Oestrogel

[mrsconradfisher]

Need some guidance! Think I’m in the middle of the menopause…periods have virtually stopped but my main symptoms are very severe hot flushes to the extent that I am boiling hot all day every day. I’m a TA and schools are hot…it’s not a good combination.

About 9 months ago, GP gave me Evorel patches. Tried using them for a month but it was a nightmare, no matter what I tried they wouldn’t stick to me. I gave up and thought I’d just stick it out so to speak. GP saw me for a review and prescribed me oestrogel plus progesterone tablets and some vaginal tablets.
I’ve basically sat on them for the past 6 months as I’m scared to use them which is crazy. I literally cannot put on any more weight. I’m only 4ft 11 and I’ve gone from a size 12 to a size 16. But equally I don’t want to feel like this anymore.
Im also not great with medication, I tend to react badly to it which is making the whole process even more scary.
Do the oestrogel and the progesterone tablets work together? It says to take the tablets in the second half of my cycle but I’m not really having a cycle so no idea when I’d take them?
I read that you could just start with the gel and add the tablets later? Does anyone have any experience of doing that?
Can you tell I have no idea what I’m doing…

@mrsconradfisher
Cant help you with progesterone tablets - as I have a coil for that. But Oestrogel is great. It's easy to apply and my symptoms started getting better after a week.
Literally changed my life.
As to weight gain - it's the opposite. You have gained weight because of your drop in hormones. HRT doesn't make you gain, it can help you to get back into your normal weight range - IF you eat more sensibly.

In your place - I'd just bite a bullet and start. Look at progesterone instructions again. If it says - take them mid-cycle - I'd take it to assume "the cycle" the way it used to be for you... Or use some average cycle - 28 days. It's not a precise science....
Your oestrogen - you need every day. Your progesterone - about half of the month.

Good luck! You really don't need to suffer the symptoms

Thank you. I just feel overwhelmed by everything at the moment (which I know is all the menopause) so just need a kick up the bum to start!

Yes the instructions say take in the second half of the cycle, so I’d just mimic a cycle as I’m not having them? Start tomorrow with the gel then in 14 days start the tablets? It was that bit I couldn’t work out as she seemed to suggest I needed to take it with my cycle. I’ve had 1 period in 8 months so I didn’t want to wait until my period to start to begin using them.

It was always my understanding that you shouldn’t take oestrogen without taking the progesterone too as on its own oestrogen thickens the womb lining and can increase the risk of cancer. But I’m not medical so check with your GP. I have to respectfully disagree with the PP and say I think my HRT has contributed to my weight gain.

I think all this nonsense you must start at a particular time is really hard and very confusing on people. Even if you read my coil booklet given after procedure that said the coil must only be inserted on a particular day of the cycle but then I never had the coil fitted for contraception means so it is all very confusing.

Women who have to have fibroids and other gynaecological issues dealt with don’t have procedures conveniently scheduled till the right time of the period cycle.

I started on progesterone capsule on a Friday eve, oestrogel Saturday morning. I’ve started missing a day of the gel here and there as it made my thighs turn into what looks like vag no 2 (don’t know about a tummy tuck but my inner thighs need serious help!) but I’m really very afraid to miss the progesterone. (I had a thin lining unlike most ladies with fibroid who mostly tend to have a thick lining)

42 and don’t get the breaks. (Yet) on it continuously.

My GP said it was fine to start the Utrogestan on the following month, as the day I got HRT was the date I would have normally started it (I still have periods). I wanted to be able to separate any side effects out so I knew which was causing them iyswim.
I have lost a small and steady amount of weight in the 8 months I’ve been on HRT, mainly due to having more energy and motivation to walk a lot and adjust my diet a little. So I can’t say the HRT has directly caused weight loss but it certainly hasn’t caused any gain.

The good thing about HRT is that you can just stop it if any side effects outweigh the benefits for you. I started to feel a difference from the oestrogel within a week, utrogestan needed a bit of tweaking but nothing too bad.

Women gain weight in menopause, it's a known fact. So - without HRT you probably would have gained even more. Sadly it's one of those gifts of nature we were dealt...

"Evidence from the SWAN study and The Healthy Women's study suggests that on average women gain approximately 1.5kg per year during the perimenopause transition, resulting in an average weight gain of 10kg by the time menopause is reached. Most of this weight accumulates around the abdomen and upper body."

@Sashya That is an extract from this report

https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf

The full report says that 50% of women gain weight. Not all.

The report also gives a lot of info on how many women's diet's are shockingly bad, and how to change that.

