How to know if hormones really are fluctuating?

[atgnat]

I've read that blood results can be normal in peri and that the symptoms can be caused by fluctuating rather than low hormones. But other than testing across different days, how can I know this is the case? I'm 39 and my symptoms aren't conclusive enough, but something is going on. I'm on HRT after begging GP (mostly due to family history of early menopause plus the primary symptoms of sleep issues, shortening period lengths, mood issues, brain fog and others too) but I'm struggling with the idea I shouldn't be on it, especially as overall I'm not feeling better. Sleep is improved but I feel absolutely insane in terms of mood and brain fog. I don't really know what to do as I feel like stopping but I was bad without the HRT too.

I started in Feb on urogestan for 12 days of cycle and estrogel gel all month. I was on 1 pump but upped to 2 this cycle in case it's a "not enough dose to calm the fluctuations" issue. I'm feeling worse on 2 but not sure if things need to settle.

It can take time for HRT to work.
At 39 and with a history of early menopause, you should be using HRT if you have symptoms. It can take 3 months for HRT to work fully so it's too soon to say. Keep going and hopefully it will get better.

I completely understand and felt much the same. I started HRT at 39, had the same symptoms and early family history of menopause. Every woman in late 30s I've heard describe their peri symptoms has listed shorter cycles, sleep issues, mood and anxiety as their main symptoms.

It did progress to raging hot flushes and night sweats in the end, I felt almost relieved in a way because I was so concerned I shouldn't be on HRT when the main symptoms I had (other than shortened cycle) could also feasibly be stress or mental health.

I've been on HRT a few years now,and really recognise when my symptoms break through. It always starts with waking at 4am for me, then migraines, mood and anxiety- I know exactly what is happening, but for some strange reason I still have this almost imposter syndrome about the whole thing, but self-doubt of my own judgement is also a bit of a symptom for me !

I think at age 39 1 pump of gel is not very much, you probably do need more. A couple of different doctors have both told me younger women often need higher doses.

It's also not like HRT was an amazing save-all for me, it has taken the edge off and I'm a mess without it, but I still have some pretty significant hormonal ups and downs despite a lot of trial and error.

Maybe give it some more time to settle then think about upping the estrogen a bit ?

If, one day you look in the mirror and think "looking goooood" then, the next day (or even later on the same day), you look and think "who IS that old crone???"..

If, one day you wake up feeling amazing, then, the next day, you wake up feeling like you've done 10 rounds with Tyson..

If, one day, you hate the world and all it stands for, then, the next, life is beautiful..

Yeah, that's how you know your hormones are fluctuating

@Question7 That does sound like me. I've been waking up at multiple times in the night again, including 5 am. It tends to happen at times when my natural hormones are probably at their worst, i.e. pre-menstrually and during ovulation, so it makes sense. But it feels like it's happening now just because I've upped the dose, so it feels like I'm doing something counterintuitive.

I do worry about being on something (anything) with a risk profile albeit small, when it's potentially in my mind that I shouldn't be on it, but my main fear is it's making me worse. My moods feel terrible since starting HRT and more unpredictable - they were before at least mostly in the luteal phase and now it could be any time and is often every day. It's just so hard to tell as I have background mental health issues (untreated) and possible neurodivergence that's becoming harder to push down.

@15minutesaday Unfortunately, I've been like that since my teenage years so as much as I'd love to rely on that for confirmation, I can't!

I have the same pattern of immediately pre-menstral and around ovulation. I also get migraines which makes it very obvious to me when my hormones are fluctuating - I think a physical symptom is so much easier to accept in your mind, when it's 'just' mood and sleep you worry it's something else.

I was worse on cyclical HRT (where you start/stop utrogestan). This was causing more migraines, but also more mood issues. I switched to continuous and have much fewer migraines but also much less mood symptoms.

If you are more up and down it might be the progesterone element of the HRT adding to the chaos. It might also be your own hormones fluctuating. If you've recently increased the estrogen and it feels worse then that's pretty normal until you settle on it - that can take longer than you think.

I don't think you're not perimenopausal, I think it's harder to manage with HRT early on because the fluctuations are greater. I got more out of HRT when I switched to continuous progesterone because that reduced the fluctuations rather than adding to them. Continous utrogestan is not for everyone, especially not in early-peri, I'm not suggesting doing that, but aiming for stability would be a good bet. I'm pretty sure it's the fluctuations rather than absolute low levels which cause problems early on.

