The menopause is the time in a woman’s life when the ovaries stop producing hormones and periods stop. This usually happens in the late 40s or early 50s. It signifies the end of the reproductive life of a woman as eggs will no longer be produced by the ovaries. For a number of years before and after this happens, many women suffer perimenopausal (or climacteric) symptoms such as hot flushes, mood swings, anxiety, tearfulness, poor sleep, vaginal dryness or lower sex drive as the body adjusts to lower oestrogen levels. The symptoms can make life miserable. The lower oestrogen levels are also associated with an increased risk of developing osteoporosis, heart disease and Alzheimer’s disease.
Olivia can talk you through the risks and benefits of hormone replacement therapy (HRT) and the alternatives to HRT. There are very few women who are advised not to take HRT because of pre-existing health problems although they can sometimes be considered in some circumstances:
- Personal history of Heart Disease,(including Angina and past heart attacks)
- Personal history of breast cancer
- Personal history of stroke or TIA- transient ischaemic attack (mini stroke)
- Personal history of active liver disease
- Unexplained vaginal bleeding – until it has been thoroughly investigated
If you have been told that you can not have HRT but do not have one of the above conditions, this may not be the case.
Some women also suffer detrimental effects of a lower testosterone level. This can cause women to have a low sex drive or to feel less enjoyment from sex. If you don’t respond to oestrogen based HRT – Olivia can help with testosterone replacement too.
As the menopause approaches, periods can also become more erratic, frequent and heavier. Most of the time this is because of the hormonal changes going on and this is called dysfunctional uterine bleeding. However it is important to exclude polyps and precancerous or even cancerous changes in the lining of the womb or cervix. Olivia is an expert in fully investigating all these conditions with the most up to date methods to reassure you and then discuss treatment options to help you with the perimenopausal problems.
Switching between HRT Types
There has been a shortage of some types of HRT following COVID and Brexit. These have largely resolved. There are occasions when you don’t respond to one route or brand so another can be tried. There are only two brands of Oestrogen gel in the UK – Sandrena and Oestrogel and one type of skin spray Lenzetto.
Please see this table for the equivalent dosage of Oestrogel, Sandrena and Lenzetto for when switching brand or formulation.
| Level | Tablet | Patch | Oestrogel | Sandrena | Lenzetto |
| Ultralow | 0.5mg | half 25 | Half-1 pump | half a 0.5mg sachet | 1 spray |
| Low | 1mg | 25 | 1 pumps | One 0.5mg sachet | 2 spray |
| Medium | 2mg | 50 | 2 pumps | 1mg or 1mg plus 0.5mg sachet | 3 sprays |
| High | 3-4mg | 75-100 | 3-4 pumps | 2-3 x 1mg sachet | – |
Progesterone vs Progestogens
Micronised progesterone, is exactly the same as the progesterone women make in their ovaries (body identical). It is thought that there is a lower risk of blood clots in the veins and breast cancer as well as fewer side effects, in women using micronised progesterone for endometrial protection in HRT, when compared with other commonly used synthetic progestogens, such as Norethisterone (NET) and Medroxyprogesterone acetate (MPA or Provera), but the difference in risk is very small, particularly for short term substitution
For a long time the only micronised progesterone in the UK was Utrogestan. There is a new brand called Gepretix.
When these are not available we use Provera 2.5mg or 5mg daily for women who normally take Utrogestan 100mg at bedtime every night or Provera 10mg daily for 12 days a month for women who usually take Utrogestan 200mg for 12 days a month in the short term.