HRT never helped, in fact I think it has made me worse. Why?

[Tuffle]

Hello, I'm 45.

2.5 years ago we went through a nasty financial crisis, and we came close to losing our home. The stress and anxiety were horrible, and everything looked bleak. I started suffering with insomnia. At the same time I noticed my periods were getting lighter and only lasting 3 days, but my PMS was getting worse.

I went to see my GP who started me on ADs, and after a few weeks I started to feel better. But each month my PMS symptoms were breaking through a bit. I then found the Menopause matters website and wondered if I was peri menopausal and actually needed HRT to control my PMS anxiety/low mood each month. I fitted the pattern of 'reproductive depression' with my history of PMS, and then severe PND, and now struggling with anxiety/depression in my mid 40s.

So I came off the AD and started trying various HRT regimes. Patches + Utrogestan, Femoston and even the BCP. But they never helped get rid of the anxiety/depression which would arrive every month, and often lasted 12-14 days. But these bad days never really followed a set monthly pattern (I know because I keep a diary).

And all the while in the background, we still had these dreadful money worries to contend with, with accompanying anxiety and stress.

But this New Year our financial situation improved . So I booked an appointment to see Dr Annie Evans. She was very sympathetic, said I was 'a classic case' for peri menopause anxiety & depression, and started me on 2 x sandrena sachets + separate Utrogestan.

I followed her regime for 2 months, but each week actually felt worse. My anxiety and depression became constant, with no more good/normal days at all. I was so bad I was signed off work, and was close to being housebound. Insomnia was awful too.

My GP who was so concerned that she put me in touch with our Crisis Team and they started me on Trazadone 5 weeks ago. But I still used the sandrena gel every day. I didn't get chance to use the Utrogestan as both months my own period started before it was time to use it.

But because I still seemed to be getting steadily worse, 2 weeks ago I went to see Prof Studd ( totally uninterested in listening to me, and didn't explain a single thing) and he prescribed me 3 pumps of oestrogel with separate Utrogestan, but not to start Utrogestan until June.

So I have been following his regime, but feel that I'm still getting worse day by day. And for the third month in a row my own period has arrived on time, despite taking no Utrogestan to cause it.

Can it be that actually I have never needed HRT? It never stopped my bouts of anxiety/low mood each month, last year. And now after nearly 3 months of top quality, strong doses of oestrogen from 2 leading specialists, I have just got worse and worse? Am I just overloaded with oestrogen, and that's why my anxiety and depression has got steadily much worse?

My oestrogen level when I saw Studd was 744 p/mol and I was mid cycle. So a decent level, and yet I was feeling dreadfully low and anxious.

I have never suffered with any physical peri menopause symptoms like hot flushes or vaginal dryness or headaches. My own periods have stayed regular and normal (just lighter) since just taking the stronger oestrogen gels, and with no erratic bleeding.

Can taking high does of oestrogen, when you don't actually need to, cause extreme anxiety like mine? I think my depression actually is caused by my anxiety. And maybe the reason my AD isn't really helping is because I'm pumping myself with high dose oestrogen every day?

I'm beginning to wonder if I should never had started down the HRT and all it's done is mess up my own hormones really badly and cause unnecessary misery. Perhaps I should have just stayed on ADs?

Any advice or insight would be really helpful, thank you.

[PollyPerky]

Sorry you've had such a rough time

TBH if you have had no other symptoms apart from anxiety and emotional / psychological symptoms, it does bring into question whether you need HRT at all.

Although the emotional side of peri can often be ignored by women and drs, it usually is accompanied with some physical symptoms such as loss of periods.

I was- just for the record- the complete opposite of you; no emotional symptoms at all apart from a shorter fuse and then hot flushes hourly & insomnia. Oestrogen sorted it within a week and as I was on long cycle HRT I had 10 weeks of oestrogen-only for some time.

The reason for using HRT is so relieve symptoms. If you have tried many different regimes under the guidance of consultants, and it's not worked, then it looks as if hormones are not your problem!

