Do I really need HRT??

[Helenmelon74]

Hi, just after some expert advice here. In February I spoke to my GP because I’d had headaches,anxiety and dizziness for months and was feeling pretty wiped out in general. GP suggested HRT (I’m 49) which I said I’d think about. In February I stopped taking Omeprazole, lo and behold the headaches stopped!! The dizziness and generally feeling crap got worse!
4th March-Coil removed (out of date, no contraception needed)

6th April-I had bloods done which showed high infection markers.

7th April- urine tested, very high bacteria levels. Started strong antibiotics.

8th April-started HRT advised by doctor due to how I’d been feeling.

10th April- FELT AMAZING!

11th April-first period in 5 years, extremely heavy and lasted 10 days still felt great!

17th April-patch containing progesterone started, anxiety sky high and mood continued to lower. Advised to stop and have another coil fitted so I could have oestrogen only patches.

26th April-Mirena fitted and oestrogen patches started. Expected to feel great again but didn’t happen.

4th May-period came, extremely heavy lots of pain, feeling so tired and flat.

I know it’s early days but I’m beginning to think the improvement I had at the start of April was actually getting rid of a urine infection that I’d had since December! (Also possibly the Mirena wearing off and my body taking over.) I’m obviously still having monthly periods which I’ve found out since having the coil removed so should I even be on HRT? Part of me wants to just get this coil out, stop patches and see how I am without any artificial hormones!

HRT is often pushed on women without any thought to their lifestyle or other health issues.

Only go on it as a last resort.

Well it's entirely up to you. If you are not having symptoms when you are not on HRT there is no law which says you must use it. Many women do manage the menopause transition without being on HRT. Others (like me) definitely do benefit enormously from patches. Back to your GP and discuss.

You have to consider how you r quality of life would be without HRT.

The symptoms you list such as headaches, anxiety and dizziness are not necessarily linked to menopause.

Be aware that ABs can cause havoc with your system and it can take weeks/ months to recover (you could try boosting your gut microbiome with your diet, which takes a huge hit after ABs.)

Why were you on Omeprazole? Do you have acid reflux? Were you on it long term (which is now regarded as risky as it has serious side effects in some people.)

I think you need to pause and take stock.
You don't nee to use HRT so why not stop for 3-6 months and see how you feel?

I have no faith in the GP tbh, I'd rather get some advice from women who have experience in the matter. My GP now does everything through online forms so impossible to actually converse with them.

I was on Omeprazole for 4 months for acid reflux that had caused an ulcer in my oesophagus. That's healed now so I'm managing the reflux with gaviscon. The headaches and anxiety stopped within a week of stopping Omeprazole and I've since read hundreds of posts from people who had the same experience. The dizziness stopped within 2-3 days of taking the ABs for the UTI and hasn't been an issue since. The progesterone patches caused my mood to become very low and this did happen on the progesterone only pill years ago too which makes me wonder if I should have had the Mirena put in at all 😩

I feel like they made no effort to look into anything just decided I was the "right age" and gave me it 🤷‍♀️

HRT is definitely not to be used “only as a last resort”, anyone thinking that probably has very outdated knowledge.

Also it IS for women who are still having very regular monthly periods.

It does seem like you’d benefit from changing one thing at a time to see where you are at. So maybe quit all the hormone meds for 3 months and see where you are?

To be honest you wouldn’t expect hrt to work in days. If you go on it again you need to be waiting 8-12 weeks to know what you’re going to get out of it

Nobody "needs" HRT - it is an option. Some women swear by it - that's fine for them. But there is a vocal lobby which tries to insist that we all should take it, and that's rubbish. I've never had it, and I feel fine. It is a choice, and you can choose however you like, OP.

Would you include having the Mirena removed again? Or just stop the oestrogen patches?

Progesterone made my mood very low indeed, on the pill and HRT. The mirena which I had put in for HRT didn't. HRT really assisted me. I've had to come off it now in my mid 50s and to be honest the symptoms haven't come back, apart from the odd hot flush. I'd been really worried.

I do take vaginal pessaries though as I need those.

Given the UTI even if you decide against HRT definitely do vaginal oestrogen.

I agree that it is a choice.

I also very much DISAGREE that "nobody needs HRT". I definitely need HRT as without it, life was very much unbearable.

@Helenmelon74 I totally understand that you are looking for opinions but the problem is that there is no one size fits all approach to HRT. It's very much a process of trial and error, working out what is the best combination for you or whether, in fact, you're happier without HRT at all. There is no right and wrong answer.

I do hear what you are saying about a rubbish GP and many of us have similar experiences, although a more common story is having to fight tooth and nail to get HRT rather than it being "pushed". I would advise looking around this forum, and there are lots of facebook groups, in person groups which have lots of people sharing their thoughts. It is early days for you, the doctor will usually say you have to give it three months. But if you think that you'd be happier trying using nothing for three months to establish your baseline and take it from there, I'd say that was a perfectly valid and sensible decision.

Do you feel like theres any possibility the merino is contributing to
your problems? If not I think I’d stop the oestrogen for 6 weeks and see what your symptoms are like.

In case helpful, premenopausal symptoms which could benefit from hrt aren’t limited to changes to menstruation and hot flushes, there’s quite a big list.

