Answers for existing patients

1. If my dose of oestrogen is changed, do I change the dose of progesterone (Utrogestan)?

In cyclical HRT:

The dose of the Utrogestan should be 2 x 100mg Utrogestan at night for 12 nights per month.

This should be taken regularly whether you bleed or not and per calendar month, irrespective of when your bleeding occurs.

In Continuous combined HRT:

100mg Utrogestan at night every night.If your dose of oestrogen is:• 1.5mg (oral dose) or more,• 75mg patches or more,• or Oestrogel 3 applications daily or more,we may increase your Utrogestan to 2 x 100mg at night, every night.

2. If I get breast tenderness what should I do?

Many women can experience some breast tenderness when they initially start HRT. This usually lasts 2-4 weeks.

If it is severe, or lasts longer, please take Super Starflower oil (Solgar make an excellent one) 1,300iu per day for 6 weeks.

Or Evening Primrose oil 2000mg a day may also help.

If you know that you are particularly prone to breast tenderness when taking oestrogen, you could take the Super Starflower oil for 3-4 weeks prior to starting HRT to prime the breasts and reduce this reaction. If the breast tenderness does not respond to this and persists, please book in for further advice. We may change your dose or the preparation you are on.

3. What should I do if I start bleeding heavily on continuous combined HRT and haven’t had a period for over a year?

This is classed as postmenopausal bleeding and should be investigated as soon as possible. Please see your GP who will organise a trans-vaginal ultrasound scan to check the thickness of the lining of your womb and to see if there are any polyps or other causes of bleeding.

4. What if I start getting some ‘old blood’, or light spotting for a couple of days initially after starting the HRT?

Please keep a note of it and inform us at your 3 month follow-up. This may happen initially and usually settles after 3-5 months.

5. What shall I do if the Vagifem pessaries irritate my vaginal or vulval skin?

Stop using them and try again once you have started to settle on the transdermal HRT. If it still irritates then please contact us for another appointment, as we need to examine you and prescribe a different preparation.

6. Where is the best place to apply the oestrogen gel (Oestrogel or Sandrena)

Gel should be applied to the inner thigh, and rubbed with the inner lower arm, not with the hands. Do not get dressed for 10 minutes. The longer you give for the gel to dry the better the absorption. Rubbing it with your hands wastes it and puts it on the taps for other members of your household!

You can put it on every night, every morning, or split the dose between morning and night time-it is up to you and whatever suites your routine the best.

Some women find using it at night helps them sleep, others prefer to use it in the mornings or split the dose. It’s very individual.

For more information look at:

www.womens-health-concern.org

7. Where is the best place to apply Testosterone gel?

Please apply testosterone to your inner wrists by rubbing them together, you can also rub your wrist onto your lateral thigh or pubic triangle.

Further information about the use of testosterone for women can be found in our Q&As for new patients (number 3 of the medical questions).

8. What can I do for my pelvic floor as I leak urine when I cough or sneeze and have to get to the loo in a hurry when I have a full bladder?

Please enrol for the 2 sessions with CompleteCoreControlandfitmummy.com that could change your life!

Lizzie Duggan and Sarah St. John teach hypopressive breathing techniques that will exercise 100% of your pelvic floor muscles, improve your posture, reduce back and neck pains and improve your gut health.

This technique also reduces prolapses of the vaginal wall and the need to get up at night to empty the bladder.