The end game?

[Y0gamummy]

Been on HRT 2.5 years. Started when 45. Had a positive response pretty much right away, moods were better, life felt manageable again and lots of physical things that I haven't even realized we're hormone related cleared up. I considered whether I needed to increase dose a few months ago as symptoms were increasing (hormonal migraine back, moods unstable) but GP said I was already on a fairly high dose. I'm on two pumps of oestrogel and tablets for progesterone 14 days. This month has been really tough. Period hasn't arrived and I've been stuck in this horrible premenstrual phase for over two weeks now. And rather than just feeling angry (my more familiar premenstrual friend), I am feeling genuinely low and vulnerable. Spent the past week thinking how rubbish I am, imagining that my friends tolerate me rather than liking me and worrying that my daughter is shunning me in favour of her dad. Almost in tears just writing this. Is this what it's like as you approach actual menopause? Periods start to space out and you just end up feeling sh*t for longer until they show up?

Do your friends and family know what you are going through? If not, then you need to tell them, and how awful it is making you feel. I'd also suggest that you go back to the doctor's and try to see a different GP if you can. They might change your dose or give you a different brand altogether. I had to switch the ones I was on and it did make a difference. Some GPs are far better than others than this, and if you don't get anywhere, do ask for a referral to gynaecology at the hospital.

You are not on a high dose.
2 pumps is medium.
3 pumps is higher, 4 pumps is the max.

You should also be having a regular withdrawal bleed around 3 days after the last progesterone tablet. Is that not happening? HRT on a cycle stops your own periods and you get a false period each month.

Your GP isn't any help and presumably knows next to nothing on HRT!
Younger women like you tend to need more estrogen. (I'm on 2 pumps after nearly 20 years on HRT and it's considered a low-medium dose.)

Can you see another GP or experiment by increasing your gel for a week or two and see if that helps?

2 pumps is definitely not a high dose. I know people on much higher tho they are going through the menopause clinic. However you can go up to 4 pumps without the need for referral. Speak to another gp, do your research and go in asking for what you want. I am post menopause and on 3 pumps.

@JinglingSpringbells the bleed after stopping progesterone had been happening up until recently. Usually 2-3 days after stopping, bleed would arrive. Last month, bleed arrived while still taking it and this month, there's been nothing and I took last progesterone dose 10 days ago now. I hadn't stopped to think about the fact it's a withdrawal bleed so should arrive without fail really... Boobs are killing me too this past week, feels like I'm breastfeeding and baby has skipped a feed.

If the estrogen dose is low, there is sometimes no bleed. And in peri your own hormones can sometimes skew it a bit anyway.
It's nothing to worry about but as we've all said-see another GP or try upping your dose of gel.

I'm appalled your GP thinks 2 pumps is high. The patient leaflet in the box says the dose is from 1 to 4 pumps. Do they not even read about what they prescribe?

So I spoke with a different GP and she thinks the progesterone is the thing to tweak. First off, I'm not taking enough as I've been taking it on days 15-28 of my own cycle, even when my cycle goes on for 30+ days. So she's said I need to be taking it for 14 days out of every 28 days regardless. She suggested seeing how things are next month as this month's anxiety and two week PMS hell may have been a blip. Beyond that, she says HRT can be a case of trying different things with no black and white answers about what will and won't work. So next options to consider would be patches or a coil and maybe progesterone all month rather than sequentially. Not for the faint hearted this menopause malarky is it! She says I'm still young (47) but I know my mum was on the other side of menopause by time she was 50 so I have in my mind that I might go the same way. Way I'm feeling, I hope so!

I would opt for progesterone all month rather than the coil if you have that option. It also helps with sleep if that becomes an issue for you.

But daily progesterone is only for women who are not having periods or age over 54.
The very low daily dose won't always control a cycle.

Some women try it to stop the ups and downs of mood on sequential, but that sometimes comes with the downside of daily spotting and irregular bleeds.

@Y0gamummy

I don't think you've been given clear guidance.
Are you trying to fit progesterone around your own varying cycle?

The advice from specialists is to start it on the same DATE each month for 14 days. This creates an HRT cycle. It will override your own cycle.
eg -So, progesterone 15th Sept for 14 days, next 14 days from 15th October etc.

@JinglingSpringbells OP was given the choice of those two options, I was just expressing an opinion on which might be preferable.

Not keen on idea of the coil so if I switch it would be to patches. First step is to start getting the right amount of progesterone as I have clearly been doing it wrong for 2.5 years. Not sure how that happened, whether GP wasn't clear or I misinterpreted, but I've been going by my own cycle all this time rather than 14 days of every calendar month. Will see if that makes any difference and if not I'll try the patches if she thinks that might help.