Tweaking HRT

[Rainsdropskeepfalling]

Looking for suggestions to take to my GP.

I'm 52, using a mirena coil and oestrogen patch (started at 50ug, now 75ug).

My serum testosterone is 0.3nmol/l so normal. My SHBG is low 12.4 nmol/l (normal 23-159) but GP not bothered about test results (both tests done at my request, not their suggestion).

Brain fog means I no longer speak up at mtgs at work for fear of not finding the words. Kissing goodbye my next promotion (I'm a senior director, PhD so on paper capable of VP level role in the next 1-3 years). My rage is very real and I snap at DH (poor sod probably wants a divorce and I can't blame him). I do sleep better now but libido has been missing for a decade now so that's not coming back. Anxiety and depression is there - but I have tendencies to depression and DS1 is 17 so of course I'm f###ing anxious, watching him piss away things. So maybe that's nothing to do with menopause.

So (and well done for reading to here) should I just ask for the next dose up patches (100ug) and a box of fluoxetine? Anything else I should explore with the GP?

What was your free androgen score? I was prescribed testosterone on this. Mine was less than 0.4, it should be ideally 2.

After 12 weeks of taking testosterone my level went up to 0.8.

I definitely have more energy and some people say it helps brain fog, though not for me.

@Leftoversgalore

Thanks for your reply. My free androgen wasn't tested so no idea. Given my testosterone was within the normal levels (0-1.8) I don't think I'll get any traction there - the GP said at the time that something exception would have to happen to allow my health authority to prescribe testosterone. I think I'm going to be offered more estrogen and AD.... I'm already taking magnesium, vitamins, minerals etc...

Is there a reason you don't want any more oestrogen? I'm on 100mcg patches and have just requested more as I'm getting flushes and night sweats again. (tbc if I get some more!)

And I'm also on the coil too.

Shame about the testosterone. My GP gave it to me straight away once the blood test was in.

@Leftoversgalore

I'm very open to more oestrogen. Esp if it brings my memory back! I wonder if I should ask about getting my androgen levels tested? I thought they would presume HRT and then use a blood test to see if I'm at a reasonable level but I understand that's not the way they do it. They just tweak until the symptoms change - which is fine as long as the symptom we are optimising away is not remembering anything and being a moody bitch all the time!

Anyway, I'll email my GP now and ask for the next dose up of patches now...

You can cut the patches up to give you a different dose rather than getting a whole new prescription and chucking the ones you have away.
I’ve recently gone onto patches and have been tweaking the dose and my GP is fine with it.

@MagpiePi that's very true. I think I've only got two left so I could 'go big' this week and then get a new box next week.

Alas the surgery had reached the max number of requests when I logged on this afternoon so I'll have to try and remember to email them at 6am when they reopen the website tomorrow.

Have you considered trying Estrogel so that you can more readily titrate the dose?

@SebastianFlytesTrousers

Yes - sorry I didn't give the full background here. I tried estrogel but I couldn't remember to apply it everyday because I can't remember anything any more, which is how I ended up with the patches. Of course once a week I fly into a complete purple rage and tear the house apart trying to remember where I've put the box of patches but I know that I only have to do that Sunday evenings now, rather than remember something everyday. 😆

I absolutely get where you're coming from. Been there myself!😁

Which patch do you have that you only need to change once a week? Or have I misunderstood. All the patches I’ve tried you change twice a week.

@ButterflyBitch

These ones (not suggesting you buy them - first link I found)

https://www.theindependentpharmacy.co.uk/menopause-hrt/femseven-patches

But I think there is more than one manufacturer of week long patches (judging from the list of HRT that you can get on the extended NHS prescription ticket).

Interesting. Had no idea you could get ones you can wear for a week!

Update: email conversation with GP number 2 says I need to wait 3 months before they will review my dose. Email with conversation GP number 1 said I should get back after 1 month and not wait 3 months.

And GP2 suggests I sign up for the wellbeing clinic to discuss coping strategies.

I don't want strategies. I want my brain back.

So new question (I may start a new thread) - should I pay £299 for the Bupa clinic or go to a local private menopause clinic? I don't want to spend another 1-2 years getting the dose right

Tbh, you should adjust the dose yourself if you know it’s wrong rather than waiting for a GP to give you permission. The outcome is likely to be the same.

