Very well explained. It's so refreshing to find a few British doctors prepared to actually do the work needed to help women at this devastating time. My own GP just told me menopause was the elephant in the room but when I asked for bioidentical HRT (by which I meant the gel and Utrogestan) he said he'd never heard of that and offered me a standard pill. I didn't want that so I've paid a lot of money to go to a private specialist. I resent that. I should get this help on the NHS. But no, I keep paying. The private specialist hasn't got it right yet either. I'm about to go back and say I want to try the gel and tablet.
HI Sue. Thank you for your kind words. Im sorry to hear that. I would go back to your GP, with a copy of the NICE guidance and ask him to look up oestrogel and utrogestan for HRT in his copy of the BNF. Good luck. R
Thank you doctor, my sister is 42 & pre/peri-menopausal, I know she's been feeling upset with menopause symptoms, I'm going to send her this RUclips video link. 👍
Thank you, I've been on HRT patches for a couple of years now ( began being in pre-menopause for around seven years, so early forties ( that is when I stopped having my monthly bleed ) as I'm now almost fifty. Yes I do have extra problems like you stated which certainly do not help my various and other serious and deteriorating health problems, thus am in a wheelchair a lot. I really abhor the side affects, especially the hot flushes - hot then shivering in bed or when I'm downstairs etc. Even worse headaches ( I already suffer both ocular and very painful migraines and cluster headaches ) Am having to keep an eye on my legs for DVT and even though my Doctor has prescribed patches ( I was on tablets ) she is worried about my bones and other things due to as I already said, my other health problems - so she may take me off them due to risks. Thank you so much again for the reassurance.
Brilliant. Thank you so much for all your help. My GP sadly had little to no idea about menopause or treatments and I would have been lost without your advice. It gave me the information I needed to fight for what I want. I can't thank you enough for all the responses you have given and thank you also for always replying so quickly. Best wishes, Debra
Debra Cannon Ah that makes me sad. But if I can help one person in each topic then this is worth it! Thank you for your support and spread the word; the more subscribers the more word spreads! Enjoy your new HRT life! X
Hi Dr Renee, my GP will not prescribe testogel and has said that seeing as Femoston oral tablets are controlling the hot flushes he will not change me to gel. I've told him that even though the flushes are controlled I've still got incredible fatigue, no libido and very teary low mood. All he offered was higher strength Femoston and antidepressants. When I told him that the risk is less if HRT is delivered transdermally as you can have a lower dose that way and to check NICE guidelines he said "Well that has not filtered down to GP's yet".
HI Debra. Sorry to hear this. I am going to do two answers, the first for you because you are confusing two things and the second for you to show your GP. For you. Testogel is not Oestrogen gel. You are correct that oestrogen is much safer and kinder way to deliver the oestrogen part of HRT. However, what you are asking for in Testogel is testosterone and this is unlicensed. It is recommended by NICE if HRT on its own does not improve libido. HOWEVER, it can only be prescribed on the advice/recommendation. So for this you would need your GP to either email Gynae which sounds remote as an option or refer you in to a menopause clinic and I would ask for that if I would you. Next answer is for you to print off and show your GP!
As a working GP I have been on the BMS weekend course on menopause and a GP Update course where menopause treatment is covered well. NICE Guidelines filtered down to GP's 2 years ago when issued and are found here: cks.nice.org.uk/menopause#!scenario. This is what is says in particular re testosterone for low libido: Sexual disorders Limited evidence showed that testosterone may increase the frequency of sexual episodes for women in surgical menopause when compared with placebo. Given the limited evidence and the fact the testosterone does not currently have a marketing authorization for this indication in women, the GDG emphasized that it should only be offered as an option for improving low sexual desire when hormone replacement therapy (HRT) is not effective. CKS has extrapolated this recommendation to include women who are unable or unwilling to take HRT. The GDG advised that the prescriber should follow relevant professional guidance, taking full responsibility for the decision to prescribe testosterone and that consent should be obtained and documented. CKS advises that specialist advice should be sought before prescribing testosterone for this indication in primary care. In terms of general advice from NICE: 1. Transdermal HRT is safer and more natural. This is due to liver metabolisation of oral HRT. With this delivery the is NO risk DVT/Stroke. The endometrium needs to be protected and this is best done with Mirena coil or utrogestran either daily 100mg (if not bleed required) or as per BNF if bleed required. Using oestrogel pump for this, dose can be titrated from 2-4 pumps depending on results. 2. If a woman is presenting with low mood for the first time around menopause then treat as menopause in the first instance.
Hi Dr Renee - please could you also do a Vlog on surgical menopause (pre-natural menopause), consequences and HRT? I’ve recently had a total hysterectomy at 44 - and launched into instant surgical menopause. A few weeks after surgery I was put on Evorel 75mg patches and Vagifem. (Been on them for about 5 weeks now). But my whole body seems to have crashed - I’ve just had one health issue after the next since surgery. Been in A&E a couple of times with swallowing and breathing difficulties. I have fluid in ears; blocked salivary gland; severe stomach acid (and associated consequences) anxiety; and a strange dipping feeling (like a rollercoaster in my chest). The HRT has stopped my hot flashes and insomnia but still have the anxiety- and I’ve lost all appetite; struggling to eat and have lost 8lb in 2 weeks. I feel like my light has gone out and have a hopeless dark feeling. Can surgical menopause / HRT cause your body to go into this sort of state? I’ve read some blogs where many women have similar symptoms and struggle to adjust their dosages to combat the symptoms. It’s all so scary.
Heidi S. I am sorry you are suffering so awfully. Sometimes it takes time to get the correct dose. You needs. Good gynaecologist who can work with you to adjust doses and try different formulations. It is possible that you have depression along side your new menopause, it's a big change and a hysterectomy can often result in this as it is a massive adjustment in anyone's life. Can I suggest you see a doctor as soon as possible and explain everything you have explained to me, including your darker feelings and despair. I wish you well. Renée
Just wanted to say I heard your story on BBC radio London about your struggle to become a doctor, and the difficulties you had getting a chemistry O'level. I unfortunately didn't hear all of it as I was working but just wanted to say your story was inspirational and I wish you were my GP!!
Thank you for the information. I have an appointment with my GP in the morning so was looking for correct info and advice. I am now much clearer about my options and what to ask for.
Dr Renee Hi again Unfortunately my GP appointment didn’t go very well. She was very lacking in knowledge and spent all my appointment frantically reading the BNF then admitted she didn’t know what to prescribe (as I asked for patches) and would speak to the practice pharmacist and leave a prescription at reception for me. I got my prescription later that day and was prescribed Evorel Conti patches which I’m not sure about as I’ve had about 4 very light periods in the last year, the last being 7 weeks ago. Also I would have preferred one of the newer patches made from yams which I don’t think this is, though I could be wrong as it’s very difficult to get a definite answer on google. I would love it if you could do a more in depth video on the different types and brands of HRT. Thank you for all the fantastic videos, I so wish my GP was as understanding and knowledgeable as you, your patients are very lucky.
Julie Mountford Hi Julie. I have actually done a VLoG on this already. Just hope over the difference between body and bio identicals . This is a body identical oestrogen but you should be on sequi not conti if you have had a period within the last year I’d over 50 and 2 years if under 50. Hope that helps.
Thank you so much for your reply. I will make an appointment to go back to my doctors, and try to get a different GP. I will find your other video so I am fully prepared next time.
Thank you so much for this informative video Dr. Renee. I have a GP appointment this afternoon, and am hoping that I will be helped this time, after having been turned away on 2 previous occasions.
Dr Renee, thank you for this video. Fabulous information. Quick question ..... I am five and a half years post liver transplant and obviously on immunosuppressants etc. I haven't had a period for over two years. I'm healthy but suffering from hot flushes/night sweats every half an hour for the last five years (I can more or less tell the time by them!!). I've had three separate times when the flushes have stopped for approx. four weeks but always come back. I've had differing views on HRT from GP /Consultant your views/help would be useful. Very many thanks for your help with this.
Shan C Hi. Have had a look at the studies and transdermal oestrogen (through the skin) does not seem to affect liver parameters or increase thrombosis in immunosuppressed transplant patients. Clearly this needs to be done with your consultant but it looks fine from the limited look at studies I have seen. Hope that helps. Renée Here is some info: www.ncbi.nlm.nih.gov/pmc/articles/PMC4828501/ www.ncbi.nlm.nih.gov/m/pubmed/9688245/
That's exactly what I thought but was so confused by then I just said okay and left. Thank you so much for your advice, I'm so grateful to know what my next steps should be. Best wishes and also thank you so much for answering so quickly.
