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[CLKD]

Do U need The Pill?  If so don't stop!

It would be best to give HRT at least 6 months B4 thinking about adding testosterone for which you will need to consultant a menopause specialist.

[Kai_63]

Ah OK thank you. I need some form of contraception and am willing to use condoms or explore some of the other options suggested previously that are more suitable for my stage. Whatever happens I’ll be protected!

I’m just not sure the extra progesterone from the mini pill is the right option right now and would be keen to see if my anxiety settles if I am just on Utrogestan.

[joziel]

There are different thoughts about when to start testosterone. I'm with Newson and they started me immediately on it, at the same time as estrogen and progesterone. I didn't have to do a test before either, just after 3 months on it.

Other thoughts are that the woman should be 'sufficiently estrogenised' before starting testosterone although then there is great debate about exactly what 'sufficiently estrogenised' means.

Frankly it's one of those things that everyone has different thoughts on, so if you want to give it a go I don't think you need to wait - is my opinion!

[Hurdity]

Thank you so much, this is really helpful.

I’m about to turn 46, the blood test was done when I was around 43.

The symptoms initially VA (and associated things such as thrush, UTIs etc) and the hot flushes but they calmed down with the contraceptive pill. More recently, and the reason I wanted to see a specialist, was that the VA was only marginally better, I’ve lost drive, motivation and confidence, have low mood, skin issues, brain fog, migraines, anxiety on and off! Some of this might of course be HRT side effects.

The person I saw is a GP but she describes herself on the clinic (one of the well known private ones) website as a menopause specialist.

I’m not keen on mirena coil but was concerned about coming off contraception when I’m this young. I’m waiting for the follow up letter which might have more details on the rationale she had for contraception.

There was a lot of information during the session so I want to make sure I understood it all correctly and can relay it here.

Hi again Kai - the symptoms you describe may well be due to taking too much progestogen ie progesterone and the mini pill - especially low mood, brain fog, migraines, anxiety and not necessarily to do with insufficient oestrogen. In addition have you had other tests to rule out thyroid problems etc? Is your diet good re minerals and vitamins, fresh foods etc?

At your age taking a synthetic hormone is less of a worry if it is working for you.

Re sex drive - continuous progestogen may not help with that and also the pills I suggested (Qlaira and Zoely) being oral, can contribute to the reduction in free testosterone - which has been linked to sex drive (through another compound called SHBG) although recently this appears to be questioned - but I haven't seen the research. Personally I would get the standard HRT sorted first before considering testosterone - and see if you can eliminate some of those other symptoms if possible.

Nothing wrong with taking sequential HRT even if post-menopause and you are still very young when many women would still be having natural periods. I still take sequential HRT and I'm 70. Just need to be vigilant re risks, of course.

Joziel - sufficierntl oestrogenised. I agree it is vague but What we don't want to do is become more T dominant  than seems to occur at and post-menopause anyway - becase oestrogen drops faster than Testosterone.

Kai - you may well find your symptoms improve once you are off the mini pill but to emphasise if you need contraception - and it would be wise to continue with this I would say because you don't know what your natural periods are doing at all (but obviously listen to your specialist), then either one of those other pills I suggested would be better, or the Mirena coil.

Hope this helps

All the best
Hurdity x

[Kai_63]

Thank you so much. So interesting about the progesterone contributing to certain symptoms.

I have had an underactive thyroid for 15 years so get tested regularly. I was a little over medicated on my last test so they have decreased my Levothyroxine and I’m feeling better. Otherwise am generally fine with thyroid and I eat reasonably well and try to do some exercise.

I actually spoke to a Peppy app specialist today and she was really good, seems to chime with a lot of the suggestions here.

She suggested coming off pill to see what happens with my bleeds (staying sequential on Utro) but she said that because I am getting a bleed with two sources of progesterone already it’s likely I’ll continue to get one even if I come off the pill due to levels of progesterone. She said I should look at alt contraception in meantime of course.

She also said to not change too much at once and wait and see before deciding whether I actually need testosterone, as you suggest Hurdity.

I understand there’s also a potential link between thyroid and testosterone levels though, so will look into that in a few months if other changes haven’t worked.

I think I’ll stay sequential Utro, up oestrogel to 3 for now and come off the current pill to see what happens.

Just to reassure everyone I will always use contraception of some kind!