HRT Advice

[Afoxindeed]

I am experiencing lots of perimenopausal symptoms - hot flushes, brain fog, low mood, horrible doom like thoughts, poor sleep. I'm late forties and was told I would likely enter an early menopause...waiting for my periods to stop but cycles are longer.

I had a hysteroscopy and biopsy for thickened womb lining which put me off taking HRT as I didn't want to add to the problem. My mother also has a history of blood clotting. Not sure what to do for the best as HRT can't be tailored? I am worried about having too much estrogen in my body. Is it worth seeing a menopause specialist? Will I just end up with patches again anway - as was prescribed last time - these caused flooding but that might have been the way I was using them as they kept falling off.

Another option is an antidepressant like Setraline (I am prone to anxiety and low mood). Does anyone take an antidpressant instead and if so, does it make a difference?

I would ask to see a specialist. I'm not a doctor but I don't think treating you for depression (unless that's actually what's going on and needs specific care) is the way to go. Menopause symptoms can really drag you down and HRT makes it so much easier. I think you need to tackle that as a priority. Please insist on seeing a specialist.

I think you need to speak with someone more experienced than your GP appears to be.

In your late 40’s you would not be classed as experiencing early menopause.

Have you discussed the options of balancing hormones with a coil or separate progesterone?

Not sure what to do for the best as HRT can't be tailored?

HRT can absolutely be tailored. There is a huge choice of what women can use. And specialists can prescribe outside the licensed doses. (I've been on a tailored regime for almost 15 years.)

You've posted a few things that are a bit puzzling.

Early menopause is periods stopping before age 45. So that's never going to be you now.

Your mum's blood clots aren't relevant because you could use transdermal HRT which doesn't increase your own risk of blood clots.

I don't know from your post if the flooding and the need for a biopsy etc was related to using HRT OR pre-HRT?

So many women seem to be put through this procedure when they are either on HRT (and the dose is just wrong so they flood) OR they are having 'normal' heavy periods in peri.

The easiest answer is you need HRT but whatever you were on before wasn't the right sort.

I also puzzled a bit about thickening womb lining and HRT. I’m at a similar stage to yours, my periods hasn’t stopped yet just erratic, hot flushes, anxiety etc. I’m reading Davina’s book atm and Menopause MN threads to educate myself before going to GP, I haven’t seen anything about thickened womb lining. I also had biopsy a few years ago.

thickening womb is definitely a known side effect, maybe only some kinds of HRT.

If OP has a history of depression it would be clinically negligent not to consider treating that.

Thickened womb ling- hyperplasia- doesn't usually happen with HRT if the dose is correct. There is/was a bit of concern that Tibolone might cause a thicker lining, but it's rarely prescribed now.

On sequential regimes, the womb lining does get thick. It goes through a cycle of being thick then shedding (like a normal fertile cycle.)

A lot of women on forums seem to be rushed into a biopsy and told they have a thickened lining, regardless of the timing of the scan and biopsy.

To be accurate, a scan needs to be done immediately after a bleed- no more than Day 7 of the cycle, if possible.

'Prone to low mood'- is that before peri or part of it?

Thank you for all your replies.

There is confusion over whether this depression (related to anxiety) is due to life changes or whether the menopause is compounding it. Probably a bit of both which is why I'm a bit muddled as to how to go about treating it i.e. depression first or menopause/HRT first or a combination of both. Incidentally the anxiety needs treating too - I have C-PTSD which has been misdiagnosed for years and only just confirmed - I'm seeing someone this week about possible therapy avenues but it is unlikely to be available on the NHS. My anxiety feels heightened at the moment, like hormones are making things much worse.

Regarding thickened lining - I had a scan due to experiencing frequent urination. The scan picked up thickened lining and hence further investigations (I hadn't had a period for a few months following covid - only realised later) but I suspect that I now experience thicker linings due to extended cycles.

When I tried HRT (prior to the scan). I had a horredous period - flooding, clotting never seen anything like. Due to anxiety and thickened lining it is making me dubious about trying HRT again.

