Hormone Replacement Therapy (HRT)

Our preference is to prescribe pharmaceutical grade, licensed, body-identical hormones.  For most women on HRT this consists of an estradiol topical patch, with utrogestan (micronized progesterone).  However, we provide personalised care, and synthetic hormones can be the best options for some cases.  We do not offer compounded hormones, due to variabilities in consistently and uncertainty with safety profiles. 

We do prescribe testosterone.  However, a consultation for a ‘testosterone prescription’ from our point of view is not as simple as that.  We will review your history, current medications, your symptoms and your goals as well as considerations of affordability, risks vs benefit and applicability.  Testosterone isn’t licensed, but like all medications we want to make sure we are doing the best for our patients.  And in cases where it is appropriate, we are happy to support medications that are off licence.  

This is a really personal question and requires an individual assessment, but fundamentally, at FemaleGP we will not judge your symptoms and tell you whether your symptoms are bad enough for intervention.  We will explore your current symptoms, your experience now, and the options available to improve your quality of life.  We also review your past medical history and experience of different stages of hormonal changes throughout life.  This is because we believe it gives clues as to how to make an individualised plan to maximise wellbeing in midlife.  HRT are one option that can improve menopause symptoms.  It is also really important to ensure that other causes of decreased well being are excluded.   

You do not have to stop HRT while your bleeding is being investigated.  10% of women experience post menopausal bleeding or abnormal menstrual bleeding.  You can discuss with your GP about changing to a progestin or increasing progesterone.  Saying this, some women do prefer to stop it.

There is no evidence to suggest that a mammogram is required before starting hormone replacement therapy (HRT). However, maintaining awareness of your breast health and staying up to date with routine screenings based on age and personal risk is always important.

For individuals under 45, breast tissue is often denser, making it harder to detect cancers through mammograms. This can sometimes provide false reassurance. If you are experiencing breast symptoms, this is a different scenario and should always be discussed with your doctor.

If you have a family history of breast cancer, let your doctor know, as earlier screening may be recommended. Guidelines generally suggest starting mammograms 5–10 years earlier than the youngest age of breast cancer diagnosis in your family.

Taking a Mirena and utrogestan together can improve some womens sleep considerably.  However, there is no data on breast health (or other conditions) about long term use of this.  

In my experience I find progesterone in addition to the Mirena is more helpful in the perimenopause, and not as much later on anyway.  

But putting things into perspective - if you can't sleep then you are at increased risk of many chronic diseases.