HRT AND ME: TREATMENTS FOR PERIMENOPAUSAL SYMPTOMS

​Most of us have heard of hormone replacement therapy (HRT) but what do you really know about it and do you have any concerns?
 
I have to admit that I thought I was going to breeze through perimenopause and not have to even give HRT a thought.  I couldn’t have been more wrong!  I have found entering perimenopause one of the most challenging, upsetting, anxiety-producing chapters of my life.  But HRT has definitely been a saving grace for me.  Being a nurse, I do advocate conventional medication where appropriate, but as a reflexologist I also support complementary therapies too.
 
In today’s blog, I am just going to give you some basic facts about HRT, and I will talk about complementary therapies in my next blog, so that you feel able to make a decision about what might suit you.  I will also give you some advice about how to approach your GP to make your appointment efficient and effective.
 
Before I come to the different types of treatment, I just want to give you a very brief background to the symptoms I was experiencing which sparked me to go to the GP.  I will give more detail in a future blog, as I am passionate about empowering you and supporting you as you go through this episode.
 
I did not really suffer from the typical hot flushes or night sweats, apart from a couple of days before my period.  That was a normal part of my cycle for most of my reproductive cycle life.  The things that became a “problem” were palpitations for absolutely no reason (which was a concern for me as my dad had been diagnosed with heart problems), bouts of anxiety for no reason (overthinking, overwhelm, difficulty sleeping, racing thoughts) and depression (crying for no reason, on two occasions thinking about driving my car into a brick wall, negative thoughts).  Whilst it had an impact on my mental health, I knew that the root cause was perimenopause because my periods were becoming very irregular, I was in the “age bracket”, and the research I had done for teaching on the menopause “retreats” made me face the fact.
 
I was very grateful to my husband coming to the GP with me, as I needed the support, but I also needed him to understand why I had become the person I had become.  Putting how I was feeling into words was so difficult.  We have one of the largest vocabularies in the world, but I still couldn’t find the right words to exactly explain it.  To be fair, I didn’t really know how I was feeling myself.  I literally sat in the waiting room crying, and remember telling the GP “I am not depressed”.  She was incredibly understanding, as I explained that the depression and anxiety were hormonally-linked.  So, what were my options, why did I choose my treatment plan, and how did I get an understanding GP?  These are things that I want to help you with.
 
As my previous blogs show, perimenopause is caused by the levels of oestrogen and progesterone production dropping in the body.  As the levels drop, symptoms develop.  So to reduce symptoms, we have to replace the levels of hormones, hence HRT. 
 
Oestrogen: products containing estradiol, estriol or estrone
Progesterone: are either synthetic, such as norethisterone, levonorgestrel, medroxyprogesterone, or dydrogesterone, or natural/body identical which is chemically produced but identical to the hormone naturally produced by the body.
 
Before considering what route you may wish to administer HRT, the first thing that you need to be aware of is that if you still have a uterus (i.e. not had a hysterectomy) you will need progesterone as well as oestrogen.  If you don’t, the lining of your womb will continue to thicken which, if it does not shed, is likely to cause other problems. 
 
HRT is administered in a number of ways:  tablets, patches, gel, implants, directly in the vagina, or coil.  I will give you information about these, but your GP or practice nurse will be able to give you much more detailed information on the different types.  I just want to give you the pros and cons so that you already have some understanding before you speak to them.
 
Tablets are the most common type of HRT and are usually taken once a day.  These are available for both the oestrogen and progesterone components.  If you are good at remembering to take medication regularly, and you don’t struggle with stomach or digestive problems, this may be the one for you.  It does need to be pointed out that if you have a risk of forming blood clots, breast cancer, heart disease or stroke, then this is probably not the right one for you. 
 
Patches are another popular choice.  You stick them on your skin and replace them every few days.  They are available in oestrogen-only as well as with a combination of both hormones.  These do not increase your risk of blood clots and they do not irritate the stomach, which can be useful if those are your risk factors. The thing to consider with patches is the possible of skin irritation, particularly if you have skin which is sensitive to plasters.
 
Oestrogen gel is my choice of treatment for the oestrogen element of HRT.  It comes in a pump and each pump is one dose, which you rub into your skin.  It is soaks in quickly and is very convenient.  I have not experienced any skin irritation from it and there is no strong smell.  As with the patches, there is no increased risk of blood clots with it.  But, it is only oestrogen, so you if you choose this method, you will need to consider how you will get progesterone into your system.
 
For the progesterone element I had a mirena coil fitted. This was particularly convenient for me as my copper coil (for contraception) was overdue to for change, so it was easy to just replace it with mirena instead.  It lasts for 5 years so I can forget about it for a good while, and it stops you having periods, so that takes away any anxiety about irregular periods.  The down side is that I don’t actually know whether I would still be having periods, so would not know exactly when my menopause day is….but, to be honest, I’m not that bothered about that. There are risks with having a coil fitted, which the clinician will explain, such as risk of perforating the uterus, but it is a tiny risk. As with all of these things, you have to consider what suits you and your lifestyle.
 
Another form of HRT comes in the form of an implant which is a small tube which is placed under the skin, under local anaesthetic. As with the gel, you will need to take progesterone in a different form.  The implant will need to be replaced every few months, and not all GP surgeries will do this. 
 
Oestrogen can also be applied directly into the vagina, as a cream, pessary or ring.  This treatment is particularly useful if you are experiencing vaginal dryness, but is not so good at treating symptoms such as hot flushes.  It does not increase your risk of blood clots or breast cancer, but you may find applying the product difficult.  Again you would have to consider how you will replace your progesterone if you still have a uterus.
 
As with all medication, you may experience side effects, the most common being: bloating, breast tenderness, nausea, headaches, indigestion, vaginal bleeding.  These often pass after a few weeks, but if they don’t you may want to try a different method/combination of HRT. Many women believe that HRT causes them to gain weight, but there is no evidence to support this, and it is common to gain weight during perimenopause anyway. 
 
NB: I’ve not included testosterone in this blog on this occasion.  I am aware that some women require testosterone replacement as well, but I am looking to support the majority of women, and not all will require testosterone.
 
So, how do you go about talking about perimenopause symptoms and HRT with your GP? This is one of the most difficult bits to do, but it is possible to get a proper consultation, and not feel rushed or pressurised.
 
The first thing I would do before picking up the phone, is to do my research into the possible HRT choice(s) that would suit you most.  Write down the options and the pros and cons as you see them.  I recommend writing it down because then you won’t miss anything when you actually see the GP.  As well as this list, make a list of the symptoms you are experiencing, and note when you most feel them, e.g. hot flushes after caffeine, or palpitations at night, bloating for 2 days once every 6 weeks etc.  When you have a limited time to discuss matters, you have to be efficient!
 
When you book an appointment, as the receptionist for a female GP who is around the late 40s/early 50s.  There is an increased chance that she will have experienced similar symptoms personally (obviously not always).  Then say that you need to book a double appointment as you need to discuss perimenopause and all your options.  Whilst this won’t give you a huge amount of time, it will be more reasonable to be able to talk about all of your options, to come up with the answer most suited to your needs.
 
I used these methods and had a fantastic experience which made me feel supported, listened to and respected.
 
In my next blog, I will be looking at natural and complementary therapies to help with your symptoms. 

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