Has anyone just given up on HRT as just not helping them?

[BusinessScrub]

I've been on HRT for two months (gel + progesterone tablets). It's for an irritable bladder, not moods or tiredness and I am close to giving up.

There's a whole confluence of things I've posted about before - have to take the progesterone vaginally and that's irritating my bladder so what's the point and I hate progesterone - but basically, I feel much worse. I am more tired, more depressed and less energetic. It is not a miracle cure for me. Possibly I am less anxious, but that's it.

Any advice gratefully received

Hi! I would say that 2 months is quite a short period of time and your side effects may settle down.
would it be worth going back to your GP to discuss?
I am a year in and it hasn’t really been a miracle cure for me except for stopping night sweats almost immediately and some improvement in anxiety.
The progesterone phase makes me very tired too.
I found the nurse practitioner much more helpful at my local surgery.
Sorry not much help but I do sympathise!

You've not said if you're using vaginal estrogen.

That's the first thing to try and it can take a few months to really make a difference- and you may have to use it more than the usual dose (eg daily, or 3-4 times a week rather than twice a week.)

Full, systemic HRT is usually an addition once local estrogen has been tried for a good while.

Also, Utrogestan is not the only progesterone. There's Norethisterone, as a tablet alongside gel or in a patch), dydrogesterone (in Femoston) , the mini pill in a larger dose, or the Mirena coil.

I hated the progesterone capsules, and have found the mirena so much better (it took 2 months to settle down). You can also use vaginally oestrogen (i have tablets that in use twice a week after initially using daily for 2 weeks)which is so helpful for GU symptoms.

@JinglingSpringbells Ah, fair point. I've been using vaginal oestrogen for years, but one of the reasons that my GP wanted me to move onto HRT is that I was using it at above dose, and so she wanted me to have progesterone as well. It worked for a long time - like ten years - but has stopped being as effective.

I gave up on patches. Fevking things always coming off, leaving sticky marks, and I could never remember which one I was supposed to be slapping on when. Just riding symptoms out at the moment. Hsvnt felt any worse to be honest.

Have you made adjustments to your diet? Drinks like tea, coffee and especially alcohol can be very irritating, as can acidic juices, fizzy drinks and sometimes hot and spicy food. It depends on what your symptoms are- if it's frequency, some drugs like Vesicare reduce bladder spasms.

There's no evidence that a higher dose of topical estrogen requires the use of progesterone- that was 'old ' thinking years ago (mentioned to me as an option around 20 years ago when I started with Ovestin) but no longer suggested. (discussed with a gynae consultant.)
If it was a concern you could have an annual (ish) ultrasound scan, or 2 weeks of progesterone to 'clear' the lining if it had built up (but again, that was an 'old' way of managing it.)

You could try oral Norethisterone instead of vaginal Utrogestan.

Not quite the situation you've asked about, but the first brand (patches) worked pretty well and then stopped being available. Second brand (also patches) worked almost as well and then stopped being available. Third attempt was oestrogen patches and utrogestan. The utrogestan gave me horrible vertigo, and because this was in the middle of the first lockdown I just came off it cold turkey and didn't bother even attempting to find a fourth option. It wasn't pleasant, but I didn't have much choice due to the timing, and by the time I could finally speak to a doctor again I'd adjusted back to non-HRT mode.

@BusinessScrub After I'd posted last night I wondered if I was misunderstanding your posts.

Has your dr suggested systemic HRT as an additional means of helping your bladder? Or, have they suggested using progesterone (and having to add in estrogen with it) because they felt you needed that owing to using more vaginal estrogen than 'prescribed' ?

If they are concerned about any build up of the womb lining by using a lot of topical estrogen, that's not a concern now. (see my previous post.) And if they are, the easiest way to deal with that is a scan now and then or a very short course of progesterone (eg Norethisterone) once in a while.

That approach is now out dated (it's in all the literature, written by specialists) but it's an option if your dr is concerned.

Hi, I have been using Estriol pessaries for vaginal dryness for 4 days with side effects of stinging, when urinating, and irritation, like cystitus has anyone else experienced this.
In the past I have had an cream with applicator(hrt) which I stopped using because of same symptoms.

It's for both, but your comments are really helpful, thank you. I have a call with the doctor in ten days time and will ask her.

You're very welcome.
My consultant is excellent and I've had answers to all kinds of questions over many years, which is what I've shared here.

If you can't tolerate progesterone but need estrogen for your bladder there are ways round this like longer cycles / infrequent use of progesterone but this is usually a specialist area, so if it's a GP you're seeing they may not know about it or be happy to endorse it.

I lost count on how many different products I tried before finding what suited me best. Don’t give up so soon there’s so many options out there with HRT it took me the best part of a year to get it right then after a good year we added in Testosterone.

I tried Estrogel then Evorel patches and Utrogesten but after a year went cold turkey as they increased my patch and the side effects were worse than my peri symptoms. Now my symptoms are increasing and I have been advised to try the coil but wondered at my age (53) if there's any point.

There is a point yes. Many women only start meno symptoms after their final period (I did.) I know women in their 70s still on HRT because their symptoms are still there without it.

At the moment I feel so terrible on progesterone that I could not take a year of this, it’s a waste of life. And it takes weeks to get an appointment to change things.

I didn’t take the tablet last night and slept well and feel energetic so am
planning to cut down over the next few weeks.

why would you need to take it for a year?

Yes. Tried various HRT preparations on and off for 4 years. The side effects were worse than the symptoms for me. I am severely intolerant to progestogens (as are 1 in 10 women), they make me feel mentally and physically awful and gave me IBS to the point I had to see a consultant/have various tests. He agreed it was likely hrt induced and was actually doing a study on that very topic. (Women on HRT are 50% more likely to develop IBS/IBD symptoms, there was a huge study done on thousands of women).
I also saw an NHS menopause specialist, who...put me on progesterone . She was not very helpful.

@JinglingSpringbells Sorry, that post was meant to be quoting @Autumnlife who said it would take a year to get right.

@Misspotterer That's interesting. I am also having nausea and upset stomach too.

But the basic problem is, I am taking this to improve my bladder. I can't take progesterone orally, as I it makes me suicidal; if I take it vaginally I am slow and it also irritates my bladder so there seems to be no point.

I also need to lose weight and lower my cholesterol, but on progesterone I can barely muster up the energy to leave the house; normally I do yoga most days and cycle 40+ miles a week.