Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: joziel on May 12, 2025, 01:56:14 PM
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Can anyone comment on this, in terms of what they experience with their GP?
I have to request my HRT monthly because my GP won't prescribe for any longer than a month at a time.
Due to the Estradot shortage, I've been calling up Pharmacy2U each month to find out what they have in stock (dosages of Estrodots) and then putting through my request via my GP for what they have. This has been working well, until this month...
This month Pharmacy2U said they had 37.5s in stock, so I called up and left a message with my GP to that end. However, after the prescription went through to them (4 days) it turned out that they didn't really have any and it bounced back to me with a code I could use in any other pharmacy. Except of course no one has any... So I called them up again and they said that they seemed to have some again, so I put the prescription through again... waited 4 days.. and again it came back to me with a code.
By this point I am getting desperate and running a bit short, so I decide it's come time to accept defeat and move to Evorel. Who knows if I can absorb it...
So on Weds I call up my GP to request this switch to Evorel and leave a message via receptionist. Nothing happens. I call on Friday morning again, to be told that it's on the list of things for the doctor to prescribe and do that day. Nothing happens again. So, this morning (Monday) I call AGAIN and tell them I have ONE patch change left and them I am out of HRT - and am told that for sure the receptionist will make sure the doctor looks at it today. So far (3pm) I've heard nothing.
So at this I decide I'm going to have to buy a couple of boxes of Evorel via Newson Health, because that was my back-up plan. I was told when I called them a few months ago that I needed to have another appointment by 8th August to stay registered with them. Only they tell me on the phone now that this isn't right because I only had a phone appointment then and that doesn't count because it's not a full review. But I can have a go and put a request through and try to explain that. Only it will take 3-5 days for them to even look at it.
Finally I desperately google online pharmacies and find treated dot com, where I attempt to order a box of Evorel. It looks like this might have worked as it's been approved although not shipped yet. But 1 box will last me 2 weeks at the dose I use. Hopefully that will buy me time to pursue my GP.
I have lost count of how many hours of time I've spent on hold, calling and emailing in all this. I don't even know if I can absorb Evorel (I can't absorb Sandrena and I am already on the max dose I can absorb of Oestrogel at 6 pumps). If I run out, I am basically going to be shaking through the night on zero sleep and totally dysfunctional.
Why is HRT treated like some kind of lifestyle choice? Would people be treated like this if this were any other medication? It just isn't acceptable.
Rant over. Is anyone else going through this ridiculous effort to get what they need?
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It's horrible having to go through that.
I actually think some of it is deliberate on the part of the NHS rather than just benign bungling and inefficiency. I suspect it is motivated by the idea that making access to ongoing hormone therapy so insecure, stressful and time consuming, you will either give up taking it or get private prescriptions.
Unfortunately this tactic is frequently successful, particularly amongst those who can't afford private care. I know several women myself who have given up hormone therapy because of how difficult it was to access a timely and adequate supply from their GP.
Most people simply don't have the time, money, energy or self-advocacy skills to constantly battle for their treatment.
It must be particularly challenging when you are on high dose transdermal. I wish I had a solution.
I know it is controversial but I personally believe systemic hormone treatment should be available without prescription, because far more harm is done on a large scale by women not having access to treatment, either at all or consistently, than would ever result from people being able to just buy it.
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Also it depends on the manufacturer, if the NHS won't buy it the products become 'out of stock'. This happens across much of the system.
[I ordered my omeprazole on Wednesday and have now run out - when I went to collect this morning, I was told that I can't have anymore until start of June]!
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My mum is struggling to obtain Premarin ( I know it’s not a common type given how it’s sourced, but it works for her).
She’s tried many pharmacies, large and small, within a huge radius. No idea when or if it will be back in stock. It’s dreadful.
Another bloody example of how women are made to struggle. Agree with bomb, most just don’t have the time or will power to keep on top of it. I bet if our prime minister were a woman, it would soon be obtainable! 🙄
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I think sadly cost may have a bearing too. Apparently the cost of Estradot patches has gone up quite a lot and patches like EstradermMX are considerably cheaper. I know there is a shortage of Estradot again but is that because the NHS won't pay the price for them as my niece in Spain can still get them? I don't know if this is the case or not but I do wonder :( .
joziel I so hope you get your patches ok - what a nightmare ... we women really shouldn't have to be going through this stress and worry every time there is yet another shortage :(
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Hi Pippa - Thx for your kind offer BTW :)
Today's update is that the treated dot com pack of Evorel 100 has dispatched and should be with me tomorrow... at the cost of £33. Which will last me 2 weeks.
