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[SunnyB]

Evening.. I am hoping someone may be able to help.. I had an appointment with my GP today to discuss/get started on HRT. I was in the consultation room for less than 10 minutes. My GP (female) basically told me what she was prescribing for me, no discussion, I tried to ask questions, but she rattled on.. She prescribed me Oestrogel and Utrogestan. She told me to use 3 pumps of Oestrogel because 2 probably won't be enough to start on seeing as I am stopping the combined pill and moving onto HRT.. I'm to use the Oestrogel each day for 2 weeks, and then add in the Utrogestan for 2 weeks and continue in this way.
She then made the prescription out for 2 to 3 pumps of the Oestrogel, plus the Utogestan?? And that was it, I was sent away with the prescription.. So now i'm feeling a bit confused as to whether I'm meant to use 2 or 3 pumps of Oestrogel? I did try to get in touch with my GP later in the day to no avail and was told I will need to make another appointment due to the sensitive nature of my query.
Unsure what to do now? Can anyone help?

[Minnie Mouse]

Hi, no-one knows how your body will react so they often prescribe 2-3 or 3-4 etc.
I personally would start lower, give it time, and slowly increase.
You can do alternate days (2 then 3 then 2) rather than jump straight from 2 a day to 3 a day.
Hope that makes sense!

[Penguin]

I would also start lower. I started on 1 pump. My prescription says 1-4 pumps so  I think they give the range to be flexible until you work out what your body needs - only you will know that. But increase slowly if you want to avoid side effects. The utrogestan is the standard accompaniment and, if you don't get on with oral, you can use the same capsules vaginally.

[Dotty]

I would start with 2 pumps every day and see how you go. It’s not wise to alternate the dosage ( 2 one day and 3 the next ) as this gives fluctuations in levels.

[CLKD]

Hi we can help!   I would start with 1 pump for 5 nights then move to 2 depending on how you feel.  Don't expect instant results ;-).  Also, if you feel that you haven't been listened to then ask for a referral to a dedicated menopause clinic, there are waiting lists both in the Private Sector and NHS.

U may however find that the GP has given you what your body requires.  Some find that keeping a mood/food/symptom diary of use.  Let us know how you get on.

[Hollyboll]

Sorry you had rubbish appt.
As others have said, start low and give it time before increasing. Takes a bit of time to settle / know about a dose, and too much can cause as many issues as too little.

Good luck x

[Minnie Mouse]

I would start with 2 pumps every day and see how you go. It’s not wise to alternate the dosage ( 2 one day and 3 the next ) as this gives fluctuations in levels.

This alternating strategy was what my very expensive private meno GP suggested !
It's a bit of a 'try & see' for everyone... I wish more was known about this.
Diary is a very good idea to track how you feel, good luck!

[Hollyboll]

I was also going to say alternating sounds risky. Fluctuations are as much of the problem as levels, as I’ve learned to my cost.

Unfortunately cost of specialist doesn’t mean they are gospel. The BmS had to put out a statement, plus plenty press coverage, because of risks from some of most expensive over-prescribing.

I’ve learned all this the hard way, there’s so much contradictory advice out there, and of course different things work for different people (and at different times).

I’ve seen very expensive pvt specialists, the second of whom contradicted the first.

As others have suggested, start low, build slowly (weeks not days once you get higher) and personally I’d avoid alternating. I’ve not done gel but some people split am and pm which may also help keep it steady.

Good luck! X

[Penguin]

I'd also agree that alternating days is risky. My understanding is that it's that the fluctuations that cause the most problems in terms of symptoms. In peri, hormones are wildly fluctuating anyway, it isn't just a stable gradual drop of estrogen. My testing has shown a normal first half of cycle, but massive spikes and dips from ovulation onwards. It explained how dreadful I was feeling in the second half of cycle. Raising and lowering estrogel on a daily basis would only have made this worse.

That said, I am very sensitive to any dose changes. First time I tried hrt, I was persuaded to go straight to 2 pumps and it was too much for me. Months later I tried again with 1 pump and it was a much easier transition. I'd personally start with 1 pump as CLKD suggests, give it at least a week or two, and then go up to 2. No way would I start on a high dose straight away, it sent me loopy.

[CLKD]

How much are the manufacturers to blame for driving a high start-up regime? 

Your body didn't get where it is suddenly so it stands to reason that take-up may be slow as hormone levels adjust.  Little steps 

[Violetta808]

Hi SunnyB. What a pity your GP couldn’t take a little time to explain HRT types and dosing in more detail.

I’d definitely start on the lower dose of oestrogel and see how you feel after a couple of weeks, and increase if you need to.

Also, it’s possible to dispense half a pump which gives more consistency than alternating 2/3 pumps on different days, and you don’t have to remember how many pumps you’ve done, day to day.

Someone here said she dispenses one pump onto thigh/upper arm in a straight line then uses that as a guide to measure half a pump.

[Mary G]

Another rubbish GP in fact the second one I've posted on today.  No wonder it's so difficult for people to get appointments with GPs if they are as disorganised as that.  It would have taken a minute or two of her time to speak to you on the phone but instead she wants to use up a valuable appointment.

Just use her to get the medication you need and do your own thing.  She is obviously not well equipped to give you any advice so I would follow the advice from here and start with one pump and then work up to two or three if needed.

[SunnyB]

Thanks for your help and sharing your experiences ladies, much appreciated.. I think i'll start with 2 pumps and see how things go.. like you say, its trial and error. I'll give it time and see what effects 2 pumps has. Thanks again!