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.

Well @Y0gamummy you're not the only one because I've been doing the same as you! I've been basing the progesterone around my own cycle. This month though I came on 10 days early but finished my progesterone anyway (so was talking it through the bleeding). I took the last progesterone tablets on Monday and I'm now finding I'm getting period pains as if my body is gearing up for another period though??

I'm not an expert but my GP has a special interest in menopause. She's always first suggested upping the estrogen if any symptoms have got worse. You can normally find out pretty quickly if that is helping. If symptoms don't improve you can always go back to the original dose.

If your cycle was super regular it wouldn't be a big deal but my cycle has always been on the long side and now with HRT influencing it I hardly know where I'm at with it. @Fishergirl I guess it would make sense for there to be a withdrawal bleed after stopping the progesterone, even if that's a second bleed in one month? Which is why aligning with your own cycle makes sense on one level (though obviously I've stopped that now as per GP advice as I appreciate its important to balance the oestrogen out with enough progesterone). I'm starting to realise one of the complications with HRT during peri is that you still have some kind of cycle going on in the background. So, now that I'm taking progesterone 14 days out of 28 days, this month I'm taking it during the best bit of the month for me, about 10 days after my period. The combination of that stage of my natural cycle and the progesterone has me feeling fantastic, no anxiety, sleeping great, calm and reasonable with everyone, even my husband. I am slightly dreading what happens next though, when I have two weeks off progesterone while my natural hormones are also dropping.

The best thing I ever did @Y0gamummy was to book a private appointment with an obstetrician/gynaecologist. He had looked after me in my high risk pg years earlier.

For about £180, he did a painless smear test, listened regarding my symptoms, evaluated what my GP had me on (cheap as chips forst line was his assessment) and recommended different and well titrated HRT (combination of pills and patches - quite unusual then). It was the best money I ever spent and difficult for the GP to argue against without undermining a senior consultant. Itnwas about ten years plus ago so the price will have gone up.

I may be lucky, but to provide hope post meno: no more periods, less sweating and no flushes, breast are no longer lumpy due to hormone surges, no more mood swings, no more headaches, no more monthly variable, albeit healthy, discharge. I accept that much stress was due to teenagers and although that has now passed has been replaced with frail elder care but the stress levels have not returned. Worked until 67, very recently

There is hope that this too shall pass and knowledge that GPs are not helpful about it.

It is supposed to take 3 years from periods starting to arrive a week or so late, until the final period. However, once they start to arrive very late, eg every 3-4 months, you’ll find it a lot easier. I found the symptoms were milder, and knowing it’s now only occasional and drawing to an end, makes it more bearable anyway. You’re at the worst bit. Thankfully this happened to me during the Covid lockdown, so I could be in a bad mood all on my own. It won’t go on forever.

Hate to bring bad news but I have found my trajectory non linear! Am mid 40s. A couple of years ago I suddenly went from my normal short cycle to having a period every 3 months or so. Dr gave HRT and predicted I'd be through it all relatively quickly. Everything super smooth at first but after about a year my own old cycle returned with ovulation, and a much shorter length than the hrt cycle, which it often overides. Super confusing! I don't know if the hrt can kickstart natural hormone production or whether the previous slow down was actually a side effect of an illness or something. Or maybe it's just another variation of "normal '.

Supposed to?
It varies with everyone. There is not set pattern.

The fee is a bit out of date, but may vary. That was still cheap even 10 years ago. (I had my first private appt many years ago.)

Most are charging £250-£300 for the 1st appt ( 30-45 mins) and less for further appts.

However, I agree it's worth it as if you work it out per week over a year or 6 months, it's hardly anything and you get expert advice.