Having not heard from my GP today or had the email from Pharmacy2U I usually get when they receive the prescription, I called yet AGAIN just now (end of day Monday). The receptionist said the doctor had done it.... then she said... no, she hasn't.... and she would speak to her and make sure she does it today. Even when Pharmacy2U get it, it is about 3 days before it's dispatched and then a day to get here, excluding weekends.
Honestly, FFS.... :(
Maybe slightly complicating things is that I also put through a request for the 37.5 Estradots using the code I'd been given last week, in an attempt to get something... arrrgggg....... I'm finding it really hard to concentrate on any work :(
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joziel - poor you this is so unfair and wrong having to do through this! I am so glad it sounds like you have some Evorel in the pipeline. I used treated.com once too in desperation and they seemed very good. Hope so much your GP pulls her finger out and gets that prescription done for you. No worries re the offer - still stands of course but sounds like you are sorted with Evorel - fingers tightly crossed for you that they work well for you x
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In all honesty I don't think this is purely an HRT issue. The NHS will stop buying items if they think they're too expensive, and will source cheaper equivalent alternatives. (I think many of us are aware that a lot of meds are definitely not interchangeable.)
Not very helpful at the moment joziel but in future, don't wait the full 28 days between requesting a prescription from your GP. Request a repeat at 26 days or earlier if you can get away with it. Also make good use of bank holidays and your own holidays to your advantage. Order earlier rather than later. If you can get away with doing this for a while, you'll build up a stockpile which takes the stress out of reordering should there be problems in the future.
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I find the whole process of dealing with my surgery, for ANYTHING, totally stressful. It appears that they make it incredibly difficult for patients even with a simple interaction. It is like a really long bad tortuous game of ping pong. So inefficient in so many ways - nothing appears joined up. I have so many examples I don't know where to start. All I would say is that I feel your pain Joziel. Fortunately we have a brilliant village pharmacy which fulfills prescriptions very quickly and bends over backwards to help out but even they struggle with supply issues at times.
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SundayGirl, I already do that - it's why I have lots of the gel and utrogestan. But I use 300mcg of patches instead of 200mcg (my prescription) by requesting a week earlier each month. And it's taken literally 3 weeks for all this palaver, because each time I request it from Pharmacy2U it takes 4 days for them to then reject the prescription as they don't have enough Estradots.
Anyways I just heard now that they have my prescription for patches and gel and utrogestan (phew) so hopefully will be dispatched v soon, and the Treated dot com box I bought should arrive tomorrow. And I guess I will cancel the Newson order form I just put through today...
I just hope I can absorb Evorel okay... :-\
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I get 6 months supply at a time of patches. A month isn't enough. Did they say why?
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Wow, you're lucky Pixie. It's standard procedure at my GP for all meds to just give them a month at a time. Apparently it's to avoid people stockpiling them. Although frankly it encourages you to stockpile because you always feel like you're about to run out so you order it a bit earlier each month and still end up with extra...
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so glad your patches are in the pipeline joziel :)
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I can get my morphine patches a week early with no explanation, but when I order Estradot off my list of repeat prescriptions, even two days early, it is refused every single time.
Estradot contains an OTC medicine, Boots sell it as Gina, yet it is so tightly controlled it's stupid. One time my prescription was issued but wasn't at the desk, they found it two weeks later down the back of a box, during those two weeks I was talked down to and disbelieved, they thought I must have picked it up, so no, I wasn't getting another straight away.
It was the same when I had oestrogel, I had to run out before I'd be issued a new script, then it can take days to find it, so it makes it necessary for us to tell lies just to get a constant supply of an essential medicine.
My doctor already told me women couldn't be trusted to take the progesterone if it's in a separate med, it took over a year of fighting to get oestrogel and utrogestan.
I can get my morphine patches and gabapentin (also controlled) with far less hassle and early if I want.
It seems misogyny is stronger than the laws concerning the control of medicines. I know when I want cocodamol or tramadol I'm refused, my husband has always been able to get them while I can't have anything ever unless a specialist advises my GP to prescribe it.
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Geeze, that's awful flo. I agree, misogeny has a lot to answer for. Even it seems from female doctors.
Anyway, weirdly I randomly got 2 boxes of Estradot 37.5s turning up - along with the Evorel this month ???
I now have the Evorels on, as of this morning. They are huge. With 3 of them on, I feel like I crinkle every time I bend over and it's quite distracting. I have them on my lower stomach...
Next week I'm going to test on day 3 of my cycle to see how much I'm absorbing from them. I'll be switching back to Estradots as soon as they are in stock properly again. Although it sounds like that might be the start of next year at this rate.