I'm not great on knowing about the alternatives to utrogestan, but someone else would be able to help you on that.

If helpful - I had similar symptoms to you and when my GP have me a blood test pre-hrt it did show I was in peri. It could just as easily have not on a different day, but I didn't have more symptoms than you when I had the test (they came later)

@Question7 Thanks for replying, this is reassuring. It does sound similar to what I'm experiencing. The problem is, if it is temporary adjustment symptoms since increasing the dose, I can handle everything but the rage and despair I'm feeling. I've been feeling similarly on 1 pump too and was hoping it was because I was under dosed. I wish I could blame the urogestan but I'm currently in the follicular phase so not on it at the moment. The GP said I "can't" take urogestan continuously, so that seemed to be that? I have been thinking about getting a mirena (but worried about its effects on me too) or an SSRI (ditto).

I just want to not feel so terrible. Doesn't help I can't get an appointment with my original GP who prescribed the HRT, so I risk going to a new GP who may be stuck on "you shouldn't be on HRT" if I express any doubt about it.

The brain fog, tiredness, poor sleep etc can all be down to other factors as well. For example, I went on HRT early (40) after demanding it for palpitations, sleep, night sweats and anxiety, but it was iron tablets and b12 that really got rid of the brain fog and anxiety. My periods are still all over the place and incredibly heavy.

i have seen various gp’s but even if they think I probably shouldn’t be on it (one is hell bent on getting me on antidepressants) they never tell me to come off it; what they aren’t keen to do is review it or increase the dosage, which i actually think I need now.

I do worry about being on something (anything) with a risk profile albeit small, when it's potentially in my mind that I shouldn't be on it, but my main fear is it's making me worse. My moods feel terrible since starting HRT and more unpredictable - they were before at least mostly in the luteal phase and now it could be any time and is often every day. It's just so hard to tell as I have background mental health issues (untreated) and possible neurodivergence that's becoming harder to push down.

@atgnat Just a few things here^^

There is no risk for you at 39 taking HRT.
If you look at all the medical evidence online, women like you with early menopause symptoms have no added risk with HRT. The tiny risk of breast cancer only starts after 50 and latest research shows no risk for at least 5 years on utrogestan (it's the older synthetic progesterone that carries a risk.)

My moods feel terrible since starting HRT and more unpredictable -

Maybe look at it another way. Your moods have become worse as you're in peri and HRT at the current dose is not enough for you. It's not HRT that's made things worse- your moods have got worse and the dose is too low to help.

1 pump is nothing, and many young women like you need the maximum dose of 4 pumps.

I've used HRT for over 15 years through a private consultant who is a UK expert. I needed 2 pumps at the start in my 50s and went up to 3 pumps for a while, and am now on 1 pump.

I know it may sound so simple but it takes time to get onto the right dose and for the right dose to kick in.

I know you're feeling emotional but it's the wrong question to ask about fluctuations and trying to see some pattern. HRT gives a steady dose to top up your own estrogen. Try not to overthink it. Increase your dose and see how that feels in a month and if it's no better, try 3 pumps.

@thenewaveragebear1983

I think I would be finding it easier to accept I'm definitely in peri if the period symptoms were more conclusive - mine have just gone from every 29-32 days to every 24-27. Which to me was a huge change and obviously coincided with other symptoms, but GPs don't seem to think it means much. I don't think it would be B12 or iron in my case as I supplement both and have been tested for both in the past. Although that maybe is a reminder to check my iron levels in case they're creeping up on the high side - probably unlikely as I've always been on the low side of normal, but I have been supplementing more than I ever have with iron for the last 6 months in an effort to feel better.

@JinglingSpringbells

I understand that modern HRT has an unwarranted bad rep, but with any medication there are risks and I'd just rather not be on something if I don't need to be. That's the fear for me - that maybe I don't need to be. There's also more specific risks such as my fibroids growing or ovarian cysts developing, both of which I have a history of.

Maybe look at it another way. Your moods have become worse as you're in peri and HRT at the current dose is not enough for you. It's not HRT that's made things worse- your moods have got worse and the dose is too low to help.