Thank you for this informative video! I’m nearing 48 and have noticed my symptoms “ramping up” over the past year or so. I also had RAI (when I was 30) to treat Graves hyperthyroid. I’m very sensitive to any adjustment to my replacement hormone and fear how HRT might play into the mix. I live in the states and it seems like no doctor I’ve had really discusses perimenopause as a possible cause of why my TSH suddenly dropped but my T4 mid range normal. I’ve been stabilized on the same dose of synthroid since I’ve been on treatment but wondered why the sudden change. I suspect that perimenopause has something to do with it.
Hi Renee, thank you for the link. I've watched the vlog and subscribed. It has eased my mind on several issues but I do have a couple of questions if that's okay. I have just turned 48 and had my last period 4 years ago. Recently the panic and anxiety got too much for me so was put in Elleste conti. Okayish for first 2 weeks then by day 15/16/17 anger, anxiety, depression through the roof far worse than before. Stopped taking it, went back to dr who has put me on Femoston 1/5. In the week that I wasn't taking any HRT I lost 2 kilos. However, now been on Femoston for 6 days and have gone back up 2.5 kilos so I do wonder about HRT and weight gain. Also, I am worried about the latter half of the pack as that's when the Elleste had me feeling suicidal. Hopefully as it's a different type of progesterone it'll be fine but just in case it's not can you give me some advice please? I always have had appalling PMT symptoms from a teenager so I fear I may be progesterone intolerant. I so badly want to feel better and I have a chronically ill child - I need some energy, some clarity and no anxiety! I would love to hear what you think, many thanks. Also on the week with no HRT my stomach went back to normal. Now however, on Day 6 of Femoston have huge stomach bloating the same as when on Elleste. Can't find anything to fit! x
Debra Cannon Hi Debra. The bloating will be caused by the progestins in the tablets. This is not actually progesterone and so for some people has hear effects. The way to avoid this is to have oestrogen through the skin, either as a gel that you rub in once a day (oestrogel) or an oestrogen path and utrogestan ( bioidentical progesterone) this is the tidally bioidentical method and gives you progesterone, not progestin. If your GP is unsure of the way to give utrogestan, it is in the BNF which they will have e to hand. Hope that helps. Thanks for watching. Renée
Debra Cannon Hi Debra. As you haven't had a period for 4 years you. An have continuous HRT. Why not either have a Mirena Coil put in and have no progesterone just an oestrogen gel that you run in once a day. The could can stay in for 7 years. Or have Everol conti patches. This way you have safer and different absorption and will hopefully feel better. Hope that helps. Renée
Great explanation and very helpful about the options available and associated risks. One thing I need to correct is that we didn't die at 50 In earlier generations. This is a misreading of statistics. People had more children as there was a higher rate of infant mortality. Those that survived into adulthood had much the same lifespan as we do today, but the average age is skewed due to the high infant mortality.
Hey. Thanks for the comment and the watch, Am always keen to learn. So have dug around. Whilst you are partly correct in that child mortality skewed the figures, not totally. We are definitely living longer now, at least another 13 years as demonstrated here. We certainly did not live to 85 as a normal life expectancy and a girl born in London in the next decade may well live until 100. That's a long time without oestrogen. The graph is quite graphic in demonstrating this but yes, often longer than 50 years.Thank you for allowing me to learn another fact or two today! :-) ourworldindata.org/life-expectancy/
Hi Dr Renee, thank you for your very informative videos. I wanted to ask you a question about dosage of HRT. I am 45 and had been having periods every 3 months before I started taking HRT. I'm keen to stabilise on HRT because there's lots of osteoporosis in the family. I have tried various types since January and all had terrible side effects. This is now my 4th combination. I started off 2 months ago with an estradiol spray 1,53 mg and Utrogestan 200 mg daily, that was then reduced to 100 mg Utrogestan and one spray of estradiol (Lenzetto). I have been on this 3 weeks and am still getting flushes, can't sleep and have a very bleak mood. I live overseas so trying to explain how I feel, when I have brain fog, is even more complicated! I feel totally desperate. My question is: given I am still having menopausal symptoms, but can't increase the dosage of either because of crippling side effects, do you feel I should just stay on this combination for longer or can I safely assume HRT is just not working for me? Does the possibility exist that they will suddenly start working during this period? I'm just not sure if they have a cumulative effect or not. Apologies for the long message and thanks for any advice that you can offer.
Carolina Hi. Thank you for your lovely words. I’m sorry to hear you are suffering. It can take a few months for HRT to work. I am wondering if the side effects are mainly from the utrogestan and whether a trial of using them vaginally instead of orally would help and then you would be able to increase the oestrogen. An alternative to this is a mirena coil with oestrogen. Have you tried oestrogen gel?
You're so sweet to reply so promptly, thanks. I will try to persist. No, I haven't tried estrogen gel yet but perhaps worth it. I think maybe trying the Utrogestan vaginally would help and also I'm confused by why he has prescribed them on a continual basis. I will look into this with him when I see him again. Thank you and best wishes.
Carolina yes you should have been without periods for a year before continuous although if you are not bleeding on continuous it will do no harm and longer term is better for the endometrium.
Hi , does hay fever get worse during menopause , never had it before but noticed it last couple of years and insomnia is so bad .. Ive just started oestrogen patch 50 and progesterone tablets , when would I notice a change ?
How normal is it for a woman to go through menopause with no symptoms? I think I did in 2020 because I haven't had a period since then, but the doctors available to me here in Texas aren't terribly helpful or reliable in giving info on menopause, so I thought I'd ask you. How does a woman know she's really gone through it when there were no symptoms other than the period stopping?
Hi Dr Renee, thank you for the video, it has helped me a lot to figure out what I need to do and why. I am post menopausal and having a lot of the symptoms you talk about, the three main ones being lack of sleep, night sweats and fogginess. My gp is said to do some research and think about what I want to do so I presume she means whether to take hrt or not. I am swaying more towards with only being age 40. I had a partial hysterectomy in 2011 and 1 of my ovaries removed in November 2017. My fsh levels are currently 49 and estrogen 3.6. Is it up to the doctor to prescribe me hrt or will I need to wait longer to be referred to the gynae department? Thank you for any advice you can give.
Paula Rustage Hi. So glad it has helped. No the GP should prescribe. You are in a great position because you don’t have a uterus. This means you just need oestrogen gel or a patch. There is actually a reduction in breast cancer risk this way. It will also protect your heart. Oestrogel is the gel. 2-4 pumps once a day the normal dose.
Dr Renee thank you so much for the reply so quickly. Is there a particular brand that I should be requesting. I am a little clueless as to types and brands etc. It is good news yes that I don’t need to take progesterone. X
Dr Renee, your comments about radioactive iodine putting you into perimenopause was interesting. Did this happen soon after? My Graves’ disease burned itself out as I refused radioactive iodine and surgery. It converted to under active about 13 years. I keep wondering if this would start me through perimenopause early. I’m almost 43.
Hi doctor Renee, I am 57 years old. I had a hysterectomy when I was 35 due to uterine cancer. My ovaries were left. At about 50 I began to have terrible night and day flushes and sweats which I couldn’t cope with. I visited the GP who put me on 25mg Evorel. This stopped the flushes etc. In Aug 2018 I began to have flushes again accompanied by nausea, I went back to the doctors, he increased the Evorel to 50mg. Since Christmas I have been having constant tight headaches that last for days, can’t concentrate and I am very forgetful. The headaches are constant accompanied by fatigue and low motivation to do anything. Visited the doctor who said to stop the 50mg patch, go on 25mg patch for 2 weeks then stop altogether! I am so confused as to what these headaches are and what or which hormone is responsible. I would like to have a test to see which hormone is deficient or dominant so I can make a decision wether to stay on it or come off, just worried about what will happen if I come off. At the moment I am at my wits end, trying to hold down a job and feel if I am going mad, just wondered if you could give me some advise please? Thankyou. Amanda
Hi Amanda. HRT commencement can bring on headaches. The advice is to go with the lowest dose of oestrogen possible and though the skin. I would recommend changing to gel and starting with one pump and if needed take it to half a pump or one pump on alternate days and see if that helps. You could have an oestrodiol blood test to see if it is very low or high. You don't have to stop HRT if you get headaches but need to find a balance with a dose that helps symptoms but minimises headaches. There is a good fact sheet on this on the BMS website. Good luck.
Hi Dr Renee, thank you so much for your prompt reply. Do you think the increase in the Evorel patch from 25 to 50 caused the headaches or because the oestrogen became the dominant hormone and my other hormones are too low? It all sounds very complicated. Do I need to up my progesterone with a gel, if so can I buy this or will I have to ask the GP?. Regards Amanda.