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Well, this is all becoming a poop show. Put the Evorels on yesterday morning. They seemed to stick well. They were ginormous and very crinkly, having 3 of the huge things on.
But last night I literally slept NOT A SINGLE MINUTE. Not even light sleep. I had the weird inner tremors which feel like I'm rocking or something, as well as tingling, and my heart beating hard and fast. I gave up at 5am and got up, took a shower, ripped off the Evorels and put one of my last few changes of Estradots on.
I don't know what I'm going to do now. I've been sobbing over my high protein breakfast. I know it's only 1 night and we should give these things time etc etc, but really these neurological symptoms come back instantly levels drop and they don't get better until levels go up. Been there before.
I had finally begun to get things figured out. I was sleeping 7.5hrs a night. I was getting more deep sleep. (All trackable on the watch.) And now this. I can't increase the gel further, I'm already on 6 pumps and we know I can't absorb more than that. I don't absorb Sandrena (tried that with the same outcome as this).
There is only the Estraderm patch left to try (which notoriously doesn't stick well and I don't hold out much hope for) or I'm going to end up on oral. At least temporarily, until Estradots come back.
I will make an appt on Monday with my Newson Health dr. But she can only prescribe products which are actually available in the UK, so it's not really going to help unless she has a secret supply of Estradots stashed somewhere. I was hoping I could just get by for a few weeks and perhaps there is some slow trickle of them into the UK and now everyone else has been switched off them, perhaps there will be some again....
Why oh why don't we have access to injections in the UK? I don't understand that at all. Perhaps not for everyone as the first line of HRT, but for desperate situations and poor absorbers like me.
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Hi there I am so sorry you must be feeling desperate. I think I have mentioned this before so please don't be annoyed! Is it just possible that actually the opposite happened? That you absorbed way more rather than way less. Some of us do absorb better on Evorel and the symptoms you describe so sound like what happens if you take too much oestrogen. I know in your experience it's the other way round but I think it's worth just flagging it up on the off chance.
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Perhaps use both together? The estradot will last longer and the symptoms should be less as the difference in levels won't be as great. Also worth taping them down. I use tattoo film since I've had to change to estraderm and it makes a big difference. Estraderm is 7cm square and it's impossible to find a patch of skin that doesn't move, the tape stops it lifting at the edges. I find least movement in the skin on my thigh (lower back might be better but I can't tape them on there). Or a trip to Spain? Might be cheaper than Newson and you get a holiday :)
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joziel - have pm'd you but site seems to be playing up either that or out internet is.... so let me know here if you don't get the message xx
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That's a horrible way to be feeling, you know I'm a proponent of oral, I am on an oral estradiol product myself, and I just wanted to say the theoretical risks of taking it orally are neither here nor there vs that level of physical and psychological suffering and I would just get some pills.
The conversation of estradiol to estrone in the body is bidirectional, and simply cannot be more harmful than going without.
Also there is no good evidence that oral estradiol with micronised progesterone results in higher breast cancer risk - oral has historically often been combined with a progestin and any small increase in risk is from that.
It doesn't have to be your forever treatment choice but is a better temporary option than rustling like a human crisp packet each time you move and feeling like 💩.
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Thanks guys. Gnatty, I don't think it's because I'm too high because these are my old symptoms back again from being too low. I did wonder about being too high, because I had some ovary pain in the evening and when I went to bed right under where I'd put the patch - but I now think that was my body trying to make some more estrogen because my levels had dipped. I used to get that back when my levels were low and I'd first gone on HRT.
Sheila I don't really have enough to use long term both together. I didn't have any probs with the Evorel sticking, in fact they stuck better than the Estradots - I am a bit worried about that with the Estraderms from what I've read but will stick them down. I can also experiment with putting them on my butt where I have more fat rather than my stomach in case that helps absorption.
Are they available in Spain then? I thought they were out of stock everywhere. And do you need a prescription in Spain? Anywhere in particular, in Spain, or just anywhere?!
bomb, I'm not worried really for those reasons with oral so much as it isn't possible to test levels if I use oral because of the metabolites so I am just guessing and treating symptoms with dosage. I don't know how that is going to work and if my GP is going to let me increase to the 4-6mg I might need orally (I guess I could buy it privately till Estradots come back) but still feel like I am flying blind without being able to compare levels. ChatGPT says that absorption orally can vary and this isn't good for neurological symptoms such as I have. And I'm already on thyroid meds, including T3 and T4, plus testosterone, so if I take oral estrogen it's going to push my SHBG up and I might not have any free levels of anything available... :-\
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I've just received 3 months worth of Estradot with no delay (yesterday). I'm with a private meno specialist and think they use the same pharmacy as Newson so you might well be able to get some quickly via them. I received them the day after I applied.
