What are my options now?

[Wonderbug81]

I've been on HRT (2.5 pumps oestrogel, sequential 12 day 200mcg Progesterone x 12 days, plus vagifem) for over two years. I'm mid 40s.

I was finding the sequential Prog was giving me a lot of side effects (migraines, teariness) so my gynaecologist moved me to 25 days Prog where the 3 day break would still allow for a bleed. Unfortunately my bleeds were erratic and I got spotting, even though I felt so much better on this cycle.

I've moved back to 12 day Prog 200mcg daily and feel awful in terms of high anxiety and mild depression (as confirmed by questionnaires).

I've got a lot of other stress in my life due to redundancy etc and I just need to feel better so I can job hunt. It's a 6 month wait for CBT with the GP. Should I try and manage it myself through meditation, exercise or add yet another med - sertraline - into the mix?

I had to take this for about 10 months previously due to a traumatic life event but I'm not generally prone to anxiety or depression.

Would be get views, I don't really want to be on medication but can't carry on like this (especially the wanting to cry all the time, irritability etc) while job hunting and trying to stay resillient.

Why dont you try a Mirena coil, so low dose and continuous, rather than tablets?

Thank you. I've still not got my vaginal atrophy under control and some of the potential side effects/downsides of mirena are making me feel anxious towards it. I know it would be worth a try but it's an invasive option isn't really an option just now.

I'm really confused by what dose you're on @Wonderbug81
Is there a mistake somewhere along the line?

12 day Prog 200mcg daily

You're using 200mgs every day?

If you are, it's no wonder you feel rubbish. That's double the dose and you're on a medium dose of gel.

For 2.5 pumps of gel you'd usually take 200mgs Utrogestan for 12 days.

You use gel every day presumably? (It's a bit unclear from your post if you're only using gel for 12 days - 2.5 pumps oestrogel, sequential 12 day 200mcg Progesterone x 12 days

You can use progesterone on a monthly cycle which means a calendar month - so 12 days per month (30 days.)

You can also use it vaginally which bypasses the nervous system and avoids the low moods.

Has your dr mentioned this to you?

It's often the first step for women who get side effects from progesterone.

Sorry it's 200mcg in total per day for 12 days of the month. I have 2.5 pumps oestrogel every day.

Thank you. I don't really want to take it vaginally as I'm already on 4 days a week Vagifem plus vaginal moisturiser daily and that's hard enough to juggle (with some hope of a healthy sex life). As I already have vaginal atrophy I suspect taking it vaginally will irritate anyway). My gynaecologist said I could take it rectally but having it done further investigation myself there's not enough research on this option yet.

Rectally is common in France I was told.
They also use it vaginally in Europe more, and the UK lags behind.

You should be able to juggle vaginal use and Vagifem. I know someone who does this and they insert Vagifem in the morning (or you could do Utrogestan in the morning.)

If you were to use Utrogestan vaginally, out of the 12 days you're on it, the 'conflict' with Vagifem would only be a few days a month.
You can also reduce Utrogestan to 10 days a month but might need a scan annually to check everything. OR you could look into other types of HRT like Femoston or Tridestra.

Tridestra is a 3 month cycle with only 2 weeks out of 12 on progesterone (it's all tablets.)

@Wonderbug81 The fundamental issue with this is you're only being offered gel and Utrogestan.
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This has become the default HRT but there are many other types and it's really too soon to be thinking of adding in ADs or CBT.

There are LOTS of other options.

The entire range of tablets, patches, gel with another progesterone like Norethisterone or the Mirena, etc.

The recent White Paper on Menopause by the International Menopause Society (another poster linked to this a few days ago) emphasises that other options about from gel+ Utrogestan are being ignored, and that tablets are fine unless there's a high clotting risk.

You might need to see a specialist but it sounds as if you already are as you've had Utrogestan suggested rectally.

The other point about using it vaginally and having a sex life- you can insert Utrogestan at any time (the night time advice is for oral use) - so daytime, after sex, or even take it orally on those days. And the same for Vagifem- it can be inserted at any time.

What contraception are you using? Presumably not the mini pill - this can also be used as part of HRT in a larger dose (again, you'd need specialist advice.)

(Most of what I've written is coming from personal experience by the way of discussions with my consultant .)