Can somebody explain HRT to me / how to start

[MarshmallowPink]

I think I need to go on HRT as I'm struggling with lots of symptoms that I think are peri (brain fog, anxiety, joylessness, change in periods, migraine). I did go a year or so ago and saw a male GP who dismissed me immediately because I'm under 45 (I'm 43 soon to be 44 for info.)

I am ready to ask for a different GP and advocate for myself but I'm also not sure how HRT works and though I've listened to Louise Newson etc I'm still confused and a bit nervous about the "suck it and see" approach.

If you've been through this, what were you initially prescribed and how did you manage to find the right balance of hormones? And how long did that take?

Thanks so much

I didn’t even go in. I asked for a phone consultation with a female doctor, explained my symptoms and how I had been failing to control them on my own (crippling insomnia, panic attacks, depression and weight gain) and asked for HRT. She was fully on board and agreed that it was definitely worth a shot, so prescribed oestrogen only patches on a medium dose because she could see that I had just had my Mirena replaced (so I didn’t need progesterone).

Could not have been more straightforward and it worked within a couple of weeks. I was 44.

It should not be a fight. You shouldn’t have to bed or advocate for yourself. If your doctor pushes back, switch doctor.

Thank you, I'm so glad you had a supportive GP

It might be worth asking to get this moved to the Menopause board. Lots of lovely posters there who will help.

The words my GP wanted to hear were “hot flushes” and she was very happy to prescribe.

If you still have a womb, you need progesterone if you are taking oestrogen. You need to come off the combined pill if you are on it, though the POP is ok.

If you are happy with the sound of the Mirena, that gives you the progesterone, otherwise you can take that on tablet form or in a combined patch with oestrogen.

Oestrogen is patches, gel or tablets, but the first two are more often recommended as the last has a higher risk of blood clots (still small but higher)

Thanks that's useful - I'm not on any contraception at all

@mnhq can I move this to the menopause board? Many thanks

I think because of your age you have to accept that you ARE going to have more of a battle because under 45 the protocol is for them to rule out any other medical problems causing the symptoms before deciding it's menopause related. You will need blood tests for your thyroid levels and lots of other conditions first, I have an underactive thyroid and that can also cause tiredness, changes in periods and depression. So get it checked!

If you are prescribed HRT then you will need both progesterone and oestrogen and there is a range of ways for achieving this - some women use an oestrogen only patch and a Mirena coil, others have gel and a progesterone tablet, others have a patch which contains both hormones. It's trial and error to see what works best for you.

You will get more specialist advice on the menopause forum which is in the Health section on MN/

Yeah, if you have an obstructive GP just say you are having hot flushes during the day and sweats at night. (later down the line, low libido are the words you need for testosterone).

My GP suggested I went on HRT when I was 44. I went to her for vaginal oestrogen as I'd started leaking.
She went through a load of symptoms with me, got me on HRT.

I started on 50mcg patch and utrogestan. Within 6 months I was on 100mcg Of Oestrogen and the mirena coil and added T at 8 months. I knew it wasn't right at first because I was still drowning in sweat at night.

My mental health is better, I have more energy, I sleep like a baby (last night a full 7hrs without even stirring), my skin is better, my vulva and vagina are pink again.

Good luck op.

I started on the lowest dose patch. Switched to a higher one a few months later. Didn't get on with higher dose so switched back to lower dose. It is trial and error but worth exploring.

I am 40 and have just started HRT. My female GP wanted to prescribe it to me based off my symptoms and the fact that my mother had an early menopause but she couldn’t without referring me to the early menopause clinic as I’m under 45.
That took a while but they were happy to give my GP the ok, and they did tests which confirmed I am in Peri.
So if your GP says no, insist on being referred to an Early Menopause Clinic at least.

My GP was being a bit difficult (more in the securing of an appointment) so I just went through these guys. It cost about £200 for initial appointments and number of reviews to ensure I had it all working as I should. No battle, super helpful and supportive and made it all so easy. Once they have your levels right you can then have your prescription ported over to your GP. Just thought would pop it in for those that need it. For reference I'm 44 and been on it for about 8 months and made such a difference to brain fog ans my general mood (anxiety, low mood, general malaise) - currently I'm just on osterogen gel x 3 a day as also recently had a mirena. Am going to get blood tests soon to consider testosterone as libido remains low.

https://thewomenshealth.clinic/menopause/

Just to add, there are lots of ways you can find private treatment, including consultant gynaecologists. The link left is for nurses, not drs as far as I can see. BUT you shouldn't need to. 44 is not super-young to start HRT. Your Gp may want to do blood tests but it's not mandatory. It's a guide to check for other things in women under 45.

You have to monitor it yourself by how you feel.

I got it prescribed at age 43, I had a long list of symptoms (each on their own would have been bearable but combined were making me feel terrible). Started on low dose Elleste duet, moved up to the higher strength after a few months. Has worked well but my insomnia is back. Moving onto bio identical oestrogen gel and progesterone tablet this weekend and will see how that goes.