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[Livluvlaf]

Hi, I just wondered if anybody has an idea as to what would be the most gentlest HRT? I’m struggling with the gel and would like to return to patches perhaps? I don’t think I need a high dose but just want to combat hot flushes and fatigue.  What strength would also be of benefit? Currently on 1 or 2 pumps of gel with progesterone taken daily.

[Dotty]

You could use an oestrogen only patch with Utrigestan.  Patches come in 25, 50, 75, 100.

[Livluvlaf]

Do you think 25 would be effective?

[Dotty]

Everyone’s different so you need enough to stop the flushes. Did one pump of gel work to stop flushes ?

[Livluvlaf]

Not always…sometimes I felt fine on 1 which I applied in the morning but on other days I needed an extra pump in the evening.  I’m not sure ur supposed to do that?  I found 2 pumps daily doesn’t make me feel great so want to change back to patches but don’t think I need a high dose anymore.

[Snowcat]

Hi Livluvlaf.  When I checked that out, it says that 2 pumps of Estragel is the same as a 50mg patch if that helps although you’d need to make sure. 

[Livluvlaf]

Thanks Dotty and Snowcat for your responses.  I will see if I can change to a 25 patch and continue with the progesterone. Has anyone had much success with overcoming fatigue on the 25 patch? Iv found my moods are back to normal and my brain fog has gone so really the fatigue is my main issue followed closely by the flushes. I found the flushes came and went with one pump of gel hence why I used 2 on some days.

[bombsh3ll]

It really depends what your individual treatment objectives are, ie symptom palliation, long term health, prevention of osteoporosis etc.

In terms of what is the most gentle, I would say the dose and route that achieves your goals with no negative effects. The lowest EFFECTIVE dose, as mentioned in treatment guidelines, is a good way of putting it I think.

Certainly undertreatment for someone who is symptomatic can be brutal, so I wouldn't necessarily think of the lowest available dose as being the most gentle.

Patches are probably a good choice if you are thinking about maintaining a relatively stable estradiol level 24/7 rather than swinging up and down on gel.

In terms of lifestyle, I personally feel that oral tablets are the least intrusive and time consuming, the most affordable for those who have to self fund treatment, and produce the least packaging waste so for me I could say this is the most gentle option.

[Livluvlaf]

Hi bombsh3ll, iv never been offered tablets and have tried different types of hrt for quite a few years.  I feel that im now coming out the other side of my menopause journey and am feeling so much better then i did years ago thankfully but really just can’t shift this stubborn fatigue and flushes.  Sometimes not even motivated to do much apart from work as just too tired. Bones are good (had a scan) uterine lining thin (although iv not always taken progesterone as directed ) so think I need just a little help rather than a big dose of hormones that might set me back.

[sheila99]

There are many causes of fatigue. It might be worth having tests to rule out the more obvious ones if you haven't already? Thyroid, b12 etc

[bombsh3ll]

Also don't forget about androgens - female testosterone levels decline progressively from our 20s and I would always think about testosterone when the prominent symptom is fatigue, low energy and motivation. (NHS only recognises it for libido despite most tissues in our body including the brain being androgen sensitive)

Like Sheila said this is assuming other reversible causes have been excluded.

[Livluvlaf]

Iv had bloods done many times and all is ok and testosterone was offered in the meno clinic many years ago but I declined thinking I might develop a deep voice and grow a beard 😱🤣 since reading up on it later down the line I asked for it but they wouldn’t give it to me.  All of this is getting me down iv noticed my hair is coming out probably due to all the messing around I’m doing with these hormones.  My gp tried me on norhisterone a few months back as that was supposed to lessen the effects of tiredness caused by progesterone. I think that was the initial trigger but I caught my self in a mirror when I was out and I can see my scalp! I was horrified  and now i don’t know wat to do!

[bombsh3ll]

I can't help with hair loss as I've had alopecia since my teens but I do certainly notice my friends' hair getting thin and straggly around menopause.

Most of them are now also going grey or having to keep dyeing their hair, so I'm super thankful that both my hair and my hormones come in a box!

If you are taking the progesterone orally you might be better switching to vaginal as that bypasses the conversion into sedating metabolites.

Unfortunately female androgen replacement has become a lot more stigmatized and vilified than it used to be several years ago, probably because women are more informed and having the audacity to ask for it, which means it is something most have to self fund, but it is still worth trying if possible.