Amanda Green Hi Amanda. We are not sure why hormones cause migraine but assume it is the swing of hormones rather than the hormones themselves in most cases. Your other hormone is progesterone and you have a continuous release of that in the patch so I don’t think hormone imbalance will likely be at play. The progesterone has very little role other than to protect the lining of your womb so it is absolutely necessary. R
I had a lumpectomy 5 years ago. Caught early and had radiotherapy but no chemotherapy. I have been on Letrozole for 5 years, horrible aches etc. Could I go on HRT when I finish my 5 year treatment? I am 65. Thank you Dr Renee
Hi Dr Renee, my period stopped over 10 years ago im 51 now. If i go on HRT patches will this start my periods again? I really dont want to start periods again. Ive been getting hot flushes and night sweats. This is why ive been thinking of asking for HRT patches for my GP. Any advice would be much appreciated. Thank you
Hi Renee, thank you for your message. I will speak to GP about this. Will this also help with the severe PMT symptoms I experienced after a few weeks of the tablets?
Debra Cannon well it sounds like that is a reaction to the oral HRT,. So hopefully taking it a different way will not have the same reaction. Good luck
Thank you. I am 48 and my periods are regular with one heavy day, but short otherwise. I have just had a couple of small endometriosis lumps removed from my navel. None was found in or around my womb, etc... I am about to visit my doctor to discuss being put on progesterone only pill, recommended by the consultant to stop the return of the endo. What I am wondering is the link between oestrogen and endo and my upcoming menopause. Shall I just stick to the POP for now until my menopause starts....will I notice if I am on POP? Should I just start the HRT? Also, just to add to the mix, I have a very low libido, which has slowly gotten worse over the past 10 years or so. I feel hot all the time, but not flashes, I wake up hot in bed, but not drenched. Thanks for your support.
Paula T-L Hi Paula. You sound perimenopausal. Oestrogen encourages endometrial tissue to grow. Having said that we use combined oestrogen/progesterone pills to treat endometriosis. The oestrogen in HRT could help the symptoms you describe and combined with progesterone (preferably utrogestan) could be enough to control the endo. You could, with your Gynae's consent, consider continuous progesterone which would stop bleeding. But then would need US every 6 months to check the uterus lining. Re the libido. This often is restored by HRT but if not Gynae can prescribe testosterone. Hope this helps.
Hi Dr Renee, I am 47 and have not had a period for 5 years and I've not had any menopausal symptoms. My GP has told me that I am now post-menopausal. I have suffered with aches and pains as well as a few other symptoms for a number of years and have been told that I am on the lupus spectrum but I do not take any medication for it as I only have flare ups once or twice a year. But due to a recent bout being worse then usual my GP thinks it may be due to menopause and has prescribed Kliovance. I am worried about taking it because I dont want to suffer side affects that are worse then the aches and pains and if I have never had menopausal symptoms will taking Kliovance cause me to have some. I would be so grateful if you could give me your views? Also, I have had a dexa scan which shows my bones are thinning and also my sex drive has gone and I would like it back. I've never taken the contraceptive pill and have only ever used natural remedies all of my life for anything. Any advice would be of help please.
Hey. Sorry you are feeling bad. The symptoms are possibly menopausal and the bone thinning will continue without HRT. There is often a settling in period of up to three months but with your lupus I would go for a continuous patch or gel plus utrogestan. It’s safer and body identical. Hope that helps.
Dr Renee, thanks so much for your reply, and so quickly too! Just one other question if you don't mind answering is whether I actually need to take HRT at all considering I have no symptoms at all? Do you suggest taking it only because of the risk of osteoporosis? Thank you.
Hi doctor Renee I am 75 and have been off HRT for years after my complete hysterectomy the doctor took me off because of all the bad press I miss it so much all of a sudden I am having burning in my vaginitis it dose’t feel like a UTI is it to late for me to be on HRT could the burning be from dryness
Mary jo Waszkiewicz Hi Mary. This is likely to be from vaginal atrophy. The good news is that it’s pretty simple to treat with no age restriction. Your GP can prescribe a vaginally oestrogen in the form of a cream. There is no systematic absorption so no age barrier. It works really well. Good luck.
Dr Renee thank you so much for getting back to me , I have a appointment Tuesday the 30th I couldn’t get into a doctor so I hope her assistant can tell if this is my problem . I love your videos so informative glad I found you 😊
hi watching your video help so much i felt like i was alone and going crazy. i had surgical menopaused my estrogen drop to 14 i felt awful, dr put me on tropical estrogen which has help i was using one pump on arm low dose, it went up to 24 after using for over a year the dr just up it to pump in half , i was so scared to use hrt but after watching your video and seeing how the risk are higher not using it , iam 48 now is there any supplements i should also take to help thank you so much sharing
Hi are the oestrogen patches and progesterone tablets body identical ? I'm waiting for coil to be fitted , been on patches two weeks still getting a couple of flushes I'm on 50 mg patches should I go up to 75 mg ?
Hi. Yes the patches plus utrogestan capsules are body identical. I can't advise you on your individual dose as I don't now you history etc. I do usually advise patients to give it a little longer however and see how it goes over 3 months.
Debbie Taylor You can definitely do that and safe. The only problem you will have is that Everol are out of manufacture at the moment. The easy alternative is gel and utrogestan capsules
Hello Dr Renee, Can you go back on HRT after a couple of months off it. I was on it a year but was so worried about the risks, you explained things so nicely that has put me back thinking should I go back on it again, I bought black cohosh and glucosamine sulphate for my aches and pains, but they are not working yet, I'm an emotional wreck at the moment. So could I go back to the chemist and ask for a repeat prescription.
Dr Renée can you get flu symptoms from menopause hot cold flushes, clammy sometimes lasts all day every day and you think you have a virus , anxiety through the roof too ?
Thanks I can't function with the flu like symptoms that carry on constantly all day every day sometimes it feels like a virus . I'm having the mirena coil fitted Monday with a oestrogen patch because tablets and patches don't work ,I'm on my seventh year now and it isn't getting any better 😓
@@DrRenee went to have my coil fitted and my cervix is very narrow or something , I had a hysteroscopy once and they had a job to get in there , it was very painful so now I have to wait for a hospital appointment to get it fitted 😓
Hi Dr Renee,The gynae department has written to my GP at long last saying that I can have HRT transdermally. I'm going to request the gel as per your recommendation but just needed to clarify a paragraph from your previous answer. "The endometrium needs to be protected and this is best done with Mirena coil or utrogestran either daily 100mg (if not bleed required) or as per BNF if bleed required. Using oestrogel pump for this, dose can be titrated from 2-4 pumps depending on results" I have not had a period for 4 years and have intact ovaries and womb. Can you please explain what you mean by bleed required or not required please? Many thanks, Debra
Debra Cannon Hi Debra. That's good news. So essentially, if your last period was more than a year ago, you don't need to have them anymore. So you either have a Mirena coil(ideal way) or you need utrogestran as a tablet 100mg every day. If your last period was under a year ago then you will need to carry on having periods for a year, unless you go for the Mirena coil and then you likely won't bleed at all and don't need to. Hope that helps. It's complicated. R
Thank you for your reply. I did understand that testosterone gel and oestrogen gel are two different things but I didn't word it clearly, sorry about that. The reason that I wanted the testosterone is because many users have said that it increased their energy levels and lifted their mood which HRT on its own had not done. Is a menopause clinic different to being referred to gynae dept because when I was referred to gynae at the hospital they just told me that I should be on HRT. When I asked about the different types and what would be best they told me to research HRT on the internet and then discuss it with my GP.
Debra Cannon Hi. Testosterone is only for libido. HRT should address the rest of the issues if the correct type and dose. It can only be started under Gynae guidance. All Gynae departments should have specialist menopause clinics and they should do the prescribing of your HRT regimen initially and your GP can then carry on. I have never heard of a Gynae clinic telling the patient to do the research. I suggest you get referred back and his time say "No, I need you to prescribe please". Good luck.
Can I ask if you recommend laser treatment for perennial tears that are really sore ,I'm using topical estrogen cream ,this has helped, but not completely
What a great question. So yes. I have had it. Perhaps I will do a vlog on it. You will still need to be really religious about using oestrogen cream and vaginal moisturisers like Yes OB but the laser made a big difference.
Hi Helen. I have two other VLOG's specifically addressing this. Try these ruclips.net/video/EtzNoN_33-w/видео.htmlsi=rWB0yg9_WycpSmOq ruclips.net/video/5oi4wVewMjQ/видео.htmlsi=ERdnKfWOUD6tB7oe Hope they help and good luck. x
Hi I've been taking the progesterone tablets all through the month without a break , is it normal to have tender breasts , it almost feels like being pre menstrual ?
