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[LAVENDER FIELDS]

Hello everyone, I have come to this site many times over the years and it has been helpful and comforting to read other people’s experiences.
I went through menopause at 45, I am now 57. I had many symptoms, the worst being severe anxiety. I have been taking continuous HRT since 2017. I was referred to an NHS meno clinic who initially prescribed 1 mg Sandrena transdermal gel rising to 1.5mg, plus 100mg Utrogestan orally. (Later, in November 2018, I was also prescribed Sertraline by the meno clinic to help with anxiety. I greatly improved on this combination.)
Unfortunately I experienced breakthrough bleeding and a scan in 2017 showed a thickened endometrial lining and I had a hysteroscopy in Jan 2018. The biopsy showed no pathology.
After this I had a Mirena coil fitted. This gave me constant BV and I struggled with bouts of debilitating fatigue for the 5 years it was in place (Oct 2018 to Oct 2023).
When the coil was removed I took 1mg oestradiol gel and 100mg oral Utrogestan. Breakthrough bleeding persisted and another scan showed a thickened endometrial lining - up to 9.6 mm plus multiple fibroids. I had another hysteroscopy in June 2024. Biopsy was clear.
Prior to the coil I tried doubling my Utrogestan dose both orally and vaginally. I could not tolerate the increase in progesterone by either method and had to reduce back to 100mg.
More recently I have tried Evorel Conti patches which didn’t work for me i.e. 3 months of dreadful symptoms plus breakthrough bleeding.
After that I tried Norethisterone but had to stop after 4 days as I felt so unwell. I now have another progestin to try (Medroxyprogesterone) but I am still getting over the side effects of Norethisterone which I stopped over a week ago - I feel my body and head need a break.
Any suggestions for a way forwards please? I feel like I am running out of options. I am due another scan and I believe this will lead to yet another hysteroscopy. Aside from having a hysterectomy, are there any other HRT regimes I can try? Is there a Studd regime for women with similar issues? Thank you. 🙏

[bombsh3ll]

Either desogestrel 150mcg daily or Slynd are kinder to take and more metabolically favourable than provera.

Both of these are off label for endometrial protection but supported by the BMS based on evidence.

A hysterectomy is also a valid option for women in your situation.

[LAVENDER FIELDS]

Thank you for your response Bombshell. I asked my GP to prescribe me Slynd and I sent her the info from the BMS. My GP refuses to prescribe me anything off label. I will ask the menopause clinic but they are reluctant to prescribe to me as they want my GP to do this. It’s really frustrating.

[LAVENDER FIELDS]

How can I get a prescription to try Slynd if my GP won’t prescribe to me? What are my options?

[bombsh3ll]

There are a ton of private online gynaecologist/menopause clinics. I would phone and ask if they prescribe it first before making an appointment.

Also search Google, YouTube tiktok etc to see if you can find any UK doctor talking about it and make an appointment with them.

You could also get a younger relative or friend to buy it for you if they say it's for contraception. It is available from online pharmacies to under 55s.

[Natalie1969]

Hi everyone looking advice been hrt years on oestrogel doctor says three pumps used two one 100 mg utrogestan nightly been using vaginally instead of orally got anhodenia no interest in anything very low self esteem bad anxiety and social anxiety been on fluoxetine months now 20 mg mood wise worse and anxiety brain fog any help appreciated don’t know if utrogestan or fluoxetine doctor said up oestrogel to three pumps stay on fluoxetine I wanted try lower fluoxetine or could be utrogestan

[bombsh3ll]

I agree with your GP it is worth increasing the estrogen.

My personal feeling is that it is better to optimise hormones before considering antidepressants, however you can always (gradually) withdraw the fluoxetine if it doesn't appear to be helping.

Some women do experience a deterioration in mental health on progesterone - this can be assessed by considering whether there was a temporal relationship between starting progesterone and the onset of mood symptoms.

You could also have a short trial without the progesterone eg 4 weeks to see if things get better - this may result in withdrawal bleeding and is not a long term solution but could be very informative.

If it does turn out to be the micronised progesterone, there are alternative options.

Finally what about testosterone? This can often be really helpful for psychological symptoms such as you describe, however you would have to say it was for libido to get it prescribed on the NHS.