Would somewhere like Dr Newson's clinic be able to tailor HRT - where could I go to obtain this?

Absolutely see a specialist. It has taken me a long time to find the regime that suits me.

I had horrendous clots and flooding on sequential HRT; it was debilitating. Continuous HRT was barely any better. I’ve had scans and all is ok. I now have a mirena coil, oestrogel and testosterone. After an initial period where I continued to bleed/spot, it all seems to have settled down and I’m feeling really good.

As you have not had a prior diagnosis of depression, NICE guidance is that HRT is used for psychological issues.

Regarding thickened lining - I had a scan due to experiencing frequent urination.

The weeing more often was also most likely linked to loss of estrogen. You can read up about this online (it's now called 'genitourinary syndrome - GUS') The bladder lining is very sensitive to estrogen loss.

Did anyone mention this to you? The treatment is vaginal estrogen (cream or a tiny pessary.) It is not classed as HRT and there is no absorption into the body.

but I suspect that I now experience thicker linings due to extended cycles

Yes. If you are going months with no period the lining builds up.

When I tried HRT (prior to the scan). I had a horredous period - flooding, clotting never seen anything like.

You said that some patches were falling off. It's possible that the patch didn't give you the amount of progestogen needed to keep the lining under control . OR that you had a lot of build up in the lining already and it came away with the HRT withdrawal bleed.

I know it all sounds scary and a lot to deal with, but it's probably not that complicated to sort it out. Ideally, what you need is an estrogen-only HRT for a few weeks to see if that sorts out your mood (getting the estrogen dose right) then adding in a progestin to control the lining.

My own experience from a specialist was 10 weeks of estrogen only, followed by 10 days of progestin. NICE has now updated it's meno guidance to say that all women in peri can have this regime which can work really well for women with progesterone intolerance.

Your GP could offer you this. You don't need to see a specialist, but if you do, the BMS has a list on their website. It's not conclusive- there will be others who aren't on that list. thebms.org.uk/find-a-menopause-specialist/

JinglingSpringbells How do you take the estrogen? I feel dubious about taken oral medication.

Forgot to mention, I do have a depression diagnosis but it is related to the anxiety issues. There have been periods in life where this has been okay but not recently.

Very few women use tablet form HRT now.

Estrogen is usually transdermal- patch/ gel/ spray.

I have to pay over £200 for an assessment. I have 3 possible issues that might prevent me or be irritated by taking HRT but it seems I have to pay this amount to be told that I am not a potential candidate for HRT. One question has been answered via e-mail but I cannot have the other two questions answered unless I pay. Largely concerns about womb lining. Also my mother (who is no longer here) had some sort of blood clotting (including possible DVT scares) but I don't know all the circumstances. A very healthy friend of mine - no alcohol, vegetarian, non-smoking, physically fit (exceptionally so for age) developed breast cancer a few years after starting HRT so this is making me anxious.

I guess I'm just going to have to pay the money or live without HRT.

@Afoxindeed I'm unsure why you think your mum's blood clot is an issue? I mentioned in a previous post that taking transdermal HRT does not pose a risk of blood clots.

The thickened lining- well, your lining would be thick if you hadn't had a period for months. It builds up until it's shed. When you had a heavy period on HRT, that was a withdrawal bleed, and many months of blood would have come away.

If you are anxious about the cancer risks do some reading around. The risks are very low and on most modern types of hrt there is no risk of cancer for at least 5 years.

Why do you feel a private appt is necessary? Can your GP not offer you HRT? There is nothing in your medical history from what you have said that seems out of ordinary OR why you can't have hrt.

*Very few women use tablet form HRT now.

Estrogen is usually transdermal- patch/ gel/ spray.*

Please can you tell me why this is?

Because it's safer re. blood clots.

No risk of clots with transdermal.

Menopause Matters website is a good medical site for info- big section on HRT.

When you had a heavy period on HRT, that was a withdrawal bleed, and many months of blood would have come away.

Thanks for the information Jingling. Can I ask what a withdrawal bleed is?
Do periods continue on HRT (so womb lining doesn't build up)?