HRT & Menopause: FAQs

I am regularly asked a number of key questions inmy role as a menopause and HRT educator, so I

have put this list of short responses together to helpyou all on your HRT journey.

This list of FAQs is a general guide only and as

always there are numerous individual adaptationsthat often need to be made.

There are too many possible questions to cover in

one list but these are some of the most raisedqueries (I will aim to add to the list over time)

If you need more guidance please see your doctor orbook in with me to gain clarity on what you need.

Stay informed and stay well ladies!

Jane x

HRT & Menopause: FAQs


What is peri menopause & when will it happen?

What is menopause & when will it happen?

This is the time when your hormones start to fluctuate and decline.You can actually be any age depending on your health history and geneticsso even young women can become peri or post menopausal but this is less

common. The average start of peri is mid 40s and it can last 3-12 years.

This is the time when your hormones have stopped doing their thing.You are considered menopausal when you have been period free for 12 monthsor more. The average age for menopause in the UK is 51 so.. simple maths tells

us that it isn't unusual for a women in her late 30s to be peri.


What are the symptoms of peri menopause?

Why can't I sleep?

There are over 40 symptoms of peri menopause. You can find many ofthese outlined on the website HERE

If your sleep issues are due to peri menopause then balancing yourhormones will help immensely! The hormone fluctuations of peri can be very

disruptive to sleep and in addition to HRT you can add in a good qualitymagnesium every night.

https://www.menopausalnotmad.co.uk/symptoms/


Is HRT safe with a family history of breast cancer?

Why am I bleeding when I take the oralprogesterone?

It is certainly not a definite 'no' to using HRT but there are some womenwho would be advised to consider increased risks such as with the BRCA

gene. As always it is a risks v benefits balance and most women still view thehealth benefits outweigh the small risks...

When you first start HRT it can bring on some random bleeding (even if youwere period free beforehand), as your body adjusts to the new regime .Thiswill likely settle down into a cycle within 3 months but if it is very heavy or

ongoing you would be best advised to see your doctor. .


When should I increase my HRT dose?

Do I increase my Progesterone when I increasemy Estrogen dose?

Generally you will stay on a dose for 2-3 months to let your body settle but agood indication of the need to increase is if your symptoms were gettingmuch better then they start to return again. At this point your body has

settled into the original dose and is now probably ready for more estrogen(Do speak to your doctor)

In general no you don't unless you are over the maximum estrogen dose eg: more than 4 pumps of estrogen gel/a 100 mcg patch/2mg tabletsIf you have spoken with your doctor about a further increase it's good

practice to increase progesterone too.


How can I help stop my bloating?

What happens if I alter my estrogen dose?

It depends why you're bloated but low estrogen levels often slow down guttransition which makes it more difficult for your gut to work effectively;

resulting in bloating and constipation. TIP! Don't drink with food & add in Omega 3 & a Probiotic to help.

Any changes require a time for your body to adjust again. It's important notto mess about with your dose of estrogen or progesterone as your body willbecome very confused and you do need to ensure your doctor knows what

you are planning to do..


Do I need to ask my doctor before increasing mydose of estrogen?

How do I know whether I need testosterone?

This is not a one line answer as of course you need to speak to your doctorbut if you have been put on a low dose (1 pump of gel) then it is perfectly

fine to increase to the next dose if your symptoms are not managed after afew months. If you are on tablets or patches you will need to ask for a new

dose anyway.

It is best to gain some balance on estrogen and progesterone before addingin testosterone so that we know what is actually working, but testosterone is

important.There is a testosterone guide in the group or you can see it on the website

HERE

https://www.menopausalnotmad.co.uk/testosterone/


Can I take HRT if I have fibroids?

High blood pressure with HRT?

So many women have fibroids and don't even notice. If they are big they arelikely to be removed anyway, but they are not a contraindication to HRT.They can bleed a bit with the new estrogen but this usually calms down.

You may need a scan if bleeding continues.

If you have high BP you can still have HRT but your BP needs to be controlledfirst. However; the HRT can often reduce and help with high BP, if it is caused

by hormone fluctuations.You would need to ask for patches, spray or gel (not tablets as these have an

added blood clot risk)


When do I take continuous progesterone?

What are the equivalent doses for the most wellknown HRTs

This is a very individual process but in very general terms, you will either startcontinuous progesterone when you have been naturally period free for 12months OR when you have been on sequential HRT for over 12 months.However, there are many other reasons why a woman would move to a

continuous regime too.

Please see the separate guide in the group


Will HRT make me fat?

Why do I need progesterone ?