Weight gain is not inevitable. There is a propensity to gain weight, as estrogen falls, but it's not a forgone conclusion.

In real life I don't know any of my friends who have gained weight (and they are all mid-late 60s.) They do a load of exercise (running, swimming, weights, walking) and some have even lost weight.

If you've not had a period for 12 months you use HRT one way.
if you're still having very occasional periods or haven't gone 12 months, you use it another way.

From what you say, yours haven't stopped completely.

So....

You use gel daily and progesterone for 12 days per month.

You can start now with both, or do estrogen only for 15 days then start the progesterone. Ignore when to start with your own cycle because it's not happening regularly.

You should have a withdrawal bleed around 3 days after the last progesterone. (But don't worry if you don't as it can be hit and miss to begin with.)

I'm sure you're doing this anyway, but have a think about your diet as many of us find we really have to cut back on carbs to maintain a healthy weight. Are you trying to lose the weight you've gained?

Tbh I’m not, I also have an auto immune condition and I can’t physically eat any less than I already do with out feeling really poorly. I do a huge amount of steps throughout the day. It’s not loads and loads of weight I’ve put on in reality…it’s just that I’m really short and all the weight has gone around my stomach.
I’ve accepted my body has changed (I was a tiny size 8 most of my adult life and looked really ill) then got diagnosed with my auto immune condition and my weight went up to a size 12 which is probably about right for me. Then this last 18 months despite eating much less than I was and moving more I’ve put on more weight. I probably need to lose about 1.5 stone. But I feel so awful all the time I just can’t face it.

Have you thought about seeing your GP and discussing Ozempic? If you have a chronic medical condition that has contributed to weight gain, is it worth considering?

You're suggesting that your auto immune condition is the cause of the weight- is that what you meant? Are you on steroids for it (they cause weight gain.)

It’s a bit more complicated than that. Ive got Rheumatoid Arthritis so I can’t do a huge amount of exercise, although I am active all day long working in a school. I suffer at night with huge amounts of pain and can’t sleep so I take Mirtazapine (an AD) which is well known to cause weight gain. But it means I can actually sleep, walk and function.
I also have pernicious anaemia which was undiagnosed for years. I basically wasn’t absorbing any nutrients at all and looked incredibly ill. If I don’t eat enough food, I feel very poorly. So it’s a combination of all of the above factors plus menopause.
I haven’t considered weight loss drugs tbh as it’s not a huge amount of weight to lose and I don’t even know if I’d qualify. It’s just when you are as short as me everything is concentrated in a much smaller area. I just know I cannot afford to put on much more weight.

Has your specialist dealing with your RA referred you to an NHS dietician?
You could ask?

Are you being treated with any of the newest biological drugs for RA?
I have a close family member being treated for an autoimmune condition similar to RA and they are on very powerful drugs which control the pain, thankfully.

No they haven’t. I’m weighed every time I go so I assume she isn’t worried about it, it’s more me that’s concerned. I will ask when I next go.
No I’m on Hydroxychloroquine, it’s been brilliant with no side effects. Pain wise I’m ok during the day, it’s at night it’s bad which is why I have the AD as it aids sleep.

Hi @mrsconradfisher I really recommend trying the HRT. Start your gel today, use it every day. On Monday 16th Sept start your Utrogestan pills for 2 weeks. Then 2 weeks off, repeat. You can plug this into your phone diary and you won’t need to remember where you are at. If you don’t like it you just stop.

I don’t want to say anything unkind but I’m short too, and the weight you have put on really is a big deal. You need to ask for help to lose it to prevent future health problems.

I wish you the best of luck. Also, from my own experience both peri-meno itself and taking ADs led to significant weight gain. I’m slowly shifting the weight now. It is really difficult but worth doing.

Thank you. I’m definitely going to start tonight. Sick of feeling awful.
I just don’t know where to start with the weight. I physically cannot eat less than I do now. I walk around 20k steps a day.
Never “dieted” in my life because I don’t actually eat a huge amount of food.
Typical day would be-
1 slice of whole meal toast or porridge for breakfast
Lunch today which is fairly typical is a whole meal pitta with cheese/salad, an apple and a yoghurt.
Dinner was 3 spoonfuls of rice, some homemade chilli and a huge amount of salad.
I’ve drunk water all day as well.

I might snack on a few nuts/raisons or a banana.

