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[Fifi key]

I'm 57 yrs old have had 1 ovary removed due to cyst . Went to see GP about going on HRT . Have been had hot flushes etc for few years . Not as bad now but fed up of them also my hair going very thin very noticeably in last 6 months , brain fog. Anyway GP told me to think what HRT I'd want & go back to tell her . Not really sure where to start . Can someone help me ?

[Dotty]

Hi Oestrogel and Utrogestan is a good choice. It's worked wonders for me.

[Dancinggirl]

Look under TREATMENTS on this site to see your options. You should probably start on a sequential HRT.
The Oestrogel with Utrogestan is getting popular but not many GPs know about this combination ( you might need to see a specialist to get this prescribed) and it's often not on their list of HRT regimes that their health authority allow.
Femoston 1/10 is a good one to try as it suits many women very well.
Go to GP appointment with the peri menopause HRT options printed out so you can show them what you want to try.
DG x

[Cassie]

Definitely the oestrogel and the utrogestan its a wonderful combo.

[Dancinggirl]

Cassie and Dotty
Though Utrogestan suits you it doesn't suit everyone - I found it the most problematic than any other progesterone. It's also not always available through the GP so, whilst you find it great, it may not be the best thing to recommend to a newbie as they could be asking for something that may not be an option for them at their GP practise and for some dealing with the gel and seperate progesterone can be confusing and and inconvenient.
Many women do extremely well with the HRT pills so they are often a good starting point - after all they now have bioidentical oestrogen anyway.
Good luck Fifi - do let us know what you decide and keep us posted on your progress. DG x

[Mary G]

I agree that Oestrogel and Utrogestan are a good combination the most dose flexible option available and this is what I used until I swapped the Oestrogel for Lenzetto recently but that's another story!

What you choose depends on various factors i.e. how well do you tolerate progesterone - do you have a history of PMS, did you get on well with the pill, have you ever had a Mirena coil and if so, were you OK with it?  Also, you need to decide if you can put up with having periods again?

To a large extent, you won't know until you have tried the various options.  You may or may not have a preference for transdermal forms of HRT as opposed to oral forms.  If you decide to go for transdermal HRT then I would definitely go for Oestrogel.  If you decide you want oral HRT then Femoston seems to be popular and you can either opt for a cyclical regime meaning periods again or a bleed free continuous combined version.

One other point, women vary as to how much oestrogen they need to function normally and rid themselves of menopause symptoms.  If you are 57 and haven't been using HRT then you might find that you don't need as much oestrogen as someone like me who needs a high dose to keep the migraines away.

I hope that helps.

[Cassie]

DG, Fifi key asked for recommendations that is what we are giving her! Surely tried & tested is the way to go?
Personally, I tried several other forms of HRT before settling on this combo 12 yrs ago and yes whilst Utrogestan may not suit everyone it is a bio identical hormone & one of the safest options for progesterone replacement. Any of the other synthetic progestegins are also capable of causing issues be they minor or major & it really is a matter of trial & error. I could not tolerate the 200mg Utrogestan, yet the 100mg used for 12 days per month, works very well for me, the proof being in my most recent scan!
Oestrogel is also a wonderful form of HRT and according to my specialist whom I saw a week ago and had a very lengthy discussion about HRT with,  is one of the best combinations of HRT around in fact when he asked me what I was currently  using and I told him, he reached across his desk shook my hand and said thankyou & well done!
Nothing wrong with trying the combo, in my opinion, it is way the better option than drinking a tablet which has to bypass the liver I firmly believe that transdermal hrt as well as vitamins and other meds are the way to go and definitely will become very significant in the yrs to come for all the good reasons. Good luck and let us know how you get on.

[Dotty]

Dancing Girl - Fifi asked for recommendations and I have told her what I would recommend. I'm a newbie to HRT and don't find Oestrogel and Utrogestan hard to use at all.

[Hurdity]

Hi Fifi Key

 

As the others have suggested it is partly down to preference although I would always go for the bio-identical (body-identical ie estradiol and progesterone) and I've always been a nil-by-mouth gal when it comes to HRT so transdermal all the way for me (I "take" the progesterone vaginally). In contrast with the others I'm a patch girl myself - didn't get on with gel and love my small Estradot patches which are applied twice quickly, whereas gel is applied daily and you need to wait for it to dry in the morning. As Dancinggirl says - if you want to take pills and have no risk factors (notably being overweight, smoker, high BP, cholesterol etc) then Femoston would be the one to go for as closest to our own hormones - although it has to go through the liver.

Let us know what you decide.

