HRT options

[Tina_Maria]

Hello All,

I had the Mirena coil (IUD) since starting menopause and was taking oral oestrogen HRT in addition for the hot flushes (nearly 10 years now). I was on Elleste solo 1mg, which I only took every 3-4 days, as I found this dose was okay for controlling the flushes, if I took more my breasts got very tender.

My coil was removed about 6 weeks ago (as it expired) and I was advised to switch to a combined HRT, so I got oral Elleste conti 2mg estradiol/1mg norethisterone. Problem is, I cannot really adjust the dose at all, I feel the estrogen is way too much but also the norethisterone, as the concentration from the coil was much less (and only acting locally). I feel a bit nauseous sometimes and my breasts are quite painful on occasions. I really need something that is far lower in concentration or something that I can more easily adjust to my specific needs, as I still have the flushes and they interfere quite a bit in my daily life, if not controlled.

I have an appointment to see my GP on Monday, so would like to get some ideas.

Would it be easier to get another coil and then just sort out the estrogen? There are some low-dose estrogen patches that would release a lower amount. However, I have difficulties with plasters (allergic to some), so I am a bit worried that this could affect me.

There are also gels, that can be applied (estrogen and/or progesterone), and I would have no problem including this into my daily routine. I suppose they can be more easily adjusted (a bit more or a bit less depending on needs?). Are there any difficulties in obtaining these at present, as I have heard that there has been a shortage in supplies, but I am not sure which supplies were affected by that.

And finally, has anyone got experience with testosterone? I am just wondering if I should incorporate this as well (if I can get it prescribed!), as I do feel quite low on energy, despite a healthy diet and daily exercise.

Any advice, experience or ideas you can share would be most welcome! Many thanks!

[JulesUK]

I’ve had that coil for 10 years (3 different ones) and it has been brilliant at managing my endometriosis. I’m 51 now and have about 3 and half years left on my current one. I’m hoping to have one as long as possible. I tried the 50g patches but I had sore breasts too and it also started my symptoms back up so I tried the 25g patches but a doctor told me the gel is better and I’ve been on that for about 4 months with no issues. I only use one pump a day but I’m experimenting with using an additional pump and so far no other side effects. My two local chemists didn’t have it in stock because of the shortage but I did manage to find a chemist that had it no too far away. Sorry I can’t help with the other questions.

[Tina_Maria in reply to JulesUK]

Thanks Jules, since most of the patches and tablets are really high in concentrations, I am leaning towards having another mirena and then top up with a gel too. I am sure you can get another mirena inserted again once yours has expired, as this is one of the options the NHS should offer. Glad you managed to find something that suits you and many thanks for sharing!

[JulesUK in reply to Tina_Maria]

I was lucky to have the Mirena changed each time during an operation but I would suggest if you’ve been getting on ok with it so far to continue. It’s a bit of a minefield isn’t it trying to juggle and manage the different hormones. I hope you find what’s best for you.

[Tina_Maria in reply to JulesUK]

Yes indeed, a minefield! I saw a GP this morning and she suggested oestrogel and utrogestan (low dose progesterone). Having had a good read over the weekend, this is what I would have picked too, given the choice (not so good with plasters, hence would be hesitant with patches). Good thing about the gel is that you can much easier adjust the dose to what you need. I feel quite positive about it, so fingers crossed! And the pharmacy had it in stock too, so quite lucky!

[katiesails]

Hi

I had a Mirena coil fitted in my 40s to help with Endometriosis and it did a great job of sorting out heavy periods. I then chose to keep it during peri/menopause as it had not been bothering me.

I have not used any form of HRT preferring to focus on my nutrition, lifestyle and a bit of mental self-help. For myself and others I have helped on the meno journey (I work in nutrition), Ive seen how what we eat and drink can for some have a positive impact. A good routine of always eating balanced meals and snacks (protein and healthy carbs) and working on hydration etc was my chosen route. I'm now through the other side, coil free.

I experienced meno symtpoms when I overindulged the sweet treats and wine. And saw them drop/disappear when I got back on plan.

I hope that might help you and you're welcome to come back with questions if you'd like to know more.

Good luck.

[Tina_Maria in reply to katiesails]

Thanks for replying. As I am hypothyroid too, I have been focusing on good nutrition / supplementation and exercise as well and I have regular blood tests to show that all is optimal. Sadly, the hot flushes are hereditary, my grandmother had them badly, my mum and myself too. I cannot go without anything, as a hot flush every 3 hours day and night is very disruptive, so quality of life will be severely impaired without any intervention.

I am happy for you that you can manage without anything, but as there is more choice out there these days, I am sure I will find something to suit me. Thanks again.

[JulesUK]

just to add, did you try sage tablets for the flushes? I took them when I had a temporary induced menopause and found they helped.

[Tina_Maria in reply to JulesUK]

Thanks, yes I tried that and also drinking sage tea (don't mind the taste), but it did not help. My mum used it too, it did help her a little bit but not much. Sadly she was taken of HRT when that study was published (and later found that the breast cancer incidence was exaggerated, as they did not correct for prior use and other important health factors!) and had to manage without anything. I am really glad that things have moved on a bit now!