HRT question. Sorry, totally off topic but I need an answer quickly!

[WitchingHour2point0]

Oh cripes!

I started HRT 8 days ago. (Estrogen patches and utrogestan). I'm on cycle day 21 and I've started my period this evening.

What do I do now?! Do I carry on taking utrogestan until I've completed 2 weeks?

[FancyPants54]

You have just started. There will be a period of things sorting themselves out and settling down. Just keep taking the HRT as prescribed and your bleeding should settle into a pattern of bleeding when you stop taking Utrogestan. For now it looks like breakthrough bleeding, so keep going.

HRT is very worth it. But be prepared for teething problems on the way to finding your perfect dose and method and don't be afraid of trying different ones if something doesn't work well for you. Utrogestan is the best and only body identical progesterone so that's worth sticking with. But you have options for the oestrogen. Patches, gel, spray and capsules. So give this regime 3-6 months and see how you feel and what needs tweaking. It took me a long time to get to the right place where I just feel normal with it. I've tried them all!

[WitchingHour2point0 in reply to FancyPants54]

Thank you so much!

I guess problems will arise as I go that I won't know to ask about in advance!

The bleeding was totally unexpected and the Dr didn't warn me for it! She said to take utrogestan for the 2nd half of my cycle, which I assumed to be day 14-28, but then the bleed confused matters. And Google was useless.

I'm quite happy to persevere. it's just all so complex!

[Happyfairy09 in reply to WitchingHour2point0]

Doctor should of warned you, get a GP consultation for medical advice, just to be sure and put your mind at rest.

I have recently changed to combined hrt patches, the nurse who removed my coil explained that if I start with periods again I need to let them know, They would relook at my hrt medication and would probably need changing.

[WitchingHour2point0 in reply to Happyfairy09]

It would've been hopeful for Consultant to warn me. I was expecting some hiccups but just not this soon!

[Amazon07 in reply to FancyPants54]

Hi 👋🏼

Sorry, don’t want to highjack thread but please could you advise what oestrogen is good for HRT? I’ve a GP appointment tomorrow and I want to know what to ask for. Im 47 and looks like I’m going through an early menopause. My gynae said that the reason why I don’t have periods is because my womb lining is only 3.1mm thick and it needs to be 4mm thick to have periods. He’s not given me anything.

I used Wellsprings Serenity progesterone cream for years to try to regulate my cycle that went awry after I stopped breastfeeding but it never seem to have made any difference and this year I only had 1 period. 😰

I’d be so grateful if you could please recommend a good oestrogen replacement please so I know what to ask for.

Thank you so much! Xx

[FancyPants54 in reply to Amazon07]

Well different oestrogen products work better or less well on different skin. So there is no holy grail. However, a good place to start is either with a body identical patch (I think all the available NHS patch products are body identical anyway) and a body identical progesterone (Utrogestan). You must not use Wellsprings progesterone cream as part of proper HRT. Progesterone does not absorb well through the skin.

The starting dose for the patch is either 25 or 50 and goes up to 100, but many women need more and can be wearing up to 2 x 100 patches at the same time. You will need a clued up GP for that though.

The other alternative product is the gel, called Oestrogel. 1 or 2 pumps to begin with. It's licensed up to 4 pumps. If the GP is willing many use more. There is also Lenzetto spray oestrogen which I like and use (gel didn't suit me and patches seemed to dump all the oestrogen into me too quickly.)

It's a case of pick one and try it and see how you feel. You must give HRT time to settle and work. At least 3-6 months. If at 6 months you don't feel right you might try a different product or raise the dose etc. It's all trial and error.

The best website in the UK for all things HRT is the balance-menopause.com

And they also have the Balance App for you to load onto your phone to record symptoms and to read information on the fly.

[Amazon07 in reply to FancyPants54]

Thank you so much Ladies!!! Just to clarify, is the Lenzetto spray oral or transdermal? Thank you very much! Seeing my GP in a couple of hours so I’ll ask for Utrogestan and Lenzetto. Xx

[RedApple Administrator in reply to FancyPants54]

FancyPants54 'You must not use Wellsprings progesterone cream as part of proper HRT. Progesterone does not absorb well through the skin.'

I'm aware that many people have used this product over the years, so I'm curious about your claim. 😊 Does your warning also apply to the Elan Organics one?

Can you give any further info on this at all?

[FancyPants54 in reply to RedApple]

No progesterone absorbs through the skin well enough to provide reliable uterine protection when using standard HRT. By standard I mean anything that is prescribed, not compounded bio-identical products.

The molecules of progesterone are too big for skin absorption where as oestrogen will absorb through the skin. I'm about to take my mum to her hair appointment so I can't look now. But I will see what I can find for you when I'm back.

I am a patient of the Newson Clinic in Stratford, for several years I was under Doctor Louise Newson herself and she told me this. She's the most prominent HRT specialist in the UK at the moment and has been for a few years now.

Progesterone creams might help some people in the early perimenopause stage to feel a bit less off-balance if they use it on it's own. But it's not a clinically approved method.

More later.

