HRT confusion

[Bedonkedonk]

I am really hoping for some discussion to help clarify some things for me. I have spoken to the nurse and a doctor at my practise and they were happy to prescribe whatever I want to try, but I am very unsure about HRT pros and cons. I tried the gel and utrogestin last year and was looking VERY bloated and puffy after a few weeks. At first I felt better mood wise, but then I went into a weird rage at about 6 months in that was escalating and I could not switch off - very out of character. I spoke to a doctor who suggested stopping the HRT just to see what happened...I did and my rage ebbed away.
Then this year I started getting very intense hot flushes, mood swings (weepy, anxious, low), erratic heavy painful long periods and feeling unstable for about two weeks a month. In desperation I started again on HRT and have been on evorel sequins patches for a week (not long I know). I am already feeling bloated, although my hot flushes are gone. I have fibroids and am scared they will get worse with the HRT, but without it I may be a psycho for two weeks a month. Good for bones, bad for weight, good for skin, bad for blood clots...I am so confused.
I would LOVE to hear from others how they weigh up the pros and cons and also anyone else with fibroids and how it affected PLUS people who did not gain puffiness and weight...or does everyone? Confused menopause brain crying out for clarity here!

Fibroids are a nuisance. Try different hrt until you find one best for you.

Are they vastly different though? I am not sure whether different methods of delivery reflects different hormones...maybe I should cut up my patches and start lower. Hoping someone with fibroids will get on and let me know whether it made them better/worse/no difference...:))

Many women find things like you describe and often it's because they're going to ofast, too soon with the dose.

My HRT is prescribed by a consultant and I was advised right at the start to start with a minute dose of gel- like half a pump. I did that for around 3 weeks then worked up to 1 pump for a few weeks. That really helped but I needed 2 pumps to control night sweats.

Most GPs don't know how to do this and just give the 'full dose' straight away.

I don't see how patches will help you. There is no way of altering the dose other than cutting them, but you can't cut the ones that also contain Norethisterone (because you won't be getting enough of it.)

IMO it would be better to go back to gel and Utrogestan (using it on a cycle, not daily.) Start low and work up gradually.

I've not gained weight or had bloating (been on HRT for years) and IMO it's about getting the dose right.

Thanks for this reply, I really appreciate the advice. I didn't include all the info but the utrogestin made me feel VERY sad. I think that was partly what made her suggest patches...but you say I cannot cut up the contis? Hmmmm...why not if I am only having a small bit of the sequi? Not arguing, just trying to understand . Do you know much about the whole fibruid part of it? No probs if not though x Thanks for responsing.

Are you sure you're on combined continuous? Some women say' conti' and they mean sequi (sorry!)

If you are, cutting the patch is okay as you're getting a bit of both hormones, but it's a bit of a blunt instrument. Because unless you use estrogen on its own, you don't know if it's the type of progesterone that's making you feel bad/side effects.
This is why the best advice from consultants who are meno specialists is to get the estrogen 'right' then add in progesterone after a few weeks.

Fibroids- it all depends. They grow sometimes with HRt but if they're tiny and not giving you any issues now, they probably won't on HRT.

Half of all women have a fibroid or more. They can get big and need removing but many women don't know they have them.

What do you experience with yours?
If it was heavy periods, then conti HRT shouldn't make them grow.

Sorry to have confused you! I have evorel sequi, followed by Conti - all in same box, but I understand that sequi is the E and Conti is the P? This is really helpful by the way. Mine have only relaly been growing in the last year or so, but were getting bigger. My sisters are big enough to make her look pregnant. We are both prone to ovarian cysts as well - I was put on the pill in the past to shrink them I understand.
Fibroids - heavy very painful periods, lots of clotting and pain that meant I had to do similar breathing to giving birth/take very strong painkillers etc. However, I haven't had a period this month which has been fabulous. I may delete this afterwards as don't want everyone exposed to my details.
Oh how I long for a second spring! Rather than having a screw loose.

I have evorel sequi, followed by Conti - all in same box, but I understand that sequi is the E and Conti is the P?

