Advice on whether this is the right approach re HRT options?

[Wonderbug81]

I'm on 3 pumps oestrogel and 12 days 200mg utrogestan. Seemed to be fine for the past 18 months but I was having low mood, no motivation and libido during that time. Other symptoms calmed down.

Menopause GP recently ordered relevant blood tests (I know these aren't reliable on their own). Came back: Oestridiol - 97 pmol and testosterone <0.4 nmol. Both at the very low end of NHS range. SBHG is 69 nmol.

Also for about the past 3 months I had a few days per month where my morning heart rate would shoot up to 150bpm. Most days it goes up to 120bpm or 130bpm which is still high. So I was referred to a cardiologist.

While this was going on my anxiety was getting worse, particularly in the mornings.

I'm waiting for heart monitor tests from cardiogist but his early view was that there was a good possibility it was stress or hormone related (the blood test results weren't back when I saw him).

Menopause GP said from the blood tests it looks like I'm not absorbing oestrogel anymore and has suggested patches to see if it improves. Also moving to continuous utrogestan. I can then consider testosterone depending on systems.

I could increase oestrogel but that would mean increasing utrogestan and I already barely manage the level I'm on (some intolerance). I take it orally because between Vagifem, Ovestin and vaginal moisturiser I have enough going on down there!

One thing I will say is that when my peri first started the first sign I had was hot flushes. They haven't come back now despite how low my estrogen is so starting to wonder if some of my anxiety is actually work stress related rather than hormonal?!

Perimenopause started in mid 40s, I'm now late 40s.

Welcome any thoughts on the recommendations made by the menopause GP and the results.

The first thing is that blood tests for estrogen are very unreliable. There are scientific papers online about this, proving how hard it is to get an accurate reading.

Surely the simplest way forwards is to increase the gel to 4 pumps for 3 months and see how that feels?

I definitely wouldn't start changing to combined continuous at the same time.

Maybe you could consider talking therapies about your anxiety and see if that's a way to deal with those if it's related to work?

Thanks. I don't want to increase to 4 pumps as it means increasing progesterone too.

I already barely manage the level of utrogestan I'm on (some intolerance). I take it orally because between Vagifem, Ovestin and vaginal moisturiser I have enough going on down there!

Continuous should help because I tried continuous 18 months ago and symptoms were more managable but GP moved me back to sequential following irregular bleeding and scans. She said I could try again in the future.

I already have a counsellor, not sure how much that or meditation/exercise are helping. I've had more stressful times in my life than this but the anxiety is far worse so definitely think some is hormonal.

There are other types of progesterone that can be prescribed , instead of Utrogestan.

For example, Norethisterone that is in patches also comes as a 5mg tablet. That can be used on a cycle, or a lower dose if taken continuously.

There's also the Mirena coil as an option.

The doubling of Utrogestan on 4 pumps is suggested but not mandatory. It's guidance and is individualised depending on how the uterine lining responds - ie spotting or not.

Regarding using Utrogestan vaginally, you can split the use of it and Vagifem etc to morning and evening.

You can insert Utrogestan at any time - directions say try to lie down for 30 mins to aid absorption. You can also use vagifem any time - day or night time.
Worth thinking of those options?

I know I'm going to sound very fussy now sorry!

Would prefer not to move to synthetic progesterone.

Mirena not an option for me for various reasons and I really don't want it.

I use some combination of Vagifem, Ovestin and vaginal moisturiser most days and it's already impacting intimacy so really don't want to do that at this stage.

I'll see if the GP will let me move to 4 pumps. Also once I move to continuous I will get a higher overall dose of progesterone anyway.