[Amazon07 in reply to FancyPants54]

Thank you so so much!! Do you see Dr Newson privately?

I hope your Mum’s appointment goes well! Xx

[Amazon07 in reply to FancyPants54]

Just to add, I used Wellsprings Serenity transvaginally to aid absorption but it did zilch to regulate my cycle! I used it transdermally for a couple of years and then transvaginally for about 8-10 months. I just stopped using it 2-3 weeks ago. I’m not sure if I had any benefits at all TBH. I was getting hot flushes pretty badly but thankfully my homeopath helped me with that! Xx

[FancyPants54 in reply to Amazon07]

It's oestrogen that we need to protect our bones and hearts and minds, not progesterone at the end of the day. Those who have had hysterectomies don't need to use progesterone as part of HRT. They can be oestrogen only or oestrogen with testosterone and they do just fine. Most of the problems women have with HRT in the various HRT patient platforms is with progesterone.

I would not have put that cream inside. You can do that with Utrogestan capsules because it's licensed for vaginal use in fertility treatment and at double the dose we use in HRT. I have seen it said that there are a lot of fillers with the cream. The less fillers the better really.

[Amazon07 in reply to FancyPants54]

Thank you for all that! 🙏🏼💝

Wellsprings advised me to use it transvaginally. I believe it’s all natural but sure as heck it didn’t seem to do anything for me 🙈(apart from costing a lot of money…)

They took more bloods last week and I’ll hopefully get an appointment with my GP in 2 weeks’ time when she’s back from her holiday, and we can then see re HRT! Xx

[FancyPants54 in reply to RedApple]

I’m still out. But this leaflet about HRT confirms what I said but with less detail about the reason why it doesn’t absorb properly.

It’s the penultimate point I think but being on my phone makes cross checking hard.

balance-menopause.com/uploa...

[RedApple Administrator in reply to FancyPants54]

Thanks. I know members have asked about this in the past, so good to have some bona-fide info. Maybe now that menopause is finally being widely recognised and proper treatment is not just available but readily being prescribed, we'll get fewer queries about those progesterone creams.

[FancyPants54 in reply to RedApple]

That web site has very good information on it. Up to date, guideline driven and researched. It's a valuable library whether you go to the clinic or not and it's pretty much used the world over. So much of the material has been translated into different languages.

But if you want more depth, you have to trawl the medical papers and that takes time. But it's out there, just like our thyroid information is out there in depth.

[TiggerMe in reply to Amazon07]

I'm with Fancy Pants, Lenzetto is quick and easy to use, easy to adjust the dose and body identical ( made from yams?!) and Utrogestan as it can be used orally or vaginally 🤗

[Amazon07 in reply to TiggerMe]

Thank you so much Ladies!!! Just to clarify, is the Lenzetto spray oral or transdermal? Thank you very much! Seeing my GP in a couple of hours so I’ll ask for Utrogestan and Lenzetto. Xx

[TiggerMe in reply to Amazon07]

Transdermal, used on inner forearm 🤗

does look like an asthma inhaler

[FancyPants54 in reply to TiggerMe]

I suppose it does. I hadn't thought of that.

[Amazon07 in reply to TiggerMe]

Thank you 🙏🏼💝

[FancyPants54 in reply to Amazon07]

That would be a very good start. I really like Lenzetto. It wasn't available in the UK when I started. If it ends up not being strong enough for you down the line you could add in a patch too.

[TiggerMe in reply to FancyPants54]

Hmm... or a bit of testosterone to back it up 🙂

[Amazon07 in reply to TiggerMe]

Could do with that! My sex drive is not the best although I think that’s due to emotional stuff too… xx

[TiggerMe in reply to Amazon07]

You could ask them to check your Testosterone level?

[Amazon07 in reply to TiggerMe]

I will ask them to test all my sex hormones! Ridiculously they didn’t do any of them last time when they sprang the blood test on me at my appointment 3 weeks ago!

[TiggerMe in reply to Amazon07]

Weirdly they generally won't test estrogen or progesterone but they will test testosterone... 😳

[FancyPants54 in reply to TiggerMe]

Yes, if libido and muscle strength isn't good testosterone is a good addition. But you need oestrogen to be high enough first otherwise the testosterone gets converted to oestrogen and wasted.

[FancyPants54 in reply to TiggerMe]

It's a bit misleading to say it's made from yams. It's not. But the original molecules were taken from yam. Now it's manufactured in a lab. It would not matter if it were originated in old tyres as long as the end result was a hormone that was identical to our own.

[TiggerMe in reply to FancyPants54]

Absolutely!... thank goodness for yams and scientists👏

No connection to pregnant mares 😅

[FancyPants54 in reply to TiggerMe]

It always makes me wonder how the first connections were made with things. Which scientist looked at a yam and thought "hmm, progesterone/oestrogen". And why did they think that when they looked at a yam.

[TiggerMe in reply to FancyPants54]

We need to go back to the old village herbalist...nature provides 🌱

[FancyPants54 in reply to TiggerMe]

Derived from yams is the term I couldn’t remember. But it’s referred too in the leaflet I’ve just shared.