Hi Renee, if I do change to gel and oral progesterone could you tell me what the dosages should be? Just to recap I'm 48 and 4 years without period, womb intact. Also, at the moment I am trialling Femoston 1/5 conti. Is this enough oestrogen and should I be including testosterone to help with tiredness? If so, will GP prescribe it? Many thanks Renee.
Debra Cannon Hi. You need to do this with your GP. There are standard doses and you can then work up if needed to control symptoms. If they are unsure re the utrogestran they can look up the regimen in their BNF. Good luck. R
Debra Cannon Hi. Not normal practice. Evidence is for oral tablets not transdermal progesterone for breast cancer risk.You would also likely find side effects from using them long term. Vaginal irritation/thrush. Also need to consider partner absorption. R
@@DrRenee I have spoken to my GP today about changing Utrogestan to continuous and she didn’t seem to know a great deal about taking it continuously, I told her what I knew that I’d picked up from your vlogs. I’m currently only 8 days in and would like to take it continuously instead of sequential as I haven’t had a period for at least 7 years, she had to call me back after she’d looked it up. She said she read that Utrogestan can be taken everyday for 25 days with 3 days free to bleed. She said she can’t advise me to take one daily as it didn’t state that in the ‘medical bible’. She basically admitted that I seemed to know more than she did. I feel more confused than ever now on whether I can start taking the Utrogestan daily from today or if I have to wait until the end of this cycle and have a bleed. Your work is amazing and GP’s need to be educated more on menopause and HRT. Thank you so much.
Essentially any woman could go to 100mg every day at any point in the cycle and should not take a break at all as per the women’s health forum prescribing guide.
Will the patch with estrogen and progesterone make the period come back. I have not had a period in more then a month. Im having alot of symptoms since my period stopped. Not sleeping, anxiety, hot flashes then chills since my last periond in early June 2020. Please help.
Hi Dr Renee, I'm abit confused. I'm 48 and having peri symptoms plus heavy close together vwry painful periods (leg pain), fibroids. My gp won't test me for menopause but just told me to have a mirena coil (i don't like the idea). What shall i do? Do i need both oestrogen & progesterone? Thanks
hln1969 you don’t need blood tests because of your age. If you are having symptoms then you can be treated for those symptoms with HRT; that’s the NICE guidelines. The mirena coil will help your bleeding but not your peri menopause symptoms but it is easy to add. Oestrogen for this and I use oestrogel which you rub in once a day. I would go back to your GP and show them this!
@@DrRenee sorry, should i ask for the mirena for the pain, heavy periods and fibroids? I just don't like idea of an object inside or is there an alternative? Thanks
It’s personal choice. I have one and it is fab. It’s gold standard treatment for heavy periods but depends how big n what position your fibroids are in terms of if you can have one.
Hi Dr I am am 57 and about to start the oestrogel and utrogestan pills. To reduce any side effects i might get from the progestetone can i administer the 2 100mg pills into my vagina or just 1x100mg pill. Thanks Also do I use the gel everyday or have a break I understand the utrogesten starts on day 15 for 12 to 14 days. Csn you clarify Thankyou
I can't advise you individually, your GP must do tnhis with knowledge of your history. Generally, the pills can be used vaginally at the same dose as orally but this is off license. In terms of the gel, this is used daily without a break.
My Dr won't give me HRT till I am 50 she says. 3 years away. She says I got to be thinner , never smoke etc. And prove that I cannot cope. 3 more years of the anxiety & depression , great !!! I'll probably top myself before then. 2 best friends f mine have recently watlz in to their doctors and have been given HRT no problem. They are both thinner than me but are still have chronic symptoms - so it's a myth that the fatter you are , the worse peri is worth. One of them is a gym freak and she is still having massive problems so fitness does not make a difference.
sallyanne scarbrow hi. I’m sorry to hear this. I would see a different doctor or see her with a copy of the NICE guidelines 2015. There is no weight contraindication to HRT, or smoking. If you have symptoms then you can start at any age as long as no real risks; uncontrolled high blood pressure or existing heart disease for example. Hope that helps.
Dr Renee .Thank you for your reply !! Since march I have been taking one 2.5mg blood pressure tablet per day as it was an average of 150 at the time . I have been attending gym since then and lost nearly a stone and BP for example today was 110 / 95 after so I assume things are better with the combination of the two. I already take the mini pill to help with peri symptoms but I reckon I only felt better for about 6 months. Do I need to give it time like my doctor has said - they make me feel like I am a nuisance.
sallyanne scarbrow sonthe answer firstly is WELL DONE! You have done the hard work. There is no age reason for not having HrT. The NICE guidelines say that over 45 treat to symptoms. I would see her again and point her towards the guidelines or see a different doctor.
Najia1977 Hi. It isn’t a symptom I see commonly but it is indeed possible. Here is some information www.womensinternational.com/what-does-tinnitus-have-to-do-with-hormones/
Hi Dr Renee I am 48 years old and up until last June I had the Mirena coil for contraception for around 12 years, the last one in for nearly 7yrs, i got it taken out as i had a bleed and an infection where upon i decided to not get another put in, i had a tiny bleed 5 weeks after that but nothing since and menopause symptoms have really kicked in and gotten horrible since getting coil out .. i was started on evorel conti patches last week.. is this the right hrt for me please.. thank you xx
Thanks for your video. It was informative. I would have liked it if you could have talked more about Progesterone. And how to take it, and what to expect. My question is, I'm worried if the utrogestan is working or not. Am i meant to get a slight bleed after the 11-12 days being on utrogestan? It's been 2 weeks since i stopped taking it for the month, and i never got a bleed. Should i be worried? Not getting a bleed after the first month of taking progesterone is that normal, does it take longer from taking progesterone in order to get a bleed? Or should i had gotten a bleed by now? Is not having a bleed after taking progesterone a sign that i wasn't putting the oral progesterone up far enough into the vagina, as i have a long vagina. I was told try put it up near the far end of the vagina. but having a long vagina, i'm not sure i'm putting it up far enough.
Becky M Hi. If you go through the videos I have done one on progesterone. Not everyone gets a bleed but you must be taking 200mg for 12 days. The length of your vagina is not important; just get them as high as possible.
@@DrRenee Thanks for replying. Yes i am taking 200mg for 12 days. Doesn't womb lining need to shed after taking progesterone? Which means a period? So you don't get a build up of too much oestrogen and increase risk of getting anything you don't want?! I'll watch your video on progesterone about contraception, i didn't know you talked about hrt for progesterone on the video too. So thanks for recommending i watch it.
I have a video on progesterone in HRT and one on contraception and HRT. You may find as you go on with your HrT that you have small bleeds. The progesterone can suppress the lining enough that bleeding is very light and some months absent. It could indicate that continuous would work for you.
I’m almost 57 and today I’m going to see my dr in tears 😭 no more suffering thanks to you 💝
Very well explained. It's so refreshing to find a few British doctors prepared to actually do the work needed to help women at this devastating time. My own GP just told me menopause was the elephant in the room but when I asked for bioidentical HRT (by which I meant the gel and Utrogestan) he said he'd never heard of that and offered me a standard pill. I didn't want that so I've paid a lot of money to go to a private specialist. I resent that. I should get this help on the NHS. But no, I keep paying. The private specialist hasn't got it right yet either. I'm about to go back and say I want to try the gel and tablet.
HI Sue. Thank you for your kind words. Im sorry to hear that. I would go back to your GP, with a copy of the NICE guidance and ask him to look up oestrogel and utrogestan for HRT in his copy of the BNF. Good luck. R
Dear madam, Can you provide us with the name of that private hospital, please? Thanks in advance.
Thank you doctor, my sister is 42 & pre/peri-menopausal, I know she's been feeling upset with menopause symptoms, I'm going to send her this RUclips video link. 👍
Dr Renée thank you for replying to my questions , I've learnt a lot from you about HRT and also hypothyroidism as I've had that for over twenty years.
It's a pleasure.
Thank you, I've been on HRT patches for a couple of years now ( began being in pre-menopause for around seven years, so early forties ( that is when I stopped having my monthly bleed ) as I'm now almost fifty. Yes I do have extra problems like you stated which certainly do not help my various and other serious and deteriorating health problems, thus am in a wheelchair a lot.
I really abhor the side affects, especially the hot flushes - hot then shivering in bed or when I'm downstairs etc. Even worse headaches ( I already suffer both ocular and very painful migraines and cluster headaches )
Am having to keep an eye on my legs for DVT and even though my Doctor has prescribed patches ( I was on tablets ) she is worried about my bones and other things due to as I already said, my other health problems - so she may take me off them due to risks.
Thank you so much again for the reassurance.