This is covered in my blog HERE

You need progesterone if you have a uterus (not had a hysterectomy). This isto ensure that the added estrogen does not over-thicken your uterus lining

which would greatly increase the risk of uterine cancer. The progesterone thins the lining and maintains a healthy balance.

It is REALLY IMPORTANT!

https://www.menopausalnotmad.co.uk/blog/2021/07/06/hrt-weight/


How long will my HRT take to work?

How and when do I apply my estrogen gel?

It is very individual but it can take up to 3 months, although manywomen notice significant improvements before then.

It's usually applied to the outside of the arms or the inside of the thighs.Apply either morning or evening. It's your choice.

Just apply to get rid of any lumps then let it dry. It doesn't take more than5-10 mins


Is HRT safe when I have Endometriosis?

When does bleeding need investigating if I amon HRT?

If you have endometriosis, it is usually fine to have HRT but it is important toconsider having a continuous (and maybe higher) dose of progesterone as

this helps stop regrowth. This also applies when you have had ahysterectomy to remove the endometriosis.

As a general rule any abnormal or unexpected vaginal bleeding needs to bechecked..however; as already mentioned, bleeding can occur after starting

HRT which usually settles. If it is heavy, ongoing or starts after 12 months of no periods, then you must

go to the doctors and ask for a pelvic scan.


Is it safe to have continuous progesterone if I amstill having periods?

Do I need blood tests?

Quite simply yes it is. There is no risk but it's important to be doing it for theright reasons such as: excessive bleeding, mood problems associated with

fluctuating progesterone or endometriosis. You need to discuss this with your doctor but you do not have to have a

bleed. It is just the same process as having a mirena coil

Blood tests for testosterone levels are important but not usually necessaryto confirm peri menopause if you are over 45 years.

Even if you are under 45 it is important to consider the whole picture ofhealth history, genetics and symptoms.


Am I too old to start HRT?

How can I increase my estrogen dose when Ihave patches?

ERRRR...NO!Women in their 70s and 80s start HRT

The small risks are still usually outweighed by the benefits

You can add another estrogen only patch or estrogen gel if you are on asequential or continuous patch.

OR You can move to an estrogen only patch at your new dose and add in

separate progesterone.


Will HRT stop my hair loss?

I have migraines or a high BMI or a family historyof blood clots!

Can I have HRT?

If the hair loss is due to low or fluctuating estrogen levels then it will help butcan take many months to feel better.

It is also worth considering some supplements such as biotin or collagen aswell to help with the process.

HRT is not contraindicated with any of the above but you would be advised(as with the BP concern), to have a transdermal option such as patches, gel

or spray.


Estrogen gel: How long do I need to wait beforeapplying lotions or washing after applying gel?

When do I have to stop HRT?

1.5 to 2 hours

HRT can be for life. You have a hormone deficiency which will always needreplacing. Of course you need to do what you feel is best for you but as long

as the benefits still outweigh the risks it is not necessary to stop.Please view the website HRT page HERE for more info

https://www.menopausalnotmad.co.uk/hrt/


What is the dose of progesterone when takenvaginally?

What is the difference between continuous andsequential progesterone?

As it is considered slightly more effective to take the Utrogestan vaginally, it isan accepted approach to reduce the dose by half depending on the regime

you are on.

This is also covered in the group guides in more detail, but simply put, thesequential regime is the 'bleed' regime whilst the continuous is a 'no bleed'

regime.


Are there any side effects of starting Estrogen?

Are there any side effects of starting Progesterone?

There are some mild side effects for many women such as sore breasts,dizziness or nausea but this will usually settle after a few days or weeks. If you

feel worse than this you may need to start on a lower dose but it's alwaysgood to check first before messing with your dose.

There are some mild side effects for some women such as a low mood orsome bloating but this will usually settle after a few days or weeks. If you feelworse or your mood is very low, you may need to change the way you access

progesterone but do check with your doctor


Can I still get pregnant when I'm peri?

Which magnesium should I take?

YES!

Magnesium citrate is a good all rounder and magnesium glycinate is good ifyou struggle with tummy upsets. (up to 350 mg per day is good)It's an important supplement for sleep and general well being.

Most Importantly!!Don't Panic!!!

For more help & guidance with menopause & HRT challenges you can booka consultation HERE

If you need to access home blood testing you can do that HERE

You'll be just fine

Copyright of Jane Pangbourne and Menopausal Not Mad

https://www.menopausalnotmad.co.uk/menopause-services/

https://www.menopausalnotmad.co.uk/we-love/#testing

HRT & Menopause: FAQs

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