HRT UPDATE SIX MONTHS IN
In all honesty, I hadn’t planned to leave it a full six months to bring you an update on how I was getting on with HRT but, all things considered it’s no surprise. A couple of issues that I feel are relevant to the journey so far have also transpired in the last month so I hope this roundup provides an informative update should you be considering the HRT route during perimenopause.
So… where to start? At the risk of stating the obvious, this has been written based on my own personal experience and I’m not a medical professional… nor do I think I know all there is to know about perimenopause. I’m still learning and finding my way through it and I would advise that you have an in depth chat (when you’re safely able to) to your GP or consultant in the first instance if you’re thinking about trying HRT.
After writing here about the long thought out decision to give it a go, I started taking it on 1 November 2019. On my GP’s advice I went for a low dose starter option and the cyclical method of a topical daily application of Oestrogen gel and a daily 100mg Progesterone tablet to be taken at night. I was instructed to apply one pump of gel to either each thigh or shoulder and take the tablet from day 1 - 25 of my cycle. This is followed by a three day break and then you start over.
I felt positive and excited to be starting the medication but was also mindful not to expect miracles too soon. The general consensus is that you may feel the benefits anytime from three weeks to three months so I went in with an open mind and low expectations. In theory you’re supposed to start taking the medication at the beginning of a new cycle but as sod’s law would have it, despite having a fairly regular bleed prior to this, nothing then showed up at all for weeks. After waiting impatiently, I made a quick phone call to my GP and we just decided that I could begin on 1st November anyway.
Within a month, the achy joints had stopped and I only realised this as I was getting up out of my chair one day. I was able to feed this back when I went in for a blood pressure check after month one but to be honest, this was probably the only tangible benefit I felt at that point. The blood pressure reading came back fine too so I carried on.
By the time I had my three month check up at the beginning of February I was able to report more benefits including:
General mood improvements all round. I no longer felt that recurring sense of “hopelessness” or “what is the point?” that had been plaguing me for so long. My mood wasn’t swinging from high to low so much either and I felt more able to deal with the daily challenges that accompany midlife..
By the time I got to month three, the breast tenderness had gone which was such a relief. I would say it took until that point to completely go and prior to that, it would pop up now and again with the oestrogen surges at various points.
I had more energy! So much so that pre lockdown, I’d started using the Couch to 5K App for running at the beach in the mornings and the sense of achievement and feel-good factor that came with this was phenomenal. I hadn’t felt so positive in quite a few years.
I also felt way less tearful and there were no incidences of that awful brain fog that I can recall… unless that in itself is brain fog!
A lot of the anxieties that had previously cropped up had seemed to slowly melt away. I recall thinking that it’s quite hard to gauge this accurately as I feel that if you keep “testing the water” you’re not entirely sure of the response that gets pinged back to self. But I remember sitting down with a friend over breakfast in early March and saying that I felt so much better.
The phrase “Spoke too soon” came back to bite me as the scale of the global pandemic began to hit home about a week later. The anxiety that followed knocked me for six. One episode lasted for about three weeks as we approached and went into lockdown and there was another significant occurrence during the last week of April.
To be honest, I don’t think any amount of HRT would have stopped either bout of anxiety and the physical symptoms that accompanied them. And I fully recognise that under the circumstances, it’s perfectly normal to feel this way… along with, I imagine, a good proportion of the rest of the world.
By the time I got to the end of April, I realised that I was having two lots of four or five day bleeds instead of one and the hideous breast pain had crept back. On the dose that I’d been prescribed, a bleed should ideally happen in the three day break after taking the progesterone tablet for 25 days, although for me, whilst it wasn’t a problem, that never really synced up. Once I realised I was having two bleeds and overall, not feeling so positive, it made me think it was no longer working.
Having arranged a lockdown telephone consultation with another female GP in the sugery, we chatted about swapping to the alternate dosing method. The gel continues daily but you take two 100mg progesterone tablets for days 15 - 26 of your cycle instead. This GP informed me that if you’re still perimenopausal and having even occasional bleeds, this is the recommended way to take the progesterone. This article by Dr Louise Newson backs that up so it seems I perhaps should have been taking it this way from the get go.
As we were talking during the phone consult, I realised that I’d also begun my annual hayfever medication on 1st April, taking a Fexofenodine tablet at night along with the progesterone. Just in case, I asked her if that could be having an adverse effect on the HRT. Upon looking this up she confirmed that yes, it can mess with your menstrual cycle.
April going completely out of kilter possibly made a bit more sense now. I also wonder if it was messing with my hormones and could that have exacerbated the intense week of anxiety I experienced at the end of April? A Google search relating to some hayfever meds and HRT being incompatible didn’t shed any light on it so I’m guessing my GP found the info on a medical reference site for practitioners. If you’re taking both and worried about the mix, I would strongly suggest talking to your GP/consultant about it in order to clarify.
So for now it's a case of taking the hayfever tablet at lunchtime and giving the two week dosing a try for three months to see how I get on. The GP also mentioned that if there isn’t much of an improvement, I could try taking the progesterone vaginally as it bypasses the digestive system completely and therefore the hayfever meds shouldn’t affect its absorption. Apologies if that's TMI but I figured that most people reading this will have a vagina so…
A Few Takeaways If You’re Thinking Of Trying HRT
Write down everything once you get started. I made notes from day one of beginning the medication - points such as when I had a bleed and for how long, when and if there were occurrences of breast tenderness and anything else that was relevant. That way, when it comes to any reviews with your GP or consultant, you have a full picture of how your body is responding. Also, setting calendar alerts for when you need to start a new cycle of medication is helpful.
Don’t expect the first combination/dosage/method of HRT to necessarily be the one that works for you straight away. I imagine it's reasonable to say it might take a year to eighteen months to get it right… with or without the anxiety and restricted access to your GP brought about by a global pandemic.
The oestrogen gel can be applied to shoulders or thighs but you need to allow five minutes before dressing so it dries in. You can take it at night with the progesterone pill or according to my GP, it doesn't matter if you choose to apply it in the morning. You also need to not allow anyone else i.e. your partner, to come into contact with the area where it's been applied for up to an hour otherwise it can be transferred to them. Something to consider should it bring back your libido that's been missing for months!
All the critical info you need is contained in the instruction leaflets for both lots of medication… which I’ve heard referred to as the Instruction Leaflets Of Doom. And with good reason - the info contained within makes for a scary read and can make you think twice about whether you’ve made the right decision when you read through it. Obviously, as with any medication, the risks need to be clearly laid out but to help maintain a balanced viewpoint, have a read through the articles on Dr Newson’ s site and also listen to the podcast interviews she recorded with Liz Earle too.
Looking Forward
I’ll keep monitoring how the new dose goes and see if I need to make any further adjustments.
In terms of the couch to 5K running, I’m aiming to try and get my groove back now that restrictions have been eased a little and I’m hoping that I won’t be rendered quite so immobile by anxiety as I was a few weeks ago. Fitness at this time of life feels more important than ever and whilst I have no bullshit beach-body requirements or the desire to run a marathon, I do want to give myself the best shot at a healthy midlife.
Finally I wanted to say a heartfelt thank you so much for the phenomenal response on my last post about this - I was blown away by how many similar stories were shared.
If you have anything to share here regarding your own experiences of taking HRT, please do so in the comments below and keep the conversation going.