Brilliant. Thank you so much for all your help. My GP sadly had little to no idea about menopause or treatments and I would have been lost without your advice. It gave me the information I needed to fight for what I want. I can't thank you enough for all the responses you have given and thank you also for always replying so quickly. Best wishes, Debra
Debra Cannon Ah that makes me sad. But if I can help one person in each topic then this is worth it! Thank you for your support and spread the word; the more subscribers the more word spreads! Enjoy your new HRT life! X
You are amazing!! Thank you so much for sharing your knowledge and helping women!!! 👏👏👏👏💜
Hi Dr Renee, my GP will not prescribe testogel and has said that seeing as Femoston oral tablets are controlling the hot flushes he will not change me to gel. I've told him that even though the flushes are controlled I've still got incredible fatigue, no libido and very teary low mood. All he offered was higher strength Femoston and antidepressants. When I told him that the risk is less if HRT is delivered transdermally as you can have a lower dose that way and to check NICE guidelines he said "Well that has not filtered down to GP's yet".
HI Debra. Sorry to hear this. I am going to do two answers, the first for you because you are confusing two things and the second for you to show your GP.
For you. Testogel is not Oestrogen gel. You are correct that oestrogen is much safer and kinder way to deliver the oestrogen part of HRT. However, what you are asking for in Testogel is testosterone and this is unlicensed. It is recommended by NICE if HRT on its own does not improve libido. HOWEVER, it can only be prescribed on the advice/recommendation. So for this you would need your GP to either email Gynae which sounds remote as an option or refer you in to a menopause clinic and I would ask for that if I would you. Next answer is for you to print off and show your GP!
As a working GP I have been on the BMS weekend course on menopause and a GP Update course where menopause treatment is covered well.
NICE Guidelines filtered down to GP's 2 years ago when issued and are found here:
cks.nice.org.uk/menopause#!scenario.
This is what is says in particular re testosterone for low libido:
Sexual disorders
Limited evidence showed that testosterone may increase the frequency of sexual episodes for women in surgical menopause when compared with placebo. Given the limited evidence and the fact the testosterone does not currently have a marketing authorization for this indication in women, the GDG emphasized that it should only be offered as an option for improving low sexual desire when hormone replacement therapy (HRT) is not effective.
CKS has extrapolated this recommendation to include women who are unable or unwilling to take HRT.
The GDG advised that the prescriber should follow relevant professional guidance, taking full responsibility for the decision to prescribe testosterone and that consent should be obtained and documented. CKS advises that specialist advice should be sought before prescribing testosterone for this indication in primary care.
In terms of general advice from NICE:
1. Transdermal HRT is safer and more natural. This is due to liver metabolisation of oral HRT. With this delivery the is NO risk DVT/Stroke.
The endometrium needs to be protected and this is best done with Mirena coil or utrogestran either daily 100mg (if not bleed required) or as per BNF if bleed required. Using oestrogel pump for this, dose can be titrated from 2-4 pumps depending on results.
2. If a woman is presenting with low mood for the first time around menopause then treat as menopause in the first instance.
Hi Dr Renee - please could you also do a Vlog on surgical menopause (pre-natural menopause), consequences and HRT? I’ve recently had a total hysterectomy at 44 - and launched into instant surgical menopause. A few weeks after surgery I was put on Evorel 75mg patches and Vagifem. (Been on them for about 5 weeks now). But my whole body seems to have crashed - I’ve just had one health issue after the next since surgery. Been in A&E a couple of times with swallowing and breathing difficulties. I have fluid in ears; blocked salivary gland; severe stomach acid (and associated consequences) anxiety; and a strange dipping feeling (like a rollercoaster in my chest). The HRT has stopped my hot flashes and insomnia but still have the anxiety- and I’ve lost all appetite; struggling to eat and have lost 8lb in 2 weeks. I feel like my light has gone out and have a hopeless dark feeling. Can surgical menopause / HRT cause your body to go into this sort of state? I’ve read some blogs where many women have similar symptoms and struggle to adjust their dosages to combat the symptoms. It’s all so scary.
Heidi S. Hi. Thanks for your comment. I have a VLOG on menopause which covers all menopause, including surgical. Hope it helps. Renée
Heidi S. I am sorry you are suffering so awfully. Sometimes it takes time to get the correct dose. You needs. Good gynaecologist who can work with you to adjust doses and try different formulations. It is possible that you have depression along side your new menopause, it's a big change and a hysterectomy can often result in this as it is a massive adjustment in anyone's life. Can I suggest you see a doctor as soon as possible and explain everything you have explained to me, including your darker feelings and despair. I wish you well. Renée
Just wanted to say I heard your story on BBC radio London about your struggle to become a doctor, and the difficulties you had getting a chemistry O'level. I unfortunately didn't hear all of it as I was working but just wanted to say your story was inspirational and I wish you were my GP!!
Simon Cuthbert Ah what a lovely comment. Thank you Simon.
Thank you for the information. I have an appointment with my GP in the morning so was looking for correct info and advice. I am now much clearer about my options and what to ask for.
Julie Mountford Hi Julie. I’m so pleased, that’s exactly the aim. Good luck. R
Dr Renee Hi again Unfortunately my GP appointment didn’t go very well. She was very lacking in knowledge and spent all my appointment frantically reading the BNF then admitted she didn’t know what to prescribe (as I asked for patches) and would speak to the practice pharmacist and leave a prescription at reception for me. I got my prescription later that day and was prescribed Evorel Conti patches which I’m not sure about as I’ve had about 4 very light periods in the last year, the last being 7 weeks ago. Also I would have preferred one of the newer patches made from yams which I don’t think this is, though I could be wrong as it’s very difficult to get a definite answer on google. I would love it if you could do a more in depth video on the different types and brands of HRT. Thank you for all the fantastic videos, I so wish my GP was as understanding and knowledgeable as you, your patients are very lucky.
Julie Mountford Hi Julie. I have actually done a VLoG on this already. Just hope over the difference between body and bio identicals . This is a body identical oestrogen but you should be on sequi not conti if you have had a period within the last year I’d over 50 and 2 years if under 50. Hope that helps.
Thank you so much for your reply. I will make an appointment to go back to my doctors, and try to get a different GP. I will find your other video so I am fully prepared next time.
Thank you Dr.Renee ❤❤❤❤
You've answered my previous question in this video!! I was sceptical about HRT...
Wonderful!
Thank you so much for this informative video Dr. Renee. I have a GP appointment this afternoon, and am hoping that I will be helped this time, after having been turned away on 2 previous occasions.
Jessica Jager ah my pleasure. Good luck. R
Dr Renee, thank you for this video. Fabulous information. Quick question ..... I am five and a half years post liver transplant and obviously on immunosuppressants etc. I haven't had a period for over two years. I'm healthy but suffering from hot flushes/night sweats every half an hour for the last five years (I can more or less tell the time by them!!). I've had three separate times when the flushes have stopped for approx. four weeks but always come back. I've had differing views on HRT from GP /Consultant your views/help would be useful.
Very many thanks for your help with this.
Shan C Hi. Have had a look at the studies and transdermal oestrogen (through the skin) does not seem to affect liver parameters or increase thrombosis in immunosuppressed transplant patients. Clearly this needs to be done with your consultant but it looks fine from the limited look at studies I have seen. Hope that helps. Renée Here is some info:
www.ncbi.nlm.nih.gov/pmc/articles/PMC4828501/
www.ncbi.nlm.nih.gov/m/pubmed/9688245/
Hi Dr Renee, will you be posting any new videos? I find them very informative and you have helped me to understand menopause better. Thank you, Paula
Paula & Zac adventurers Hi Paula. Thank you for that lovely comment. I do a VLOG every 2 weeks.. so keep subscribed and you will get notified !
That's exactly what I thought but was so confused by then I just said okay and left. Thank you so much for your advice, I'm so grateful to know what my next steps should be. Best wishes and also thank you so much for answering so quickly.
Thank you for this informative video! I’m nearing 48 and have noticed my symptoms “ramping up” over the past year or so. I also had RAI (when I was 30) to treat Graves hyperthyroid. I’m very sensitive to any adjustment to my replacement hormone and fear how HRT might play into the mix. I live in the states and it seems like no doctor I’ve had really discusses perimenopause as a possible cause of why my TSH suddenly dropped but my T4 mid range normal. I’ve been stabilized on the same dose of synthroid since I’ve been on treatment but wondered why the sudden change. I suspect that perimenopause has something to do with it.
