HRT not helping crushing fatigue

[Phish]

Sorry, this might be long but I'm really hoping someone might have some ideas.

I'm 46. I'm in perimenpause. I've been on HRT for 18 months. I started on 37.5mg estradiol patches and am now on 75mg Estraderm patches (only 75mg ones I could get) and take the mini-pill continuously.

Started taking HRT after I put two and two together - migraines, night sweats leading to terrible sleep and exhaustion, very low mood, weight gain, brain fog, dizziness and crippling anxiety which left me struggling to function normally.

The HRT has definitely helped with the sweats, migraines and anxiety but I'm still really struggling with absolutely crashing fatigue. After a day at work I am fit for nothing - struggle to even sort the kids out, never mind exercise or think of socialising. In response, the GP has continued to increase the estradiol dose but it's not helping.

I watch what I eat and don't drink but I'm still gaining weight, although that's not surprising as I am far to tired to exercise.

Had full bloods and apparently there are no issues with thyroid, anaemia or vitamin levels but I really can't go on like this. I'm 46 but feel about 96 and have no life apart from work then spending the weekend recovering.

I have another GP appointment coming up and I really feel like I need to go in there with some idea of what I want to happen next so, can anyone please help with suggestions of what I should be asking for.

why the mini pill continuously? Is this for the progesterone part of your HRT? or for contraception? Did you use it before starting hrt?

If you are in peri with some periods still, it's not recommended to use continuous hrt ( 2 hormones daily.) You ought to be on sequential which is continuous estrogen and progestogen of some sort for 12 days per cycle.

Taking progestogens daily can make people moody, sluggish and depressed.

Does any of this sound along the right lines?

Go back and see your GP ASAP
The mini pillow not enough progesterone to protect your uterus lining from building up with the oestrogen. This isn’t a safe combination.
If you need contraception then you can carry on with the mini pill but still need HRT progesterone as well. Your patch is oestrogen only for women without a uterus or with a Mirena coil in.

You need to be on a bleed type or a continuous combined if you had had no periods for at least a year before you started HrT.

Thanks for the replies. I've taken the mini pill for years. As I'm still having occasionally sporadic periods, the GP said I needed contraception so suggested that the mini pill as the progesterone in that would also meet the requirement for progesterone alongside the patches.

I did mention whether the mini pill was the right thing at my last appt but she said it was fine and clearly it was the estrogen causing problems!

The mini pillow [pill] not enough progesterone to protect your uterus lining from building up with the oestrogen. This isn’t a safe combination.

@Tellingitlikeitisnt You don't know what dose of mini pill she is on.

My menopause consultant offered me the mini pill as part of hrt, so it's perfectly safe if the dose used is tailored ( larger dose than one pill a day) to use as HRT. Many mini pills are Norethisterone or similar which is what's used as HRT.

It's unlikely her gp has given her an estrogen-only patch without discussing what she needs to go with it.

Obviously if he's not given it for part of hrt that's something she needs to look into.

Op, I'm very similar to you. Watching this thread.

x-d posts.

It is unlikely it's the estrogen and if so, it would be too little not too much.

You need to ask her to check the dose of your mini pill. The one I was offered (I didn't take it and chose Utrogestan instead) meant I'd need to take 3 a day to work alongside estrogen gel.

Why not swap it for a Mirena, or use the Pill (combined pill) which is also used for younger women like you instead of hrt? The Pill is now used right up to menopause and the one that is most like hrt is Qlaira.

I'm taking Cerazette, which I've been on for seven years. Switched from combined pill to cerazette seven years ago after getting awful headaches during the week break.

It definitely sounds like the progesterone element I take at the moment isn't right.

A single cerazette tablet is not adequate progesterone alongside oestrogen patch in a woman with a uterus

This really needs to be looked at
Are you having regular bleeds?

Not regular bleeds, very sporadic.

@Phish
I can’t tell you strongly enough that you will need a scan of your uterus to check lining of womb and a proper HRT that has adequate levels of progesterone
You can take the mini pill alongside the HRT for contraception but it is not enough on its own to make oestrogen safe

Please see a GP

Just to let you know, I have a result of sorts as the GP has agreed to refer to a Menopause Clinic. Now just need to see how long the wait will be.

Thanks everyone for all of the advice.

But left you on the same pills?

OP even a google will tell you that’s not a safe combination

@Tellingitlikeitisnt Are you are pharmacist?

The dose in the mini pill she's on is 0.75mcgs.

It may well be enough to offset the dose of estrogen. I think her dr needs to advise.

@JinglingHellsBells

No I’m married to a GP

Loads on google

You can take the POP alongside HRT for contraception but the progesterone in POP is not adequate to protect the endometrium

Not sure why who you are married to is of any relevance.

The POP can be used if in the correct dose to offset the dose of estrogen.

My consultant (one of the top 3 in the UK) offered me it. I won't go into details of the exact amount because that depends on the dose of estrogen used, but it's not correct to make a blanket statement as you did saying it can't be used and the pic you posted doesn't help really either.

Op- discuss with the clinic.
If you are in peri and having some periods, it's possible that you have enough natural progesterone of your own along with the POP to prevent build up of the lining. It needs someone who knows your full medical status and the dose of the hrt etc to make a call.

Cerazette is 0.75mgs , most combined, continuous hrt uses 1mg daily for the progesterone. But you are using .75mgs daily which is a lot in tota; a month and almost the same as women would use post menopause when they have NO natural progesterone of their own.

Could the fatigue be related to life not Menopause?