Do I need to accept HRT is a series of trade offs rather than a total solution?

[Wonderbug81]

I was fine with Oestrogel 3 pumps (alongside Utrogestan sequential) for a couple of years. It was never perfect, still had a lack of motivation, loss of libido, fatigue etc.

Then I totally stopped absorbing the gel (lots of symptoms incl anxiety, cardiovascular issues and depression).

Moved to 75 Evorel patch (twice a week) and feeling much better but still spotting on and off after three months which is an issue on various levels.

I did originally try 50 evorel after gel and was OK but still not feeling great and had some anxiety.

I moved to continuous Utrogestan 100 mcg daily at the start of the year as it had been a few years and that has helped with side effects of that and there was no spotting etc. Blood tests via menopause doc also showed v low testosterone so I would like to try that.

Basically though whatever I do, it seems like there will be issues. It's all been verified by (private) menopause doctors but I need to speak to yet another one.

Do I go with 50 evorel patch so I at least don't have the spotting and hope testosterone helps with the rest?
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I gave up on HRT altogether because of exactly this. It felt like whack a mole.

I never attempted HRT , and listening to friends, Im kind of glad

The only thing that really bothers me has been the lack of libido. If there was a female equivalent of Viagra , life would be sweet

Exercise and eating a healthy diet sorts out most of the pains that menopause brings and sertraline sort the brain fog - and much easier to stablise the dose

I'm glad you've been able to manage most of it. There's no question exercise and diet help.

I have had 25 different peri symptoms in the past 5 years. The HRT has resolved it at times, sometimes very well but as I'm finding, you sort out one thing and another crops up as your hormones constantly change too (including side effects from the HRT itself).

That said, I know my peri is particularly bad and I'm better with HRT than not. I dread to think what kind of life I'd have otherwise, I would probably have to have left work. Maybe I just have to make my peace with issues.

Can i ask what you are doing other than HRT?
HRT is great but it's not a silver bullet for everything.

Apologies if you are doing this already but there is accumulating research on gut health/ depression and peri. Diet can make a massive difference - the usual stuff like no UPFs, eat lots of foods with phytoestrogens, ditch alcohol, etc and maintain a healthy weight.There are many tips on diet / peri on the Zoe website.

Sorry if it sounds like a lecture but it's something my consultant (private) feels very strongly about even though they are also very pro HRT.
Likewise, exercise is proven to help mood - MIND has evidence and advice on this on their website.

I have had 25 different peri symptoms in the past 5 years. The HRT has resolved it at times, sometimes very well but as I'm finding, you sort out one thing and another crops up as your hormones constantly change too (including side effects from the HRT itself).

If you are using a constant dose of HRT your hormones should be relatively stable, even allowing for your own fluctuations.

I've found gel works well for me. Over 15+ years on it (started early 50s) I've gone from 2 pumps to 3, and now to 1. I also use Utrogestan but slightly differently to the licensed regimens, with a consultant.

Have you considered the Mirena coil?
That would stop the bleeding and then you can adjust the estrogen.

You say you're seeing a private specialist- have they ever suggested long cycle HRT- using progesterone every other month to reduce the side effects?

If there was a female equivalent of Viagra , life would be sweet

There is- testosterone, but it's usually prescribed alongside estrogen.
ADs are no longer used as first line treatment for meno symptoms- not for brain fog- that's what estrogen improves.

It actually sounds as if you ought to consider HRT.

I'm on patches but find I need to change them after 3 days max. You could always try the 100s (I'm on more than that).

Hi OP.

Why have you never increased the oestrogen?

I went straight up to 100mcg patches very quickly. Then I had the Mirena fitted which sorted out the bleeding thank goodness.

Some of the symptoms you mentioned are also side effects of progesterone intolerance - fatigue and anxiety were massive issues for me when I took Utrogestan.

The Mirena plus testosterone via GP fixed all the issues for me.

I already did the healthy eating and execrcise/weights part of it so that wasn't going to make any difference for me.

What made the difference was getting enough oestrogen to stop the sweats.

Also if you are not absorbing sufficient oestrogen, you will not get the benefits from the testosterone.

Moved to 75 Evorel patch (twice a week) and feeling much better but still spotting on and off after three months which is an issue on various levels.

If you're spotting on 75mcg patch the guidance is to increase progesterone- either 300mgs x 12 /14 days, or 200mgs daily.