Most meals I don’t even finish, honestly I’ve got a tiny appetite. But I do need to eat regularly or I feel very ill. So it’s not like I’m gorging of sweets, crisps etc. I don’t drink at all either.
There isn’t much I could cut out food wise. I could up my exercise but most nights I’m out of the house until 9pm (my son plays football) and tbh I’ve felt so awful recently I can’t face it.

Drs have been advised not to mention weight in case of offending their patients.

This is just an idea but looking at your food intake, I am only comparing it with mine (I'm short too but a bit taller than you and much older) and I can't eat carbs at 3 meals a day. I just pile on the pounds. I aim to eat at least 7/8 portions of fruit and veg a day. Breakfast is usually full fat yoghurt (plain) and fruit, lunch might be soup, a salad or cheese and an apple, dinner is all the usual stuff (homemade) and more yoghurt/ fruit but I reduce rice/ pasta/ potatoes to a small portion. I eat oat cakes and nut butter mid afternoon if I'm starving.

Are you in a secondary school? 20K steps is an awful lot of miles- 10 miles a day.

Not saying I'm perfect by any means @mrsconradfisher but just saying what helps me not gain weight in case it might help you. Basically, low carb and increasing protein in the form of greek yoghurt, nuts, and fruit and veg.

No primary. I walk to work and walk home, it’s 1.5 miles each way. I am literally on my feet for 6 hours a day…I work in KS1 but with a child that runs so I spend all day chasing her round the school for want of a better description.
My step count might be off as I apparently do 2/3 steps to other people’s one step as I found out on holiday! We’d walked the same distance yet I’d done a couple of thousand more steps than other people.
Carbs might be the culprit, will try to reduce.

Your steps will be more if you are shorter. DS does 1,500 less than me over a long distance and DH does 2,000 less as he is tall with a long stride (we discovered this on a recent holiday!) But 20,000 is still a decent amount.

I didn't say women all gain weight in menopause. I was replying to the post saying that menopause HRT contributed to someone's weight gain. Which is unlikely. Correlation vs causation.

Menopause kick-startes weight gain. You go on HRT. Gain slows down but still there. You think HRT caused gain....

I must be living around different women somehow. Or, rather maybe women around me have not yet got their peri/M under control.

Most of my friends in the gym noticed a marked decrease in metabolism in late 40s. Many started developing the typical "tyre" around the waist area. And struggling to lose it. Then peri symptoms started.
HRT did help with keeping up with the exercise and managing symptoms. And
healthy controlled eating as well.

Sorry if this isn't right and confuses things but with intermittent and heavy periods I was advised take the progesterone all of the month, no breaks at all and it's totally stopped periods, it's very much like the foil without being inserted as a comparison.

Also with the gel if you are prone to reactions I would start smaller than the advised dose, not just straight in with 2 giant pumps, and build up gently over a course of weeks. That minimises reactions, just be mindful of a histamine reaction that makes you feel panicky and very strange anything that causes heart palpitations to increase or breathless just stop and go back to the GP.

But maybe chat to your GP again and double check.

Yes I did wonder whether to try one pump first for a few weeks and then work up from there, had to do that before with other medication.
My periods are very intermittent and they are also very very light.

I would in that case start small 1/2 for maybe a week then one pump the 1.5 etc.. that way you can gauge your reactions and settle at what feels right for you.

I'm saying this as someone who reacts to some antibiotics, can't take certain medications and is super sensitive to HRT.

I was told to use gel and 2 pumps and had a reaction so I'm always nervous when people go all in. But then most are absolutely fine.

I had to go to patches as it's a slower gradual release the daily spikes with gel don't work for me.

Just thought I’d update if anyone is interested… I’ve done a full month on oestrogel and feel so much better. I’ve only used 1 pump a day so far which I’m aware is a very low dose but I have awful side effects with things usually so wanted to do it gradually.
I feel much better in myself, far less achy, no headaches which I’d been getting nearly every day, less angry and less emotional (DS1 just left for Uni and I’ve coped really well). It’s like a fog has been lifted.
Also took the progesterone for the second half of my cycle, took it vaginally as was really concerned how awful would make me feel. All worked ok, no side effects and literally the day before I was due to stop them I had a bleed so assume that’s all worked ok as well.

Do I just stay on 1 pump if it is all ok or do I need to up it to 2 pumps? Trying to get a GP appointment as well but none available.

It’s really important to take the Utrogestan if you are still having periods. Any doctor will insist on it.
I take Mirtazapine and never put weight on with it until menopause and I also can’t exercise so I feel your pain.
One plus point for me is that Utrogestan helped me sleep.
Good luck and give the regime a try!