HRT - just can’t get the balance right

[Hotmess66]

Can anyone offer me some advice because I’m just about at my wits end now.

Been on HRT for about 3 years. I’m 51. No idea if I’m menopausal or still peri because I’m on continuous and don’t bleed, but I feel like I still get pms so probably peri. I’m under a gynaecologist due to unrelated issues, she oversees the HRT.

When I first started it was miraculous. Within days no more flushes, better sleep, felt calmer etc. But after a few months (on patches - everol sequi) I started getting some gastric issues so I was changed onto gel / utrogestan. Then because my bleeding was ridiculous and I’d been on HRT for a year, I was advised to just take the progesterone every day, and I haven’t had a bleed since. Which is great.

However, although the hot flushes and things are under control I am absolutely knackered all the time, and my anxiety is completely through the roof. I was advised to up the oestrogen from 2 pumps to 3, and then 4. But anything over 3 gives me horrendous bloating, and I mean horrendous - it’s not much fun being in your 50s and being asked if you’re pregnant every other month. So I went back down to 2. Then, after months of begging I was given testosterone to add in. Instantly just bloated back up again, even worse than with the oestrogen, so had to stop using after a few days.

So now I have no idea! I feel like I’ve exhausted everything. Am I missing anything? I already take the utrogestan vaginally, they’ve offered me the mirena but would that make any difference? Has anyone been on HRT and taken sertraline as well for the anxiety / emotional bit of the menopause?

Sorry for the long post. Any advice or shared experiences very welcome!

Yes switch to mirena. Taking utrogestan is like walking through treacle for me. I could barely drive I was so tired.

Mirena still makes me tired but less so. I still get cycles and have pmt/cramps but barely any bleeding.

Where and how much testosterone did you apply? I use 1/8 of testogel and put on my thigh. Haven't noticed anything other than increased energy and libido.

Thanks for the replies, I will look into the mirena.

Same as you Drooly. It had the same effect (bloating) as too much oestrogen for me after a few days.

Would you consider sequential or does the idea of a monthly bleed appall you?

I feel very 'fat' on the Utrogestan phase, although using it vaginally helps a lot (I wouldn't want to do that using it daily.)

I'm a lot older than you but still use sequential as I didn't get on with Utrogestan daily.

There are various options which if you're seeing a consultant they might agree to.
The most obvious are if you try sequential you can space the bleeds out and do longer cycles (not just the usual 4 weeks) - they could be every 6 weeks, 8 weeks or even every 12 weeks (this is allowed by NICE for women intolerant of progesterone.)

I'd query if it IS the estrogen making you bloated or the combination of it AND utrogestan.

By sticking to just estrogen for a few weeks on its own you can start to see the wood from the trees and work out the dose more easily.

Thank you for your reply. I didn’t know you could leave such long gaps, so you would take the progesterone for 15 days and then not again for 6-8 weeks?

I was advised to go down the continual route due to really debilitating bleeding (fibroids) so really not sure I can cope with that again!

Sorry if this is a stupid question, but when you are fully in menopause and no longer having periods, do you still get a bleed on sequential HRT?

Please get your thyroid checked and ask for an antibodies test as was in same situation as yourself and so exhausted, in dragging feet exhausted. Only issue I have now is my horrible doctor trying to get him to up my meds as on a very low dose. I am also on continuous and do not miss periods as were so heavy but feel bloated on continuous. Also get your iron checked. It is awful when things are going good and then boom back to square one. Talk to your doctor and get bloods done and see what happens. Am sure someone will be along to give you good advise.

Thank you. Thyroid and iron and everything else was checked before they prescribed the testosterone. I’m sorry you’ve had a hard time with your GP, some of them are absolutely useless.

Hotmess66 I agree, he did not even pick up on my thyroid my doctor at family planning/women's health did even though had been losing eyebrow hair, leg hair which are signs of it. He also would not give me hrt at 48 or 52. Am changing doctors but so hard to find one who are taking new patients but the receptionist is so lovely at doctors and goes out of her way to help with prescriptions etc as she knows he is a narcissist pig. Hope you find something as so hard just when think are sorted and hrt going well and then having to change again. Really helps having people on here and have to educate ourselves as so many doctors clueless. Take care of yourself xx

@JinglingSpringbells please could you explain how the spacing out bleeds works?

Wish I had the answer but I had similar to you and saw a menopause consultant who told me I was still sporadically producing my own oestrogen, so combined with the hrt I sometimes had too much and sometimes too little. In my case I was bleeding profusely and opted for a hysterectomy.

Blood tests don't really help as if you have one on a Monday, by Friday the results could be different.

The only thing that did help me when I was going through this is the Minerva coil, but I decided I didn't want it long term.