With peri-menopause and menopause finally being taken seriously and enjoying some attention from the media and medical world, and not before time, maybe we can start to put some of the confusion and myths about choosing to take HRT behind us. The Women's Health Study that declared taking HRT increased our risk of breast cancer has now been called out for being misleading. And I hope that means women can now get better information and more choice around managing their menopause.
Experts like Dr Louise Newson are working really hard to provide clear, evidence based information. The documentary presented by Davina McCall and produced by Kate Muir made great strides in helping women understand. I am not an expert - far from it - but I am happy to share my personal experience on my blog. I have a Menopause resources section where I share some of the best information I have found to help you do your own research.
This post is to update you on where I am with my HRT journey, share some HRT gel reviews and discuss progesterone intolerance. I also want to highlight some of the myths surrounding HRT and point you in the right direction for getting help with your menopause symptoms.
HRT gel reviews
The main hormone we need to replace when we hit peri-menopause is oestrogen. There are several products available from the NHS in the UK. They are all body-identical and safe for most women. Your GP can prescribe them, you do not need to go to a private specialist or clinic that offers bio-identical hormones from a compounding pharmacy.
HRT Patches - I tried an oestrogen patch originally but I didn't get on with it as I didn't like the permanent plaster mark on my bottom plus when I had a blood test it revealed I wasn't absorbing efficiently enough which is why my symptoms hadn't really eased. However, many women get on very well with the patch. There is oestrogen only or the combined patch with progesterone.
HRT Gel - this is my preferred method for getting my oestrogen. I have been successfully using Oestrogel (by Besins) for a few years. But in the last 6 months or so I have been having problems with it. There have been supply issues, resulting in some women being given the Parallel Import (PI) from their pharmacy and finding it didn't work, although Besins say that Oestrogel and Oestrodose (PI) are exactly the same. My daughter picked up a prescription for me a while ago and when I unpacked it at home, I found out it was the PI, Lloyds Pharmacy refused to exchange it so I had to lose my prescription fee and ask my GP to issue a new scrip, I didn't want to risk a return of my symptoms. Then I went through a period of symptoms returning that coincided with having my vaccines (there is no proof of the vaccine causing issues but a lot of women are reporting hormonal fluctuations). Then a few weeks ago I could not get my prescription for Oestrogel fulfilled anywhere locally or via Lloyds Direct. When I saw my private specialist, he informed me there were supply problems and suggested I try Sandrena.
Oestrogel - this comes in a bottle pump pack and I use 3 pumps every morning. You dispense the gel onto your hands and rub it lightly into your upper inner thighs or top of your outer arms. It is quite a wet consistency and can take a few minutes to dry. Many women find this a pain as you cannot get dressed until it is dry and it is best not to rub it in too much as the absorption is better if left to dry naturally.
Sandrena - this is the original body-identical HRT gel and I did try it once before but thought the bottle pump pack would be more convenient. It comes in a box and each box contains individual foil sachets. The equivalent dose for my 3 pumps of Oestrogel is 1.5 mg so I was given 1 x 1.0 mg sachet and 1 x 0.5 mg sachet daily. I cut the top off, squeeze the gel out and apply to top of my inner thighs the same as the Oestrogel. I find it is a thicker consistency and less gloopy so it dries quicker. I also feel the actual gel quantity is slightly less.
Update: I spent about 4 months on Sandrena but noticed a recurrence of some of my symptoms, after having a blood test, it turned out my oestrogen levels were very low so my private consultant suggested I switch back to Oestrogel - like the patch it seems that I do not absorb Sandrena gel successfully - you can read my update here!
The HRT shortages continue although stocks are slowly coming through, if your local pharmacy cannot fulfil your prescription then you could use the Online Prescription Stock Checker at Boots which checks stock within a postcode area to save you a wasted journey.
This is a good instagram post from @hormoneequilibrium discussing how to apply oestrogen gel. They explain that if you apply correctly then absorption is better and lower doses are needed.
My top tip is not to overthink it, keep it simple, there is no need to split the dose between morning and evening. Just apply your Oestrogel or Sandrena gel in the morning, leave to dry and get on with your day.
HRT Tablets - I have never tried tablets, this is the 'old style' HRT and it is best not to take them now, the HRT body-identical gels are much safer and considered the gold standard in HRT. However, I have recently seen a post on @hormoneequilbrium announcing a new combined HRT that is body-identical and is in tablet form, it is called Bijuve.
Progesterone and progesterone intolerance
If you still have a uterus (not had a hysterectomy) then if you take oestrogen you must take progesterone. This is to prevent a build up of your endometrial lining and it possibly causing cancer. To find out more visit the British Menopause Society or read my post about understanding progesterone intolerance.
The main progesterone prescribed now is Utrogestan and as it is a body-identical progesterone it comes with less side effects and is safer.
An alternative is having a Mirena coil inserted. Although it is a contraceptive device it releases a very small amount of progesterone and protects your uterus lining for approximately 5 years when it needs to be replaced.
A lot of women report an intolerance to progesterone, from mild to severe. It can cause bloating, tummy pain and severe low mood.
Either the Mirena coil or taking Utrogestan as a vaginal suppository rather than an oral tablet does seem to be a better option and reduces the side-effects. Taking progesterone as a tablet at night can help with sleep! Worth remembering!