Are you using progesterone on a cycle or continuously?
Your consultant ought to be managing this as it's BMS guidance.

Thank you. I drink around 1 unit of alcohol a month at most, good weight, walk regularly, weights more sporadically.

It's not progesterone causing side effects, especially since I've moved to continuous. The changes in side effects coincided with evorel patch level changes.

Gel worked fine for 4 years and all of sudden didn't. It happens apparently.

For various reasons I won't go into I don't want the coil.

Oh interesting. I assumed 75 was too high for me because I'm getting the bleeds (whereas I wasn't on 50). It might be a case of playing around with it I guess.

Continuous but I assumed the spotting was due to the estrogen. Hadn't realised it could be due to progesterone levels. Will speak to GP.

Yes. It made me put on a huge amount of weight. Went off it and lost weight immediately

I was good on 3 pumps gel which is 75 evorel patch roughly. I assumed 100 be too high.

Anxiety and fatigue have largely gone away since I moved to 75 patches and moved to continuous progesterone.

It’s been a bit whack a mole for me too. But I had a look at the symptom checker list my doctor gave me on the first appointment and I ticked 26 of them, now it’s 5.

It gets hyped up on sm and I think we expect it to be a total solution, or what worked for one person to work for us. I feel like my hormones catch up with whatever medication I’m on sooner or later.

My specialist will only change one or max two components at a time, for three months and then reassesses, and that feels frustratingly slow. I’m guessing that she’s gathering a lot of research data.

I have read on several forums that some women absorb better from Estradot than Evwrol patches. But it’s also the patch that In often hard to come by.
A friend of mine had a similar experience to you, each type of hrt worked well to start with but eventually she stopped absorbing. In the end she went on to the oral tablet, and while it’s not body identical, she doesn’t have any contra indications (hx of bc or blood clots) and she’s doing very well on it.

That's interesting. I don't think it's the patches themselves that are the issue, I seem to be absorbing OK for now, it's getting the dose right.

If spotting it usually means the progesterone is too low. You need the oestrogen high enough to manage your symptoms and then progesterone keeps the uterine lining thin. I’m on 100mcg patch and take 300mg of utrogestan for 12 days a month. If I was taking it continuously I would be taking 200mg every night.

Continuous but I assumed the spotting was due to the estrogen. Hadn't realised it could be due to progesterone levels. Will speak to GP.

The spotting occurs because you're on a medium-high dose of estrogen and the progesterone isn't enough to control the build up of the womb lining. So it sheds.
There has to be the right ratio.

There has been a lot of guidance on this recently for GPs from the BMS so your GP ought to know.

I’m also in the throes of this. One symptom sorted and another pops up. Whack a mole, as a PP called it, is exactly how it feels!

But whenever I do a symptom survey, my score has improved. Sometimes it’s hard to remember how bad it was pre HRT.

At the moment I’ve come off a 3 month continuous patch trial, because of breakthrough bleeding and progesterone intolerance, and now think I have progesterone withdrawal causing migraines. Can’t live with it, can’t live without it.

After so many years of dismissing the Mirena coil, I’m calling my GP on Monday to ask for it. I’m hoping it’s my miracle.

@JinglingSpringbells can nhs GPs prescribe testosterone? I’m getting a private prescription at the moment and it’s really been a game changer, but I can’t really afford it.

I find at the end of the patch I get very anxious, loads of stomach issues. What I've found works is to not take the old patch off for half a day as I put the new one on and change 3 and a half days rather than 4. I feel like the patches need half a day to bed in a bit and every time I took an old one off I'd get a crash regardless of having the new one on.

@Actnaturally my GP prescribes. Just told her I had no libido. Sent for blood test. Free androgen index was undetectable. Got testogel prescribed.

Also, mirena coil was the reason I could stay on HRT as I am severely progesterone intolerant. It's disgusting stuff. Plus no more bleeding either!

One of your first messages was about libido. You need testosterone for libido. That’s something I started taking a couple of years after the other bits. It took a week or 2 to start benefiting, but it has changed things a lot.

yes.
I have a friend who's been on it for ages on the NHS.

It might vary with Trusts but I've no idea.

There are lots of women here on this forum on it via NHS.

@Doodledoggle and @JinglingSpringbells
Have you had any of the unwanted side effects of testosterone?
I have a tube in my bathroom cabinet waiting for me to be brave and just give it a go!! 😂 I'm really nervous about it.