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That’s amazing. Whats the pharmacy? Is it CloudRX? That’s who Newson use. I think they might use Smartway as well but they are resourceful and probably will use whatever pharmacy has it.
I’ll be calling them on Monday to book my review ASAP and will fill out the prescription form in the meantime.
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Yes, that's right, Cloud Rx . Fingers crossed for you tomorrow.
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That's great thanks. I've filled out the prescription request form but they told me on the phone last week that it is more than a year since I saw the doctor so they don't know if the doctor will honour this without a follow-up annual appointment with me. I'm a little peed off about this because I had a phone consult in August last year (which resulted in a letter the dr wrote to my GP too) and I was told this was the date my 'year' was up, when I asked in January. If it's now going to delay getting Estradots I won't be happy :( But I'm calling tomorrow to book the annual review anyway...
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I'm still able to get Estradot via Newson, I think it is CloudRX but I'll check later.
I had just started thyroid treatment for overlapping symptoms in January when I couldn't get Estradot via the NHS and I couldn't cope with the idea of cushion at the same time as starting the thyroid med. Luckily my original Newson appointment was still inside 12 months.
Whilst I accept that there is a bigger Estradot shortage from the manufacturer I do think this is also an NHS created issue as they won't post for Estradot and the supplier has other customers who will pay.
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If this were a male hormone issue, the government would be building the Estradot factory - you can be sure of that ;D ;D
I have filed a prescription request via Newson and pleaded to be prescribed some given the misinformation re when my review was due. I've also made an appointment with my Newson doctor but could only get one in 2 weeks time.
The other prob is that I really need Estradot 100s, given the dose I'm on. Because a box of 25s and a box of 100s are almost the same amount. At the moment I am putting on AN ENTIRE BOX of 37.5s at each patch change. I currently have 8x 37.5s stuck on me. And I can't afford that, privately. So if I buy them myself, I really need 100s.
On Weds I will be trying 5x Evorels and sticking some on my bum. This is all ridiculous. Why oh why can't we have injections available in the UK? I don't understand why we are sticking things on ourselves, dealing with absorption, and waiting hours for gel to dry and risking contaminating family members with it - when in the US you can just give yourself a quick shot twice a week and forget about it the rest of the time???? Is there some UK law about giving yourself shots? But diabetics can inject insulin? Why are private UK doctors not offering shots? Does anyone know?
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Flights to the US are cheap... (I wonder why no one wants to go there now ;)). It might just be a licensing issue though I understand they have a different approach to safety. Here you have first to show it's safe before it's licensed, there I think you can use it first and they withdraw it if it's found to be unsafe. What about an implant? You used to be able to get here though I'm not sure if you still can.
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You can still get implants here - I get E2 and T at Chelsea and Westminster (NHS) and they have made all the difference in terms of absorption
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laszla, what is the dosing like with implants? If you get the dose wrong you can't take it out.... How did they start you out? Do you get multiple pellets or just more stuff in one pellet if you need to increase? What happens to the pellet afterwards, does it break down in your body or stay there forever or what? And do you know if they are available privately? I can't now wait months and months for an NHS referral...
I'm fine with T. For some reason I have zero problem absorbing Testogel. In fact, I have to use LESS than the amount recommended for women or my levels go too high. Why the Oestrogel made by the same company I just can't really absorb, I've no idea.
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laszla, what is the dosing like with implants? If you get the dose wrong you can't take it out.... How did they start you out? Do you get multiple pellets or just more stuff in one pellet if you need to increase? What happens to the pellet afterwards, does it break down in your body or stay there forever or what? And do you know if they are available privately? I can't now wait months and months for an NHS referral...
I'm fine with T. For some reason I have zero problem absorbing Testogel. In fact, I have to use LESS than the amount recommended for women or my levels go too high. Why the Oestrogel made by the same company I just can't really absorb, I've no idea.
Joziel the standard pellet dose for oestradiol is 50mg and while in theory this is, I believe, equivalent to 2 pumps of oestrogel (which worried me at first as it seemed too little), in fact they absorb so differently in my case that the two systems aren't really comparable. For the first two pellets (spaced 4-6 months apart) I had the 50mg dose and gradually my plasma levels went up but it was quite slow.