This is all fine if it's actually true - but that's unknown. There must be some women who either end up on HRT when they don't need it or that it may not be useful for them, i.e., when it isn't hormonal fluctuations causing their symptoms or when hormonal fluctuations are causing the problems but adding HRT just seems to be adding fuel to the fire. Being on too low a dose is the basis I'm working on, though, which is why I upped my dose to 2 pumps 12 days ago. But I just feel like an even worse version of this time last month - i.e. I've worsened the problem I'm trying to fix, is what it feels like.

Look at it this way - you are far more at risk from an early menopause.

My consultant always emphasises there are risks of not using HRT.
I'm not sure how much you know, so apologies if you do, but if periods stop before 45 that is early menopause. Before 40 is premature menopause. Medical advice is to use HRT to prevent osteoporosis, heart disease and dementia, especially if periods stop before 40.

Early menopause tends to run in families. It's a high risk for osteoporosis in your 50s and older.

Your periods haven't stopped yet
BUT-

• Your cycles are shorter- first sign of peri
• You have mood swings - peri
• Sleep issues- peri
• Brain fog- peri
• Family history of early menopause - big red flag

I wonder if you're fighting a psychological battle by having all of this at 39 - 10 years early compared to the average. I understand that can be hard to accept.

Not all women need HRT.
Many women do but struggle on mainly due to not recognising a whole host of symptoms as being linked to menopause.

You're topping up your own hormones. That is not dangerous.
The dose of HRT is far less than our own estrogen levels anyway.
Fibroids don't always grow. HRT doesn't create ovarian cysts.

Give HRT more time. It's not an overnight 'cure' which is why medical advice is try a dose of HRT for 3 months and see how that feels.12 days on another pump is nothing. It can take many weeks to feel benefits. And even then you migh tneed 3 pumps.

If you still feel rotten and your GP isn't clued up, and can afford it, arrange to see a private consultant who is experienced in HRT .

@JinglingSpringbells

My ovarian cysts are already flaring unfortunately, although they seem OK this month. I do know all the risks and implications of early peri - it's why I fought to get on HRT in the first place, which makes it even harder that it feels like it's now "going wrong". I've been aware I'll likely go through early peri since my early 20s when my mum told me both she and my maternal grandma did. I've been dreading it for sure, but nothing could have prepared me for how it's actually been, including adaptation (f that's what it is) to HRT.

I think the psychological battle for me is I've had hormonal issues all my life, starting with terrible puberty, so it feels like while it's ever-changing it's also never-ending - a horrible combination. I think I'm also grappling with the fact I've had anxiety, depression and possibly OCD-related issues since my teens and have basically ignored them and tried to work around them. It's making me feel like I'll never be OK on just HRT because I need to treat these issues which may be making perimenopause worse for me.

I appreciate your thoughts. I do feel horrendous but I'm going to keep going for as long as I can. I have had a plan all along to try only one thing at a time and to persevere through to 3 months with every change, but I was hoping any side effects/adaptation stage would be more tolerable.

I found that very helpful - thanks ! (I'm not the OP).

@atgnat I have worried about all these things too. And I did feel worse on the wrong dose of HRT because I was, as you say, essentially adding fuel to the fire with greater fluctuations because it wasn't enough to stabalise anything.

I know you always hear all these women who say they started HRT and felt fabulous 3 days later, but many many people have to keep trying different things until they find what works. Most people don't feel great immediately, many people feel worse initially.

It is a really hard thing to do because 1) you are initially stirring things up by adding more hormones in, and your body and brain have to adjust to that each time and; 2) you have to wait such a long bloody time for it to settle down before you can conclude it's not worked and you need to try something else.

For me, stability looked like 100mg patch (max dose) and 200mg utrogestan continuously (double the normal daily cont dose). I had to work that out very slowly and incrementally. You figure it out yourself along the way, if you're not already doing it I'd really recommend a diary.

I had HRT prescribed initially by a private meno specialist, I was so uncomfortable about it being private I booked an appointment with my GP practice specialist and asked her to tell me the stats about risk and talk it all through with me. I'm very lucky, she's very current with her knowledge. It was my GP who suggested continuous utrogestan is better for women with menstral migraine, and she was right. (You can use it continuously by the way, the risks increase slightly if you're on it for more than 5 years, the main reason they don't give it to pre-menopausal women is because you're likely to get breakthrough bleeding which needs to be investigated).

