It can be confusing when first thinking about replacing your oestrogen through HRT so we will try and simplify it for you. Oestrogen comes in the form of:
What you choose is individual to you and how it will suit your lifestyle.
The doses can also be confusing so here is a run down of the general equivalents:
Sandrena gel 0.5 mg
Sandrena 1 mg
Sandrena gel 1.5 mg
Sandrena 2 mg
When we add in oestrogen, we also need to make sure we have enough uterine protection, so we must be adding in a regulated progesterone as well. The exception to this is after a hysterectomy, in which case, it’s generally not needed.
However, it does have other benefits to some women even after a hysterectomy (e.g. sleep, mood) and is worth discussing with your prescriber.
Progesterone is predominantly a hormone for endometrial protection. It stops the lining of the uterus from over thickening, which can lead to endometrial cancer. Other benefits include help with sleep and anxiety.
There are a few options, which are as follows:
There are two main regimes for progesterone use. For those that still have periods, you would be on a sequential regime. The doses for a sequential regime is:
Utrogestan 2 x 100 mg tablets on days 15-28.
Provera 10 mg on days 15-28
Combination patches and tablets are all individual according to the brand
For those that do not have periods anymore, you would be on a continuous regime. The dose for a continuous regime is:
Utrogestan 1 x 100 mg taken everyday without a break.
Provera 5 mg taken everyday without a break
Mirena coil releases 20 mcg daily for a period of 5 years.
The regime you are on is always individual. The above is general guidance.
Please note:
There has been new guidance published by the British Menopause Society regarding the use of micronised progesterone when on higher doses of Oestrogen.
Higher doses include the following:
4 measured pumps of Oestrogel
100 mcg oestrogen patch
6 sprays of Lenzetto
4 mg oral oestradiol
There has been an increase in the amount of women presenting with abnormal bleeding patterns while on HRT. Abnormal means unexpected. Bleeding of this type can potentially indicate changes in the uterus that can be associated with the risk of endometrial cancer.
Although, we know that bleeding is a common settling issue when first starting HRT, or making any changes to a current regime, it can also be cause for further tests such as a hysteroscopy, ultrasound scan, or biopsy.
To reduce the need for these tests, clinicians are now being advised to increase the dose of micronised progesterone if on the above 'higher doses.'
Therefore, on a sequential regime, the recommended dose of micronised progesterone is 300 mg on days 15-28.
On a continuous regime, the recommended dose of micronised progesterone is 200 mg daily.
There is no need to worry if you cannot increase your dose straight away. It is fine to wait until your next doctor or specialist review.
What? Testosterone is for men!
Actually, it isn’t! Our ovaries make 3-4 times more testosterone than they do oestrogen.
Testosterone is responsible for:
When you have been replacing your oestrogen and have relatively good symptom control, but it still feels like there’s something missing then ask your GP for a testosterone blood test.
The following ranges are what to look for:
Serum testosterone: 0.5-2.4 pmol.
Free androgen index: (FAI) 1-5%
1% is very low and would benefit from supplementation. Top of the range is 5%.
Often, the FAI is not tested but this can be worked out if you have the serum figure and SHBG (sex hormone binding globulin)
Serum divided by SHBG x 100 = FAI
Testosterone replacement isn't often offered as a stand-alone treatment to women during menopause. Once established on oestrogen, it can be added in if needed.
Testosterone options and doses:
Please note:
Starting HRT can come with many worrying thought's. Is it safe? What will it do to me? How will I feel?
All perfectly normal responses to starting something new.
What is good to remember is that HRT is simply replacing the hormones our body isn't making anymore. The same hormones we have had since puberty.
The symptoms we get in perimenopause and menopause is a sign that our natural production of hormones are declining. The most recent research suggests that the sooner we start replacing those hormones, the better protection we have against issues such as osteoporosis, dementia, diabetes, heart disease and so on.
The issue for many of us, is that we don't replace them soon enough, so our body is really depleted of hormones and this can cause some issues when we do start to replace them. We can also feel worse for a while, symptoms can feel exacerbated because this sudden influx of hormones is confusing.
This can also be said when increasing doses or changing to another product. The body needs time to adjust to these changes, and while it does, there can be some effects to look out for. These include:
The general rule is to give each change or addition, 3 months to settle fully. This can be how long the body needs to adjust, but often, it does settle a lot sooner than that.
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