HRT - what to ask for at the GP appointment

[Summervibes24]

So after resisting to go down the HRT route I find myself an anxious, low-confident/ self-esteem mess and it's getting worse not better. I have an appointment with the GP on Friday to discuss HRT or anti-depressants but I think I'm pretty decided on HRT.

I know this has been done to death on MN but could someone just let me know what I should be asking for at my appointment so I'm not fobbed off e.g. do I need patches or gel? Should I ask for testosterone too? I know this is going to be trial and error but I'm hoping to get this right as soon as possible.

'she had no opinion so I went for the gel - not sure if that is better or not / that stumped me a bit. I will start with one pump.'

Neither is better it is just personal preference, some women don't like having a patch stuck on, some don't like applying gel every morning. The pro with gel is you can start low on one pump then increase to 2 after a couple of weeks or more so it gives you more scope to play around with the dose.

'However, there is observational evidence from a large French study and a Danish study which point to it being safer. So it's accepted as being safer, if not safe.'

Thanks I'll look for that.

The French study is called E3N https://pmc.ncbi.nlm.nih.gov/articles/PMC2211383/

The other study (Danish) was on the effects of HRT on cardiovascular health but BC results were assessed as well.

I'm 37 so not quite yet looking at this but out of curiosity why is it difficult for women to get a prescription for HRT?

Because some women don't got forearmed with info. So they may present with a list of varying problems and the gp has to decipher what the problem is.

If you read NICE guidelines, do research, know the options then I doubt anyone will have a problem. 'I have read research and guidelines. I'm, for example, 52 and would like to try trasnsdermal micronised hrt with a 6 mth review' will probably get you what you want.

We see it here all the time. GPs only have a 10min slot, they need to know what the problem is and what you want.

@Janiie Oh good to know thanks. Yes I wasn't keen on a patch and yes I want to start on one pump so glad I made the right decision for me.

I put my hands up and admit I struggle to decipher academic papers, these wordy papers with stats etc can be a bit flummoxing. I wish there was an idiots guide summary because all that stood out for me amongst all the blurb is 'Compared with women who had never used HRT, women in the estrogen alone and estrogen–other progestagens groups had a significantly increased breast cancer risk'.

Thank you good to know!

@JaniieI don't know where that quote is without you linking to the paragraph.

My guess is that that line is an introduction to looking at the reduced risk of micronised progesterone, as the paper is headed ' Different risks of different progesterone.'

It is still unclear whether some are more deleterious than others regarding breast cancer risk. The goal of this study was to assess and compare the association between different HRTs and breast cancer risk, using data from the French E3N cohort study.

Usually on these papers there is a 'Conclusion' at the end where everything is summed up in a short paragraph. Or the research may be explained relatively simply at the start in the 'Abstract'.

Yes I did skim and then go to the results and conclusion, was all still a bit woolly imo but I'll keep reading!

E3N is the first epidemiological study that we know of to be providing results indicating that estrogen–progesterone and estrogen–dydrogesterone combinations may be the least harmful estrogen–progestagen HRTs regarding breast cancer risk. However, more evidence is required before these results can be translated into firm clinical recommendations for the management of menopausal symptoms.

Right at the end^.

The BMS has a report on different types and concluded that there is no added risk using micronised progesterone or dydrogesterone for 5 years.

There is probably not going to be a long term controlled trial (because which women would agree to that?), which is what my consultant has told me.
Consultants like Prof Nick Panay are pushing for it and likely to be frustrated it's never happened.

One fact is that HRT is cheap so pharma doesn't have much to gain by pursuing research.

And it would need to be for 10 years and then a 10 year follow-up. So not really helpful to women now in their 50s or older.

@Summervibes24

Hi this is great to hear that you had a positive experience with your GP! Starting HRT can feel like a big step, but it’s good that you’ve been given options. As a healthcare professional you are encouraged to provide the most up to date evidence based options. To all the patient to make an informed decision it allows the patient to have autonomy in their decision making. So, a doctor will usually never say this is better than that or words to that effect, plus as you prob already know one size doesn’t fit all. A drs role is to provide you with the relevant up to date information/evidence and with that you are able to come to a decision, which promotes and allows “autonomy” and “shared decision making”. It is also to prevent bias and sadly to minimise liability.

Anyhow here’s a quick guide to help you feel more informed:

Oestrogen – Gel vs. Patches

• Gel (like Oestrogel) is flexible—you can adjust the dose easily, and it absorbs through the skin. Just apply to clean, dry skin (usually thighs or upper arms) and let it dry before dressing.
• Patches provide a steady release of oestrogen and can be more convenient if you prefer not to apply something daily. They might be better if you have sensitive skin or worry about remembering a daily application.

One isn’t necessarily "better" than the other—it’s about what suits your lifestyle and how your body responds. Since you’ve chosen gel, starting with one pump is sensible, and you can review how you feel after a few weeks.

Progesterone

• Since you’re still having some periods, you’ll likely be on sequential HRT, meaning you take progesterone for part of the cycle.
• If you’re taking Utrogestan (micronised progesterone), it’s usually taken at night because it can have a calming effect and may help with sleep.
• You’re right to wait until day 1 of your cycle before starting—it helps keep things in sync.

What to Expect

• It can take a few weeks to notice changes, and full benefits may take 3 months.
• Common early symptoms can include slight bloating, breast tenderness, or mild headaches, but these often settle.

You’ve made a great step, and if anything feels off, you can tweak things as you go. Keep checking in with how you feel! Well done and wishing you all the best on your new journey. X