Hurdity x

[Fifi key]

Thanks everyone.my apptwith GP Is tomorrow evening. I'll keep you posted . I had no idea that not only are there choices of hrt but also delivery - pills patches etc . Have I understood that hormones through pills go through the liver but not if patches & gels  ? What is the problem if hrt goes through the liver ? Sounds like something bio identical would be good ?  I def don't want
periods again . Thanks again everyone. You've given me a lot to think about x

[Dancinggirl]

If you look under TREATMENTS you will see your options. Print this off to show the GP as this helps with discussion.
HRT pills are not a problem for most women ( yes they are processed by the liver as is anything that is taken orally) but transdermal does suit many women very well, as discussed by many others. Nearly all HRTs , whether pills, patch or gel, have bio identical oestrogen these days. It's the progesterone part of any HRT that can be problematic for some women. Utrogestan is the only bio identical progesterone available and it is growing progressively popular, however, as I mentioned before, there have been reports by women on this forum, telling us that they have been unable to get this through their GP as it is not on the list of available HRT treatments at their health authority. That is not to say you couldn't get it from your GP - you will need to discuss this with them as it seems to be a post code lottery.  By printing out the information from this site you can illustrated what you would prefer.
I suggested the Femoston 1:10 as it has the gentlest progesterone of the synthetic progesterone types and whilst patches, pills and gel are good, particularly as we get older, you may find your GP is only familiar with the standard combined HRT pills and patches in the drugs book.
Even though you may be post menopause, it can be good to start with a sequential  HRt (which brings a monthly bleed) as this gives you the opportunity to see if the progesterone suits you or not - if over the first 3 months you find you feel Ok with that particular progesterone then you can then switch to a continuous HRT regime.
It does seem a lot to take on board at first but it's good to get clued up so you can go forward feeling positive about your choices. 
I used HRT for 25 years due to premature menopause and my best HRT regime was having a Mirena fitted and using Oestrogel daily applied to inner thighs. Sadly Utrogestan gave me erratic bleeding and made me feel sedated but, as others have said, it can work well for some.
Let us know how you get in. DG x

[dangermouse]

I think you'll find anything absorbed by the blood still gets processed by the liver (hopefully!) but oral will go through twice as part of the digestion process too.

Sublingual and vaginal is fastest as it's absorbed straight through the mucous membranes, then transdermal though the skin and fat cells and then oral will take the longest, although transdermal can sometimes take the longest if used in more fat dense areas.

[Hurdity]

Fifi key

You will find more summary information about tablet vs transdermal oestrogen here:
https://www.menopausematters.co.uk/route.php

In particular this:

The different routes of estrogen used have different metabolic effects (e.g. on clotting factors and blood fats) but the implications of the differences is controversial and the main factors determining choice of route are individual preference, response and past medical history. Most often, HRT is started in tablet form.

Indications for non-tablet route.

    Individual preference.
    Poor symptom control with tablet HRT.
    Side effects such as nausea with tablet.
    Bowel disorder which may affect absorption of tablet therapy.
    History of migraine (when steadier hormone levels which may be achieved with a patch may be beneficial).
    Lactose sensitivity (all tablet preparations of HRT contain lactose).
    History of gallstones.
    Current use of medications such as anti-epileptic medication which may interfere with the break-down of tablet HRT.
    Variable blood pressure.
    High triglyceride levels.
    Risk factors including Body Mass Index greater than 30, family history or past history of deep vein thrombosis or pulmonary embolus, after full discussion and specialist advice when necessary.

As you can see and as I mentioned if you have high BMI etc you are at greater risk of cardio-vascular disease. Also older women are at greater risk of stroke anyway so anything that might increase this risk such as smoking apparently would make it less advisable to take oral HRT. The medical conditions and HRT are given here: https://www.menopausematters.co.uk/atoz.php and you will see the medical circumstances under which transdermal routes are preferred over oral HRT. These factors do become more important as you get older.

Re going through the liver - there are more metabolic by-products from processing oestrogen taken orally than transdermally and these are what can cause issues. It's called first pass metabolism ie has to go through the liver before it gets into the bloodstream. Transdermal oestrogen gets directly into the bloodstream so can be used directly before going anywhere else - although it's removal is eventually processed by the liver.

Also more info here - scroll down to delivery route: https://patient.info/doctor/hormone-replacement-therapy-including-benefits-and-risks.

I am just pointing this out because of your age and for you to conisder with your doc whether you have any additional risk factors, and also if you are intending to stay on HRT for some while - maybe start with the delivery method that is safer long term?

Utrogestan is lived by some, tolerated by others as a necessary evil, and hated by others either because of side effects or because of bleeding control (usually due to taking orally and oestrogen dose being higher). I use it cyclically - as I said in my last below - also vaginally, and maintain a cycle with a withdrawal bleed every 6-8 weeks ( to minimise duration of sdie effects). I have always had good control of bleeding and have a short withdrawal bleed at the expected time (despite being mid 60's!

Hope this helps

Hurdity x