I don't think high oestrogen causes anxiety. if it did, it would be obvious during pregnancy when women 'glow'. oestrogen is a really positive hormone and gives women energy.

Maybe your GP was a bit too quick to give you ADs? Life changing events like financial issues are horrible, and I'm not minimising them, but trying other things like CBT and counselling is the current advice either before or with medication.

Can I ask what you are doing to try to help your low mood, yourself? Have you tried exercise- shown to be very effective. Have you got a job you enjoy, friends to talk to, something to look forward to each day even if just immersing yourself in a book? Can you take the focus off your mood swings - then maybe the clouds will lift a little?

Have you actually been diagnosed with clinical depression by a specialist?

Maybe you ought to ask your GP if it's safe to stop the meds altogether (tail off?) and see how you feel, at the same time as trying counselling/ CBT / self help?

[Badders123]

I would come off the HRT asap if I were you!
It didn't seem to suit me either
My gynae says hormonal meds don't suit all women - I seem to be one of them!
Part of my problem was that whilst on the HRT I was flooding - massive bleeds - which leads me to think that's it's not for me at this time
Once my bleeding has actually stopped - who knows?
HRT will still be there in a few months/years time after all
Good luck X

[akarrie]

Hi there. Was just reading your post from 2016 about how HRT hadn't helped you and made you feel worse, and wondered how you were feeling now? Have you stayed on HRT and found a good regime for you etc?

I have felt for a long while that my HRT is making me much worse, any attempts to increase estrogen cause me more upset and even worse anxiety than normal. I too have tried taking the advice of leading specialists, and feel my estrogen levels are too high, or maybe my progesterone too low. Any advice would be great, but also fully appreciate you may not want to respond about this after such a long time.

[EllaLeo123]

Hi I need some advice please. So I switched from the Evorel Conti patch to the Oestradiol gel and utrogestan 100 mg yesterday and decided to apply the 2 pumps in the morning and the utrogestan in the evening. Within less than a hour of the gel I began to feel very nauseous and throughout the day my anxiety heightened so I decided to take the utrogestan a bit earlier as I felt awful. I’m now very frightened of applying the gel and contemplating going back to the Evorel Conti patch today. Has anyone had a similar experience? I’m not sure if I need to persevere with the gel, the Evorel Conti patch took a few weeks to settle and it was because of the side effects of anxiety when I applied a new patch that I switched to the gel and utrogestan in the hope that it would suit me better. I’m feeling so confused...

[JinglingHellsBells]

Has anyone advised you on what dose gel compared to Evorel? You might be swamping your system with a bigger dose.

The sickness is like morning sickness. My advice, which worked for me, is to start with 1 pump gel for 2-3 weeks then build up gradually to 2. you can go to 1.5 pumps first. Also try splitting the dose- 1 pump morning, the next evening.

No point taking Utro earlier in the day- it won't help anxiety.

[EllaLeo123]

Thank you for replying JinglingHellsBells. No I was just given the prescription for 2 pumps a day and 100mg Utrogestan to be taken day 1-25 no other advice. I’m also thinking that the oestrogen was too much and the nausea makes complete sense to me now you mention the connection to morning sickness and the oestrogen level raising in pregnancy. I am very new to hrt and I always thought it was the progesterone content of the patch that was making me feel very agitated. But having had the oestrogen separately has had me questioning all of that. I honestly was in such an agitated state yesterday that I thought it may be because I hadn’t taken them both together ( as in the conti ) which was why I took the utrogestan earlier. I was also not told by my gp whether I should take them together, I had noticed people on a Facebook group used gel in am and utrogestan in evening as it made them drowsy. Your suggestion does sound like a good way to see how I feel, I’m quite nervous about trying it again at the moment to be honest though. So from what I understand you had similar, I just assumed that as I’ve been on the evorel conti for 5 weeks that it would be a smooth transition. Can you tell me a little about your journey on this gel/utrogestan regime?

[JinglingHellsBells]

Ella
Happy to help if it does.
I've used them both for nearly 11 years.
I am still using a sequi regime because I don't feel great on Utrogestan daily.
I see a consultant privately so my regime is slightly different to what most GPs suggest.

