Is HRT Right For my Perimenopause Symptoms?

It’s been a long road to try and get help and support for my perimenopause symptoms. Treatment for them has taken a long time to get right; and I’m not necessarily 100% sorted right now, but things are getting better.

Perimenopause is the period of time before the Menopause. It can last 5-10 years, when oestrogen levels decline before periods stop altogether. Once you’ve had no periods for a year, that’s your menopause. Following this, you’re post-menopausal.

If you’re not sure if you are suffering from perimenopause symptoms take a look at my first post on what we should all know about the perimenopause.

Many women in their forties start experiencing a whole host of different symptoms and get worried about what might be causing them.

The first signs of perimenopause tend to vary for different women, but they are things like insomnia, aching joints, brain fog, anxiety, depression, hot flushes, itchy skin, tiredness, dizziness, irregular periods and so on. There are over 50 symptoms which you can check out HERE.

I began experiencing perimenopause symptoms around the age of 46; I’m 50 now. I only realised what was happening 18 months ago, I had no clue that perimenopause existed and could cause so much disruption to my life. I think, like many women, I believed I would hit menopause around 55, get some hot flushes and my periods would stop. I didn’t know that 7-10 years before that I would experience such debilitating symptoms.

The main symptoms which caused me to get help was anxiety and depression. I literally could not get out of bed during some weeks of my cycle. I was anxious about all kinds of things which was affecting family life and my work. It was seriously getting out of control.

Then my memory went. My brain fogged up, I couldn’t think clearly, couldn’t remember names, events, places. It was like my head was full of treacle and there was no way to wade through it. It was petrifying.

My periods actually become much more regular, lighter and closer together. I got digestive issues, became very tired, had patches of itchy skin and developed pain in my wrists – attributed to RSI.

All of this happened over a period of a couple of years. There were other things too like waking up at 4am every night. All types of problems I’d never experienced before.

But the anxiety and low mood really needed some attention. So I visited a GP.

Perimenopause Support from GPs

This was my first mistake. I went in assuming he would have all the answers and know much more than me about what was going on. He didn’t. In fact, he said he was the wrong gender to help me.

Even though I felt very depressed and was crying in his office, he sent me away to have blood tests at a later date, after just 5 minutes of speaking to me. He seemed embarrassed and uncomfortable and couldn’t wait to get rid of me.

I never had those blood tests. The NICE guidelines say blood tests aren’t required over the age of 45 to diagnose perimenopause; it should be done by symptoms.

I changed GP surgeries and found one who could help me.

I had started researching HRT, the different types of HRT, the HRT benefits, and the pros and cons of taking HRT. I felt I had a little information but was still looking to the medical profession to inform me better.

The second GP was lovely and sympathetic. We talked about the Menopause Matters website, she gave me some ideas and options but wanted me to take anti depressants to help my mood. I wasn’t depressed as such, just couldn’t life my dark mood.

I did take them, in the absence of anything else. I now wish I’d been better prepared to fight for HRT instead.

NOTE: Anti depressants should not be prescribed in place of HRT according to NICE guidelines.

After 2 or 3 appointments of discussing HRT she wanted to test my bloods – I still hadn’t been given HRT even though I was keen to try it. The ADs were helping my mood slightly but nothing else. Still she was reluctant to prescribe HRT but without giving me any real reason. She clearly didn’t know how to prescribe and manage it.

Eventually she wrote to our local Menopause Clinic at the hospital who asked to see me. The appointment given was for 3 months time.

So it had taken almost 6 months to see someone who may be able to help. I didn’t feel there was anything special about my situation, I was just struggling with perimenopause symptoms as many women of my age do.

The Menopause Specialist

There are around 29 Menopause clinics in the UK who specialise in treating women with menopause issues.

It’s worth noting that GPs get very little training in menopause, fail to recognise the symptoms and are incredibly reluctant or ill-informed about HRT. They will very often prescribe anti-depressants instead. But we are not clinically depressed.

Within 5 minutes of seeing the specialist she told me I was clearly perimenopausal and how did I want her to help me. I asked for HRT, she said great and sorted out a treatment plan.

There are many different types of HRT including tablets, gels and patches. Implants can be available privately but not so much now. There are side effects and they vary from woman to woman but they usually disappear after a few months, and there are some risks.

Let’s just chat about the risks right now.

The Risks of HRT

HRT Tablets give you a higher risk of blood clots but this falls to zero with transdermal gels and patches. The breast cancer risk has been widely reported and, often, taken out of context or based on old information and research.

You have a higher risk of breast cancer from being overweight, drinking or not exercising.

For every 1000 women, 23 get breast cancer.

For those taking a combined HRT another 4 will get it. The same numbers if you take the combined pill.

