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Perimenopause | Why I decided to take HRT

26/3/2019

15 Comments

 
Talking and sharing my perimenopause symptoms is incredibly personal and I have wondered if I am happy to do so but I do believe that my journey to HRT and what has happened to me, what I have found out, might help someone else who is suffering in perimenopause and needs some support and advice during menopause.  And with Carol Vorderman all over the papers again this week talking about HRT and how it changed her life, I thought I'd be brave, I do believe we need to be more open about menopause, so here goes ...
perimenopause and hrt
When did it start ...

​I probably noticed a change in my health around the time I turned 50 although I suspect there had been things going on before that but I had not attributed them to perimenopause - may be from at least age 45?

My symptoms mainly included:
​
Night sweats (see my post about menopause and wool duvets here)
Occasional hot flushes but this has not been a big issue for me
Brain fog (quite severe at times)
Low mood and anxiety (which got a lot worse)
Stress
​Much lower alcohol tolerance (I wrote about it here)

What I tried first ...

I went to my GP and she suggested I go for a uterine scan to see what was going on - I'd already had a uterine ablation (removal of the womb lining some years earlier due to heavy periods - although this meant very light or no period, it has since proved to be a bit confusing in working out where I am with my cycle).  I later on had a blood test but it wasn't felt I needed HRT at that stage.

I struggled on with vague symptoms, I was a bit unsure if it really was menopause related but eventually I went to see a private GP locally and had a chat and some blood tests and she felt I did need some hormones - and this is where the confusion started although I didn't know that at the time.  She prescribed bioidentical hormones which I assumed were different/better to what the GP would prescribe (see more later).  But I didn't feel they helped and when I went back it meant more bloods tests and more private prescriptions - all getting very expensive so I decided not to continue.

At some point my symptoms must have worsened as I then went back to my own GP who referred me to the specialist menopause GP in the main practice.  We had a long chat and she explained that blood test results are not completely accurate as hormones do go up and down during the cycle and can be inaccurate and that a clinical diagnosis post age 45 is best (if pre 45 then it is considered an early-menopause and blood tests are necessary).  I did however have blood tests as well.  She felt certain my symptoms were menopause and prescribed HRT (oestrogen patches and progesterone tablets).  I was prescribed body identical HRT (please see below for more info on bio and body identical hormones).

If you take oestrogen then you must take progesterone to protect the lining of your womb from building up and causing cancer and this applied to me as well despite the ablation.  

Just a reminder - you are in perimenopause in the time leading up to the day of your last period.  Menopause occurs when you have been period free for one year exactly (so in fact the term menopause only refers to one day).  You are then post menopause.  Not everyone will have any symptoms and everyone's symptoms are different and vary enormously.

Looking back I can't remember if I saw an improvement in symptoms once I started on the HRT but slowly I started to feel quite unwell - very stressed and anxious, bloated and nauseous.  I did some research and realised the progesterone can cause this as well!  I spoke to the GP and she changed my prescription to vaginal suppositories (not tablets) as these bypass the liver and are less likely to cause a problem.  Basically a lot of women are sensitive to progesterone - so do look out for symptoms - more info below.

Off I went again.  But I still wasn't convinced I was seeing any benefit.  Another blood test showed that my oestrogen was still really low and it was concluded that the patches weren't working for me and the oestrogen was not getting into my system.  I changed to oestrogen gel (oestrogel).  However, I was still having a problem with the progesterone.  I had to take it for 12 days (1st to 12th of every month) but by about day 8 or 9 I was suffering from severe low mood, rage and anxiety.  It was awful!  The GP explained that I was certainly progesterone sensitive/intolerant but was cautious about reducing the dose down - although I had read that 7 days of 100 mg is possible - I was taking 12 days of 200 mg.  I wasn't convinced I was getting enough oestrogen and I wondered if I really needed some testosterone but until we sorted the progesterone my GP was not comfortable with increasing oestrogen and introducing testosterone!

Finally seeing a private specialist ...

Difficult decisions!  I felt I needed a second opinion.  More research.  And I found Professor John Studd who now has a private practice but had been Consultant Gynaecologist at the Chelsea and Westminster and a menopause and hormone specialist.  I read a lot on his website and he is confident that if you are progesterone intolerant you can have the reduced dose of 7 days of 100 mg.  

I decided I would go and see him - I got an appointment with a member of  his team within a week and headed into London.

He took my full history, he understood and listened.  He gave me a new prescription and reassured me that my GP had been heading down the right route but was too cautious simply because she has to follow the NICE guidelines.

Another comment about bio identical hormones and progesterone.  If you go to a private bio identical clinic then you will probably be given progesterone from a compounding pharmacy that is in cream form for you to rub onto your skin.  This type of progesterone will not protect your uterine lining. 

EDIT - Since writing this post I have found another term used for HRT, body identical HRT so I needed to clarify where the confusion lies.  As a result I wrote a second shorter blog post here - What is the difference between bio identical HRT and body identical HRT? 

