Tipping point for starting HRT? Advice please.

[JoanDarc]

I’m 46 and think I’m starting to get more peri symptoms - joint pain, really dry eyes, skin, night sweats but it’s the brain fog, exhaustion and fatigue that I’m really struggling with and it’s definitely affecting my performance and confidence in work. Has anyone started for these symptoms only? Periods still there but frequency changed.
I’m ashamed to say for vanity reasons I’m worried about any weight gain on HRT, I’ve always been naturally slim and although do a lot of exercise, I’ve never had to watch what I eat, worried HRT could affect this although know this will probably change with menopause anyway! 😬
Have listened to so many podcasts and done a bit of reading but to be honest so confused. Any experience much appreciated.

I don’t know about weight gain due to taking HRT, I definitely haven’t put on more weight but I was already overweight to start with so it may affect someone slim more than me.

I can only imagine that having more energy and feeling better in yourself would help you to make good choices re food and exercise.

I am 47 and had the same symptoms as you, I started hrt about 3 months ago and the joint pain has all but gone, I have more energy and my libido has come back a bit. Brain fog has lessoned but I still get mind blanks on words occasionally

You don't need to wait if you've got symptoms.
Try it and see if it helps.

Weight gain is an ongoing debate.
I've used hrt for 16 years and not put weight on.
I didn't put weight on when using the Pill years ago.

Some women do, some don't. The dose and type can possibly be a factor.
Obviously in peri, it's hard to be sure it's HRT if you gain weight.

Thanks everyone for your input. Reflecting on it, I’m probably nervous about starting HRT when my physical symptoms are tolerable and worried what the pay off is.
It also sounds very difficult to get the balance right for each individual on type/ dosing. May consider having a chat with GP to scope it out further.

Bear in mind that posters tend to use this forum for advice and are having some problems. You're mentioning getting the dose right etc and it's making you wary.

I have a few friends on HRT and they've never had any issues (and my dose /type was right from the start.)

You will tend to get biased experiences online.

My dose was spot on straight away and type fine!! No weight gain either (I'm 6 months in) or any other undesirable side effects.

Your symptoms sound utterly intolerable to me actually!! But we're all different. That would make me miserable. It'd really impact my quality of life. My 'only' symptom was night sweats. I wasn't putting up with that!!!!! I managed a week and thought sod this. Interestingly a load of other stuff which I hadn't connected with peri then improved including joint pain and waking at 4am.

A lot of women gain a spare tyre at this stage of life because fat in that area contains a type of oestrogen and our bodies prioritise it. It can be very hard to shift.

Diet and exercise are really important - and of course I understand the vanity reasons; diet culture has done a number on women! But if you want to be fit and healthy in your later years, it’s vital to protect our bones now. Diet should be focusing no protein to help retain muscle, calcium for bone protection, and exercise needs to include weights to maintain bone density.

The only symptom of peri menopause, that cannot be attributed to other causes, is hot flushes and some ignorant gps won’t prescribe hrt without that. But unstable oestrogen production is linked with a host of problems like the ones you’ve listed. With more women in medicine, and the communication benefits of social media, there’s more understanding of this. Frozen shoulder is a great example of this. UTIs are another - it’s now thought that oestrogen might be more effective than antibiotics for recurring utis.

I have brain fog, exhaustion, dry eyes and skin, vaginal dryness, night sweats, heavy periods, anxiety, muscle pain and twitching. The GP is refusing HRT because my periods are still regular and I’m not having hot flushes every five minutes.

The muscle pain and twitching is absolutely debilitating, I’ve spent months worrying that it’s caused by a serious illness. So I’ve gone private to access HRT. I can live with being fat if the pain and twitching stops. Waiting to see if it’s going to work.

Don't underestimate the importance of good sleep - it is so important for long term health and short term wellbeing! If you're having night sweats and struggling with fatigue and its knock on consequences I think it's worth trying HRT for that alone. It's great that you're already active as that will help to manage symptoms, but good sleep will help ensure you have the energy to keep exercising as well as supporting good recovery. I also find that after a bad night's sleep it's hard to resist the tendency to reach for a snack for an energy boost, which is more likely to lead to weight gain than HRT.

Dose wise I've found it fairly straightforward. Getting gel or spray estrogen is great because it allows you to experiment with your dose (within the range prescribed) to see what works for you. The gel can be a bit messy so I like the spray best.

Thanks everyone, it’s really encouraging to read some positive stories of starting HRT and it going relatively smoothly.
I think part of my reluctance is that the symptoms have probably built up gradually over the last 1/2 years so I’m still questioning are they all related where on balance I know it’s most likely attributed to peri.
@bidon @UnaOfStormhold can I ask what type you take, I see gel or spray mentioned but are you also taking tablets too?

I have a mirena coil for the progestogen component and use lenzetto spray (I have previously used estrogel and sandrena which worked well but I find the spray more convenient).

Yes agree totally with this. I’m on it after starting having two periods a month and having a couple of self harm incidents - very minor ones.

don’t recognise the weight gain comments at all. My weight goes up if I est too much and down if I don’t!

Your symptoms are almost exactly like mine, I started tablets 3 months ago, they're working amazingly, had to add in some ovestin this week. I'm 49 but feel like I'm about 40 again! Just capable, hopeful, happy, able to concentrate, able to sleep etc etc.

I had some of the symptoms you describe, I started on HRT and they were gone within a few months. I’m on patches and take tablets 2 weeks out of 4, no issues. I started on a low dose and have moved up once so far.

I'm 46 and had all these symptoms for 2 years. Started HRT in May. Yes I gained weight as I'm a glutton, however, over 6 weeks I have lost 15lbs. So it does come off.

The only issue that it's not helped is my hot flushes. I spend a lot of the day roasting.

I should have said in my earlier comment that I have been on HRT for about a year and a half. I have lost a significant amount of weight during that time.

I started it because my periods went insane (genuinely ridiculous) and there is also a massive history of osteoporosis in my family. Two pumps of oestrogen plus utrogestan resolved the menstrual problems and I hope may help with the bone loss.

I have put on weight since going on HRT, but I was putting it on before I went on it. My waist is gone .

Thanks everyone, mostly really encouraging posts about starting HRT. I’ve been thinking more about it over the past few days and think part of my reluctance is questioning if it’s exhaustion at life - classic demands of busy home life, kids doing loads of activities, demanding role and ageing parents needing more input, but know in reality this can’t explain the physical symptoms.
@WeedsAndWildflowers your experience sounds so positive, would love that!
I’m going to take this week and do some reading to make sure I’m well informed before scheduling a GP appt.

I was a bit undecided as to the cause of my symptoms - but after a week on HRT I genuinely couldn't believe how good I felt. The onset had been so slow and over a couple of years like you so I'd actually not realised just how bloody AWFUL I'd been feeling until that feeling went away!

Give it a try. If after a few weeks you still feel crappy then you know to look elsewhere for the cause.

This is exactly how I feel! Is only dawning on me now that how rubbish I feel isn’t normal or needs to be tolerated. You’ve hit the nail on the head, it’s the slow build up over time that fools you. So pleased to read it helped you, fingers crossed!