Help please with HRT dose

[CampingHappy]

Hi
I am starting HRT and have finally found a local pharmacy stocking the Utrogestan.

My doc has prescribed 2 pumps Oestrogel daily and 1 x 100mg Utrogestan capsule every day at night (I am 54, periods stopped last June).

I am really keen to minimise the risks and so would like to start with 1 pump of gel but would I then need a lower dose of Utrogestan?

Pharmacy have put aside another 30days of Utrogestan but what happens after that if they are unavailable again?!! 😬

I am pretty scared of starting HRT due to the cancer risks but hope to not be on it long term & just get through this tough period (lost mojo/feel flat, anxiety & panic attacks espec. when driving (never had this before), separated after 17yr relationship at Xmas, 2 sporty boys 16 & 14 plus work full time so mega busy) - so if anyone can simplify the cancer risks that would also really help me.

Thanks 😊

Hello there are others here who are far more knowledgeable than me, but I understand the Utrogestan dose would stay the same even on one pump. I'm on patches so not familiar with doses in pumps but from what I've read here one pump is quite low so you might need to up that in time should your symptoms not improve. I recommend looking at information published by Dr Louise Newson (the Menopause Doctor / Newson Health) for information about the cancer risk. I hope you are feeling much better soon.

OP, you haven't gone a full year without a period, so you are not post menopausal. Your utrogestan needs to be sequential rather than continuous, otherwise you may experience erratic bleeding. Continuous progesterone is only suitable for post menopausal women ( which simply means 12 months without a period).

What are the cancer risks? I've had breast cancer and use HRT. The risks to my understanding, are minimal and there's more chance of developing cancer, if you are unfit/ smoke/drink etc etc. The WHI who published that flawed report back in 2000 or whenever, did a lot of damage!

Best of luck 🤞

Speak to your GP they are best placed to advise

Thanks everyone.

I wonder if my GP thinks I'm almost 12mths since my last period so pretty much there. I'm not keen to have a bleed again but is it risky to be on continous?

Don't think it's risky, but you are still a few months away from a full year period free. Sequential might be better. Others may disagree I guess.

@CampingHappy the dose is okay as the guidance is either no period for 12 months OR aged over 54.

There is no risk if you mean 'womb risk'.

However, there is a small chance you may get bleeds unexpectedly AND all women on continuous can expect erratic bleeding for the first 6 months anyway.

In terms of safety, your womb is fine on this dose, but there is some evidence that breast cancer risks are less (by a small percentage) using sequential rather than using progesterone daily.

That's a personal choice and most GPs just go with the 'established guidance' of continuous for women like you but there is no absolute rule.

In terms of safety, your womb is fine on this dose, but there is some evidence that breast cancer risks are less (by a small percentage) using sequential rather than using progesterone daily

Thats interesting, so I could minimise risk by asking for the dose to be sequential irrespective of my age. How does that work in terms of when you use the gel (would like to start with 1 pump) and when you take the Utrogestan? I guess it doesn't matter when I start the process as I don't have periods. Thanks

@JinglingSpringbells do you have a link to the continous v sequential risk? Do you have experience of 1 or the other? Thanks

I believe that while there is a smaller risk of breast cancer on sequential there is a higher risk of endometrial (uterine] if you Google there is some info.

Risks are small in both scenarios but only fair to offer balance.

Imo I don't think women want to be having bleeds years after their last official period.

I wouldn't just use one pump of oestrogel - you might as well not bother. If you have symptoms such that your dr recommends HRT, you need a dose that will actually help alleviate them!

@ImAvingOops how about if one pump does alleviate symptoms though? It must do for some or it wouldn't be prescribed surely?

I've been prescribed one pump - but the doctor just pulled this out the air really as she wasn't sure if one or two would suffice!

I often wonder if I'd do better on two pumps

Yes I have tried both.

I didn't feel well on continuous and stopped after about a month and I was spotting all the time despite being several years post meno.

I don't have the stats to hand ( it is out there and I've read it many times) but there is a lower risk of around 1.7% on sequential compared to continuous. All specialists agree that combined continuous carries the highest risk.

I have discussed this with my consultant and their opinion is that the very small risk of endometrial cancer with sequential is far more easily treated, if caught early (I pay for annual scans) if it's a choice between the two.

I don't like having bleeds at my age , but I'd rather put up with those for 4 days of inconvenience.

Hello, my menopause specialist started me on one pump of oestrogel with 100 mg utrogestan nightly. I then moved up to 2 pumps. I was very anxious about starting so 1 pump suited me initially.

One pump of oestrogel is enough to relieve all symptoms for me.

@CampingHappy I'm a bit older than you, started HRT last June. I'm on one pump of oestrogel plus 100mg Utrogestan daily. It works well for me.

I did try increasing my dose of oestrogel to two pumps as that's the usual dose, but all it did was make me bleed constantly. Now everything has settled down after 9 months I seem to be perfectly fine on one pump.

@CampingHappy Just wanted to pop along and mention something I forgot. The risks of hrt, using Utrogestan, are not there for the first 5 years. The research showed no increase in breast cancer for 5 years' use.

It's more of a concern for women using combined continuous HRT longer term.

@JinglingSpringbells thank you and to everyone for your advice & experiences. 🙏
I am going to start with 1 pump from today and progesterone daily and if I have a problem with side effects or bleeding, may then change to sequential.
I do only want to be on it short term ideally and other than the effects of the dreaded menopause, I am fit, exercise daily, and not overweight.
Fingers crossed it helps with the insomnia/anxiety/panic attacks/feeling low and life doesn't feel like a battle with emotions every day! 🙄😄

I am 54 and put on 2 pumps of gel on every evening before bed and sequential utrogestan which I take on 1st -12th of every month. The doctor advised me to do that so it is regular. I take them at night time.

I have now gone up to 3 pumps per day and put the extra pump on in the mornings.

My personal journey took years of my periods slowly getting longer between cycles firstly I missed every other month. Then they went to every three then monthly then two a year then nine months apart went a whole eleven months then had a horrific one then went a full year without one.

@CampingHappy I'm going to message you rather than repeating all my personal med stuff online!