Starting HRT several years after menopause

[BlackInk]

Hello
My periods stopped out of the blue about 8 years ago when I was 42. GP at the time said it was up to me whether I took HRT, so I didn't - I did have lots of symptoms of 'something' but not classic menopause symptoms so didn't think HRT would help.
Anyway, fast forward to now and feeling so crappy decided to speak to a GP about HRT. She was shocked that I had been through early menopause without HRT and I'm 4 days into taking progesterone tablets and using oestrogen gel.
The past couple of days I've had really quite severe pelvic pain. Feels like ovulation +++ and period pain mixed together, and sex v painful.
I suppose what I'm asking is whether starting HRT can cause pain like this, especially given it's been such a long time since I had a period. Also, interested in any experience from anyone else who has tried HRT several years post-meno.
Thank you :)

It is normal to have a kind of 'wakening up' as the hormones will affect your uterus and it won't last forever. Did your GP explain what the hormones do?

Estrogen makes the uterine lining thicker and progesterone stops it happening, so that by using both every day it means the lining stays thin and shouldn't overgrow. Spotting is common for 6 months when you start this type of hrt.

You shouldn't be experiencing painful sex though.

Was this happening before HRT? Because loss of estrogen causes painful sex (and it may have happened anyway.)

Your GP possibly isn't aware of subtle variations on HRT that specialists can offer. BUT if you could cope with an occasional withdrawal bleed ( a false period) you could use only estrogen for several weeks (this is also described in the NICE menopause prescribing guidance as a long 3-monthly cycle) and progesterone for 14 days every 12 weeks.

Is your GP also referring you for a bone density scan? They should as loss of bone density is a risk with early menopause. If they are not, ask!

Thanks for replying @JinglingSpringbells, and so comprehensively!

GP does seem quite good. She's put me on separate estrogen and progesterone so that she can adjust each of them if she needs to, and mentioned maybe adding some testosterone later if needed. No mention of a bone scan though.

It does make sense that my reproductive system (defunct as it is) would react to the sudden influx of hormones. The painful sex is definitely new and definitely coming from my ovaries/uterus rather than vaginal. No dryness issues. It's hurting all the time, but especially jarring when I walk and during sex. Feels just like ovulation pain, but worse. Bearable though.

She does want to follow up with me in a couple of months, so perhaps I should just wait and see if it settles. Very early days yet!