Hi Renee, thank you for the link. I've watched the vlog and subscribed. It has eased my mind on several issues but I do have a couple of questions if that's okay. I have just turned 48 and had my last period 4 years ago. Recently the panic and anxiety got too much for me so was put in Elleste conti. Okayish for first 2 weeks then by day 15/16/17 anger, anxiety, depression through the roof far worse than before. Stopped taking it, went back to dr who has put me on Femoston 1/5. In the week that I wasn't taking any HRT I lost 2 kilos. However, now been on Femoston for 6 days and have gone back up 2.5 kilos so I do wonder about HRT and weight gain. Also, I am worried about the latter half of the pack as that's when the Elleste had me feeling suicidal. Hopefully as it's a different type of progesterone it'll be fine but just in case it's not can you give me some advice please? I always have had appalling PMT symptoms from a teenager so I fear I may be progesterone intolerant. I so badly want to feel better and I have a chronically ill child - I need some energy, some clarity and no anxiety! I would love to hear what you think, many thanks. Also on the week with no HRT my stomach went back to normal. Now however, on Day 6 of Femoston have huge stomach bloating the same as when on Elleste. Can't find anything to fit! x
Debra Cannon Hi Debra. The bloating will be caused by the progestins in the tablets. This is not actually progesterone and so for some people has hear effects. The way to avoid this is to have oestrogen through the skin, either as a gel that you rub in once a day (oestrogel) or an oestrogen path and utrogestan ( bioidentical progesterone) this is the tidally bioidentical method and gives you progesterone, not progestin. If your GP is unsure of the way to give utrogestan, it is in the BNF which they will have e to hand. Hope that helps. Thanks for watching. Renée
Debra Cannon Hi Debra. As you haven't had a period for 4 years you. An have continuous HRT. Why not either have a Mirena Coil put in and have no progesterone just an oestrogen gel that you run in once a day. The could can stay in for 7 years. Or have Everol conti patches. This way you have safer and different absorption and will hopefully feel better. Hope that helps. Renée
Great explanation and very helpful about the options available and associated risks.
One thing I need to correct is that we didn't die at 50 In earlier generations. This is a misreading of statistics. People had more children as there was a higher rate of infant mortality. Those that survived into adulthood had much the same lifespan as we do today, but the average age is skewed due to the high infant mortality.
Hey. Thanks for the comment and the watch, Am always keen to learn. So have dug around. Whilst you are partly correct in that child mortality skewed the figures, not totally. We are definitely living longer now, at least another 13 years as demonstrated here. We certainly did not live to 85 as a normal life expectancy and a girl born in London in the next decade may well live until 100. That's a long time without oestrogen. The graph is quite graphic in demonstrating this but yes, often longer than 50 years.Thank you for allowing me to learn another fact or two today! :-) ourworldindata.org/life-expectancy/
This isn't the case. 150 years ago the average life expectancy of a woman was 49. Today it is 83 (depending where you live int he UK).
Could you please mention the side effects of tibolone? I'm 52, already in menopause for 5 years and just started Livial a week ago. Thank you
Hi Dr Renee, thank you for your very informative videos. I wanted to ask you a question about dosage of HRT. I am 45 and had been having periods every 3 months before I started taking HRT. I'm keen to stabilise on HRT because there's lots of osteoporosis in the family. I have tried various types since January and all had terrible side effects. This is now my 4th combination. I started off 2 months ago with an estradiol spray 1,53 mg and Utrogestan 200 mg daily, that was then reduced to 100 mg Utrogestan and one spray of estradiol (Lenzetto). I have been on this 3 weeks and am still getting flushes, can't sleep and have a very bleak mood. I live overseas so trying to explain how I feel, when I have brain fog, is even more complicated! I feel totally desperate. My question is: given I am still having menopausal symptoms, but can't increase the dosage of either because of crippling side effects, do you feel I should just stay on this combination for longer or can I safely assume HRT is just not working for me? Does the possibility exist that they will suddenly start working during this period? I'm just not sure if they have a cumulative effect or not. Apologies for the long message and thanks for any advice that you can offer.
Carolina Hi. Thank you for your lovely words. I’m sorry to hear you are suffering. It can take a few months for HRT to work. I am wondering if the side effects are mainly from the utrogestan and whether a trial of using them vaginally instead of orally would help and then you would be able to increase the oestrogen. An alternative to this is a mirena coil with oestrogen. Have you tried oestrogen gel?
You're so sweet to reply so promptly, thanks. I will try to persist. No, I haven't tried estrogen gel yet but perhaps worth it. I think maybe trying the Utrogestan vaginally would help and also I'm confused by why he has prescribed them on a continual basis. I will look into this with him when I see him again. Thank you and best wishes.
Carolina yes you should have been without periods for a year before continuous although if you are not bleeding on continuous it will do no harm and longer term is better for the endometrium.
Hi , does hay fever get worse during menopause , never had it before but noticed it last couple of years and insomnia is so bad .. Ive just started oestrogen patch 50 and progesterone tablets , when would I notice a change ?
It can, as can all allergies.
How normal is it for a woman to go through menopause with no symptoms? I think I did in 2020 because I haven't had a period since then, but the doctors available to me here in Texas aren't terribly helpful or reliable in giving info on menopause, so I thought I'd ask you. How does a woman know she's really gone through it when there were no symptoms other than the period stopping?
Hi Dr Renee, thank you for the video, it has helped me a lot to figure out what I need to do and why. I am post menopausal and having a lot of the symptoms you talk about, the three main ones being lack of sleep, night sweats and fogginess. My gp is said to do some research and think about what I want to do so I presume she means whether to take hrt or not. I am swaying more towards with only being age 40. I had a partial hysterectomy in 2011 and 1 of my ovaries removed in November 2017. My fsh levels are currently 49 and estrogen 3.6. Is it up to the doctor to prescribe me hrt or will I need to wait longer to be referred to the gynae department? Thank you for any advice you can give.
Paula Rustage Hi. So glad it has helped. No the GP should prescribe. You are in a great position because you don’t have a uterus. This means you just need oestrogen gel or a patch. There is actually a reduction in breast cancer risk this way. It will also protect your heart. Oestrogel is the gel. 2-4 pumps once a day the normal dose.
Dr Renee thank you so much for the reply so quickly. Is there a particular brand that I should be requesting. I am a little clueless as to types and brands etc. It is good news yes that I don’t need to take progesterone. X
Paula Rustage Hi. No. Oestrogel is the brand of gel. Patches are evorol, oestrodot and a few others. Good luck.
Dr Renee, your comments about radioactive iodine putting you into perimenopause was interesting. Did this happen soon after? My Graves’ disease burned itself out as I refused radioactive iodine and surgery. It converted to under active about 13 years. I keep wondering if this would start me through perimenopause early. I’m almost 43.
Zoe Moorcroft Hiya. No its the direct effect of the radioactive iodine on the ovaries, not the thyroid condition.
Hi doctor Renee, I am 57 years old.
I had a hysterectomy when I was 35 due to uterine cancer. My ovaries were left. At about 50 I began to have terrible night and day flushes and sweats which I couldn’t cope with. I visited the GP who put me on 25mg Evorel. This stopped the flushes etc. In Aug 2018 I began to have flushes again accompanied by nausea, I went back to the doctors, he increased the Evorel to 50mg.
Since Christmas I have been having constant tight headaches that last for days, can’t concentrate and I am very forgetful. The headaches are constant accompanied by fatigue and low motivation to do anything. Visited the doctor who said to stop the 50mg patch, go on 25mg patch for 2 weeks then stop altogether! I am so confused as to what these headaches are and what or which hormone is responsible. I would like to have a test to see which hormone is deficient or dominant so I can make a decision wether to stay on it or come off, just worried about what will happen if I come off. At the moment I am at my wits end, trying to hold down a job and feel if I am going mad, just wondered if you could give me some advise please? Thankyou. Amanda
Hi Amanda. HRT commencement can bring on headaches. The advice is to go with the lowest dose of oestrogen possible and though the skin. I would recommend changing to gel and starting with one pump and if needed take it to half a pump or one pump on alternate days and see if that helps. You could have an oestrodiol blood test to see if it is very low or high. You don't have to stop HRT if you get headaches but need to find a balance with a dose that helps symptoms but minimises headaches. There is a good fact sheet on this on the BMS website. Good luck.
Hi Dr Renee, thank you so much for your prompt reply. Do you think the increase in the Evorel patch from 25 to 50 caused the headaches or because the oestrogen became the dominant hormone and my other hormones are too low? It all sounds very complicated. Do I need to up my progesterone with a gel, if so can I buy this or will I have to ask the GP?. Regards Amanda.
Amanda Green Hi Amanda. We are not sure why hormones cause migraine but assume it is the swing of hormones rather than the hormones themselves in most cases. Your other hormone is progesterone and you have a continuous release of that in the patch so I don’t think hormone imbalance will likely be at play. The progesterone has very little role other than to protect the lining of your womb so it is absolutely necessary. R
I had a lumpectomy 5 years ago. Caught early and had radiotherapy but no chemotherapy. I have been on Letrozole for 5 years, horrible aches etc. Could I go on HRT when I finish my 5 year treatment? I am 65. Thank you Dr Renee
Hi Dr Renee, my period stopped over 10 years ago im 51 now. If i go on HRT patches will this start my periods again? I really dont want to start periods again. Ive been getting hot flushes and night sweats. This is why ive been thinking of asking for HRT patches for my GP. Any advice would be much appreciated. Thank you
Hi Renee, thank you for your message. I will speak to GP about this. Will this also help with the severe PMT symptoms I experienced after a few weeks of the tablets?
