel 50 on my bum as a trial run as these new patches are so big I don’t want to see them on the front of my thighs. I just can’t believe that absorption won’t be affected by my having an hour long daily bath though. Does anyone have any experience of this to share? Would be lovely to hear others HRT stories, trials and tribulations…
Anyway I will report back and let you know how I get on.

Sorry not to reply earlier. I'm in bed with covid - it's horrible. Will rejoin you all when I'm over it.

RosieSun
I'm doing ok, thanks for asking. I'm being trained up with some new stuff at work and my anxiety isn't helping. I sometimes feel like I just can't do my work anymore. Anything new just sends me into a tizzy.
I really don't think the HRT is doing anything for me at all. Hopefully you'll get on well with your new regime RosieSun.

Oh no @DoctorMarten. I hope you get better quickly. It’s a rotten illness. Take care.
What type/dose of HRT are you on @Theblacksheepandme? It’s awful when you are waiting for treatment to kick in and it lets you down. Maybe your dose isn’t right. (Obviously you will be wondering this yourself!). My nerves are always all over the place. I frequently burst into tears. I relate to the work anxiety. We were all given a new laptop at work a couple of weeks ago and I was just about in meltdown worrying about how I’d manage to plug it all together and set it up! Hell knows how I will cope when I actually get a real problem to deal with. Really hoping this new higher HRT dose will fix me.

Hi @RosieSun how are you doing with your increased dosage? I've also got an appt next week to discuss an increased dose. My anxiety and joint pain is much better since starting HRT but sleep in the second half of the cycle is still elusive 😔
Also still getting bad night sweats and skin breakouts.
Am hoping an increased dose will help.

Hi all. Been a bit busy lately but thought I'd check back in.

I've had almost a month on the higher dose now - Evorel Sequi plus an extra Evorel 50 each time.

Generally much better - sleep okay so long as I watch what I drink - too much wine and sleep is terrible still but i do feel much more like myself.

Aches & pains were much improved until I damaged my ankle too.

Had a review with GP and have agreed to stay on same dose for now with 6 months review.

Hope you're all doing ok...

Hiya! I'm a poster from the start of this thread but had my periodic name change!

Been on evorel sequi (50s) for what must be coming up to a year now. Reading back, there have definitely been some improvements that have lasted. I was a bit disappointed, I recall, that improvement wasn't 'like flicking a switch' for me, but improvements did come.

Anyway, last few months I've had the feeling that some of the worst symptoms are coming back. Rage. Low mood. Frequent urination. Waking up during the night (normally to go to the loo). I guess it's probably time to increase my dose? Last autumn I was prescribed gel to 'top up' on days where I felt I needed it, but am doing that daily now and I can really tell the difference on days when I've forgotten to use it.

Does anyone have experience/knowledge of when on average women need to increase doses?

Also, when are periods/withdrawal bleeds supposed to happen? Mine are completely irregular, even with the sequential patches, and some month don't happen at all. I assumed it was all part of being peri, but @JinglingHellsBells post up thread made me think maybe I've not got enough progesterone to counteract all the estrogen (which is patches 50 plus gel 2 squirts plus whatever my body might still be making.

Hi all, I had my review appointment just over a week ago. I get blood tests done for medication I am on that has nothing to do with menopause. I decided to forward them to the menopause clinic together with my blood pressure results. Anyway at my review I told the doctor that I don't feel any better at all. My anxiety and rage is my main problem and that has not changed at all. I have absolutely no sex drive and no change there either. I have vaginal atrophy and have been using pessaries and they were making me quite sore.

The doctor told me that my oestrogen levels were showing as high and changed from sachets to a pump dispenser. She said the pump will allow me to use less or more. It is all trial and error regarding how much I require. She told me to use less than what I was using for the next 3 months. She prescribed cream instead of pessaries for my vagina. She also prescribed the testosterone which is for women. The testosterone is for my sex drive. I'm a little frightened to take the testosterone. I haven't started the new regime yet as I need to speak with my pharmacist and he is on holiday until tomorrow.

Review again in 3 months. I need to get further blood tests in 3 months due to the Testosterone.

Hope everyone else is keeping well and had a nice Easter?

Hi Everyone

Joining the thread as you’re all so knowledgeable and I’m at the point of needing help managing symptoms.

44, peri for probably at least 2 years. Mirena coil so periods v light/short although still have them and becoming v frequent at every 21 days. Main symptoms are:

jaw acne
fatigue and brain fog with word recollection/concentration
PMS night sweats
crepey skin on neck appearing
hair drying
anxiety and feeling low
RAGE. Does anyone else have imaginary arguments with their DP because they have pissed you off so much? I’m losing the plot!

none of these things are ‘me’.

History of clots so will see what the GP says. Thinking of going to a private menopause specialist GP but maybe I give my usual one a go first and see what happens.

Do you think they’ll prescribe at my age? I need to read up on all the different medications.

TIA