Advice need for changing from a cyclical HRT to a continuous HRT

[JustHereWithMyNewYear]

I wonder if anyone can help me prior to going to the GP?

I have been on a cyclical HRT in tablet form (Novofem) for the past 5 years. I started taking it while still having periods but I am 54 this year and feel that it is time to come off this (I’m also sick of getting periods tbh). My GP practice has not seen me since COVID lockdown started and I get a repeat prescription ordered on the nhs app every 6 months. I’m not happy about the lack of care in this but equally I haven’t pushed to see them.

I would like to move to a different - non tablet form - suitable for my age where periods shouldn’t really be happening. I know that if I go to the GP they will ask me what I want to go on as they are absolutely terrible with menopause matters. Can I ask what others have used when switching from cyclical please?

TIA

I started cyclical at 52 and a few months ago at 54.5 I got a Mirena coil fitted (for continuous progesterone) and have estrogen gel daily. Only partially successful, though, as I'm still having periods (less often and less heavy, which is a win)

Thanks @BatshitIsTheOnlyExplanation I didn’t think to mention this but I absolutely do not want to have a coil fitted. I’m think patches/ cream sort of thing.

How have you symptoms been since changing over? I am scared that mine will come back with a vengeance.

A timely thread as I'm going to see my GP about this tomorrow.
I've been on cyclical HRT for about 5 years and started to experience extreme heavy bleeding.
Transpired I had been prescribed too lower dose of progesterone so had to temporarily come off it (HELL!) while I had scans/biopsies taken.
Biopsies were clear thankfully.
I have a 8cm thickening of the womb lining and 2.5mm fibroid but I'm not sure what happens re these until i speak to GP 2mo.

I wasn't keen on the idea of a coil either, but I found that oral progesterone (or vaginal pessaries) gave me the absolute rage, so I really didn't want that 24/7/365.
Symptoms seem ok, no hot flushes, no brain fog.

@HumourReplacementTherapy I’m so glad you’re OK but hope the fibroids and thickening don’t cause you issues. Please do let me know the outcome of your GP visit, I just have no faith in mine.

@BatshitIsTheOnlyExplanation god, I don’t need any more rage! 😂 I see a few people on this board have mentioned that they had this as an issue, do you think the dosage was too high in that instance?

I wonder if I’ve called it the wrong thing, it’s sequential HRT I’ve been taking so 16 days oestrogen and 12 days progesterone.

OP, regarding the rage, yes, I think the dose of progesterone was too high. It was very predictable. Estrogen every day of cycle, progesterone 12 days out of 28. By about day 6 each cycle I was so irritable and wanted to kill someone (DH, kids, colleagues, anyone would do).
I tried vaginal progesterone as it's half the dose, but it wasn't loads better. I don't know what the Mirena dose is, but it seems to be hitting the spot between what the medical professionals say I "must have" and feeling quite normal.

@JustHereWithMyNewYear
if you are after patches or gel you are best getting the gel or patches and separate progesterone and would would take the progesterone daily with the patch or gel or spray so you don’t get a bleed they would probably give you utrogestan as it’s body identical.

Thank you @Christine0708, do you still get a period with this arrangement?

Good luck with your appointment @JustHereWithMyNewYear
Mine is later this afternoon, I've not seen this particular GP before so I'm trying to get as much info re options as I can before I go.

I have the oestrogen gel and progesterone tablet ( utrogeston) daily. No periods.

@HumourReplacementTherapy I haven't made mine yet (don't even try the first days of the week, not a chance in hell of getting an appointment) but do let me know how yours goes.

@Tatapie thank you, that's good to know, can I ask which oestrogen gel do you get and what dose of progesterone? I am trying to avoid the rages!

Sure it's 100mg of the utrogestan and 2 pumps of the "oestrogel"

Thank you. 🙂

@HumourReplacementTherapy how did your appointment go? I have a telephone appt with my GP today (between 9am-1pm hopefully I'll be near my phone when they call!) it seems impossible to get an actual appointment these days.

Spoke with my GP yesterday, what a waste of time. He's insisting that I have a blood test done to 'prove' I'm in menopause before allowing me to change my HRT.

NHS guidance is to change over once you are 53 (I am 54 in a few months).

Blood tests are notoriously inaccurate but I am currently taking hormones so what is the blood test actually going to prove??

I now have to get a new prescription of Novofem because the blood test will not be done and back before I run out of tablets. <sigh>

Oh no @JustHereWithMyNewYear
That's absolutely ridiculous as all it will show are your hormone levels the day the bloods are taken.
It's absolutely not in the guidelines at all at your age.
Can you speak to someone else?
My GP has put me on the wrong dose of progesterone AGAIN!
Ffs!
So she agreed to the continuous regime, using a patch this time instead of gel (50 strength) but she's incorrectly told me 200mg of progesterone a day (if it's continuous it should be 100g with the 50 strength patch)
So last time I was on too little now too much.

@HumourReplacementTherapy honestly, it was the most frustrating conversation. It just goes to show how poorly informed some GPs are.

Im sorry your prescription has got messed up again, can you call the surgery and ask for it to be changed?

I went from sequential to continuous a few months back and a huge amount of hair fell out over a period of several months. The change in hormones is the only thing I can think can be responsible, my blood tests came back fine… currently waiting to see a dermatologist. Has anyone else had this?

Oh blimey @maltravers thats sounds awful! I haven’t heard of that before, I do hope it’s not a common side effect? Have you adjusted your HRT since?

I went back to the old one as I still had some(but need to discuss this with the GP). I’m waiting for the dermatologist’s view first, but apparently sudden hormonal change can cause this… it can’t be that common or it would be all over this board I assume.

I hope you get to the bottom of it, like we don’t have enough to deal with. 😔

Tell me about it! Thanks 🙏🏻

@HumourReplacementTherapy Had another telephone appointment this morning with a different doctor in the practice who was happy to change HRT. I have just looked at the prescription on my NHS app and he's prescribed 200mg of progesterone a day and 80g of estradiol. That progesterone sounds too high given your experience?

Progesterone doses should be increased if the dose of oestrogen is high so 200mg daily could be correct depending on you oestrogen dose (80mg doesn't seem right. Is it a gel? If so, how many pumps?). I am on the highest strength oestrogen patches 100mg and take Utrogestan 200mg every night with no issues.