Started/stopped/restarted HRT - 3 month review - what next...

[Justwantabitofmeback]

I started HRT back in January. Mainly because I was at breaking point due to lack of sleep for months / return of hot flashes through the night.

56, Post menopause for 2 years
Everol 50 patches, Continuous Utrogestan 100mg, Ovestin cream

I was on it for 38 days - hot flashes disappeared within 2-3 weeks, had some problems getting to sleep/nightmares, one 3 day bleed.

Then told to stop everything until a breast issue was investigated. Hot flashes and vulva itching returned very quickly. I only stopped for 2 weeks (went private to get all clear for breast quickly).

Now on day 30 since restarting. Currently, hot flashes are (mostly) away. Sleep is ok (only sleep issue is waking early around 5am and not being able to get back to sleep). No further bleeding. I still feel fuzzy headed, difficult to concentrate at work (reading and understanding difficult technical concepts), and tired / no energy.

My 3 month review since first starting is coming soon. Should I ask to continue where I am until 3 months from when I restarted is over. Or ask to increase Everol 50 to 75?

I kind of feel I should give Everol 50 more time, but at the same time a bit impatient and don't want to "waste" time on it if I need to move to a higher dose...... We are in the middle of a difficult project at work and I am struggling with it - am reading technical designs 2-3 times and they are just not sinking in 🥺 - there have been some mistakes/misses, but thankfully my (male) boss has been reasonably understanding (probably because he doesn't want me to explain my menopause symptoms again 🙈).

I have had no real negative side effects from the estrogen or progesterone, and I as I understand it I can move to Everol 75 (if that is the right next move) without increasing Utrogestan.

Appreciate any thoughts / experience.

I absolutely would. I'm in a different place in my HRT journey, I've been on 100mcg patch for two years now, with mirena (now 47, started it at 44).

I went up from 50 to 75 in two months and then 75 - 100 after the four month mark.

GP was super supportive given the emotional state I was in and the night sweats and the prolapse/severe atrophy.

The thing that gave me most energy was swapping utrogestan to the mirena. The utro made me feel like I was walking through treacle every day I was so tired.

Plus I added T prescribed by GP.

The 3-month 'rule is just guidance. So you don't need to stick with it.

Are you completely sold on patches?
Gel is better IMO because you can adjust the dose more carefully.
You might need for example somewhere between 50 and 75mcgs and you could get this with 2 and a half pump of gel.

If you want to try a higher dose of patch maybe your dr could give you a prescription for both 50mgs and 75mgs so you can try the 50mgs for a bit longer and then increase if necessary?

The guidance on using more estrogen/ progesterone is that if you had spotting with a higher dose of estrogen you may need 200mgs Utrogestan a day.

The utro made me feel like I was walking through treacle every day I was so tired.

Good point, dh was mentioning I had started yawning a lot recently (I never really noticed it, thought it was just the same tiredness as before) I might as a first step start trying the Utrogestan earlier in the evening for a couple of weeks and see if it helps.

I am not keen on idea of the Mirena, but really, other than the insertion/removal process which does concern me a little but I could manage, I can't really say why.....

@JinglingSpringbells I like the stick them on and forget about them aspect of the patches and hot flashes stopping implies they are working for me somewhat. Is Everol 50 to Everol 75 a "big" jump up? Do you know if the NHS supports cutting patches (a full Everol 50 + 1/2 Everol 25) to step up gradually or would it be stepping up to Everol 75 and if I had problems switching to gel to get a mid way dose.

I think I might try the utrogestan earlier in the day by making sure I get my dinner before 6pm then take utrogestan at 8-9pm instead of leaving it until bedtime/11pm at night and see if it helps. Then ask for the 3 month review in a couple of weeks and see if I can try the Evorel 75 and if the daytime tiredness is still there perhaps utrogestan (still 100mg?) vaginally might be a next option before considering the Mirena...