I know I should switch to transdermal HRT, but I don't want to! Help?!

[NormaSnorks]

Am 57 and have been on HRT for 7+ years. It's honestly been a life saver as without it I get ALL the symptoms and my quality of life is dreadful.

I started on Elleste Duet 1mg (a tablet form of sequential HRT ) and basically I'm still on it (except that I now take Novofem, which is the same Estrogen/Progesterone mix)
It's a low dose and it seems to work really well for me - no major side effects.

The problem is that I KNOW that transdermal HRT is deemed safer/better because it doesn't go through the liver and I should probably switch, so about 4 years ago I asked to switch to patches + Utrogestan. It was a disaster! I tried Estradot, then Evorel and then Evorel Conti and had terrible problems with all.
I had a VERY bad reaction to the Utrogestan - completely knocked me out so much overnight that I damaged my shoulder from pressure on it/ not moving. Also gave me migraines/blurred vision, which was terrifying. (Didn't try taking it vaginally, as that wasn't really talked about then, but I'm not keen to take it again in any form!)
And I didn't seem to absorb from the patches at all, so my symptoms came back and the GP kept upping the estrogen level of the patches, so I ended up on a much higher dose (in theory) than I had been on the tablets.
Evorel Conti made me feel continuously like I had PMT and my symptoms still weren't controlled.
So I went back to Novofem as I knew it worked!

But I keep reading and thinking I should try to switch to gel or patches, but I can't really work out my options, if I don't want Utrogestan. For various reasons I don't want/ can't have a Mirena either.

Any advice?

Following as I'm taking Novofem too but everyone else seems to be taking transdermal. Like you I keep hearing how transdermal is better but I'm doing fine on tablets and don't want to mess things up!

I think one of the risks of tablets is stroke and clots, so I check my blood pressure at home and eat a healthy unprocessed diet with lots of veg.

I'm doing fine on tablets and don't want to mess things up!

Yup! This is basically how I feel!
I also monitor my blood pressure too, and keep my weight within a healthy range.

Stick with what works! If it ain't broke, don't try to fix it! You could end up in a real hormonal pickle! Honesty I can't stress that enough.

Getting the right balance can be nigh on impossible.

Tablets are fine. The risks are small.

I use oestrogel (4 pumps) with cyclogest 200mg pessaries (off licence but suggested by my GP). No issues whatsoever. I feel happier with this combination although it is more fuss than tablets

Those of you on Novofem, can I ask if you still get period-like bleed? I'm on it and get 2 really heavy days a month when I hit day 3 of the oestrogen (orange coloured) tablets. I'm getting really sick of being tied to the house 2 days every month, but the only other women I know on HRT have had hysterectomies, so I can't ask them.

I’ve stayed on oral. Tbh since mine was changed 2 years ago and the oestrogen reduced I don’t have quite as much energy as I did. On top of that I can’t bear going through potentially 3 months of feeling crap/hormonal etc. when I first went on to HRT the first few months were awful because the first meds didn’t agree with me and made me feel worse.

Slightly off topic but I found your post very interesting OP. I love uterogestan as it helps me sleep really well but I have also developed a bad shoulder on the side I sleep on. I suspect it’s from the same reasons.

Yes, I do, but it’s not much & very manageable - I only need a mini tampon or even just a liner. The only issue is that it sometimes drags on for e.g. days 2-9 after starting a new pack.

My GP told me that I only needed dual phase HRT until one year after my first natural period, and I was happy about that and looking forward to going progesterone only because my HRT pseudo periods are inconveniently heavy.

But everything I've read since, including this thread, suggests that because I still have a womb I will need to keep taking oestrogen indefinitely.

If it works for you, keep taking it.

@thenightsky I have very light, short periods now and only need to use liners. I'm 50.

I think by ‘dual phase’ your GP meant what is called ‘sequential’ HRT - basically you take Estrogen only for the first phase of the month (16 days in my case) then Estrogen + Progesterone for the remainder (12 days). When you start the estrogen only phase again you get a short bleed that mimics a ‘real period’.

After menopause you can switch to a ‘continuous’ regime which (if you still have a uterus) means you take a combination of estrogen & progesterone together continuously and shouldn’t get a bleed. this is probably what your GP was referring to.
Its the estrogen that helps the menopause symptoms, so you will always need some of that on HRT.
If you’ve had a hysterectomy you can take estrogen only (no progesterone is required).

