Do I really need to take progesterone tablets with the topical Oestrogen cream? *[title edited for clarification]

[kerstina]

Dr has prescribed me the oestrogen cream but also progesterone tablets which I can’t swallow anyway. I did tell him that and queried why I needed the tablets but he said because of risks of cancer with the oestrogen but looking online it seems because it’s topical and low dose I don’t need the tablets. Can anyone confirm the right information please.

• [Note from MNHQ: We've edited the title at the OP's request, to make it clear that it's topical oestrogen cream, not HRT gel, that she's been prescribed]

Only if you don’t want endometrial cancer

I think you’ve caused confusion here OP with your opening post as you talk about both gel and cream.

you are clearly now saying it’s the vaginal cream only that you’re taking and NOT the clear gel you apply to your body

therefore no progesterone required

Topical estrogen (Vaginal Estrogen) doesn't require progesterone to be used.

Read the Ops post properly before responding

You're right, I was wrong.
I meant to come back to the thread and say so, but I forgot.
🤣

It's dreadful a GP is so uneducated on this.(Even if they are old this cream and no need for progesterone has been the case for 20 years.)

No, you don't use progesterone with vaginal estrogen.
This info is in all the HRT guidance (and vaginal estrogen is not strictly HRT.)

You have been given (0.01%) the very weakest version because the usual one is 0.1% estriol. With the sort you have, you need to use 10x as much in the applicator and that can be quite messy. Maybe ask for 0.1%?

0.1% cream is available over the counter now (called Ovesse) in a pharmacy (it's £20 a tube) and it doesn't need progesterone with it. Again, showing your GP is out of date.

You could go back to the GP and tell them as this is mis-prescribing and actually dangerous. How many other women are being told this?

Yes I agree I am sorry about this .

@kerstina Can you try to pluck up courage to feed this back to the people concerned? I'm surprised the pharmacist didn't query it too because they are usually on the ball with this.

Also, the leaflet in the packaging is out of date and UK consultants have been asking for years to have it changed.

The risks etc on the leaflet are for systemic HRT, not vaginal treatment.

Yes I will. I struggle with being assertive about things I am not sure about. When I had scabies I kept telling the drs that the permethrin cream was not working and I know they did not believe me told me it was post scabies rash but DH caught it months later even after repeated cream use . I also had it confirmed by a rheumatologist and they were still arrogant about it. Typing this I think I need to change surgeries !

I am also going to check the script and check pharmacy gave me the right dose of cream

There is both 0.1% and 0.01%.

The weaker one means you have to apply 10x as much which isn't very nice- tends to ooze out.

Your GP is dreadfully uneducated. I've used this cream for 20 years and even then there was no requirement for progesterone.

I also think you need to address whether you want to try systemic hrt or if you only want topical vaginally estrogen for GSM. You mention antidepressants for other symptoms which suggests you may really benefit from systemic HRT if these symptoms are hormonally driven. HRT is much simpler to trial & stop if not helping than antidepressants are, in the first instance. Anxiety, depression & insomnia is very common in menopause & due to hormonal deficiency. I would also ask to see a different GP or ask if you can be referred to a menopause clinic to properly address your symptoms.

I agree.

But many women use both.
Systemic HRT often doesn't work enough for vaginal and bladder issues.

@kerstina You say you are roughly 10 years post menopause.
If so, how old are you now?

If you had an early menopause (before 45) that's something to take seriously because it can affect bone density and you may need a bone density scan.

If you had a 'normal' menopause in your 50s, and you're now in your 60s, you can still use systemic HRT (for anxiety etc) but you would only be allowed transdermal estrogen to avoid the very small risk of blood clots.

If your GP is not great with HRT, you would be best seeing a different one.

I am 57 the end of December. Feel stupid that I can’t remember date I stopped periods , it’s something I should have noted. I think I was about mid forties , I was going through periods late 30’s . I was given info about it by a great dr who left unfortunately but I decided against going on HRT at the time. I had a breakdown in 2017 which I had many symptoms but the worst was getting to sleep then waking up with a horrendous panic attack . I stopped sleeping at all and led to suicidal thoughts and was sectioned. They didn’t even think to look at HRT as just given anti psychotic medication which I couldn’t wait to get off. But I had a lot going on in my life negative things and I just lost ability to cope so because I have suffered with anxiety since four years old I can see why drs would think that it was anxiety and depression. I have never been as bad I was during this period of my life and probably no coincidence I was happiest and most relaxed when I was pregnant.
When I saw the dr at the weekend I did mention I thought I might have autism but he didn’t make any comment about that. He upset me as he put not in employment on my notes . My DM has just died I was extremely close to her even through her dementia and my DS has just left home . I think I am being touchy but it made me feel worthless as it’s the first time I have had to focus more on my own issues .

I'm sorry to hear your mum has died recently. That must be very hard for you.

Maybe you should see another GP who knows about menopause. Or if you can afford it, a private specialist gynaecologist?

Your bone health could be at risk if your periods stopped long before 51-ish (average age) and you do need to push a GP for a DEXA scan to check for bone loss.

This is really the first step and take it from there. HRT is the drug of choice suggested by the British Menopause Society for women with bone loss or prevention, before 60.

If you cannot swallow tablets, you would need to use HRT patches or have the Mirena coil for the progestogen part of it.

How do you use the progesterone capsules vaginally? Genuine question. Are they absorbed better vaginally as they dont have to be digested? I'm on the patches and progesterone tablets.