HRT options

[Rainsdropskeepfalling]

I'd like to speak to my GP but from a position of knowledge so I'm looking for advice.

I'm 52, mirena fitted but presumably going through the menopause. I spoke to my GP a couple of years ago about broken sleep and being a bit warm at night (not full blown flushes) so he prescribed oestrogel. I used it a few fine but then forgot and my sleep wasn't worse so I haven't bothered to start again.

But now I think I need to do something. My mood swings are crazy, my brain fog is frightening, I can't sleep for more than 2 hours, and now I've got ringing in my ears all the time. I was quite dizzy last year so a GP prescribed citapolam over the phone for anxiety but I only took that for a few weeks before stopping.

I'd really prefer a tablet over a gel (I'm crap at remembering the gel before bed). I would like less brain fog and to sleep.

Does anyone know what options I might have? Should I just up the dose on the gel and set a timer for 10pm everynight to use it? Or 3am as I'm always awake anyway?

TIA

If you already have the mirena the easiest thing to do is just add the gel (oestrogel) but yes you’ll have to get into a regular routine of using it. I do mine just before I get dressed after my shower, I find by the time I’ve rubbed it in (I do 3 pumps, one on each thigh and my upper arm) it’s soaked in and I can get dressed.

@Xrays do you use the gel in the morning? I read somewhere about it making you feel
more edgey so thought the evening was better.

I'd ignore things you may have read like that.
Side effects are very individual.
I've used gel for almost 15 years and have had no side effects with it.
I split my dose morning and late evening- can't feel any difference between those timings.
Don't anticipate problems based on someone's side effects that may be nothing to do with the HRT (but their own hormone levels.)

I wanted to avoid having to take/do anything daily so I have patches which are applied twice a week and a pessary at the same time.

When I used the gel for a month or two, it helped a bit with the sleep but wasn't transformational and when I stopped i didn't revert to where I was. I'm wondering if I should just start again, up to four pumps in the evening and see if that helps with the sleep, the moods, the aches, the vertigo and ear ringing.... I'm not sure there's much point in going to the GP if it's just a case of finding out what works for me? I presume I'd have to be consistent for 6 months before going back to ask for patches or something else?

Just realised I'm travelling with work and carry on luggage only so I can't restart the gel until I get back

I was told to use it in the morning and utrogestan at night so that’s what I do and it works fine for me. No side effects at all.

I wouldn’t start straight on 4 pumps, I’d go to 1-2 and then increase slowly. Less likely to have side effects that way.

You should use the gel in the morning to start off with as it may keep you awake at night. Also agree 4 pumps is a big dose to start off on. If you do need 4 pumps I would apply 2 pumps in the morning and 2 pumps at night.
Finally you can travel with the gel even though it's over 100ml. It's a medicine so normal rules don't apply.

Would oestrogen patches rather than the gel be easier for you, I use gel these days, but had the patches in the past, I think you change them twice a week from memory

You can carry on gel. Every trip I get the guy who stares at the Oestrogel and my H tells him "never try to separate a woman and her HRT".

Interesting about using the gel in the morning - I think it will be easier for me to remember so I will try that. My GP suggested I use it in the evening, start with one pump and then up the dose by one pump every three days until the symptoms disappeared, but I feel like I have a lot more symptoms now. I just want to sleep for more than two hours and not end up on the sofa every night....

Patches work well with Mirena (that's what I'm using) and it might suit you better if you find it hard to remember to apply gel.

I'm on oestrogen patches and progesterone pills (Utrogestan). I quite like patches as I dont' want yet another daily thing to do and they're not so messy and quite convenient. But in relation to sleep, I've found that it's the Utrogestan part that gives me a great night's sleep. Noone seems to mention it on here when bad sleep is mentioned. They tend to talk only about the oestrogen component. But oestrogen alone (for the two weeks out of four on the sequential regime) made me really wired and not sleep well at all. The utrogestan on the sequential regime was too much and i was very slugged out. But on a continuous regime the utrogestan gives me a really perfect night's sleep. I don't know if it might be worth exploring different HRTs from a sleep point of view? But that's the effect on me anyway.

@menopauseadventurer thank you. This is what I was looking for - options. So that if the GP says just carry on, I can ask about other options. I had a look at the NHS website and there isn't a list of what can be prescribed for menopause symptoms so I've been unable to lookup different meds to understand their merits. Sure, I'm sure there will be some not a good fit for me because of my age etc but I've no family history so I think I should have options.