Hrt options

[JessicaPeach]

I'm 42, been experiencing lots of peri symptoms (low mood, tired, irregular periods, night sweats) My GP suggested we start with a full round of bloods which I was happy with, they have come back that I am deficient in b12, vit d and folate. My fsh was 25.3 and lh 14.

Dr has suggested we treat the vitamin issue first and repeat the bloods in another 4 weeks with a view to starting hrt.

From the reading I've been doing there seems to be absolutely loads of different combinations, what is a standard type/dose to start with? I'm booking in for a mirena as have been meaning to do that for ages anyway post birth, it will be my 3rd mirena. Just want to be able to narrow down what I might be offered and do some research in case I'm given a choice.

If you have your uterus still - which I am assuming you do as you mention mirena - then you need both progesterone and oestrogen. The Mirena will give you the low dose of progesterone you need to protect your uterus.

Then it's really just the oestrogen. And your choices are patches, gel or spray really, there are tablets too but these are not generally used any more as the other options are much better/safer. It's a matter of personal preference and trying one to see how you get on. Personally, I didn't get on well with the gel at all, the patches suit me so much better. Other women don't like the patches and prefer gel. For me, the benefit of a patch is that I whack one one twice a week and forget about it. Gel you need to apply every day. Whatever method you choose your GP will probably start you on a low dose 25 or 50 mcg patch or a couple of squirts of gel a day, see how you go and work up from there until you are feeling better.

I was started on a 25 mcg patch (I don't take progesterone as I've had a hysterectomy) and am now stable on 75 mcg. I also have oestrogen cream for vaginal atrophy which I use twice a week too.

@JessicaPeach i’d recommend downloading Dr Louise Newsome’s app ‘balance’ lots of useful info and on her website/insta.

I have this already, thank you!

This makes a lot of sense, good to see it broken down, thank you. She mentioned patches in the appt so I presume that's the usual starting point at my gp surgery.

I'm wondering if I'll need it at all once I sort out my b12 etc but I'm comforted knowing they are completely willing to prescribe it so I might as well give it a go and see how I feel.