I think it is really common to feel like you do when you start getting menopause symptoms at a young age, even if you also know that you have a strong family history of early menopause. In my family, there is also a strong history of osteoporosis- it never occurred to be before I spoke to my GP that these were correlated, but she was completely sure HRT was the right thing for me and explained it really well. Logically I know that is a completely sensible way to think, but for some reason I still have a wobble over it - I think that is part of peri, you feel more worried and unsure, particularly about your own health. I completely understand your desire for some concrete way of knowing you are doing the right thing.

My issue is not low overall levels I don't think (although they do get low, as shown by one pre-hrt fsh/lh test). It is massive fluctuations. I needed a high dose of hormones to bring the baseline level up high enough that when they dropped, the drop wasn't so great. As my own hormones are declining, which they definitely are, that stability I get from the patch is increasingly beneficial. I did feel worse for a long time before it got better, but I knew I felt so terrible off HRT that wasn't an option. There was a bit of blind faith involved.

If you've ruled out other possible causes - iron, b12, thyroid, then given your family history, age and symptoms - there's no reason to think it is not perimenopause. It is the most likely explanation.

You don't have to use HRT if you're not comfortable with it, but we will all go through menopause at some point, it's a process and a transition and at no point before your periods stop will there be any certainty to it. Both my Mum and her mum had completely regular periods until one day they just stopped. Both of them had osteoporosis- you can't avoid risk by not doing anything.

It is very unpleasant to wake up several times a night, have violent mood swings, brain fog and the feeling you don't recognise or trust yourself anymore. We hear a lot about hot flushes and delayed periods - but this might not ever happen. It doesn't mean the symptoms you've been having aren't very valid and real signs of perimenopause, they're often the thing people find harder than a hot flush, or 10. I know I do.

Ultimately it is up to you whether you continue to pursue trying to find a solution, or decide to just live with the symptoms until you feel more sure, or they get so bad you can't cope with them anymore.

I think you might really benefit from a discussion with a private specialist - worrying your GP might take your HRT away from you if you're honest isn't going to help you feel reassured, and feeling confident in your plan is important. Find someone with some decent medical knowledge and lay all your worries out in front of them. Trusting someone to use medical judgement is the most certainty you are able to get I think.

I do really understand where you're coming from. My experience has been very similar to yours.

PS - I do think that cyclical utrogestan might be behind the change from mood symptoms just during your luteal stage to being all month long. That is how it felt for me. I don't know why an extra pump of gel would make that worse though.

I'm not sure what the alternatives are. Mirena or POP amongst others I would guess. Continuous utrogestan is used in peri for women with hormonally sensitive migraine as an exception as it can cause a lot of breakthrough bleeding, although it has not for me.

I think the main point is that you don't know if how you feel are side effects of HRT or not.

IMO opinion the way you feel is not a side effect of HRT. It's low estrogen.
Everything you've written points to that.

If you have a lot of ovarian cysts are they monitored? Do you have regular scans?

FWIW I had one cyst while on HRT and it was there before HRT. Because of my age then (and also post meno) it was checked every 4 months for 2 years. It disappeared. It was never affected by HRT.

If you have issues like anxiety and depression have you considered finding a good therapist to work with?
You can't 'blame' HRT for making those issues worse- they are separate issues if you've had them for years.

@Question7

This is so helpful, thank you. Adding more estrogen to top it up when it's potentially fluctuating low (which it will be, if I am to believe I am in perimenopause, and thanks to this thread I am finally starting to accept this again) but a low-dose top-up not being enough during the dips makes sense. I have been keeping a symptom log but I find it so abstract to look back at that it somehow just loses meaning to me, especially when brain fog is at its worst. I did start to keep a written diary last month but did it intermittently, but funnily enough I did an entry on the same cycle day last month and what I wrote is almost identical to what I’m experiencing now, so it’s seeming like it is something about my own cycles in the background. I’m thinking looking at continuous instead of cyclic might be a good option for me too. It’s good to hear breakthrough bleeding isn’t a given, and what you say about breakthrough bleeding needing to be monitored makes a lot of sense. I had wondered “why is that a problem for you?” when the GP seemed to act like breakthrough bleeding on continuous would be a terrible thing. It’s definitely something I’m willing to try.

