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[Oon]

Hi there,

I've been on combined HRT (Prempack) for the last 5 years. I'm 53 now and would like to change to something that doesnt give me a monthly bleed. My GP is reluctant (not very HRT friendly ) Is he right to be cautious? He'd like me to come off HRT altogether but I'm reluctant. Any thoughts?

[Taz2]

Hi Oon.

Some GP's like you to come off HRT after five years - especially if you began taking it before the age of 50 - just to see where you are and how many symptoms you have. Some women find that their main symptoms such as hot flushes, mood swings don't return. If you find that you still need HRT then you should be allowed to restart it. It can be good to find out how you feel without HRT but you do need that reassurance that you would be prescribed it again should you feel you need it.

The guidelines used to be that conti hrt could be used after the age of 54 - this was when I was allowed to swap - so this could be why the GP is reluctant.

As Stellajane says the transdermal route is good. Have a good read of all of the info on this site before tackling the GP again.

Taz x 

[Mary G]

Oon, no, your doctor is not right to try and get you off HRT.  What reason has he given for being anti-HRT?  Assuming you don't have a serious underlying health reason for not taking HRT, he can't just try to steer you away from it because he feels like it.  He is obviously very misguided on this issue and not up to date with the current thinking and new NICE guidelines. You are only 53 and if you stop taking HRT now, you will be oestrogen deficient for many years which could lead of all sorts of health issues in later life.  Also, I don't know if you had any menopause symptoms before you starting taking HRT but if you did, there is every chance they will return when you stop.

I can understand why you don't want periods and like Stellajane, would recommend bio identical Oestrogel and Utrogestan which can be used on a continuous combined basis if you use the Utrogestan everyday.  There are also plenty of other continuous combined products to choose from but one thing to bear in mind is that all continuous combined HRT regimes mean taking progesterone everyday as well as oestrogen and this can (a) lessen the positive 'feel good' effects of the oestrogen and (b) cause more side effects particularly if you are sensitive or intolerant to progesterone.  If you have always got on well with the progesterone part of cyclical HRT then this might not be an issue for you but it is something to bear in mind.   

[Hurdity]

Hi Oon

  from me too!

I agree with everything the others have said!

Here is some info on balancing the risks and benefits of HRT:
http://www.menopausematters.co.uk/balance.php

Hurdity x

[Oon]

Thanks all, that's really helpful advice and much appreciated. And thanks for the warm welcome too.

My GP, who is in his mid 30's, thinks I shouldn't be on it for more than 5 years but it is clear he doesn't know much about the subject. In an effort to be helpful he said 'I wouldn't want my mother on it for that length of time'  Cough splutter - I nearly fell off the chair, I mean I know I'm in my 50's but really?!?! That's given me quite a few laughs ever since.

I started HRT because i was finding mood swings and some other associated side effects pretty vile. What a relief it was to go on to HRT - I felt I was me again almost immediately and I'm not very keen to give that up.  I haven't ever thought about a patch, but it sounds like a good idea (I can forget the occasional tablet...) As for my tolerance to progesterone, I think it might be a bit dodgy (bladder problems and a bit moody during that part of the cycle.) I'll have a read of the info on this web site, at this point I'm wondering why not oestrogen only...

Thanks again for your comments.

Oon

[Mary G]

Oon, that made me laugh too, it's a bit like a referee not understanding the offside rule, mind you.....

Seriously though, if he doesn't understand HRT he's not in a position to advise you on it is he?

You clearly need HRT so take it.  If you do decide to go the gel/patch route you will need to take Utrogestan for a few days every month to bring on a period.  Come back when you have decided and we can give you some more advice. 

[Oon]

Thanks Mary G. Offside... oh yes.

I've had a good browse - what a great site this is.

I'm definitely not planning to come off HRT and my current thinking is to go with a gel. I like the variability/ self regulation that I anticipate comes with that, but am a bit confused about how it works in practice. Am I right in thinking that i'd use an Oestrogel every day then Utrogestan pessaries for 12 days a month? That sounds like a bit of a fankle and seems to mean that there is no end to the monthly bleed.... What would you recommend as a no bleed option? I might try that first and see how I get on. 

[Mary G]

Oon, yes, that is the downside of that regime, you still have periods unless you take the Utrogestan everyday.  There is a patch some some women use that is continuous combined and the progesterone in that patch is well tolerated - I think it's called Femseven.  Other combi patches have norethisterone which is difficult to tolerate. 

One other thought, you could try for a long cycle and take just one pump of gel everyday (that's a lowish dose) and then just take the Utrogestan every other month which might make it more bearable.  I use Utrogestan vaginally because it works better and has fewer side effects. 

[Oon]

Great. Thanks so much for sharing your knowledge, it's so helpful. I'll think a bit more and return to my gp armed with a clear request.

[Oon]

Right, that's me off to my GP tomorrow and I'll ask for bio identical Oestrogel and Utrogetan.... Fingers crossed!