Scared to start HRT

[user1480889603]

I'm 52. I got off lightly so far - never had problems with my periods, no pain ever. I've not had perimenopause symptoms except low ferritin. Over the past few years I've had shorter periods lasting 2-3 days plus a few periods which lasted 11 days with very heavy bleeding and low mood (a totally new thing for me). I thought long and hard about getting HRT (oestrogel and utrogestan) for the heart and bone benefits. That's really all I wanted it for. Now I'm ready to take it and have the prescription but for the past 2 months I've been bleeding every day and there is no sign it will stop. So I'm finally ready to start the HRT in the hope that this stops! But I'm about to go away to work for a week followed by a holiday for 9 days and I'm worried that I will have more bleeding or pain etc. Is it best to wait until I return? I am desperate for this holiday as not been away for a year and I'm really tired. A few years ago my doc prescribed Evorel patches and I was in bed for two days with period pain and a terrible headache (never had headaches either). I stopped taking it because I didn't realise that it can take 3-6 months to get used to the HRT. I can't have this when I'm travelling. My plan was to wait til I return and then sit out the winter at home waiting for my body to get used to the HRT. But now I'd really like to just get on the HRT as I'm sick of bleeding every day and don't want that on holiday. I'm guessing my body is not producing enough progesterone to counterbalance the oestrogen and I need the HRT now. What kind of initial side effects can I expect when I start taking HRT?

HRT won't stop your own periods and the dr ought to have told you that.
It will, after a few months, give you a predictable withdrawal bleed every 4th week.

If you start HRT now, the estrogen isn't going to stop the bleeding. The sort of HRT that you will have (as you still have your own periods) is sequential. The first 14 days are estrogen only and the next 14 days are estrogen +progesterone.

It's the progesterone that helps to stop the womb lining growing. At the end of the 4-week cycle, the lining will shed when you've taken the last patch that month.

TBH if bleeding is the real issue, would you consider the Mirena coil (and estrogen as a patch/gel alongside?)

I'd not think about side effects in advance. Not everyone has them.

Thank you for your reply. I'm not expecting it to stop my periods as such - I just want the HRT to get me onto a cycle where I have the predictable withdrawal bleed every 4th week. I don't mind how long that takes. Then at least I have some idea of when I'm going to be bleeding. I'm ready to start HRT now because it seems like after bleeding for 2 months there is hormonal imbalance that needs addressing.
I was told by my GP (if I have understood correctly) to apply oestrogel every day and take the utrogestan for 12 days each month. Does it matter which 12 days? I was just going to start them both together - or take the utro calendar days 1-12 for simplicity.

You can start them both together or wait for 1st October for Utrogestan.

It's maybe a good idea to start on a low dose of gel- 1 pump- for a month so you body adjusts to it and this will also lessen the bleeding. The blood loss is directly related to how much estrogen you use (and if 200mgs doesn't control it, the advice is 300mgs x 12 days.)

My sister was the same OP and takes progesterone orally. Have you been checked for fibroids?

@JinglingSpringbells thank you so much for this - so it's the oestrogen that is related to the blood loss and you recommend upping the dose of oestrogel (or did you mean utrogestan? for 12 days in a month? And I'm wondering if waiting til 1st October to take the utro (rather than starting both medications at the same time) will be easier for the body to get used to?

I agree to check it out, ask doctors for a proper ultrasound scan. I had heavy periods on and off for a few years and they told me it is fibroids. Some people say it is Oestrogen dominant. So if you are planning to take Hrt with too much oestrogen, it may increase bleeding, need to balance your HRT. Also doctor can prescribed some tablets to stop temporary bleeding, if you go on holiday and for some health issues. My GP suggested Mirena coil in the past for me, but I didn't take it. Hope you find your answers and solve your health problems. x

Sorry if I confused you.

Estrogen stimulates the womb lining (makes it thick to receive an egg.)
So the amount of gel you use is relevant.

Taking progesterone stops the lining growing and becoming very thick (that's why it has to be part of HRT).

The amount of progesterone has to be in the correct ratio to do this. The dose is 200mgs x 12 days for 2 pumps of gel.

What I was suggesting is that as you're worried about side effects of HRT, it's often suggested by specialists that women start on a low dose of estrogen. That would be 1 pump of gel.

If you feel ok on it there is no need to increase it to 2 pumps, if it's controlling symptoms like hot flushes and sweats.
But if not, the usual dose is 2 pumps.

If you start using utrogestan now, bear in mind that you may get a withdrawal bleed around 15 days later. (You may not however, because you will only have had 15 days of estrogen and the womb lining may be too thin to shed.)

@JinglingSpringbells Thank you. So does that mean for 1 pump of gel it's just 100mg of utrogestan? I think I'm inclined to start on the lowest dose. This was suggested as when I was on the evorel patches a few years ago the side effects were so awful the doc suggested cutting the patches in half. I gave up after one month because I hadn't realised you're supposed to persevere for a few months. I think this time as I still don't have many symptoms - just the bleeding - I would start low and see if that brings some regularity to my cycle.

We all respond differently to the hormones but it may be helpful to know I'm in perimenopause and I take Utrogestan continually so I don't have periods - it's perfectly safe and for me it's been a blessing. HRT also started working straight away for me. I did tons of research and discovered doctors only tell us to have a break (and therefore a period) each month because they think we want one. Not me! I suffered with severe pain and vomiting each month from age 11 and then on HRT I felt so low and cried a lot when I took a break from utrogestan so taking it continually is much better - my GP is very supportive. Hope you feel better once you get hormones in balance.

Thank you. So does that mean for 1 pump of gel it's just 100mg of utrogestan?

No, you need to use 200mgs Utrogestan even with 1 pump of gel.

If it helps, HRT doses are 1/10th of the levels of hormones in the contraceptive pill, and unlike the pill the hormones are body identical so they're much less likely to cause side effects. I always had painful periods so my GP said to just take the Utrogestan (progesterone) continuously which is perfectly safe and healthy to do. I used to take it vaginally which means the hormones go straight to where they're needed but now I have a new partner (after divorce) I take the tablets orally. Women who haven't had kids should be aware the Coil can be extremely painful to have fitted which is why I'm on tablets. If you have a combined HRT patch, the progesterone will be synthetic and your body may respond differently (not as healthy / more side effects possible).

I should have added that I don't have periods at all any more due to continuous Utrogestan in peri menopause and I love it!