That sounds like a great experience with your GP. Mine isn’t as bad as some that get mentioned on here, but my whole journey into this involved GP basically saying she would prescribe HRT based on symptoms at my request, then getting spooked by normal bloods and acting like she’d never said anything of the sort (gaslighting me, basically), then consulting specialists/the other GPs in the practice who would back up her decision for a trial of HRT. It all paints a picture of “we shouldn’t be giving you this, but we’re making an exception because you’ve asked for it”, which I think has coloured my mindset.

My grandma also had osteoporosis and I suspect my mum will be heading that way too. Both didn’t take HRT and are generally avoidant medically, which I have inherited to some extent and isn’t helping in this. I appreciate the reminder - I definitely don’t want to be going down a path towards osteoporosis.

@JinglingSpringbells

I had monitoring scans for a while a few years ago. They showed a picture of cysts that would resolve every few cycles. I’m just going off symptoms at the moment, but they’re very recognisable and I’ve never thought I've had a cyst and then on ultrasound it turned out I didn’t. I have, however, thought I haven’t had cysts and then it's turned out that I have got them, with no symptoms. I’m just quite scared when it comes to anything making the cysts worse as I had a large one removed when I was younger and it was a terrible experience before and after and has left me with issues. I am aware HRT isn't supposed to make them worst, so that is some comfort.

I’m really not trying to blame HRT for anything. I think it’s great it exists, I’m just scared of being in some way incompatible with someone like me who seems sensitive to hormones and that it is making pre-existing issues flare to a point I can’t manage them anymore. I would much rather guard against osteoporosis and all the other risks, but if I’m feeling so bad and the thoughts get so dark I have to guard against that too.

You both have managed to convince me this is perimenopause, something I once had conviction in to begin this HRT journey in the first place, but have lost along the way as I get scared of how I’m feeling. I think it's just a matter of figuring out what is going to work for me and trying not to go mad in the process.

I’m now happily post menopausal and to be fair had a pretty easy peri menopause. I had a Mirena coil fitted at 40 after years of high blood loss during menstruation which result in chronic iron deficiency anaemia which had to be treated aggressively during pregnancy.

I started HRT in my early 50s, adding estrogen patches to the Mirena because I was having mood problems and muscle and joint pain.

The HRT had no impact on the physical symptoms so we had to go back to the drawing board and I started to take B12, Vit D and magnesium. I had a good response but somewhat annoyed that the default for skeletal problems during perimenopause is to throw HRT at the problem. Had I been advised to take the supplements I probably wouldn’t have bothered with HRT since the common symptoms were minimal and didn’t really impact seriously in day to day life.

A lot of women who have Mirena fitted have a “better” peri menopause. The possible reason for this is that cessation of menstruation means that you don’t develop the chronic problems associated with chronic blood loss. In peri, periods often become heavier, longer and your cycle varies, so the body often ends up in deficit. It can be difficult for the body to keep up and many of the symptoms associated with low iron, magnesium and vit D mirror those of peri.

If you aren’t sure about HRT I would start with addressing other potential causes of the symptoms you are experiencing.

I have a number of friends who have had the same experience and have been disappointed with HRT. Even when doses have been increased their underlying reason for seeking treatment has not been addressed. We hear so many women evangelising HRT it is often difficult to be luke warm about it.

Finally, as one of the “tiny” number who have developed hormone positive breast cancer after taking HRT I am a little uncomfortable with how much it is minimised. There are very few studies available on the risk for women taking HRT peri menopausally. Most of the data associated with peri menopause is from women who have had their ovaries removed or have had primary ovarian failure so replacement therapy is medically necessary. For women who have normal ovarian function function, ovulating and menstruating, the data is scant. I have managed to find a meta analysis study from 2025 worth a quick read. The big problem is that oestrogen only, which appears to reduce the risk, is not recommended to intact (still has ovaries and uterus) women because it significantly increases the risk of uterine cancer. Combined HRT significantly increases the risk of early breast cancer , particularly triple negative, in 16-54 age group.

Over the next 20 yrs we will be able to get a better idea of the effect of HRT on perimenopausal women who have not entered a premature or surgical full menopause. It is only very recently that HRT has been prescribed to peri menopausal women. Qualification was, until recently, evidence that menopause was complete ie cessation of periods.

We see so much positive information and experience of early HRT but as yet the practice can’t be fully evaluated because it’s too early to see the long term effects of taking pre meno HRT for symptoms only. Lots of data for those without ovaries but little for those with ovaries basically.