This means you are sequential.
Continuous combined is every patch has estrogen + progesterone.

From the patient leaflet
Evorel Sequi contains two medicines:

• An oestrogen (estradiol)
• A progestogen (norethisterone)

They are both female hormones.

Evorel Sequi comes in a ‘memory pack’. This can be used to help you remember when to change your patches. Each pack contains eight patches.

• Four ‘Evorel 50’ patches marked CE50 (containing estradiol only)
• Four ‘Evorel Conti’ patches marked CEN1 (containing estradiol and norethisterone)

So you can't cut the conti in half as you'd be reducing the progesterone as well. You could half the estrogen only patches.

You could try other types of HRT including combined continuous.

Yes, I did read that, but didn't realise I cannot lower my P to match a lower E with the Conti.
Thanks you're a legend. I am going to go back to the doc and although the nurse is lovely, this time will ask to speak to their menopause specialist and discuss getting onto a tiny dose somehow via the combined patches.
Hope you have a lovely Christmas and thanks so much for taking he ice to respond. I feel like I have had a consultation! Really kind of you. xx

ALTHOUGH it does occur to me that if I'm having less E surely I can have less P too? Given that is to thin the lining of the womb, I amine it is thickening so much if I am having less E?

Ah my friend has this. Apparently something 10pc of women have a bad reaction to progesterone. Did you have PND? That can be an indicator. The solution for her was Mirena coil and then she was fine with the gel

Not officially PNDD, but utterly psycho and emotionally unstable during the week running up to my period so maybe it had developed? When I was younger it was OK. I had the Mirena coil when I was younger and had a horrible reaction psychologically. I gather there are different generations of oestrogen and progesterone and sometimes it depends which one? The nurse defo said I had progesterone sensitive from my notes.
I am just confused about how to weight up the pros and cons of this whole thing, but as Jingles said perhaps can try all the options first and I am defo up for very light dosing as a start.

I completely agree with your logic!

Most patches and tablet forms of HRT have the same amount of progesterone regardless of the dose of estrogen.

I can't say for sure that you can't cut the conti patch in half but (as an example) all the HRT in tablet form has the same amount of Norethisterone (not less.)

https://www.menopausematters.co.uk/perimeno.php

Look at the chart- all the tablets with Norethisterone have the same amount (1mgs) . The lower dose tablets don't have less Norethisterone.

If your GP is confident in prescribing, you could have an estrogen only patch and then use Norethisterone as a tablet ( a 1mgs tablet.)

OR it's possible to use a higher dose of the mini pill as a progesterone. This is more specialised and they may not be confident to prescribe.

It's also worth thinking again about a low dose of gel and Utrogestan.

All the best! x

I saw a meno specialist because of progesterone sensitivity and she recommended using the utrogeston (progesterone) vaginally. Apparently it not being digested in the stomach helps with the symptoms of intolerance - mine were bloating and crushing anxiety.

It really helped and meant I could get my oestrogen gel levels working for my other symptoms

Agree.

I use it that way. Still have some symptoms with it- mainly increased body temp- but no mood symptoms.

Did you have a reaction when having it inserted? My friend had the same and had to have sedation but once in was fine

No, no reaction at all when inserted. Afterwards I ended up with a non-harmonised coil for a long time and that was fine. It was a mood thing - this huge dark, paranoid cloud came over me. I felt slowed down, a feeling a darkness adn doom. I am generally very jolly and upbeat so I really noticed it! Your friend - sounds horrible.

OH this other way of inserting progesterone sounds really worth a discussion!
OK I'm going back to the doc armed with some ideas that I will lay out in front of her (with visuals) to discuss! Determined to get this right and be kind to myself. This time of life is hard enough without losing all my usual self regulation due to hormonal difficulties. 😍thanks loads for the responses - still very open to hearing from other with fibroids and how HRT was for them...

It isn’t as simple as “half the oestrogen means you can half the progesterone”, unfortunately

It does sound as if you are very sensitive to progesterone. Hopefully they can find a solution for you

That is a huge shame! Do you know why? If not I'll google it ;) thanks o everyone who contributed here.