Perimenopause | Why I decided to take HRT

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 ...

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).

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.  If you have stopped having periods then you might not need the progesterone. 

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 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 for vaginal suppositories as these are more local and 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.  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 bioidentical hormones and progesterone.  If you go to a private bioidentical clinic then you might 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.  For a full and clear understanding of the different approaches to HRT please see this leaflet issued by the Chelsea and Westminster Hospital - hopefully it can explain much more clearly what is best!

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.

You can read more about how bioidentical hormones differ from conventional HRT on this link here.

​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.

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 (Estrogel), 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.

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