Taking Utrogestan as a vaginal suppository is not licenced by NICE so your GP will be unable to approve it. However, many women using support from groups like The Menopause Support Network or Dr Louise Newson do take it vaginally. It is exactly the same tablet and dose. It rarely comes with an applicator in the UK so you have to just do it yourself! Push it up as high as you can. Please do your own research though, I can only share what I have tried or been advised but everyone is different.
As mentioned above some of the HRT Patches come as combined Oestrogen and Progesterone and a lot of women get on better with these.
It does seem that if your oestrogen dose is right and you have minimised your menopause symptoms then often progesterone is better tolerated.
The two different HRT regimes can also make a difference. . Either sequential/cyclical HRT if your last menstrual period was less than one year ago or you are still having periods. Or continuous HRT when you are considered post-menopausal (one year after the date of your last period). Sequential means Oestrogen every day and progesterone for 14 days every cycle. Continuous is oestrogen and progesterone every day.
For the full downloadable version of this factsheet (incl. page 2), please visit
Primary Care Women's Health Forum
Testosterone is also a female hormone and often misunderstood. Low testosterone in women can cause lack of energy, brain fog and reduced libido. Unfortunately testosterone is not licenced in the UK for use by women. But it can be prescribed by a private specialist (in my case), some GP's and most menopause experts - but only for low libido (so make sure you say you have low libido). If you are taking HRT and your oestrogen levels are balanced but you are still reporting some symptoms, it is worth investigating testosterone. It is often the final part of the hormone jigsaw.
There are three main options for testosterone available in the UK. Either AndroFeme (a cream you rub onto your arm) or Testim or Testogel (a gel also rubbed onto your arm). AndroFeme is specifically made for women and I prefer this as I take a small dose every day and it is easier to remember! Testim and Testogel are made for men but can be used by women in smaller doses (but often this means taking it every other day or 3 x per week and I got in a bit of a muddle)! However, if you are lucky enough to get an NHS prescription then it is likely to be for Testim or Testogel. I pay privately for my AndroFeme.
Dr Louise Newson has an excellent factsheet on Testosterone, I suggest starting here to understand it more fully.
There are so many myths and so much confusion around HRT.
HRT causes breast cancer.
HRT will make me put on weight.
Taking HRT is delaying the inevitable.
I suffer from migraines so I can't have HRT.
You can only use HRT until you are 60.
And many many more! Please read up on these, they not accurate and often misleading and we need to get the message out there that taking HRT is okay for most women and can change your life.
My personal story - update
I am now back on 3 pumps of Oestrogel and 0.5 mg of AndroFeme (testosterone cream) daily. And I am feeling fabulous in my fifties!
But I have been unable to tolerate progesterone (even in an off-licence low dose), I have tried the Mirena coil and more recently Utrogestan.
A number of years ago I had an endometrial ablation, this is a surgical treatment for heavy periods and during the procedure most of the uterine lining is destroyed or removed. My ablation was very successful and I have not had a period since.
Whilst it has meant less urgency in dealing with my progesterone intolerance, it does not mean that I can dispense with the need for progesterone completely. There is still a chance that my endometrial lining will build up again due to taking the oestrogen.
At the moment my private specialist has been monitoring me very closely and I have 6 monthly pelvic scans to ensure that no thickening is occurring.
But this is still not a solution so we have discussed two options, a full hysterectomy or trying the Kyleena coil. The Kyleena is an IUD and contains a smaller dose of progesterone than the Mirena. It is not licenced for use with HRT because of the smaller dose. If I choose the Kyleena I will still need regular monitoring. I am not keen on a hysterectomy due to possible complications.
I am currently thinking about these two options and have not yet made a decision.
A lot of women give up on HRT because they cannot tolerate progesterone. But it is worth trying all the different options before giving up completely.
I want both the immediate health benefits of HRT (symptom relief) and the long term benefits of taking it (protection from heart disease and osteoporosis and lots more) so I am keen to solve the progesterone problem!
Please note: my HRT regime was prescribed by a private specialist but my prescriptions have now been taken over by my NHS GP (a specialist menopause doctor at my practice). I choose to get my testosterone privately so I can get AndroFeme however, it is possible to get Testogel or Testim from your NHS GP. My GP has been excellent but due to my progesterone intolerance I chose to see a private specialist for a second opinion and monitoring that cannot be provided on the NHS.
I hope sharing my thoughts and an update of my HRT journey is helpful, do get in touch if you want to ask any questions. I never mind hearing from you. I have collated a section on my blog specifically to share the best menopause resources I have found so do go and take a look.
Love Michelle xx
Further reading ...
Understanding progesterone intolerance and HRT side effects with The Menopause Coach
The rollercoaster of menopause mood swings! The theme for World Menopause Day 2022 is cognition and mood
Oestrogen reviews | how I learnt that I really do need my HRT!
What do do it you can't obtain your usual oestrogen gel - update on current shortages and supply problems - Dr Louise Newson, Balance.
Disclaimer: this blog post is a personal review of my own experiences, it can not replace medical advice. Please do your research for your own individual circumstances and consult either your GP or a specialist menopause clinic - I recommend a few on my Menopause resources page.
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