HRT advice please

[countrytweed]

Hello very wise ladies, I'm hoping you can give me some advice and your experiences please for next steps 🙏🏼

Background: I'm 43 (2 kids, 8 & 5) and main peri symptoms for past 3yrs include irregular periods, (very) low moods, anxiety, irrational rage and basically lack of joy - not consistently bad but always there.

Started 2 pumps of gel at the start of this month, oral Utrogesten a week ago, and in all honesty I feel much worse. Today I'm in floods of tears for absolutely no reason at all (this time of year is full of exciting things), getting out of bed seems impossible. My question is... how long can I take to kick in??

I suspect I'm sensitive to progesterone having had awful PMT, but the Mirena fills me with dread. Do I up the gel? Try patches? Try Utrogestan vaginally? I realise it's v early days... but I just want to feel better and more positive about life. Thanks for listening x

It is very early days. I'd start by upping gel to 3 pumps then also trying these -
and try Utrogestan vaginally.

If those don't work -
Try a Mirena coil
Try patches which contain Norethisterone (rather than micronised progesterone.)
Try a CCP such as Zoely which is sometimes given to young women in peri.

Thank you for the reply @JinglingSpringbells I'll give those things a try... quick q, if you start bleeding/get period during the 12 days progesterone and you're taking it vaginally, do you switch to orally?

if you start bleeding/get period during the 12 days progesterone and you're taking it vaginally, do you switch to orally?

Yes :)

@JinglingSpringbells 👍🏼 thank you

Just wondering if anyone had the same sort of start to their HRT and did it get better with tweaks? (guess I'm just looking for some hope when I feel anything but hopeful rn... 😌)

Hi OP i had the same issues. I went on for 2 months, at which point I realised I started crying 48hrs after the first utro tablet, and stopped about 3 days after the last one. I told my GP that I was finding it difficult. She suggested CBT to help with the crying and suicidal thoughts. Which was nice of her but no good for me!

I tried a further two months vaginally then had a coil put in.

I found the symptoms were the same vaginally as orally, though some women find it works better. It also gave me awful thrush and exacerbated the soreness from the atrophy.

The coil is fine for me. No more crying, still have suicidal thoughts most weeks but it isn't debilitating like on utrogestan and I don't feel so overwhelmed. My GP promised to take it out immediately if I struggled with it.

I've gone up to 100mcg patch, mirena and testosterone which made a massive difference to my energy levels, though I still find I'm very tired on HRT. I sleep like the dead in patches, waking up for the odd night sweat which haven't totally gone away.

The testosterone has also worked on my libido, though that's an unwelcome side effect as I don't actually want to have sex! However once you are stable on the oestrogen, you use 'libido' as an excuse to get your GP to dispense it. My GP nodded as I said the magic word and sent me off for a blood test and then gave me T.

The symptoms may not be connected with starting HRT and are in fact just your peri symptoms getting worse. Not everyone gets on with Utrogestan. Try it vaginally, try 3 pumps of gel, then reassess.
Good luck.

Also OP. When I did switch to vaginally, my GP gave me actual vaginal utrogestan in 200mcg pessary form. These were much easier to use than the little fiddly tablets.

Thank you... will try the 3 pumps and Utro vaginally and see how I go 🤞🏼 Currently sat in the car while my DH and kids are in the shops cos I can't stop crying. FFS being a woman is so sh1t.

Thanks for tips @Droolylabradors I'm glad things have improved for you. I don't know why I'm so scared of trying the Mirena, I guess cos it's not as easy as tablets to stop quickly if it's causing bad side effects 🤔 Also the words "lost" and "embedded" 😬

@countrytweed last spring, I spent many hours walking the dogs and sobbing along rainy bridleways. It's so so shit. I promise you there's a way out of it.

But do take action ASAP. Hopefully you have a nice husband. Mine is lovely but thought I was going mad and didnt know quite how to respond to it all.

@Droolylabradors Thank you lovely, that's a relief to hear it can improve. And DH has been incredible, he's basically the glue holding this whole s**tshow together 😂

@JinglingSpringbells As I'm 6 days into the Utro, could I stop taking it for the next 6 (as it's first cycle) then start taking it vaginally next 15th of the month??

Hmmm...why?

Ideally you should take the whole lot (12 days) but if you find that impossible, there is guidance that for women very intolerant you can do 10 days (but best not to all of the time.)

The other thing is, you need your body to get used to it. Sometimes, side effects reduce over time.

One other thing is that it's easier to take it on the same day each month (which means it's a 30 day cycle, not 28) and many specialists suggest that.

So if you started it this cycle on 12th July (or whatever day) you'd do 12 August etc.

@JinglingSpringbells yep maybe my body just needs to get used to it (just trying to find a way of not having to take it tonight for another day of weepiness tomorrow 😝)

UPDATE: I upped to 3 pumps (from 2) and took the Utro vaginally and it really seems to have done the trick 😄 Weepiness went (apart from a little yesterday, which I now realise was the day before my period) and I feel a lightness again. Long may it continue!

Thank you so much for your words of advice and support @JinglingSpringbells and @Droolylabradors