Information Hub

Oestrogen Replacement

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:

  • Gel
  • Patch
  • Spray
  • Oral tablets

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

  • Oestrogel 1 pump
  • Patches 25 mcg
  • Tablets 0.5 mg
  • Lenzetto 1.5 sprays

Sandrena 1 mg

  • Oestrogel 2 pumps
  • Patches 50 mcg
  • Tablets 1 mg
  • Lenzetto 3 sprays

Sandrena gel 1.5 mg

  • Oestrogel 3 pumps
  • Patches 75 mcg
  • Tablets 1.5 mg
  • Lenzetto 4.5 sprays

Sandrena 2 mg

  • Oestrogel 4 pumps (licensed maximum)
  • Patches 100 mcg
  • Tablets 2 mg
  • Lenzetto 6 sprays

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 Replacement

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:

  • Utrogestan/ Prometrium
  • Provera
  • Mirena coil
  • Combined patches
  • Combined oral tablets

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.

Testosterone Replacement

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:

  • Muscle strength
  • Memory
  • Clarity
  • Libido
  • Brain fog
  • Fatigue
  • Low mood

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:

  • Testogel or Androgel (US) Besins Healthcare (UK) (1% testosterone gel in 4.5g sachets containing 40.5mg testosterone): Starting dose 1/8 of a sachet/day each sachet lasts 8 days, a pea sized blob.
  • Testim gel sachets 1% gel in 5ml tubes, starting dose 0.5ml per day. Each sachet lasts 10 days.
  • Tostran (2% testosterone gel in a canister containing 60g ) : Starting dose 1 metered pump of 0.5g = 10mg 2-3 a week (maximum of 3 pumps a week)
  • AndroFeme (1% testosterone cream in 50ml tubes): Starting dose 0.5ml/day = 5mg /day i.e. each tube should last 100 days.
  • Testavan : Androlabs 2% gel. One gram of gel contains 20 mg testosterone. One pump actuation delivers 1.15 g (1.25 mL) of gel equivalent to 23 mg of testosterone. Recommended female dosing is 1 pump per week (maybe 2, depending on levels and symptoms)

Please note:

  • Testosterone should never be applied directly to the clitoris or any area of the genitals.  This is unsafe and may cause some adverse effects. It is generally recommended to apply on areas such as the thigh or upper leg; some people find absorption is good in areas such as behind the knee.

Starting or adjusting your HRT

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:

  • Bleeding
  • Bloating
  • Sore breasts
  • Increased anxiety
  • Palpitations
  • Insomnia

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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