HRT experts these doses seem right?

[Chocolateporridge]

I've been in peri for about 4 years and on HRT for around a year.

My GP has tweaked my doses a few times and currently I'm on 4 pumps of Oestrogel a day plus 300mg Utrogestan (taken vaginally because orally really triggered my IBS). The GP increased my Utrogestan recently because of updated guidance on how much progesterone to take with High dose estrogen.

I was still getting regular periods when I started HRT, but the GP initially put me on 25 days out of 28 on Utrogestan and they dwindled to a 3 day bleed approximately every 6 weeks.

Now she's got me taking 300mg Utrogestan for 14 days then off for 14 days alongside 4 pumps of Oestrogel every day. I'm on my second month of doing this. I'm feeling absolutely exhausted, I ache all over and my legs are really sore. I was putting that down to my Fibromyalgia but I came across something online that suggests this is actually due to too high levels of progesterone.

I have got myself SO confused with it all, are there any experts out there who can advise? GP appointments are like gold dust here 🙄

I'm on utrogestan continuously 200 mg per day. I have oestrogen implant now because I don't absorb through the skin. But at some point I was on 6 pumps and levels were low. You need blood test to check levels. Maybe you also need testosterone but levels need to be right that is not approved med so some of GPS won't prescribe only consultants.

I'm starting to think maybe the Oestrogen is too high? Can I drop the dose without asking the GP?

Ive just dropped my dose. I was on Evorel Sequi patches plus one pump of oestrogel per day, but was reading about having too much oestrogen, so have gone to just the patches and will monitor symptoms. It seems you can get symptoms from too much or too little oestrogen so I'm going back to a minimum to see if I can work it out myself.
Haven't discussed it with the dr.

You shouldn't without testing levels. Checking levels every few months is very important. I know they go by symptoms but is always first way to check what's going on. I wouldn't say oestrogen is high why you not take vaginally I do for 9 years it had Less side effects.

Also I'm menopausal since I was 35 years old get use to it that you never will be full of energy and back to normal is just next step and that's how it is. Research about your diet and exercise, supplement - your body needs more now I'm on magnesium for 9 years. Supplement. I did all of this years ago it won't be the same like before, think about your life and how to improve health. Read do learn and think positive it is next step of your life.

@Chocolateporridge You are exhausted as the progesterone dose is too high!

Your GP appears to have misunderstood the guidance by the bMS.

It says that women using higher doses of estrogen may need more progesterone.

And the guidance says 'consider '- it's not mandatory, It's there as an option if the 200mgs dose doesn't control bleeding ( heavy or long withdrawal bleeds, or spotting.)

4 pumps of gel is 3mgs estrogen. This is acceptable (and the patient leaflet says you can use that amount.)

You should also have never been on continuous HRT when you had regular periods. Your HRT then should have been on a cycle.

The cyclic dose for Utrogestan is 12 days per month. The 14 days was introduced as 'GP training on HRT' and it was suggested that women would find 14 days 'easier to remember' than 12 days. Again, the 14 day option is to control bleeding.

You don't need your hormones testing. It's never accurate anyway.

If you want to read the BMS progesterone guidance it's all online and has been left as a link here several times.

The report from the BMS was mainly because some women were using very high doses of estrogen (above 4 pumps) and there was some concern.

You should talk to your GP (or another one who is maybe more experienced) and if necessary print the BMS guidance to use as part of that discussion. Progesterone is renowned for all the side effects you have so it's not surprising you feel dreadful on that amount.

@JinglingSpringbells thank you so much, that's really helpful! I think the brain fog is making it so hard to understand what's going on, plus I have long Covid which just seems to exacerbate everything!

I'm on patches and I've never had my hormone levels tested. I've been bleeding so frequently and starting to get achy like I was before I was in hrt. I bleed for about 4 days every couple of weeks and get period pains too. I'm wondering if I need to change the patches more frequently but should my doctor be checking with blood tests?

@Littledogball you might need a bit more oestrogen. I'd talk to the prescriber at your GP surgery.

Thank you I will.