HRT - please explain the basics to me like I've just landed from outer space

[TerrificEchidnaSpikes]

After weeks/months of gradually worsening symptoms - aching joints, brain fog, constantly itchy skin and now almost daily hot flushes/night sweats that have completely destroyed my sleep - I have booked to see the GP tomorrow morning.

What happens at the GP? Do I just list my symptoms and ask for HRT and they give me a prescription there and then? Or do they need to arrange tests, reviews, etc?

What does HRT actually comprise, typically? I've been reading this board and there seem to be so many creams, gels, patches in various combinations. The options seem daunting and I'm worried the GP will ask me what I want!

Will HRT really help my symptoms and maybe even regain some of my eroded energy (not going to say regain my lost youth )?

And (last set of questions for now) are the HRT side effects very common? I realise there will be a bias because people won't report when everything is tickety-boo. But I've always been a headachy person and am a bit worried that HRT would make this worse.

BTW, I've already been on Mirena for 15+ years and haven't had a period the whole time, no side effects either. And beforehand got on fine with the combined pill for many many years. So I hope (assume) HRT won't hit me like a truck?

My GP happily gave me HRT based on my symptoms alone, no tests needed. I also have a Mirena (progesterone) so just needed extra estrogen which I take in the form of gel, which I rub into my upper arms every morning. I was offered the gel or patches but my GP recommended the gel as patches can fall off and it is very easy to increase your doses of gel if you need to. I have two pumps of the gel each day but can go up to 4.

I've not had any side effects that I'm aware of and it has worked well for me.

If you’re 45 or over they will go off symptoms alone.

I agree that a combination of gel or spray (for oestrogen) and mirena or Utrogestan for progesterone is best.

Patches are less flexible to adjust the dose and the progesterone in them is synthetic so some women don’t get on as well with it (I certainly didn’t).

I have the Lenzetto spray as it dries more quickly than gel.

If you are experiencing vaginal dryness and vulvar itching or thinning, you can also get local oestrogen. This is a cream or a pessary. Topical oestrogen in this area manages local symptoms better than general HRT.

If you have a Mirena you are in a good place as you are already accustomed to this kind of progesterone and don't have problems with it. It often seems to be the progesterone element that people don't get on with.

I have been using Oestrogel now for, gulp, over six years. Find it very easy. I had a weird frozen shoulder, night sweats, insomnia and flat mood and it worked well. Good luck!

If you're over 45, based on your symptoms, yes, they should go right ahead and give you HRT.

Many doctors would nonetheless also want to do a full suite of blood tests to a) get a base level for future reference and b) to check for other things (eg in my case, I did start HRT, but I also got a ginormous dose of Vitamin D and a recommendation to take an OTC iron tablet!)

As I understand it, if you're on the Mirena already, you wouldn't get a progesterone supplement as well. But I'm not 100% sure.

Most likely, theyd' start you on oestrogen. Usually the pump in the first instance. 1-3 pumps daily is the standard entry level amount. You'd then need to assess how it works for you etc. If it's not quite right, you can and should go back. In our area, you can be referred to a specialist menopause clinic if you are struggling to get levels right, but I know that's not true everywhere.

After a few years of trial and error I'm on a low dose of the oestrogen gel, take the vaginal oestrogen and also progesterone 14 days out of 28 and testosterone!

Thank you all so far, just the level of information I was looking for

I'm 52 so hopefully the GP will take one look at me and fire up the prescription printer!

Just thought of another question, do you pre-pay in bulk for repeat prescriptions or just PAYG?

The cheapest way, if you're not getting any other meds, is an HRT pre-pade certificate. I get the regular pre-pay one as I have some other meds I take so I can't tell you how much it is, but it is a LOT cheaper and a really good deal and I think you can maximise savings by buying for a year.

You can get a HRT prepayment cert - it’s £19.95 for a year. Be prepared to be patient, it takes a while to kick in fully and get the dosage right.

Read up on testosterone if your symptoms don’t improve with oestrogen HRT alone as that can crash too and cause fairly similar symptoms.

I'm feeling quite hopeful now, really I just want the sweating to stop, it has really freaked me out because it feels like my sweat glands are possessed 😬

Re sweating, for reasons I don't understand, taking an omega 3-6-9 supplement at a fairly high level helped me. They went away completely for a while and now only return on a cyclical basis.

I went on HRT 4 months ago. I'm 42 but the sweating was effecting my functioning.

It kicked in and stated working by the second day.

I’m 47, on my 3rd month, I’m on combined as have had a period in last 12 months ( albeit 8 months ago ) .
My hot flushes stopped immediately , my Itchy skin has improved prob 80% , and my sleep has also improved although I still wake up several times a night.
Nurse practitioner ( who prescribed for me ) said will review dosage in a month or so time but I’m happy enough that my flushes stopped as they were unbearable .

I paid for a HRT pre payment cert as 2 prescriptions and it’s paid for itself . I’m on the patch , I wasnt asked what my preference was , but my friend ( different symptoms ) is on the gel .

I had great advice from a friend, you walk in and say I would like to be prescribed HRT and let me tell you why, then list your symptoms. Also have a copy of the NICE guidelines on your phone just in case you need to quote it.

I have done this for other things, including asking for an ultrasound and my lovely GP said that all sounds very reasonable.

I started HRT 9 weeks ago. On the starting dose I am on a lot of my symptoms have disappeared including dry hot flushes. I know it will need tweaking but I have endo so mine is slightly more complicated. Keep a diary of your symptoms from now on so you can see if there is an improvement.

I am on Oestrogel as I use a hot tub for pain relief so cannot use patches as it can increase the delivery.

I have a prepaid cert just for the HRT as I rarely have other meds.

Hi OP, re sweating - I’m absolutely not trying to scare anyone but think it’s important to raise awareness & share my friends experience. She went to GP suffering from terrible night sweats & was prescribed HRT, after a few months there was no improvement so they increased the dose. To cut a long story short she has just been diagnosed with cancer in her neck which has been missed for a year due to GP assuming her symptoms were menopause.
So if anyone with night sweats finds they don’t improve with HRT please seek further investigations.
Like I said I really hope no one thinks I’m saying this to scare anyone & I certainly don’t want to derail the thread but I think it’s important information & we need to be aware that not every ailment post 40 is down to the menopause.

Thank you got asking this, I've been prescribed patches today!

My night sweats and hot flushes stopped the night I started my progesterone. That alone made me continue and they hadn’t even been the reason I went on it. I started because my hair was falling out. It still is, but stopped shedding quite so much when I started HRT. The problem is, though, I also started minoxidil the same day so I think that’s why my hair got a little better, as recently, I’ve had to stop using the minoxidil as my cat has been very sick and although probably unrelated I know it’s highly toxic to cats - although I was so careful. (Rubber gloves to apply; excessive handwashing after, etc.)

The HRT has had so many good effects, though, in alleviating symptoms that I was just living with because I thought that’s what meno was. I mean, it is. But you don’t have to live with all that shit. HRT is great. I’d recommend it to anyone who is able to take it without serious health risks.

For me, the minor risks are so outweighed by the lack of mood swings, no more hot flushes, no more night sweats, less anxiety, possibly healthier hair (and skin), less brain fog and stronger bones.

Small update that the GP was happy to prescribe, I was given a choice of patches or gel and I went with the gel based on this thread's recommendations. I have just started yesterday so can't report on whether it's worked yet!

Hope it helps @TerrificEchidnaSpikes