HRT - combined patch or oestrogen patch/gel?

[Reinounido]

I'm late 40s and am peri menopausal (dry skin, aching joints, dropping things more frequently, hot flashes and foggy minded). I've had these symptoms for several years now but because my periods are still as they ever have been and I don't suffer from night sweats, I didn't look into (or think I needed) HRT.

I went to see my GP earlier this week about my symptoms and he's recommended for me to either start a combined patch (containing oestrogen and progesterone) which I would change twice weekly or a oestrogen patch/gel with a progesterone tablet for two weeks out of every month. I'll have to change the patches twice a week and use the gel every day.

Can anyone advise if I should opt for the combined patch or the patch/gel + tablet or help with any pros and cons of either choice?

I went for the Mirena coil as I had heavy periods, and gel. I like this as the progesterone is low dose and continuous, and the gel is easily adjustable.

I’d second PP- I issue HRT a lot as part of my job and patients who ask for guidance where to start I usually recommended:

1. Mirena + oestrogen patch/gel/spray
2. Combined patch
3. topical oestrogen and oral progesterone

I think for ease of the options you’ve given I’d try to combined patch. Oral progesterone in my experience has more side effects and it’s more faff having two separate things!

The combined patches turn me into the wicked witch of the west - apparently it’s the progesterone might be something to be aware of!

I'm on the combi patches, but swapping to an oestrogen patch plus progesterone tablets because the progesterone in the patch didn't agree with me

I don’t think anyone can tell you what’s going to be best for you because it’s so individual. I’ve tried all sorts of HRT - gel and utrogestan and now conti patches alongside mini pill and found that the patches and mini pill work best for me. I couldn’t get on with the utrogestan, it was giving me a really upset stomach so I prefer to side step that and have the patches instead. I went into early menopause aged 37 and don’t want any bleeding at all due to lupus complications so I take the mini pill for that and then the HRT has been added in. The gel combi made me have a lot of clotting and bleeding which was awful. None on the evorel conti and mini pill. It’s very much a case of just trying things.

Thanks for all the replies.

@Pigeonqueen I agree. After reading the replies I'm slightly put off starting HRT, as though I'm rocking a boat unnecessarily because I feel I'm edging into peri-m instead of experiencing its full-blown symptoms.

I'm wondering if I should hold off as I remember watching a documentary on TV where - was it Davina M? - pushing women to go on HRT as soon as symptoms start and starting earlier is better.

I’ve on the gel plus progesterone tablets - it’s working well

i started at 49 - periods where just staring to go jsur a little bit haywire and I was forgetting words etc. it’s helping more than I expected and I wish I’d started earlier.

i have friends early and mid 40s who are on it and think they’ve made a good choice for them!

You could try the combi pill at first? I went on it last year after many many tests to check my symptoms were not anything else… irregular periods, mood swings, lack of joy, brain fog, insomnia, night sweats, aching joints etc
I was eventually offered HRT, mirena coil or the pill. I decided on the pill as I’d been on it before in my teens and early 20s and it seemed less scary that starting HRT - I know that sounds silly! But I tried the mirena after my second child and it sent me doolally.
anyway, I had a good few months where symptoms improved and I felt more like myself again, however I’m still getting night sweats periodically and lots of spotting.
I’m trying the patches after my next pill packet 🤞
Good luck OP, there’s a good FB group called the menopause support network where basically every question you could ask has been answered and everyone is so helpful.

I’m very happy on the combined patches and they are so straightforward

I’ve got the mirena for progesterone and the gel. I like the gel because I can vary the dose of oestrogen if needed. I’ve found that the standard two pumps isn’t enough for me so I’m now on 3 and it seems to be settling things down.

I have oestrogen patches and separate progesterone tables which I take for 12 days a month. They have really helped. If you decide on combined patches they only come in one strength so it you want to up your oestrogen you would then need them separate. I recently increased my patch from 50 to 75 and was no problem as they’re already separate.