I was advised to start with a pea sized amount of gel. I found 1 pump controlled daytime flushes, but not at night. After about 3 weeks on 1 pump I increased to 1.5, then 2 pumps.

I use utrogestan for 10-12 days every few weeks and always take it at night. This is a 200mgs dose and can make you feel dizzy and / or sleepy.

I find my experience with utrogestan varies each cycle. Sometimes I don't notice I'm using it, other times I sleep better, sometimes I sleep more badly.

I don't find it affects my mood or anything but by the time I am coming to the end of the course of it I do tend to feel a bit lacking in energy- it's quite sedative.

You should not experience that as you are on a lower dose, using it daily.

[Aliceland69]

Thank you for your reply HellsBells
I think that I need to see a specialist as today after going back to the conti on Sunday I am feeling so very low, can't stop crying and feeling hopeless. It's so difficult when I felt so much better until the one day I tried the gel. I am seeing my gp on Thursday. Thanks again

[JinglingHellsBells]

it's pretty much impossible the gel would make you feel low. The odds are you are not getting the benefits yet.

why are you on conti? can't you switch to a sequi regime? that was you can identify which hormone is making you feel worse (if any.)

[JinglingHellsBells]

why did you come off the previous type anyway? You've not said :)

How old are you and how long post meno ( to be using a conti type)?

[Aliceland69]

Hi again jinglinghellsbells apologies for not replying sooner as I didn't seem to get any notifications? It's been a very rough and dark few days. So I will be 50 in June, I told my gp that I had a period last March 2018 and then one in the Nov 2018. She put me on the Evorel Conti, I too have questioned this, but I think there have been crossed wires. I felt my mood lift almost immediately as did the brain fog and my creativity and motivation became such a contrast to how I've been feeling for many years. However the anxiety felt very different because my mood was lifted but it was still very intense that I needed to distract myself especially on the new patch days. So I spoke to my gp as I felt the patch was a one size fits all and the progesterone content could very well be the issue and a Mirena was suggested as it has a slower released progesterone. I had a coil in my younger days and I suffered a lot of pain especially during my period so it was taken out swiftly, I was never able to tolerate the pill nor the depo injection as it gave me anxiety and awful mood swings. So I was prescribed the gel 2 pumps a day and micronised utrogestan 100mg daily. So I waited until my new patch day on Saturday and in place of the patch I began the new regime as in my first post. Because of my reaction to it I went back to the patch on Sunday as I felt wretched. So be it psychological or not I have felt awful ever since, anxiety constant and feelings of hopelessness, I think I had such high hopes that I fell very quickly. So I saw my gp on Thursday and I have been referred to a gynaecologist as it was beyond her level of expertise which I understood but I do wish there was more training and time to of least said to me, try just one pump and the utrogestan every other day or something to tide me over whilst I wait. So I decided to not put a new conti patch on which was due Thursday and initially the anxiety lessened but today I began to bleed and I feel awful. So where I am is that I have a private appointment booked with a gynaecologist on the 12th of April which I'm hopeful our insurance will cover as it's £250... but that is another story. I can do one of two things, go without any hrt until the appointment or try the 1 pump of gel and utrogestan to see how it goes before I see him. If I do that how long should I wait to begin it now I'm having a bleed? Im honestly so grateful that you have given me your time, it's a crazy long post I know but I wanted to give you as much info as I can...I feel utterly stuck but I'm thinking that as I had 2 periods in a year that the regime will change regardless? I'm grateful that I have a supportive husband he finds it incredibly difficult seeing me so poorly and feels utterly helpless

[JinglingHellsBells]

I've put my answers in italics where I've added them.

It's been a very rough and dark few days. So I will be 50 in June, I told my gp that I had a period last March 2018 and then one in the Nov 2018. She put me on the Evorel Conti, I too have questioned this, but I think there have been crossed wires.
Conti is only for women 12 months post menopause ( after last period.) The synthetic progestogen in the patch is one of the main causes of mood changes.