For those who are overweight, another 24 will get it. And drinking 2 units of alcohol per day gives you another 5 in every 1000.

This chart from Dr Louise Newson puts it into perspective.

Which Type of HRT did I choose?

After a little discussion the Menopause Specialist recommended a Mirena coil to protect my uterus (if you have a womb you need progesterone like the coil so the oestrogen you take doesn’t build up the lining).

Then I chose an Oestrogen patch as I felt there would be few side effects and it was easy to manage.

The GP had to fit the coil though, and unfortunately, persuaded me out of it, giving me a sequential patch instead. This meant I was receiving my progesterone via the patch as well as the oestrogen. It’s a common prescription and one that suits many women.

However, the progesterone patch made me very ill. You apply it for 2 weeks of the month, and when you finish you will probably bleed. Not everyone does. I am particularly sensitive to progesterone. I stopped using it after a few months.

A few months later I did persuade the GP to fit the coil.

After a month I started on an oestrogen patch again. It did little for me and I stopped after 2 months. It felt like I really hadn’t found the right kind of treatment.

So 4 months later I was back to see the Specialist, with a coil but no oestrogen. She wasn’t impressed! And together we decided I should try the gel. Perhaps that would suit me better.

We all respond differently to the variety of HRT treatments and what suits one woman won’t work for another. It took time to find what was right for me.

For 3 months I applied the gel – the beauty of this is you can increase or decrease the doses. It’s sensible to give each dose a good period of time to work. I was on 4 pumps of gel within a few months and felt a lot better.

However some symptoms didn’t improve. Brain fog, energy and libido were still issues and oestrogen was not tackling them. I didn’t feel right at all and wanted a more in-depth analysis of what was happening to my body.

I’d started increasing my gel to 5 pumps to see if that helped and booked a private appointment with Hormone Health – a clinic endorsed by Dr Nick Panay, one of the leading voices on the Menopause in the UK.

Personal HRT Prescribing

Whilst my decision to visit a private specialist may be controversial, I didn’t make the decision lightly. I was getting help from the NHS via the Menopause Clinic, but appointments were short of course, and about 6 months apart.

When treatment ideas didn’t work, I would be aware of this within a month yet had to wait another 4 or 5 to see the specialist to find out what to do next. It was very difficult and my quality of life was suffering.

I needed a more personalised approach – I needed to spend time explaining my history and having someone analyse that in detail.

That’s exactly what I got in my private appointment. An hour of discussion, ideas and how we could proceed to get me feeling good again.

I had a set of hormone bloods taken, particularly to assess my Testosterone levels. Testosterone treatment can be helpful for women who are struggling with menopausal brain fog, low mood and energy, plus a low libido.

Results showed my levels were low, but quite surprisingly, my oestrogen levels were incredibly high. I was overdosing and causing some unpleasant symptoms similar to actual perimenopause symptoms themselves.

So, after 2 appointments with the private specialist, 2 sets of bloods (my oestrogen levels came down) and a private prescription I now feel like I’m on a good regime.

Currently I take 3 pumps of Oestrogel daily and 1 pump of Tostran every other day. I have a Mirena coil too.

The Tostran (testosterone) was a game changer and really gave me my life back. It’s only been a month on it as I write this but I feel like the old me. My brain fog has gone and I have energy again. I feel dynamic, full of life and vibrant – life is no longer the slog I felt it was. I realise I had felt like that for a few years.

It’s not all fixed, I still have some joint pain but it’s 100 times better than it all was.

How Long After Starting HRT do You Feel A Difference?

I get asked this a lot and I think it’s varies for different women. It took me a few months to get decent benefits from it, but now adding an extra pump for a week on a daily basis will alleviate any extra PMT symptoms I may get.

I believe, for both Oestrogen and Testosterone you need to see how you feel after at least 3 months, maybe 6.

If I can help anyone on their perimenopause journey by sharing my story, I’ll be so happy. I am incensed that we have to struggle with this, that we can’t find the right information, that our GPs aren’t always well versed in recognising symptoms and that they aren’t properly informed around prescribing HRT.

This has to improve. We deserve so much more. Why are we in this situation where women have to suffer so much?

Historically women haven’t discussed how they feel at this time in their life. Menopause is seen as a topic worthy of ridicule, of shame, of embarrassment. Many women are told to just get on with it, to suck it up, fight it with yoga and supplements or eat a plant based diet.

Whilst many of these things can help us feel better, they won’t replace the lost oestrogen or protect your body from osteoperosis, heart disease and dementia. HRT can do this and can give you back your life.

If you’re reading this and resonate with some of the symptoms, my journey or want to find out more about HRT treatments, let me give you some places to do extra research.

I highly recommend the following:

I do hope this is useful, and well done if you’ve made it to the end.

Leave me a comment below if you have any questions.

Jen x

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