Edited to add: I am not a medical professional but am going on my own experience. I can feel a difference in a few days.

@MagpiePi I think that's what I'm going to do - when someone up thread suggests using half a patch I realised how easy this would be (although I only have 3 left in the box).

The chat with the GP via the website didn't go well in that they wanted to talk to me then and there but I was at work, so they closed that discussion and told me to get back in touch on a day when I could actually talk to them. I am more than capable of learning about options in an email discussion - after all that's how we work now....

I have signed up for the taking therapies as well (I sense if I didn't then I wouldn't get any further) - I'm going to stress that I want a talking therapy which will fix my brain fog. I already get my steps in, run 3 times a week, I've been doing Pilates for 13 years, I get the physical well being side of things. I'm just hoping I can get HRT rather than the CBT they offer by default which I tried a couple of years ago when I got stuck with a therapist (10 minutes phone calls every month, I'd sit in my car at work) and she'd walk me through the script on how less enjoyable I currently found shopping, going to the pub, having dinner with friends, etc - all things I don't do, not because I'm depressed but because I don't do these things. And how I don't like having my photo taken (I'm overweight and don't need photographic evidence to remind me - I'm also one of these people who can't identify themselves in a group photo - my picture of me and the real picture are quite different and I much prefer my own picture thank you!)

See. That's a rant. I look forward to the three 30 minutes talking therapy (over zoom) sessions fixing those too.

So the GP has told you you can't have any more oestrogen at the moment and try CBT instead? Wtaf?

My GP suggested CBT last year when I told her I was suicidal on utrogestan, but she also increased my oestrogen at the same appointment (which was my second month on HRT) AND suggested taking the utrogestan vaginally.

I did also read a couple of books on CBT for couldn't for the life of me see how it would help.

Like you I weight train 3 times a week, walk the dogs for miles every day, swim a couple of times too, bedtime yoga, Plus shed loads of oily fish, veg, good protein, etc.

In fact the sobbing was WHILE I was exercising, there was A memorable day where I was doing dumbell rows in a Plank with tears streaming down my face.

If I were you and I had the funds, I would go private and then get the prescription transferred to the NHS.

I am seeing a gynae about something later this month and while I'm in there I intend to ask him about my HRT too whilst I wait for my GP to say if I can go over 100mcg patch.

Should add, I'm seeing private gynae.

Your CBT over the phone sounds useless. Good luck OP.

@Leftoversgalore

I've emailed a local private menopause clinic - it's possible I'd get to the same point with my GP but I think it's going to be quicker and more convenient to do this privately...

I'm really pleased for you OP. It's something to almost look forward to!

It's so hard to get anywhere in a 13 minute GP appointment.

It will feel lovely to have a full half hour with someone who is an expert.
.

@Leftoversgalore I haven't made it to a 13 minute GP appointment yet - it's all been via the askmygp website or when I got the blood tests, over the phone. I did have to go into the surgery to take my blood pressure once but the machine wasn't working so that didn't happen (I got the nurse to record it when I went in for a smear test a few months later).

@Rainsdropskeepfalling don’t know how you’ve got on with the private consultant messages you’ve sent. But I used the BUPA menopause service and found it very helpful. I then transferred my prescription to my own GP.

I asked to be put on testosterone and my gynae obliged. It's made a huge difference - energy levels, mental sharpness and libido all returned quite dramatically.

I had to reduce my T dose as bloods showed it was out of the range of normal but no ill effects so I am staying on a lower dose.

People have varying rates of 'normal' testosterone. I have a feeling mine was always reasonably high for a woman.

@WilloTheWispy sorry my message wasn't clear. So far I've only had online/phone consults with my GP. I've booked a private one for next week - I looked at the Bupa ones but the private clinic is the same price for the same length of discussion with a named clinician, local and in person.

@Babamamananarama I requested my testosterone levels were tested but at the time the GP who authorised it said that my health authority were unlikely to sanction testosterone supplementation - and when my result came back as 0.3, so within the normal levels of 0-1.8, that was that. But as I understand things, the HRT is adjusted to suit the symptoms not the blood tests anyway, so I guess my test result would have had to have been orders of magnitudes different for action to be taken. I've given up on my libido as that faded away a decade ago, but I refuse to lose my marbles unnecessarily. And I've been tired for so long I've come to accept the standard message from the doctor is it's because I am tired....

Good luck with your appt