I felt my mood lift almost immediately as did the brain fog and my creativity and motivation became such a contrast to how I've been feeling for many years.
That would be the estrogen working.

However the anxiety felt very different because my mood was lifted but it was still very intense that I needed to distract myself especially on the new patch days.
That would be the Norethisterone, the progestogen.

So I spoke to my gp as I felt the patch was a one size fits all and the progesterone content could very well be the issue and a Mirena was suggested as it has a slower released progesterone. I had a coil in my younger days and I suffered a lot of pain especially during my period so it was taken out swiftly,

I was never able to tolerate the pill nor the depo injection as it gave me anxiety and awful mood swings.

The Pill is a large dose of synthetic hormones. HRT estrogen is natural, like your own.

So I was prescribed the gel 2 pumps a day and micronised utrogestan 100mg daily. So I waited until my new patch day on Saturday and in place of the patch I began the new regime as in my first post.

It is practically impossible for the estrogen to cause this as it's exactly the same as what was in your patch It would also be impossible for one capsule of Utrogestan 100mgs to cause your symptoms. It is more likely to be the patch hormones still in your system or your own meno symptoms as you are still in peri.

Because of my reaction to it I went back to the patch on Sunday as I felt wretched. So be it psychological or not I have felt awful ever since, anxiety constant and feelings of hopelessness,

^As above. More likely to be your own fluctuating hormones or the result of the progestogen in the patch. You would also suffer withdrawal symptoms coming off the patch once the progestogen left your system.
^

I think I had such high hopes that I fell very quickly.

The standard advice is 3 months on any new HRT.

So I saw my gp on Thursday and I have been referred to a gynaecologist as it was beyond her level of expertise which I understood but I do wish there was more training and time to of least said to me, try just one pump and the utrogestan every other day or something to tide me over whilst I wait. So I decided to not put a new conti patch on which was due Thursday and initially the anxiety lessened but today I began to bleed and I feel awful.

The bleed is because you have stopped the patch and it's a withdrawal bleed or your own period

So where I am is that I have a private appointment booked with a gynaecologist on the 12th of April which I'm hopeful our insurance will cover as it's £250... but that is another story.

Private insurance does not cover menopause. It will cover periods and gyane issues but not if you say they are menopause. I can do one of two things, go without any hrt until the appointment or try the 1 pump of gel and utrogestan to see how it goes before I see him. If I do that how long should I wait to begin it now I'm having a bleed? Im honestly so grateful that you have given me your time, it's a crazy long post I know but I wanted to give you as much info as I can...I feel utterly stuck but I'm thinking that as I had 2 periods in a year that the regime will change regardless? I'm grateful that I have a supportive husband he finds it incredibly difficult seeing me so poorly and feels utterly helpless

The only advice would be to start the gel and use it as a sequi regime, so gel only for 2 weeks then gel and 200mgs Utrogestan for 12 days. You are still in peri so not ready for conti HRT

[Aliceland69]

Thank you for your reply to my very long list of symptoms and concerns. I will take on board all of what you have mentioned and I have decided to take note of using the gel 1 pump for 2-3 weeks. I'm in receipt of a US health insurance as my husband is retired USAF so it may work slightly different as they do support Hormone replacement therapy claims so my question will be if it covers menopause related hrt something I will contact them about on Monday. I also found a specialist who is local to me and is listed on Dr Louise Newsons website and I therefore I am happy to pay either way. Thank you again

[SalRobins]

GP put me on Femostan 1/10 just over 3 weeks ago and I stopped it last night. It’s made me really ill. I’ve been bleeding for over 10 days (period normally lasts 2/3 days for me these days and are still regular) and I’ve had the most horrendous anxiety! I can barely breathe or walk, head spinning, palpitations, feeling like I’m going to faint, upper back pain and sore skin on my back, my neck and shoulders are so tense they’re like rock and I can’t stop thinking about dying! (probably because it feels like I’m dying!) I’ve NEVER experienced anything like this before. GP has done all blood tests to rule everything out and it all boils down to the oestrogen and then added progesterone (I got 100 times worse when I started taking the grey combo pills!) causing me to have anxiety.
I’m going back to the natural method and see how I go. I don’t get hot flushes, just aches, pains, itching skin (I scratch it in my sleep until I bleed!), no energy, no libido, weight gain, concentration and memory issues, which effect my job, and I’ve become a recluse.

