Have I been on HRT long enough to tell if it's having an actual effect?

[GlomOfNit]

I started late March, Sandrena and Utrogestan (2 capsules a day 12 days a cycle). I started with the 0.5 mg Sandrena sachets once daily, after a couple of weeks went onto 1mg daily, tried 1.5mg but had to ration back down due to local shortages of Sandrena but the local supply seems a lot better (plus the pharmacy seems to have given me the same number of boxes of 1mg sachets as the GP prescribed boxes of 0.5mg sachets, so this month I think I have double the amount GP prescribed! I'm hanging onto it in case of future shortages). So now I'm up to the maximum dose recommended by GP, 2mg daily. I also had a very illuminating chat with a medic friend, also in perimenopause, who was so shocked at the lack of knowledge in her fellow medics that she started running study sessions for them! She is a font of gold frankly (hope she lurks and is reading this) and suggested that actually 2mg is not crazily high a dose and that 'most women' will need to titrate up to this dose (Sandrena) to fully oestrogenise themselves. She also suggested that I need to give it 6 months. I suppose it's been about 3.5 months so far.

What's changed? Well, not much. In fact in many ways I'm feeling worse. I was initially put on it by GP for palpitations which were ruining my life. They have decreased slightly but stress still brings them on. My periods were massively erratic and could be any length and any heaviness/lightness - I'm still settling into a cycle now but have had pretty erratic bleeding. I also still have spotting about a week after stopping the period/withdrawal bleed. My breasts are back to feeling really tender for weeks on end, which was happening in bursts of months at a time pre-HRT (I mean, I'd have a run of a few months where they were sore for second half of cycle). I'm headachey. My joints are killing me and I'm actually about to talk to a GP about my constant lower back pain which seems to be referring down into knee and ankle (arthritis??). I'm foggy and have appalling memory - I keep wondering if I have a bloody brain tumour!! My mood/anxiety is not great much of the time and the fatigue is appalling most days. My libido is still on the floor. Just about the only thing I don't get any more are night sweats (never really had daytime flushes) and my sleep is mostly fine. Though I wake every morning feeling utterly exhausted.

So yes, essentially I sound like a perimenopausal woman who ISN'T taking HRT! I'm starting to wonder if I have a weird problem absorbing the Sandrena, since I've now been on 2mg a day for about 3 weeks. It never really stops being sticky on my thigh and normally my tights or trousers stick to me a bit when I put them on, but I'm giving it half an hour most mornings. Should I try a patch instead?

My GP practice are mostly fairly negative regarding how long you're 'allowed' to be on HRT and most of them were reluctant to discuss my symptoms (for years and years!) - it was only when I saw a very much younger male GP that I was put on HRT to treat the palpitations. And since then I've talked to another one who keeps telling me I'm not allowed to be on this for longer than 5 years... So if I go back and suggest it's not working well, it may be a right old battle to change HRT rather than be taken off.

But should I just give it another couple of months??

I found some improvement after three months but significant improvement after 6. Now sleeping much better, no night sweats and much calmer. Might be worth persevering

It can take some tweaking ot get HRT right, but it is life changing when it works, so do persevere.

My peri symptoms - night sweats, low mood, lack of energy - improved after a couple of weeks. I started with Oestrogel and Utrogestan but switched the Utrogestan for a Mirena coil. I was initially prescribed 2 pumps of the gel per day but have increased this to 4. I recently tried going back down to 3 but got a return of night sweats and poor sleep so am back to 4.

It sounds like the problem is your GP! Can you go back to the younger GP who was more positive? I have found the 'Menopause Matters' forum to be helpful. https://www.menopausematters.co.uk/forum/index.php

It is ridiculous that women are given the lowest dose and are expected to just shut up and be grateful for it, even if it doesn't help them.

How long have you been on 2mg? Is that the 3.5 months?

Will try to find an equivalent table for you

No, I've gradually built up to 2mg (and had to scale down at one point due to shortages). I'd say I've been on 2mg about 3.5 weeks now?

Night sweats definitely are better. Palpitations may have improved but stress definitely bringing them on more.

I don't actually think the utrogestan is making me feel 'worse' (unless it's responsible for the sore breasts in second part of cycle) so that's a plus.

But low mood, low energy, no libido (ok I know that's something estrogen doesn't always help with).

Hi @GlomOfNit Sorry you feel frustrated.

I think you should start counting the 3 months (the time drs say it takes to feel the benefits fully) from when you upped to 2mgs estrogen.

The low 0.5mgs dose you were on was pretty useless for someone in peri as it's so low. Even 1 pump of estrogel gives 0.75mgs (and the normal dose with it is 2 pumps daily.)

The stickiness may be unique to Sandrena. I've always used Estrogel which I find dries very fast - half a pump per thigh, twice a day - and it dries in under 5 minutes. I have heard that Sandrena is stickier.

It's also possible that Utrogestan is making you feel worse or at least not helping! I know it's 'flavour of the month' but it doesn't suit everyone.

It's a shame that many GPs don't know a bit more and are constrained by the product licences, re. doses. When my consultant (privately) prescribed HRT he put me on a long cycle, of 10 weeks estrogen-only, then 10 days of progestin (not Utrogestan at the time.)

This meant I could easily judge the effects of estrogen, starting on a low dose of gel (1 pump) and gradually increasing.

So, you may be one of those women who don't get on with Utrogestan and a patch with Norethisterone in might suit you better, or the tablet Femoston which has a more body identical type of progestin very similar to Utrogestan but often more tolerable.

It's a case of playing around with various types and finding what suits you best.

At the moment, I'd suggest you see how you go in a few more weeks.

Thanks, Jingling. I'll bear that in mind - counting from 2mg - and give it a little while longer.

Hard to tell with the utrogestan - I've said I don't feel markedly worse during the 12 days per cycle I take it but perhaps it could be making me feel a bit crap the whole time, I suppose?

Just to say that yes, Sandrena is far stickier/slower to dry than Oestrogel.

(I was initially prescribed Oestrogel, but given Sandrena sachets due to shortages 4 months ago. Now using Oestrogel - so recent experience of both).

If the 2mg is the right dose for you it will prob take longer than 3.5 weeks to get the full benefit.
Also, if I remember correctly, the max licenced dose for sandrena is only 1.5mg, so at review they will prob want to switch you to something else.
In your place I would make sure to be fully informed as to what it is you want to be put on (I will be asking for 1.5mg sandrena plus 1 pump (0.75mg) oestrogel).

Meant to post a comparison chart, finally found it.

I went from 50 to 75 about 5 weeks ago; I'm only starting to feel any differently. And I'm not sure it's enough yet.

But that's after being on 50 for 4 months as well. They tested my oestrogen and found it borderline too low, hence the increase. It really can take a good 3 months to kick in.