If I could turn back the clock I would still opt for HRT. My breast cancer was more advanced than it should have been because the breast screening service was suspended during covid so I had to wait an extra year between screening. My tumour would have been picked up at a much earlier stage but treatment & outcome would have been the same. I have the common as muck post meno form of BC that is easy to treat.

I wouldn’t deter a woman from HRT but I would strongly advise attending regular screening when offered. Stick to the recommended dose and address any mineral or vitamin deficiencies commonly associated with chronic blood loss. Don't rule out other causes if your symptoms, it’s easy to accept they are peri menopause symptoms but as Davina McCall has discovered her menopause was disguising a condition that was far more serious. In addition the high doses of HRT she was using may have contributed to her recent breast cancer diagnosis.

https://oicr.on.ca/study-reveals-young-onset-breast-cancer-risk-for-women-taking-hormone-therapy/

@Crwysmam I'm sorry for your diagnosis and hope you're doing ok now.

The accepted practice in the UK is that women under the age of menopause (average age 51) have no added risk of breast cancer when using HRT. This is because the risks of not using HRT are far more significant and the risks of natural progesterone are different (lower) to progestins.

This is about POI (premature menopause) but the guidance applies up to the age of average menopause. https://www.menopausematters.co.uk/pm-management.php

The research in that link is based on progestins, not natural micronised progesterone (Utrogestin.)

None of the large studies include micronised progesterone. There are a couple that do, which show not added risk for at least 5 years (BMS has a statement on this.)

There is also no known link between a high(er) dose of estrogen and BC- online interviews with UK specialists and guidance from the British Menopause Society say that.

Over the next 20 yrs we will be able to get a better idea of the effect of HRT on perimenopausal women who have not entered a premature or surgical full menopause. It is only very recently that HRT has been prescribed to peri menopausal women. Qualification was, until recently, evidence that menopause was complete ie cessation of periods.

HRT has been available for peri for 20 years. I've friends who have used it.

And the report I post is from 2025. A meta analysis of global studies. It reflects the increase in early breast cancer in women under 54 who have taken HRT, combined, for perimenopause. Women who take just estrogen have a lowered risk but are able to take estrogen-only because they have had their uterus removed. If you still have a uterus you are advised against estrogen-only HRT because it increases the risk of uterine cancer.

So if you’ve had a hysterectomy and take estrogen-only you there is a reduction in risk of breast cancer. If you’ve have a uterus and take estrogen only you have an increased risk of uterine cancer. If you take combined HRT there is an 18% increase in risk of developing breast cancer.

Statistically overall risk is small but it sort of brings it into focus when you become a statistic. I did the risk assessment and was comfortable with it until I had breast cancer and realised that the overall risk ( all causes) for women is close to 1 in 6 women will develop breast cancer. A small increase in an all causes largish risk seemed a little more significant when I did the maths.

Breast cancer diagnosis is a minefield of risk assessments. When I was given my recurrence risk it is 3% or 1 in 30ish and yet my overall risk before HRT was 17% or 1 in 17. I’m still more worried about my recurrence risk which is half that of the risk of developing another primary tumour, which is a bit arse about face.

There is also no reliable evidence that “natural” hormones are safer than synthetics. Although there is a difference between systemic and dermally applied hormones.

I think the reason it is an issue for the NHS to use continuous in peri is because guidance says that breakthrough bleeding after 6 months use should be investigated, but ongoing breakthrough bleeding is normal and expected for a perimenopausal woman on continuous utrogestan - so they end up doing all these expensive investigations.

I'm not sure utrogestan is the ideal thing to use, I struggle with migraines on synthetic progesterones, even the coil, but not with utrogestan - which is why I use this continously.

I am on double the daily dose, which is why breakthrough bleeding is not an issue. But I can't imagine that being a preferred option if migraine wasn't a factor. It is not very good at controlling the lining and is not great at providing stability or cycle control in comparison to some of the synthetic alternatives. It does have a lower risk profile though. I also get other benefits from it such as improved sleep and feel less anxious - this is very much not the case for everyone though.

Not to sound like your GP and try to put you off - but I think the breakthrough bleeding does create people significant issues as it is sometimes accompanied by the PMS type symptoms.

My menopause specialist's initial suggestion was actually the combined pill, Zoley, she said that's good for younger women in peri. I think that might be a good option if you're struggling with your own hormones causing chaos and you're very sensitive to fluctuations? You can use it back-to-back so it is a kind of continuous stable supply, just not HRT. But maybe you'd feel more comfortable with it not technically being HRT anyway. I think you can use it up to age 50.