I’m coming back as a man!

[BooseysMom]

You are still in peri so not ready for conti HRT

I'm sorry to jump in here but I wanted to say I believe I'm in peri due to worsening symptoms, but I'm still having regular periods. The gp wouldn't fit a coil and suggested I try Evorel Sequi and Conti patches. I have had all sorts of pills before and found my mood swings are far worse so gave up everything 10 years ago.
So I'm wondering why would they prescribe this if I still have regular periods?

[JinglingHellsBells]

The gp wouldn't fit a coil and suggested I try Evorel Sequi and Conti patches. I have had all sorts of pills before and found my mood swings are far worse so gave up everything 10 years ago. @BooseysMom

You either have sequential or conti- not both.

See here under the heading What is HRT?

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/449/menopause%20and%20hrt.pdf

Why will your GP not offer you treatment with a coil?

And in peri you don't have continuous HRT

[BooseysMom]

Dear God, I despair in GPs! I have def been prescribed both.. x3 packs with both patches, half 50 half Conti. She was very vague and dare I say unknowledgeable when I asked about how do I take it?
I asked for the coil and was told no
not until Oct or Nov because of Covid (of course).

[BooseysMom]

I forgot to say thank you! @JinglingHellsBells

[JinglingHellsBells]

@BooseysMom Ah that makes a bit more sense. I think that with these patches, you use the estrogen only for half the month then the estrogen + progesterone for the 2nd half of the month.

(Obviously women on the conti regime only use the conti patches every day.

HTH

[JinglingHellsBells]

BTW there is no reason not to see you in person and fit a coil. She can wear PPE, you can wear a mask and she isn't going to be working on your face, is she

Have you thought about your local FPC to see if they would?

People are still being treated, and drs are seeing patients face to face.

[BooseysMom]

@JinglingHellsBells..
Thanks for confirming about the HRT..that's a relief. I'm probably being over anxious but the first few side effects listed are breast cancer, ovarian cancer and one other. DM died of breast cancer that spread everywhere and i know the risk is low but I'm just too scared to take these pills.

BTW there is no reason not to see you in person and fit a coil. She can wear PPE, you can wear a mask and she isn't going to be working on your face, is she

I know, it's a ridiculous statement. They're currently doing smears so why not coil?!
I think the FPC is a good idea.

[jessstan2]

I was worse while being on HRT, including migraine. I stopped taking it and felt better in no time!

[dontdisturbmenow]

I too was worse in hrt. I worked out that the peri phase for me was characterized by huge surge of oestrogen and that's what was making me feel awful. Getting in hrt not only made it worse but I didn't tolerate the progesterone so it was double bad.

I gave it up, coped as I could with the symptoms until I was 12 months without a period and things started to get better.

It's still tough at times, and I still get the occasional oestrogen surges when I feel worse, but all in all, I've been much better since the actual menopause and each year is easier. I hope to be getting closer to the other side now.

Hrt doesn't fit everyone.

[BooseysMom]

@jessstan2
@dontdisturbmenow
I have a feeling I'm going to be the same tbh as the pill never suited me and I had to stop taking everything 10 years ago. But I'm going to give the Sequila patches a chance for 3 months and I'll come straight off if I get bad side effects.
@dontdisturbmenow
I'm glad to hear you feel better now the menopause is through.
It just shows hrt doesn't suit everyone. I wanted to manage it without hrt but it's getting worse every month.

[Jules36912]

Hello, I’ve also struggled with anxiety throughout my life, but at 48 am feeling pretty grim with rising and falling hormone levels. So I’ve been prescribed Utrogestan and Estradiol but after 2 weeks I feel sick, with a headache and more anxious but at the same time ‘flat’ and dazed. I’m starting to wonder if HRT is not for me - difficult to know and wondering if I should persevere or give it up!