I am also 49 and in peri the last couple of years. I did have the implant contraceptive which I'd had in for heavy periods. I was on my second one so almost 6 years with it.
I decided to have it taken out last summer just so I could see where my periods were at cos on it I had no periods at all.
For the first couple of months I had no periods. Then they came back & I had them every 2 weeks for a couple of months. Then they slowed down again. I had one in February & then the next one was last week & was very heavy for 2 days & then stopped.
As there is breast cancer in my family (dad's sister died of it in her 40's and a cousin on the same side has had a breast removed) doc has said there's a very slightly higher risk for me on hrt so for now I've decided not to have it.
My main symptoms are fatigue & joint pain I've been trying to walk a bit more & do some yoga for the joints & I've started taking a menopause vitamin supplement which I only started this week so no difference yet. Ive never had a hot flush or night sweats.
A friend of mine is on hrt & swears by it & is a bit preachy about everyone being on it & how you need to be on it early etc etc but I've told her I'll go on it if I need to but I'm happy enough right now.

My mum is one of three. One sister had it, the other two didn’t. They had no menopause symptoms at all, periods stopped- the end. Whereas my one aunt had hot flushes, sweating, etc. She swore by HRT.

Another one disagreeing that nobody needs HRT here. Some people do. I do. I get awful symptoms without it and it exacerbates my underlying health conditions not to have it.

UTIs are a classic sign of loss of oestrogen, OP. If you don’t want HRT systemically (which is thought to lower various other health risks) maybe see how you get on with taking pessary oestrogen as your only HRT. It’s a low dose and local oestrogen replacement. Hopefully it will stop the recurrence of UTIs.

Around 1 in 5 women will breeze through menopause without needing any support. The other 4 may benefit from hormone replacement. It’s impossible to know which group you are in until you’re there.

@CleverCats I'm not sure, I had 2 consecutive coils for 10 years previously because I couldn't tolerate any other contraception, I did have some depression and anxiety which I take 225mg venlafaxine for (and hate taking it!). It's made me wonder if my issues could be to do with the coil. I'm driving myself slightly insane here 😂 I don't need any contraception now so it was put it purely for HRT purposes this time. I feel like I had so much going on and should have dealt with all that first! I was just so desperate to feel better! I think I'll probably take the patch off and see how I go for 6 weeks or so.

The mirena made me crash when it went in, such terrible mood and utter exhaustion. It settled after a few months. I'd say you might benefit from some more oestrogen.

Ps. I don't have my mirena for contraception as we prefer condoms and still use them. I just have it for HRT as I can't stand any other progesterone.

Quite frankly it's not random women on mumsnet who can advise you best as we all have different experiences! You should ask for a referral to a menopause clinic where specialist doctors and nurses can help you decide. A bone density scan is worth having. If the wait is too long on the NHS (!) and you can afford it, go privately.
FWIW I have been on HRT for years. Aside from severe depression, sweats and mood swings, I take HRT (oestrogen and progesterone) to protect my bones as I have osteopenia. My bone density worsened for the 18 months I came off meds due to GP scare about breast cancer which has since been discarded. Once back on HRT my bone density significantly improved.
Issues with osteopenia and osteoporosis are not discussed enough with regard to menopause and HRT.

I'm no expert but what I would say is that it took me months to settle on the Mirena. I had the Mirena previously in my 30s as contraception and had it out within 6 weeks as I felt so rough on it. This time I persevered and after a few months it settled and I feel myself again (I also have oestrogen patches). We are all unique and it's trial and error unfortunately. Perhaps give it some more time before making any further changes.

With respect, women who've not used HRT rarely appreciate the different types, brands, or the way it can be individualised (more so by specialists and more so by private specialists who aren't 'controlled' by NHS rules.)

@Helenmelon74 Any kind of progestogen whether it's a coil or patch or a tablet can cause low mood. As you say, if your low mood coincided with your first Mirena, it's possible it didn't suit you as well as you thought.

It's 'sold' as being more or less side-effect free, but the medical research shows that some of the hormone in it is actually absorbed systemically, and at the same level as a low dose patch.

It's only my opinion but the fact you have been on ADs for many years is relevant. And if that coincided with the Mirena, that's more relevant.

As others have said it really is trial and error.

HRT is the first line treatment for low mood in peri.
However, you're more complicated as your low mood seems to have come at the same time as using a Mirena. You should consider having it removed and seeing how you are.

There are options for women who are intolerant to many progestogens, such as 3-monthly cycles (this is all in NICE by the way) where the use of progestogen is reduced to an absolute minimum of 12 days in 84 days.

So, don't dismiss HRT outright, but give you mood time to settle and see how you feel then. You might also want to consider talking to your GP about the long term use of ADs which don't work for peri-based low mood. (Dr Louise Newson has a lot of info and case studies on this, on her website.)

I would like HRT that replicates Femodene as closely as possible and does not allow endometriosis to return as I feel fucking fantastic on it, but can only take it for another year or so. Bit worried that "bio-identical" oestrogen will be counterproductive as my body seems to like ethynlestradiol, which has been discontinued in the UK for menopause treatment.

When I had the copper coil and my own hormones for five years I got endometriosis, so bugger that. Symptom free after several years on desogestrel and two years back on combined pill.

I don't blame the doctor for trying HRT as a lot of feeling shit symptoms are hormone related. I was getting vaginal atrophy on desogestrel, all back to normal now. But there are also others to consider like cortisol, adrenaline, and thyroxine.

I worry about osteoporosis too with low oestrogen - my mum is ok but my dad had it. I wouldn't be taking any chances.

I'm also a bit worried that the type of progesterone prescribed for HRT is typically levonorgestrel which is the fucker in Mirena and Microgynon which made me depressed.