Debra Cannon well it sounds like that is a reaction to the oral HRT,. So hopefully taking it a different way will not have the same reaction. Good luck
Brilliant, I really enjoyed that thank you. I have a question, where is the best place to post it please?
Hi Paula. Thank you. Just post here and happy to answer. R
Thank you. I am 48 and my periods are regular with one heavy day, but short otherwise. I have just had a couple of small endometriosis lumps removed from my navel. None was found in or around my womb, etc... I am about to visit my doctor to discuss being put on progesterone only pill, recommended by the consultant to stop the return of the endo. What I am wondering is the link between oestrogen and endo and my upcoming menopause. Shall I just stick to the POP for now until my menopause starts....will I notice if I am on POP? Should I just start the HRT? Also, just to add to the mix, I have a very low libido, which has slowly gotten worse over the past 10 years or so. I feel hot all the time, but not flashes, I wake up hot in bed, but not drenched. Thanks for your support.
Paula T-L Hi Paula. You sound perimenopausal. Oestrogen encourages endometrial tissue to grow. Having said that we use combined oestrogen/progesterone pills to treat endometriosis. The oestrogen in HRT could help the symptoms you describe and combined with progesterone (preferably utrogestan) could be enough to control the endo. You could, with your Gynae's consent, consider continuous progesterone which would stop bleeding. But then would need US every 6 months to check the uterus lining. Re the libido. This often is restored by HRT but if not Gynae can prescribe testosterone. Hope this helps.
Hi Dr Renee, I am 47 and have not had a period for 5 years and I've not had any menopausal symptoms. My GP has told me that I am now post-menopausal. I have suffered with aches and pains as well as a few other symptoms for a number of years and have been told that I am on the lupus spectrum but I do not take any medication for it as I only have flare ups once or twice a year. But due to a recent bout being worse then usual my GP thinks it may be due to menopause and has prescribed Kliovance. I am worried about taking it because I dont want to suffer side affects that are worse then the aches and pains and if I have never had menopausal symptoms will taking Kliovance cause me to have some. I would be so grateful if you could give me your views? Also, I have had a dexa scan which shows my bones are thinning and also my sex drive has gone and I would like it back. I've never taken the contraceptive pill and have only ever used natural remedies all of my life for anything. Any advice would be of help please.
Hey. Sorry you are feeling bad. The symptoms are possibly menopausal and the bone thinning will continue without HRT. There is often a settling in period of up to three months but with your lupus I would go for a continuous patch or gel plus utrogestan. It’s safer and body identical. Hope that helps.
Dr Renee, thanks so much for your reply, and so quickly too! Just one other question if you don't mind answering is whether I actually need to take HRT at all considering I have no symptoms at all? Do you suggest taking it only because of the risk of osteoporosis? Thank you.
Hi doctor Renee I am 75 and have been off HRT for years after my complete hysterectomy the doctor took me off because of all the bad press I miss it so much all of a sudden I am having burning in my vaginitis it dose’t feel like a UTI is it to late for me to be on HRT could the burning be from dryness
Mary jo Waszkiewicz Hi Mary. This is likely to be from vaginal atrophy. The good news is that it’s pretty simple to treat with no age restriction. Your GP can prescribe a vaginally oestrogen in the form of a cream. There is no systematic absorption so no age barrier. It works really well. Good luck.
Dr Renee thank you so much for getting back to me , I have a appointment Tuesday the 30th I couldn’t get into a doctor so I hope her assistant can tell if this is my problem . I love your videos so informative glad I found you 😊
Mary jo Waszkiewicz it’s a pleasure. Thanks fir your support. Good luck with the GP.
hi watching your video help so much i felt like i was alone and going crazy. i had surgical menopaused my estrogen drop to 14 i felt awful, dr put me on tropical estrogen which has help i was using one pump on arm low dose, it went up to 24 after using for over a year the dr just up it to pump in half , i was so scared to use hrt but after watching your video and seeing how the risk are higher not using it , iam 48 now is there any supplements i should also take to help thank you so much sharing
Hi are the oestrogen patches and progesterone tablets body identical ? I'm waiting for coil to be fitted , been on patches two weeks still getting a couple of flushes I'm on 50 mg patches should I go up to 75 mg ?
Hi. Yes the patches plus utrogestan capsules are body identical. I can't advise you on your individual dose as I don't now you history etc. I do usually advise patients to give it a little longer however and see how it goes over 3 months.
I had evoril Conte patches but they don't work could I cut a patch in half so I have one and a half patches on or is that not a good idea !
Debbie Taylor You can definitely do that and safe. The only problem you will have is that Everol are out of manufacture at the moment. The easy alternative is gel and utrogestan capsules
Hello Dr Renee,
Can you go back on HRT after a couple of months off it. I was on it a year but was so worried about the risks, you explained things so nicely that has put me back thinking should I go back on it again, I bought black cohosh and glucosamine sulphate for my aches and pains, but they are not working yet, I'm an emotional wreck at the moment. So could I go back to the chemist and ask for a repeat prescription.
Hi Joy. Yes of course. You may get some erratic bleeding in the first 3-6 months but yes it is possible to restart. Good luck.
@@DrRenee thank you for replying
Dr renne I have slightly raised iron levels 155 ug/L is this anything to do with being post menopausal ?
Hi. No menopause does not affect iron levels. Your GP should be exploring the cause for this.
Dr Renée can you get flu symptoms from menopause hot cold flushes, clammy sometimes lasts all day every day and you think you have a virus , anxiety through the roof too ?
All of those thing can be menopausal symptoms, and coupled with the anxiety it sounds quite likely.
Thanks I can't function with the flu like symptoms that carry on constantly all day every day sometimes it feels like a virus . I'm having the mirena coil fitted Monday with a oestrogen patch because tablets and patches don't work ,I'm on my seventh year now and it isn't getting any better 😓
Debbie Taylor This is a common theme I’m afraid. But usually sorted quickly and smoothly with oestrogen. I would add the gel to the mirena.
@@DrRenee went to have my coil fitted and my cervix is very narrow or something , I had a hysteroscopy once and they had a job to get in there , it was very painful so now I have to wait for a hospital appointment to get it fitted 😓
Debbie Taylor Ah sorry to hear that Debbie. This does happen to some women but should be fine under sedation.
Hi Dr Renee,The gynae department has written to my GP at long last saying that I can have HRT transdermally. I'm going to request the gel as per your recommendation but just needed to clarify a paragraph from your previous answer.
"The endometrium needs to be protected and this is best done with Mirena coil or utrogestran either daily 100mg (if not bleed required) or as per BNF if bleed required. Using oestrogel pump for this, dose can be titrated from 2-4 pumps depending on results"
I have not had a period for 4 years and have intact ovaries and womb. Can you please explain what you mean by bleed required or not required please? Many thanks, Debra
Debra Cannon Hi Debra. That's good news. So essentially, if your last period was more than a year ago, you don't need to have them anymore. So you either have a Mirena coil(ideal way) or you need utrogestran as a tablet 100mg every day. If your last period was under a year ago then you will need to carry on having periods for a year, unless you go for the Mirena coil and then you likely won't bleed at all and don't need to. Hope that helps. It's complicated. R
Thank you, great info.
Thank you for your reply. I did understand that testosterone gel and oestrogen gel are two different things but I didn't word it clearly, sorry about that. The reason that I wanted the testosterone is because many users have said that it increased their energy levels and lifted their mood which HRT on its own had not done. Is a menopause clinic different to being referred to gynae dept because when I was referred to gynae at the hospital they just told me that I should be on HRT. When I asked about the different types and what would be best they told me to research HRT on the internet and then discuss it with my GP.
Debra Cannon Hi. Testosterone is only for libido. HRT should address the rest of the issues if the correct type and dose. It can only be started under Gynae guidance. All Gynae departments should have specialist menopause clinics and they should do the prescribing of your HRT regimen initially and your GP can then carry on. I have never heard of a Gynae clinic telling the patient to do the research. I suggest you get referred back and his time say "No, I need you to prescribe please". Good luck.
Can I ask if you recommend laser treatment for perennial tears that are really sore ,I'm using topical estrogen cream ,this has helped, but not completely
What a great question. So yes. I have had it. Perhaps I will do a vlog on it. You will still need to be really religious about using oestrogen cream and vaginal moisturisers like Yes OB but the laser made a big difference.