Another thing I discovered is that oestrogen is better in gel form not tablet.  The tablet is the 'older' form of HRT and carries more risks.  So ask your GP to prescribe the gel.  They might not want to as it is more expensive.  Patches are an option but they didn't work for me and I didn't like the mark they left behind or that they were visible in my bikini or my underwear.

And finally testosterone is not available on an NHS prescription (usually) as it is not licensed for use by women in the UK.  Do not be put off though, if you think you need it, be pushy!

How am I now ... my results

Three months later I went back to the clinic and was delighted to report a huge improvement.  On my first visit I was very tearful and upset and had no confidence in ever finding a solution - I wasn't even sure it was perimenopause.  When I returned for my check-up I felt like me again.  Just normal, back to who I was before perimenopause started.  It is such a relief - but it shouldn't have taken me so long to find the solution.

Everyone is different and of course I have absolutely no medical qualifications at all - the purpose of my post is to explain what happened to me and hopefully help someone else find the right path for them.

​Before I went down the HRT route I did try alternatives like diet, exercise and general healthy living and I did seek support from alternative menopause experts but in the end I found that the HRT route was what worked for me.

A few other things to consider ...

Whilst HRT does carry risks you are more at risk from being overweight or drinking too much alcohol.  So addressing your general health is the most important place to start.  Drinking every night might mask some symptoms but ultimately it will make everything a lot worse.  

Do look at some lifestyle changes first.

Don't just accept what your GP tells you, do your own research, then go back with a clear idea of what you want.  There is an excellent Facebook group called The Menopause Support Network where you can find out more information and ask questions.

A private consultation is not cheap but for me the expense was worth every penny.  As well as the consultations there is the cost of blood tests, scans and the private prescriptions although once you are settled on the right HRT your specialist can ask your GP to take over the prescriptions on the NHS (probably with the exception of testosterone).

I take oestrogen (Oestrogel), progesterone (Utrogestan) (both are body identical and available on the NHS) and testosterone (Androfeme 1) only available on private prescription.

My private consultant is Mr Michael Savvas at the John Studd Clinic.  There is a lot of information on the website about HRT and hormonal conditions in general.

For so long I worried I would be judged for deciding to take HRT and I kept it quiet.  Now I feel like me again, I think it is important to shout about it and share my story with others.  When I look back I realise just how unwell I was.  

I love being happy again!  If you have any questions do email me and I will see if I can help.

Love from
Michelle xx


And if you want to read what Carol Vorderman has to say then have a look here (she also sees Professor John Studd).

IMPORTANT NOTE, Body Identical HRT and Bio Identical HRT are often considered to be the same thing and this is such a grey area and the difference is very subtle.  There is cBHRT (from compounding pharmacies) and rBHRT which is regulated and also referred to as Body Identical HRT, you can read more detailed information on the British Menopause Society website here.  I wrote a second blog post looking at this in more detail and you can find the post here.
I link up with:

Is This Mutton
#WowOnWednesday
perimenopause and hrt
Perimenopause - why I decided to take HRT #perimenopause #menopause #hormones #HRT #midlife
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15 Comments
Irene
26/3/2019 06:52:48 pm

Michelle thank you so much for this post, it definitely needs to be spoken about much more. I took HRT for several years (I am now 65) and I don't think it's an exaggeration to say it gave me my life back!! Love reading your blog and like to visit shops that you recommend in and around Marlow when I visit my daughter who lives in Wargrave. Best wishes Irene xx

Reply
Michelle Green
1/4/2019 02:31:05 pm

Thank you Irene, it is lovely to hear from you and so pleased that you visit this way sometimes! Time with your daughter must be very special. Marlow is a beautiful town. Michelle x

Reply
Jacqui Berry link
27/3/2019 08:24:10 am

Michelle, many thanks for your honest post! We are all different and I see a couple of things that apply to me. I'm lucky to be okay atm, but will be seeing my doctor in the summer for a check up. Thanks for sharing. Do join my #chicandstylish #linkup every Thursday. Jacqui Mummabstylish

Reply
Michelle Green
1/4/2019 02:32:01 pm

Hi Jacqui, oh yes I must get into a better routine with my link-ups and set myself reminders - March has been a crazy busy one! Michelle x

Reply
Jo Harvey
27/3/2019 10:15:48 am

I know you were worried about sharing this very personal experience but by doing so you will help so many people, well done for doing it. You are my go to person for all sorts info like this as you have been for many (many) years and you are right we should be menopausal out & proud, we have earned that right!

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Michelle Green
1/4/2019 02:32:57 pm

Hi Jo and thank you so much darling for all your support and I am so glad I can help a little. Lots of love Michelle xx

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Medespoir link
8/4/2019 02:58:15 pm

many thanks

http://www.medespoir.net/in-vitro-fertilization-tunisia.php

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Pharmsmart link
10/4/2019 07:55:27 am

Nice post!

