HRT decrease / increase

[fiddleydiddleydoo]

Hi, I’ve been on Femoston Conti for about the last five or six years. Just recently the Pharmacy at my GP suggested that I should be thinking about coming off it.

I agreed to the lower dosage which I’ve been on now for just over a week and I definitely feel different this week. I’m quite anxious and a little tearful, also a bit overwhelmed with things and wondering if it could be because of the reduction in the HRT.

I will try tomorrow and make an appointment with the doctors for next week but I’m wondering, as the new tablet I’ve been given is half the dose of the old one, could I tonight take two tablets of the new dose?

TIA

There is no reason to stop HRT after 5 years.

A pharmacist has not authority to suggest you stop unless your GP has asked them to review it.

How old are you now?

There is no time limit to HRT and the old '5 year limit' was ditched ages ago.

It seems a bit heavy handed for a pharmacist to prescribe a lower dose - if that's what they did.

Depending on your age though, (close to 60 or over) you might be better off using transdermal HRT (patches or gel, with micronised progsterone, which will lower the risk of blood clots.)

If the amount of estrogen and progesterone is exactly half in the lower dose (assume it's 1mgs of estrogen) then yes, it would appear fine to take 2 tablets.

Tablets aren't the best way now to use HRT so if you swap to transdermal types you may find you need a lower dose anyway because with oral HRT a lot is lost in digestion.

I would be asking for an appointment with a doctor for this. Far too many of these reviews are done by a pharmacist who isn't even based at the practice. This is my case. Ask them what have THEY done to monitor you on this ? Regular monitoring of eg blood pressure etc? I bet the answer is NOTHING like my GP Practice. We were told that we had to go into the practice and request HRT on paper as opposed to online . When I asked why they said " oh it's because some women are not using it properly and we need to monitor it " 🙄- how many times has a doctor in my practice asked me about in in my 6 years with them ? NEVER! I challenged this and they now allow me to order online and I get a month's supply at one time. Ask them why they want it reduced. Ask them for an appointment with the GP at the practice who is the lead on this. I bet they don't have one. Ask for a referral to a menopause clinic. Transdermal is the safest way to take HRT. I despise this low class treatment that women get regarding HRT.

Thank you both very very much.

I will contact the GP tomorrow and push for an appointment with a menopausal specialist. I am with a fairly large surgery group, so I imagine it’s quite likely that they have a specialist.

And I like the idea of using patches instead of tablets. Assuming that’s what transdermal means 😊

It's best to go to the discussion with your GP with the thoughts that YOU will decide if and when to come off HRT.

It's your choice.

Your GP has to explain risks and benefits but the final choice is yours UNLESS something has changed and you're at much greater risk (and that's not being on HRT for 5 years.)

This is NICE guidance.

Agree!

I've had a telephone appt with a GP this afternoon (the GP that I usually see for a long term condition I have). He was very surprised that his colleagues had suggested I stop HRT and had suggested the lower dose. Apparently the dose I'm on (1/5) is already quite low anyway.

I'm going on holiday this week so for now we agreed that I'd go back on the original does of Femoston Conti and when i come back from holiday I'll make an appt to discuss a better option.

He's suggested maybe an estrogen gel plus progesterone tablet to be taken at night. That sounds like a good plan yes? I'm 59 and have been on HRT since 2019.

Great news!