But everything I've read since, including this thread, suggests that because I still have a womb I will need to keep taking oestrogen indefinitely

That's exactly what I thought too. In fact, my GP said the same when I first went on it... you need to shed the lining to help prevent cancer of the womb. That thought alone has made me keep going with my 2 heavy, painful days each month. But, I'm now 63 and getting seriously hacked off with it.

@NormaSnorks it's not mandatory that you stop tablet form.
For women over 60 it is more of an issue as tablet form has a higher risk of blood clots. So if you remain on it, that's something to bear in mind.

A better tablet form is Femoston. This has an almost body-identical type of progesterone - which is pretty much the same as Utrogestan. It's considered safer for breast cancer. Latest research shows no added risk of BC for 5 years on Utrogestan (research for over 5 years shows little risk too, compared to other types.)

You are using a tablet form that gives a bleed - see link below- for peri meno. You could switch to combined continuous - see 2nd link- on Femoston. or stay on sequential Femoston.

Sequential is slightly safer for BC - by about a 1% lower risk- as the breasts are not exposed to both hormones every day.
I know the bleeds are a PITA as I'm still using sequential in my 60s (from choice.)

Just a few things for you to think about.

[[https://www.menopausematters.co.uk/perimeno.php

[[https://www.menopausematters.co.uk/postmeno.php

Why not swap to a combined continuous type? You don't have to take the sort that gives a withdrawal bleed- but see my post above.

@JinglingSpringbells

Thank you for that info, that is mega-helpful. In fact, I'm tempted to save your post and show it to the practice nurse next time I go for my review. I will also ask for a swap to Femoston. I do find the GP surgery pretty clueless actually. Its a very rural practice with its own dispensary, so you are often stuck with whatever tablet they have in their small stock. Plus the GP is in his 70s and his practice nurse is not far off. They both seem to spout info about HRT that is 20 years out of date. <<sigh>>

I use Evorel patches with Provera as my progesterone.

You're welcome.

It's pretty shocking that a GP doesn't know the 2 basic types of HRT! There are countless training guides written for GPs that they can read in 30 mins online.

The links I left are just one. There is another named GP Notebook which is a training manual for GPs and is easy to read (I've read it- not that I'm a dr!)

And you can of course go to any pharmacy for your meds- no need to stick with the practice one.

If you want to stick with them they can order in anything you are prescribed.

It's pretty shocking that a GP doesn't know the 2 basic types of HRT

hahaha. That's not the half of it! When I first went with peri, they put me on a tablet that was meant for people who had had a hysterectomy! It wasn't until I went in 6 months later and told them I kept trickling blood randomly on any old day that they realised and sent me for hysteroscopy. I did get a profuse apology that time.

Also just to say I tolerate progesterone HORRIFICALLY, was suicidal on the implant, in hospital with suspected strokes on the mini pill and had a migraine for a week in 4 (and was also horrifically depressed/angry) on the combined patch but am pretty much OK on vaginal utrogestan, headache on 1/2 days and maybe slightly sadder but was told I either took it or had to come off oestrogen which has been life changing, genuinely.

So, please don't totally discount it without trying it first

Isn't femiston metabolised through the liver though? I thought one of the main benefits of transdermal was not involving the liver?

Eventually, all drugs go through the liver, but tablets are 'first pass' through the liver.

Going through the liver isn't an issue as such. The liver is fine! It's that the metabolism of the drug that way can make blood clots more likely BUT the risk is tiny, rare in younger women, (under 60) and far less than the Pill as it'a natural estrogen unlike the Pill.

@JinglingSpringbells - Thanks! I will have a look at Femoston. I don't have a problem with a sequential regime, in fact I think I prefer it as my 4 week cycle is basically 2 x great weeks on estrogen, 1 OK week when I start taking the estrogen + norethisterone and then just sometimes 3-4 days at the end of the last week when I begin to get PMT symptoms. Then my bleed is fairly insignificant/ not a problem.

On a continuous regime I just felt constantly 'flat' as if the norethisterone dulled everything. I'd rather have the highs and lows! And it's good to hear that it has a slightly safer profile.