[Lily905]

Keep taking your HRT as prescribed. It may be helpful to keep a "diary" from when you started HRT so you can explain to your doctor what's been going on

[WitchingHour2point0 in reply to Lily905]

Hi Lily,

I am, roughly speaking! I see my consultant again in 2.5 months so hopefully I'll have more data to give to her.

[Lily905 in reply to WitchingHour2point0]

Exactly. Keep Data. I went though a lot if different HRT till I found the right one which ended up being the patch & tablet duo. It just takes a short while for your body to settle down. Best Wishes

[Jacarilla]

don’t worry it took nearly 18 months for everything to settle in my case. It’s often a bit of a shock to the body to suddenly have oestrogen again depending on how depleted you were before you started HRT. Expect some hiccups, I actually felt worse before I felt better but it’s worth going with the flow. We are all different and one size does not fit all. You may have to tweak doses or even method of delivery, I’m on the lenzetto spray now. Louise Newson’s website has loads of info and there’s a good reliable Facebook group called The HRT Truth Collective run by Jane Pangbourne who is a qualified menopause advisor. (She also has a website called Menopause Not Mad) all of these resources I found invaluable when I was struggling to find info.,I hope that helps.

[WitchingHour2point0 in reply to Jacarilla]

I've been very depleted for quite a long time. In early 2022 I was at 9% in range for oestrogen. At the last check in September, I was at 14% below range.

So I'm hopeful I'll start to see improvements fairly quickly. There will undoubtedly be more hiccups as I go - I just have no clue how to preempt what they might be!

I'm not on facebook but I'll look at that website. Thank you

[CoeliacMum1]

Hrt is a very individual thing on how we absorb the gel/patches through our skin and Utrogestan for that matter and our individual cycles and hormones dictate along with dosage.

There is a settling down time but do keep dates of these events and how long things last and mention it all to your GP regardless if this settles down …but on cyclical regimen you are expected a bleed, on continuous regimen not… Ive had scary last few months.

My story with hrt and still on it.

I’ve been on both regimens.

I started hrt 3yrs ago and I never stopped bleeding which ever I tried under GPs advice and knowledge of my issues.

I started continuous regimen and then my GP after my 3month review wasn’t happy gave me few more months (this was through covid) I was still bleeding sent for an ultrasound found ovarian cyst and this clearly was a hormonal cyst just 3months later at my second ultrasound found it had gone had to come off hrt for these investigations along with a CA125 blood test… I was put on cyclical regimen after probably going continuous too soon… still bleeding year on as well as the usual withdrawal bleed… then another GP recently thought it possibly as my endometrial lining was too thin and that I actually needed to up my gel and Utrogestan continuously …forward 3months on doubled dosage another ultrasound and lining thickness had increased (assuming now had too much gel) and if still perimenopausal it was within normal range but given age and many assuming I’m post menopausal given I’m 57 (definitely not gone a year without a period) it had triggered a further investigation to gynaecology and a Hysteroscopy with biopsies to see what is going off will add I do probably have adenomyosis all 3 ultrasound have commented.

I was put on 2WW for suspected endometrial cancer unfortunately NHS couldnt fulfilled the 2WW criteria nearly double that was my date when came through so I went private I found oncologist gynaecologist rang secretary she got him to do over phone consultation that morning he asked me to get to hospital within next 2hrs and wanted to see me… I had hysteroscopy with biopsies this was done within days under general anaesthesia along with a polyectomy (he found 2 polyps and removed) and had D&C and a Mirena coil fitted getting progesterone - progestin in this case, direct to where it is needed, as clearly Utrogestan was not doing it’s job for me at my stage in this menopause journey … I’m waiting for my pathology results but observationally he said all looks benign and healthy elsewhere … I had that couple weeks ago… I have follow up in couple of weeks. Ironically my mobility has improved a bit, I’m still getting some problems but now wondering if all gynaecological with this adenomyosis along with polyps which latter wasn’t seen on ultrasound is all my mobility issues… I had always said thyroid was the problem as know my FT3 levels are low and poor convertor… given crossed various areas off for cause … ultimately I wonder if FT3 is being blocked by my oestrogen dominance and poor methylation - only a thought at this stage.

I have since been trying to research, looking at thyroid and oestrogen dominance link to menopausal complications, as I am aware oestrogen can be an antagonist and I don’t mean taking hrt necessarily just what we naturally circulate use and supposed to detoxify or don’t as many have this problem…I’m aware I probably have methylation issues here as do many.

Hopefully my pathology will be ok but it’s an anxious wait.

Bottom line is don’t dismiss any peri/post menopausal bleeds do inform your primary healthcare provider… this area is increasing and waiting list are getting longer, so sooner mentioned sooner dealt with if that’s what is required.

[WitchingHour2point0]

Hi Coeliac,

Thank you for sharing. This must be an intimidating wait for you. I sincerely hope you get a negative result for anything iffy.

I'm only 37 and still having periods so I know cyclical HRT is right at the moment and I'm hopeful that this bleed was just my body being totally confused by having a reasonable amount of hormone in my system but I will keep an eye on things over the coming weeks.