I don't know very much about alternatives because I've never been able to use synthetic progesterone due to migraines. There are other options though!

I really think you'd benefit from a candid conversation with someone who knows all the options well. Non-medical individuals tend to be a bit unknowingly biased towards whatever has worked for them, but we all function a bit differently.

@Question7 I thought combined pill was out of the question if you have migraines? I tried to take it in my early 20s (can't remember which one it was) and had a migraine every day for 2 weeks before the GP took it off me and said it shouldn't have bene prescribed in the first place due to migraines.

My plan for now is to continue with the trial of 2 pumps as I'm already into it. If I can reach 3 months on this dose, great, but if things are this bad next month I think I will have to trial the next thing or maybe consider the private consult. It's not great that I sort of feel like I need to work all this out myself based on my GP's reluctance to prescribe HRT in the first place.

@Crwysmam Thank you for your perspective. It's hard to know what to think with all these studies, the adamancy of figures like Louise Newsom proclaiming the safety of HRT versus hearing about real-world examples of maybe it not being the case.

It's out of the question if you get migraine with an aura or if you get an aura for the first time after taking the pill. It is OK to take COC if you don't and have never had an aura with your migraines.

Back in the day they used to just ban everyone with migraine from the pill, but they've since learnt that it is safe for people who do not get an aura. I checked it with my neurologist. She was quite for me using it as she said its often helpful for women with purely menstral migraine and no other risk factors for stroke.

But if you found you had worsening migraine on the pill then maybe its not for you. I've actually never taken COC so I've no idea if it might get worse initially then better once your cycles stop (if they do, not sure that's a given on Zoley).

Ah, OK. My migraines are definitely with aura, so I won't go down that avenue again. I was wondering if this Zoley pill was somehow different, but I guess it isn't.

It's probably best to wait for UK experts like the consultants who contribute to the British Menopause Society statements on that kind of research.

The Daisy Network is a charity for women with POI and its consultants who write the guidance will be up to speed on this or be able to interpret it by looking at it carefully. Some of those consultants are the best in the world and have their own practices in the UK. Anyone worried could consult them for advice.

It's been known for decades that the progestin part of HRT is the added risk of BC. (I was told that 20 years ago when I was considering HRT.)

The study you linked to does not include micronised progesterone.
The BMS has a statement saying it appears that natural micronised progesterone appears safe for at least 5 years (and there are some long term studies on that.)

Obviously there is always some doubt and women need to make up their own minds on risk.

Meta analysis can be flawed. There was a lot of criticism against one that was done in the UK 2-3 years ago because it included all research including the flawed WHI research, non-peer reviewed research, poor quality research and none of the women were using micronised progesterone. many specialists commented on the flaws and I think the BMS produced a written statement in response.

Transdermal HRT is not safer re. cancer. It has a lower blood clot risk because it's not metabolised first via the liver, but there is no evidence it's less of a risk otherwise.

It's a dilemma for all women, managing risk and benefits, but for OP I'd suggest she sees a specialist if she's worried and needs more advice.

I am one of those irritating women that felt a million times better on HRT after about 3 days, but, it quite soon became clear that the initial oestrogen dose (2 pumps of gel) wasn't enough and I increased it myself over a few months until I found the right dose, which was 4 pumps/100mcg.

I did change onto patches and found that when I changed the brand, I went from Evorel to Estradot, I had to cut down the Estradot patches to start with and work back up to the full dose, so it could be that you would have better absorbtion with a different method or brand of medication.

I know that I am on too much oestrogen as I get jittery and anxious, and if it is too low I immediately get night sweats returning. I was recently advised to go down to 75mcg because '100mcg is a old big dose' but the smaller dose did not work for me.

I had a Mirena coil fitted, mainly as I couldn't be bothered with having to remember to take Utrogestan pills but also the prospect of no more periods was a no brainer IMO.

I realise I am lucky as I didn't or don't have any confounding symptoms such as migraines or MH issues, and that HRT has worked really well. I also have access to a menopause specialist GP as well as several GPs at my practice who are all really clued up with menopause and HRT and are good at working in partnership with me.

I hope you can find the combination that works for you @atgnat as when it is right it can be a life saver.