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claire link
11/4/2019 08:24:48 pm

Hi Michelle, thank you for your honesty on your menopausal journey. I think everyone has got to find their own route through it and it sounds like you have, which is great! I myself am peri-menopausal and have dabbled with bio-identical progesterone from Marion Gluck's clinic, however, my symptoms have not been too bad, mainly bloating, mild hot flushes etc.. I got my GP to do the hormone tests rather then the clinic as it is quite costly. It did help a bit but in the end I came off it and decided to address my diet. I am a nutritional coach and have always eaten low GL foods which I know has helped alot in relieving symptoms, however, my weight started to creep up, mostly on my tummy, so I decided to take it further alternating GL and keto which has really helped me and clients that I have coached, lose the belly fat. Anyway, thank you for sharing your experience, i'm sure many women out there can relate to it. Claire x

Reply
Jane
8/9/2019 11:27:40 am

Hi Michelle, thanks you for writing about this. I am embarking on my HRT journey and have been prescribed estrogel and progesterone tablets, both body identical. However I feel I may have progesterone intolerance as my first dose of progesterone (2x100mg) I felt like I severely drunk and drugged. I went back to my gp and asked if I could try halving the dose but was told that this would not give me sufficient protection. do you know of any information anywhere I can take to my gp to show that it is in fact possible to do this? Thanks again, we need to keep on talking about this.

Reply
Michelle Green
9/9/2019 12:07:32 pm

Hi Jane, how are you feeling? You have certainly been prescribed the best HRT so that is good! And sometimes it might take your body a while to get used to the utrogestan so you could try and stick with it. However, I couldn't! So using the tablets vaginally instead is often better as they then bypass the liver but still give the same protection - it gets complicated with the GP as they are not licensed for use this way! If this doesn't work then reducing the dose is possible but again the GP will be reluctant as it doesn't fit with the NICE guidelines. I read loads about it on the Prof John Studd clinic website. Also there is a brilliant facebook group called The Menopause Support Network - you can find lots of info on there (search utrogestan and look in files). Please do email me if you want to chat some more. Michelle xx

Reply
Lindsey
2/1/2021 11:40:39 am

Hi,
Quick question. regarding the 7 day vaginal 100mg regime. Did Prof Studd say that is OK for post menopausal women?
Would we still expect a bleed?

Reply
Michelle Green
2/1/2021 03:07:27 pm

Hi Lindsey, it is the minimum dosage but is off-licence but can work for those that struggle with progesterone intolerance. He writes about it on his website. It offers some protection for the uterine lining. But you would need to check for your specific situation with either his clinic or another specialist. If you email me I have a couple of recommendations for online consultations that might help you and might be more cost effective and I can explain a bit more if that would help. Michelle xx

Reply
Parveen Betab
10/1/2021 11:53:48 pm

Hi Michelle, thank you so much, I have just come across your website (having just turned 50 a month ago) and have found this article in particular so helpful as I have been considering my options for treatment or what is a very challenging menopause journey.

I thought it useful to mention that on the recommendation of a menopause wellbeing coach, I asked to be referred to a menopause specialist via the NHS. I recently had a telephone appointment and they have prescribed me the same as you mention in your article, oestogen gel and a low dose of progesterone as I think I may be intolerant from experience. I also know that they will be able to prescribe me testosterone (I asked for it) but they won't until I have first settled with the oestrogen and progesterone. The hospital I was referred to was Chelsea and Westminster and they were very good, there are other specialist centres around London for those that live in the area. I'm hoping to start on the tablets this week, fingers crossed that I will be able to tolerate it and it improves my symptoms, I'm a psychotherapist working with trauma and mainly women who experience domestic and sexual violence so need to be at my best energetically and emotionally.

It's really good to know that the treatment is working well for you.

All the best on your onward journey!

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Michelle Green
11/1/2021 11:55:58 am

Hi, I am so pleased you had a successful referral and good advice. A menopause coach can be a fabulous idea and such a support. Yes I do hope the progresterone works out for you (the oestrogen gel should be fine) - and it works for many so no reason not to expect otherwise. There are different dose options before giving up completely though and I am sure the hospital will advise. But yes get the oestrogen established then you will be able to assess if you need testosterone. Always encouraging to know someone found my post, found it useful and have managed to navigate their own journey and get the help needed! Love Michelle xx

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    Michelle ...

    ​Welcome to Fifty & Fab, a lifestyle blog to inspire you. I am a blogger with a passion for writing about style, beauty, health and fitness with a focus on the over 50's. I am based in Marlow but work across London and the South East.

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     Hi, I’m Michelle and my blog Fifty & Fab is all about my journey into and through my fifties.  I share style tips, health and fitness inspiration, I talk about my holidays and days out and I tell you about my beauty regime and my lifestyle.  I hope you might pick up a tip or two and get some inspiration!

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