HRT vs Combined Pill - Was I Given Incorrect Advice?

[OrigamiRabbit]

I had an appointment at my GP surgery this morning with the menopause nurse. I gave her a list of all my symptoms, and that I'd mentioned some of them before at a different appointment and was told that they'd swap me onto HRT.

She said that as I'm already on the combined pill (CP) there was no point moving onto HRT as CP has higher levels of oestrogen and HRT would be lower. She said a lot of my symptoms are just a combination of being stressed and getting older.

I found a helpline online for BUPA and, while they couldn't really say much because I'm not a BUPA member, the woman said the oestrogen levels in the CP wouldn't be high enough to deal with menopause symptoms.

Does anyone have experience of this? Is it true that the CP is better than HRT?

AFAIK and I am not an expert, the oestrogen in the pill is synthetic, and the oestrogen in most HRT (patches, gel, spray) is body identical. The menopause nurse does not seem very clued up.

In your situation I'd be considering something like a mirena coil for the progesterone and contraception, and patches or gel for the oestrogen. How old are you and what sort of symptoms are you having?

I'm 46.

The symptoms are

• Anxiety and unable to cope with things I used to be able to do
• Not enjoying hobbies any more
• Not tolerating heat/occasionally feeling like I'm overheating from the inside
• Skin dry and crepey
• Spots
• PMT symptoms returning
• Headaches on pill-free week
• Anger
• Hair thinning (possibly, it's fine anyway!)
• Mood/mental state swings
• Being overwhelmed by every day tasks
• Trouble sleeping (staying asleep rather than getting to sleep)

I absolutely would not want a coil but I also don't really need the contraception side of things IYSWIM.

I think you need a second opinion. HRT in patches or gel is far less risky for older women than the combined pill (in terms of risks of blood clots etc) and if you are having symptoms of menopause you should be offered HRT. If you don’t want the coil there are lots of other options for you- the mini pill and utrogestan alongside oestrogel (many younger women find this beneficial even if you don’t need the contraceptive side of things as the mini pill can stop any bleeding - that’s what I’m on, I’m 44), utrogestan and oestrogel, patches etc etc.

I was told exactly this, but the pill has made no difference so I'm going to go back and ask for HRT, if I can actually manage to get another appointment.

You'd have to come off the Pill at 50 anyway.

Your GP isn't right.
The combined Pill is sometimes used for much younger women but it tends to be one of the newer types that have body identical estrogen.

I doubt you're on that?

There's no point using the Pill surely if you don't need contraception- why are you on it now?

In terms of why I'm on it now, it's to control my periods which were horrendously heavy, irregular and painful, combined with awful PMT. The combined pill stopped all of that and it suited me, so the nurses (the nice ones, not this woman) said to stay on it until the menopause.

I was told the same by my GP when I looked into HRT last year. Now I am moving to a coil because I'm 50 and they have said I can't stay on the pill due to the risks.

Your GP really can't 'gate keep' HRT like she is.

You're within your rights to say you don't want to stay on the Pill because of the increasing risks as you head towards 50 and the fact it's synthetic hormones, so not the same as HRT..

However, HRT won't prevent heavy periods if you're inclined to have those.
Why not stop the Pill for 3 months , see how your periods are and take it from there?

The Pill is not a substitute for HRT and if it was, all women under 50 would be using it instead, surely? So your GP isn't right.

At the moment you have no idea if you're in early peri, close to post menopausal or what.

It wasn’t even a GP, it was the bloody menopause nurse! I’m going to speak to my GP tomorrow and ask either to see someone else in the practice or for a referral to a private clinic.

Having looked up the oestrogen content of my current pill, it’s 35 mcg. HRT appears to start at 25mcg and go up to 100mcg and possibly even higher if necessary. So what the hell was she talking about when she said I was already on a high dose?

The types of estrogen in the Pill and HRT are different.
So it's not possible to compare the actual amount as they are not the same.
The Pill is synthetic hormones which sometimes are 'stronger' than estradiol (in HRT.)

Not saying the nurse was right, but there is no like-for-like comparison of the hormones.

I hope you find a way forward.

I wasn't told that at all, I was told they were exactly the same! By a GP as well! So frustrating how little knowledge there is of something that affects so many millions of people, and you don't think to question it as you think a GP would know, or at least say they're not sure.

(the one I was prescribed is definitely synthetic oestrogen)