The doctor I work with, once I reached about 800 nmol (which was a tad high for me), suggested cutting the next implant in half to 25mg as my rate of absorption seemed to increase with time and this was a good strategy as when I was due for my next pellet my plasma E2 was 650 nmol, a good level for me.
I then had a mishap in that that very good and 'tailor-made' approach doctor was away at my next visit and I had a nurse who hurried me, wasn't interested in the numbers (as I and the previous doctor are because it works for me) and insisted that a whole 50mg pellet was a better idea. Stupidly I didn't stand my ground.
Result is that now I've gone too high (for me), nearly 1000, caused a little bleeding and cramps, now resolved but the gp's making a fuss, even though endometrium is fine at 5mm.
But I consider this just a blip, it gives me the advantage of having tested what higher serum levels are like for me and establishing that my sweet spot is probably about 650-700.
The pellet itself breaks down (it's very small) and insertion isn't painful. But clearly you don't have the same degree of control of absorption with pellets though for me they are incomparably more effective and convenient than slathering myself in gel and never getting above 400 max.
I believe they are available privately - I actually didn't have a very long NHS referral wait but that was a few years back and it might well be worse now.
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That's interesting, how often do you need to have new pellets put in? Is it every 6 months?
And where do they go, in your arm? Does it hurt?
Before you tried pellets, what had you tried in terms of transdermal and what was happening? How high did you manage to get your levels and what symptoms did you still have?
I might be okay with slightly lower levels around 650, but at the moment - because I am getting my thyroid levels right - I don't want to be changing estrogen as well. So it is best to hold it steady until everything is good and then to slowly see if I can come down a bit. I have no high estrogen symptoms like sore boobs or bleeding at weird times, but I do have very heavy periods at this estrogen dose. They are very short - it is 2 days of armageddon. I can slightly control when it comes by extending the utrogestan use a bit to delay...
UPDATE: Newson have come through and prescribed me Estradot 100s. WHOOP WHOOP. Only 48 patches. Which will last me 2 months at 300mcg and 3 months at 200mcg. I am wondering if I can use 200 and stick fk knows how many Evorels on as well.... surely I have to be absorbing something from them... I think they couldn't prescribe me 3 months at 300mcg because that wasn't my last valid prescription from them. Hopefully after my follow up in 2 weeks, they will change that.
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That's interesting, how often do you need to have new pellets put in? Is it every 6 months?
And where do they go, in your arm? Does it hurt?
Before you tried pellets, what had you tried in terms of transdermal and what was happening? How high did you manage to get your levels and what symptoms did you still have?
I might be okay with slightly lower levels around 650, but at the moment - because I am getting my thyroid levels right - I don't want to be changing estrogen as well. So it is best to hold it steady until everything is good and then to slowly see if I can come down a bit. I have no high estrogen symptoms like sore boobs or bleeding at weird times, but I do have very heavy periods at this estrogen dose. They are very short - it is 2 days of armageddon. I can slightly control when it comes by extending the utrogestan use a bit to delay...
UPDATE: Newson have come through and prescribed me Estradot 100s. WHOOP WHOOP. Only 48 patches. Which will last me 2 months at 300mcg and 3 months at 200mcg. I am wondering if I can use 200 and stick fk knows how many Evorels on as well.... surely I have to be absorbing something from them... I think they couldn't prescribe me 3 months at 300mcg because that wasn't my last valid prescription from them. Hopefully after my follow up in 2 weeks, they will change that.
About 6-8 months per their official guidelines https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/hormone-implants-in-hormone-replacement-therapy-hrt (https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/hormone-implants-in-hormone-replacement-therapy-hrt), I would say that as time goes on they need to be spaced out a little more as the fist couple of times they were inserted at between 4 and 6 months.
They're inserted in upper buttock, they switch side each time, if you get 2 pellets (E2 and T) they go in together. They give you a local anaesthetic shot before so it doesn't hurt.
Before pellets I tried estradot patches (pathetic absorption for me) and mostly oestrogel, got up to about 6 pumps and bloods never more than 300-400 tops after about three years and it just wasn't practical for me to increase the gel.
No vasomotor symptons (though I guess always being cold kind of is even if not in its more typical manifestation), awful fatigue, palpitations sleep and mood and bones getting thinner and thinner - went from osteopenia to osteoporosis in the femur but since the implant all three of my bone density values greatly improved, no more osteoporosis - obviously this is the area that's easiest to measure the benefits of HRT in the most, literally, concrete terms.
Sleep is still a problem but everything else has improved and to me the long term benefits have always been crucial, not just the here and now.
They are certainly worth considering for anyone with absorption issues.
Glad you got your patches resolved.