Help! I think HRT is making me worse.

[Dawnpri]

I have been on various hrt for eight months now, first Conti patches and then estrogen patches and Utrogestan. My patches have been increased more and more so I am now up to 250 but I am feeling more and more ill. I am burning up all the time, which causes my chest to feel like there is an internal pressure. I also have unbearable anxiety. I am absolutely desperate and my gp doesn’t know what to do. The menopause clinic just told me to stick with it but I don’t feel safe any more. Has anyone else got much worse on hrt? I am even starting to wonder if I’m intolerant to the estrogen itself, as I’m using the utrogestan vaginally and I’m told that shouldn’t be affecting me. Things seem to get worse each time the patches are increased. I would be so grateful to hear from anyone who has experienced similar.

Sorry I'm not an expert but if you aren't seeing any benefits at all perhaps reduce and then stop or reduce and try a lower dose? I have friends who can't tolerate a higher dose of oestrogen they feel jittery and weird. Try gel rather than patches which will give you more control to up or lower doses as needed, or maybe try adding anti depressants in if you think anxiety is an overriding problem.

Thank you so much for replying. I have just spoken to my gp and she has also suggested reducing the dose so I’m going to do that and see if it helps. Will then have to have a rethink.

I’m coming to the conclusion for myself that dealing with the menopause needs to be a multi targeted approach rather than just relying onHRT.
So diet, exercise, yoga , mindfulness, massage, vitamin supplements alongside the HRT and hopefully all things work together.

I think you’re probably right. Ironically, all of the other strategies have gone out of the window because I’ve been so unwell with the menopause/hrt/anxiety. I need to try and actually do some of those things.

Are you really on a 250mcg patch? I didn't know one existed. Online the most I can see if 100mcgs.

Most women start on 37mcgs and maybe go up to 50, 75 or 100.
How are you getting 250mcg?

I'd stop for a few days after the next bleed, and then start again on a lower dose.

Which patch do you have and what dose?

I’m sorry to hear you are having it so bad @Dawnpri. * Ironically, all of the other strategies have gone out of the window because I’ve been so unwell with the menopause/hrt/anxiety.*

I totally get this. When you feel good it’s easy to do exercise, get fresh air, and prepare super healthy meals etc. When you feel lousy, getting up, going to work, caring for your family etc. is a huge achievement in itself. