Please share your HRT protocol and what symptoms have been worse before and after etc

[Cornishbelle]

I'll start

I'm 46 and on oestrogel 1.5 pumps
Micronised progesterone 1 a day every day
I still have regular periods though these have lightened due to the progesterone I imagine

I had terrible joint pain insomnia brain fog

Joint pain definitely better and other two things improved a little

My libido is still through the floor and I have vag dryness and itching

I get terrible bloating in the lead up to me period

Wondering to ask for a change in protocol eg prog not every day and to enquire about more oestrogen or ask about testosterone or topical oestrogen? My GP was quite reluctant for me to go on hrt so not sure if this will fly

Why has your GP put you on daily progesterone when you still have regular periods?

Daily progesterone = combined continuous form of HRT.
It's for women post menopause, or over 54, or under 54 with no periods for one year. I can leave a link to medical sites if you need proof.

I see so many posts like yours here almost daily and can't understand why GPs are doing this when it's very, very basic stuff.

Obviously there may be exceptions and maybe you're one of those, for a reason.

It sounds as if your GP was 'reluctant' they are also not educated on how to prescribe. It's not their choice whether you have HRT- it's yours. Unless there is a valid medical reason NOT to prescribe, it's your choice.

You should normally be on 2 pumps at your age,- where has the 1.5 come from?

I think you need to see a different GP if you can.

My experience was a private consultant in my early 50s, one of the best in the UK, and I used long cycle HRT which is progesterone once every 3 months- this is an option for women in late peri. I'm not advising it's for you- but it shows the contrast between what your GP has given you at 46 and me at almost 53!
I felt great although I built up from 1 pump to 2 over a couple of months. My flushes and night sweats and insomnia went within a few weeks.

@Cornishbelleget some topical Estrogen cream for the vagina for the dryness. It works a treat. Gp can prescribe and I think in the uk it can also be purchased from pharmacies.
Im not in the uk
Im on 1 pump per arm of oestrogel
1 100mg progesterone tablet days 1-13 of my cycle and 2 a day from day 14 onwards.
Caveat I have PCOS and am not in the uk
Im very happy. I get the occasional night sweat but that’s it.
Also the vaginal Estrogen cream has sorted out dryness really well.
Im 47

You are though on a very unusual regime.

No one is prescribed 1 Utrogestan for half a cycle and 2 for the next.
This is not a licensed dose in the UK and obviously it's something that has been 'tweaked' by your consultant to manage your PCOS.

@JinglingSpringbellsit works really well for me. I see a gynecologist for this. She has been consistently cautious and listened to me from the start. I began on a very low dose and I can email/call and have it and when I have had issues. It’s changed my life for the better better. Periods are manageable after years of horrible issues since my 30s

I used to be on Everol Conti patch but switched to tablets and gel recently. One pump. All symptoms gone libido back.

I don’t have regular periods and am 54.

I remember your other post on this.

It's good that it helps you.
But it's because you have PCOS that you have something different. It can't be used as a guide for anyone else as you're not in the UK and also it's not a licensed dose on the NHS.

Thanks everyone for your replies

Weirdly I am also diagnosed with pcos, although I'm not sure if this had any bearing on gp dosage choice etc. I was also on mounjaro when I started hrt last may and plan to restart that too soon so I think i need to go have a review appointment. Should I ask for a referral to a gynaecologist? I imagine the wait might be substantial on nhs

Oestrogel, I do one pump. Mirena. Testosterone gel about 3x a week for libido/orgasms.. Oestrogen cream to save my vag from shrivelling up when I’m old.

I have never had any symptoms apart from low libido at one point.

Progesterone tablets for 2 weeks, gel every day - estradiol I think 1 mg. No symptoms or side effects that I can think of but I do try not to overthink it as your brain can be quite fanciful i find. I never had any side effects on the pill either. What i am not having on HRT is the desire to self harm, I look forward to sex and I am not having 2 periods a month nor wanting a divorce. I do get very bad period pains and I get some pmt so feel a bit off/sad ( i do wonder if my hormones have dipped again) but the bleed is non existent - I have never had heavy periods though.

I had brain fog, anxiety, irrationality, joint pain, sore mouth, itchy skin, headaches, forgetfulness, sudden pmt etc

I was prescribed Utrogestan sequentially and the Everol 50 patch. Everything improved bar the mental health symptoms so after 8 months

After 8 months I’ve been changed to continuous Utrogestan (taken vaginally) with the option to up my patch to 75.

I was feeling better but I’ve woken up today feeling very low/flat with horrible spikes of anxiety.

Im nearly 40 and have been suffering for 2 years.

I’m also 46, nearly 47 and am on a very similar regime, just with more oestrogen. So 1 micronised progesterone every day, no breaks, and I use about 2.5 pumps oestrogen. Our advanced nurse practitioner suggested I try this regime to reduce the side effects I was getting with 2 progesterone tablets, and to help my insomnia which was still not great on sequential regime. It is working really really well for me at the moment but obviously things change as we progress on this rocky road so I’m not counting any chickens! I must have enough of my own hormones to still be triggering periods (much lighter too thank goodness) but this last month was barely anything. I’m going to see how next month goes and then consider taking a 3 day break from the progesterone the month after if still no period.
I was told it was fine to try tweaking the oestrogen if I felt I needed to, but has to be kept below 4 pumps or you need more progesterone. If I were you, before I went back to the GP, I’d try up your oestrogen to the ‘standard’ starting dose of 2 pumps and see how you go. I also tweak mine a little over the month as I feel I need a bit extra in the second half of my cycle.

@TwinklyStarfish do you mind me asking how long you have been on this latest routine and how do you tweak your oestrogen later in your cycle

I started on the patches, then I went to 2 pumps gel and 1 progesterone for 25 of 28 days. When I spoke to the last doctor, she said you shouldn't be taking continuous progesterone if you're still having periods, so now I'm trialling 3 pumps of gel and 200mg progesterone for days 15-28 of my cycle. Honestly, every doctor I've spoken to has told me something different and one openly admitted she didn't really know how best to change hrt doses. I wish all doctors were better trained on this.

Two pumps of gel. 2 progesterone pills day 15-28.

Fixed hot flushes and sleep disturbance within weeks. Both were debilitating so that is amazing. Still feel quite anxious but manageable but for physical symptoms it’s been fantastic

I’m 43 and had hot flushes, night sweats, sleep disturbances and brain fog. I’d have lived with the first two without hrt but the brain fog was dreadful. I’ve had chemo which can exacerbate peri symptoms.

Ive got the mirena coil and 3 pumps a day of oestrogel and I feel normal on that. Previously tried the progesterone tablets but didn’t feel great on them. Had some random bleeding initially on the mirena but it settled down within 3 months and I now just get very very light bleeding once a month.

@Cornishbelle My advice is you keep this simple and don't overthink it.
You're not on the standard dose for a woman your age.
See this link. www.menopausematters.co.uk/postmeno.php

It is going to be far simpler to revert to the usual 2 pumps of gel (maybe needing to increase to 3) and 12 days of Utrogestan in a month.

The only reason some GPs say 14 days is 'to make it easier to remember'.
This was in the GP guidance by Dr Louise Newson.
Many women are sensitive to progesterone and can't tolerate 14 days.
Some women do need 14 days if they are bleeding heavily on 12.

Consultants allow variations (taking less) but sometimes that requires scans now and then.

I've just been authorised to take 2 utrageston on days 1 to 7 and 1 the rest of the month. This is because I was having really bad sleep on one week out of the month which I believe was hormone related. I'm on 3 sprays of lenzetto as well.

Since about October. I started HRT on the sequential regime in early August and she changed it at my 3 month review based on my sleep still being iffy and really tender boobs during the two weeks on progesterone. I know I read up at the time to check this was an acceptable regime and found information that backed it up as being ok, I just can’t find it right away now. I’m going to do some checking later to put my mind at rest and I’ll post back.

There will always be individual variations, usually with a consultant's input, but the point is that these more unusual doses are not mainstream and can't be advised as suitable for the OP.

Many women find too much Utrogestan unbearable. I take it on a cycle and do not like it much even using it vaginally. I sleep worse (compared to many women who like it for sleep) and it makes me very hot and sweaty.

I find my sleep is better by more estrogen and less progesterone.

Im on the mini pill which has hugely reduced the blood bath periods i was starting to have and have 3-4 pumps oestrogen. I also take magnesium. I have had a few different combinations of HRT but this has so far been the best. Generally calmer and mood improved. Sleep is better. Libido has never been affected in fact since perimenopause has increased and felt very hormonal, fancying everyone etc at times !
since starting HRT I can not drink much alcohol as have horrendous hangovers, had a long phase of not drinking at all
and now have maybe 3 or 4 drinks a week and I think cutting right down on booze has helped with some of the rough menopause symptoms.

@JinglingSpringbells it's crazy how long it takes to get the variations of dose right. I'm about 8 years in to taking her and still don't feel completely like my old self. I always found your advice valuable over the years.

Do people who go through various formats find their GPs helpful? I'm dreading even having to deliver the news to mine that I have a human body.

The key is to find a GP who knows what they're talking about when it comes to menopause and then asking for them every time. Usually women. It also helps to do your own research and go into the conversion with an idea of what you want out of it.