Hi Helen. I have two other VLOG's specifically addressing this. Try these
ruclips.net/video/EtzNoN_33-w/видео.htmlsi=rWB0yg9_WycpSmOq
ruclips.net/video/5oi4wVewMjQ/видео.htmlsi=ERdnKfWOUD6tB7oe
Hope they help and good luck. x
@@DrRenee thankyou x
Which one can causes blood clots the estrogen or progesterone? Ty so much
Oestrogen but only if you take it as a tablet. It does not if taken through the skin.
Hi I've been taking the progesterone tablets all through the month without a break , is it normal to have tender breasts , it almost feels like being pre menstrual ?
Thank You
Hi Renee, if I do change to gel and oral progesterone could you tell me what the dosages should be? Just to recap I'm 48 and 4 years without period, womb intact. Also, at the moment I am trialling Femoston 1/5 conti. Is this enough oestrogen and should I be including testosterone to help with tiredness? If so, will GP prescribe it? Many thanks Renee.
Debra Cannon Hi. You need to do this with your GP. There are standard doses and you can then work up if needed to control symptoms. If they are unsure re the utrogestran they can look up the regimen in their BNF. Good luck. R
Can a 44 years old woman who still has periods get pregnant ?
Yep. Its certainly more difficult.
Hi Dr. Renee, just wanted to ask your opinion on Utrogestan taken vaginally to lessen side effects? Many thanks
Debra Cannon Hi. Not normal practice. Evidence is for oral tablets not transdermal progesterone for breast cancer risk.You would also likely find side effects from using them long term. Vaginal irritation/thrush. Also need to consider partner absorption. R
Are you saying that if starting HRT over 50 you should bleed for a year by taking sequential then switching to continuous?
No. That any woman if any age does not need to bleed again once they have been without a period for 12 months.
@@DrRenee thank you.
@@DrRenee I have spoken to my GP today about changing Utrogestan to continuous and she didn’t seem to know a great deal about taking it continuously, I told her what I knew that I’d picked up from your vlogs. I’m currently only 8 days in and would like to take it continuously instead of sequential as I haven’t had a period for at least 7 years, she had to call me back after she’d looked it up. She said she read that Utrogestan can be taken everyday for 25 days with 3 days free to bleed. She said she can’t advise me to take one daily as it didn’t state that in the ‘medical bible’. She basically admitted that I seemed to know more than she did. I feel more confused than ever now on whether I can start taking the Utrogestan daily from today or if I have to wait until the end of this cycle and have a bleed. Your work is amazing and GP’s need to be educated more on menopause and HRT.
Thank you so much.
Essentially any woman could go to 100mg every day at any point in the cycle and should not take a break at all as per the women’s health forum prescribing guide.
@@DrRenee thank you.
Will the patch with estrogen and progesterone make the period come back. I have not had a period in more then a month. Im having alot of symptoms since my period stopped. Not sleeping, anxiety, hot flashes then chills since my last periond in early June 2020. Please help.
Ps. Im 52
Yes it is possible that your periods will commence again on a sequential patch.
Hi Dr Renee, I'm abit confused. I'm 48 and having peri symptoms plus heavy close together vwry painful periods (leg pain), fibroids. My gp won't test me for menopause but just told me to have a mirena coil (i don't like the idea). What shall i do? Do i need both oestrogen & progesterone? Thanks
hln1969 you don’t need blood tests because of your age. If you are having symptoms then you can be treated for those symptoms with HRT; that’s the NICE guidelines. The mirena coil will help your bleeding but not your peri menopause symptoms but it is easy to add. Oestrogen for this and I use oestrogel which you rub in once a day. I would go back to your GP and show them this!
@@DrRenee thank you so much for replying. I have an appointment booked mid April (best i could do) so i will mention this 🙂
@@DrRenee sorry, should i ask for the mirena for the pain, heavy periods and fibroids? I just don't like idea of an object inside or is there an alternative? Thanks
It’s personal choice. I have one and it is fab. It’s gold standard treatment for heavy periods but depends how big n what position your fibroids are in terms of if you can have one.
@@DrRenee thank you 🙂
Thank you so much
So I would just take the utrogesteran continuously with no break, the same as the estrogel?
Debra Cannon As long as you are over 50 and no period in the last year, or under 50 its 2 years.
Hi Dr I am am 57 and about to start the oestrogel and utrogestan pills. To reduce any side effects i might get from the progestetone can i administer the 2 100mg pills into my vagina or just 1x100mg pill. Thanks Also do I use the gel everyday or have a break I understand the utrogesten starts on day 15 for 12 to 14 days. Csn you clarify Thankyou
I can't advise you individually, your GP must do tnhis with knowledge of your history. Generally, the pills can be used vaginally at the same dose as orally but this is off license. In terms of the gel, this is used daily without a break.
My Dr won't give me HRT till I am 50 she says. 3 years away. She says I got to be thinner , never smoke etc. And prove that I cannot cope. 3 more years of the anxiety & depression , great !!! I'll probably top myself before then. 2 best friends f mine have recently watlz in to their doctors and have been given HRT no problem. They are both thinner than me but are still have chronic symptoms - so it's a myth that the fatter you are , the worse peri is worth. One of them is a gym freak and she is still having massive problems so fitness does not make a difference.
sallyanne scarbrow hi. I’m sorry to hear this. I would see a different doctor or see her with a copy of the NICE guidelines 2015. There is no weight contraindication to HRT, or smoking. If you have symptoms then you can start at any age as long as no real risks; uncontrolled high blood pressure or existing heart disease for example. Hope that helps.
Dr Renee .Thank you for your reply !! Since march I have been taking one 2.5mg blood pressure tablet per day as it was an average of 150 at the time . I have been attending gym since then and lost nearly a stone and BP for example today was 110 / 95 after so I assume things are better with the combination of the two. I already take the mini pill to help with peri symptoms but I reckon I only felt better for about 6 months. Do I need to give it time like my doctor has said - they make me feel like I am a nuisance.
sallyanne scarbrow sonthe answer firstly is WELL DONE! You have done the hard work. There is no age reason for not having HrT. The NICE guidelines say that over 45 treat to symptoms. I would see her again and point her towards the guidelines or see a different doctor.
Thank you Dr Renee xxx
Does this interfere with psych meds?
Kat G No.
It is Very Nice
Thank you. I need B and C vitamins.
Dr Renee is tinnitus normal?
Najia1977 Hi. Do you mean in menopause?
Yes
Najia1977 Hi. It isn’t a symptom I see commonly but it is indeed possible. Here is some information www.womensinternational.com/what-does-tinnitus-have-to-do-with-hormones/
My doctor said no
See a new doctor or insist on a referral to menopause clinic.
Hi Dr Renee I am 48 years old and up until last June I had the Mirena coil for contraception for around 12 years, the last one in for nearly 7yrs, i got it taken out as i had a bleed and an infection where upon i decided to not get another put in, i had a tiny bleed 5 weeks after that but nothing since and menopause symptoms have really kicked in and gotten horrible since getting coil out .. i was started on evorel conti patches last week.. is this the right hrt for me please.. thank you xx
Evorel conti are a good combination patch. Hope its working.
Thanks for your video. It was informative. I would have liked it if you could have talked more about Progesterone. And how to take it, and what to expect.
My question is, I'm worried if the utrogestan is working or not. Am i meant to get a slight bleed after the 11-12 days being on utrogestan? It's been 2 weeks since i stopped taking it for the month, and i never got a bleed. Should i be worried? Not getting a bleed after the first month of taking progesterone is that normal, does it take longer from taking progesterone in order to get a bleed? Or should i had gotten a bleed by now? Is not having a bleed after taking progesterone a sign that i wasn't putting the oral progesterone up far enough into the vagina, as i have a long vagina. I was told try put it up near the far end of the vagina. but having a long vagina, i'm not sure i'm putting it up far enough.
Becky M Hi. If you go through the videos I have done one on progesterone. Not everyone gets a bleed but you must be taking 200mg for 12 days. The length of your vagina is not important; just get them as high as possible.
@@DrRenee Thanks for replying. Yes i am taking 200mg for 12 days. Doesn't womb lining need to shed after taking progesterone? Which means a period? So you don't get a build up of too much oestrogen and increase risk of getting anything you don't want?!
I'll watch your video on progesterone about contraception, i didn't know you talked about hrt for progesterone on the video too. So thanks for recommending i watch it.
I have a video on progesterone in HRT and one on contraception and HRT. You may find as you go on with your HrT that you have small bleeds. The progesterone can suppress the lining enough that bleeding is very light and some months absent. It could indicate that continuous would work for you.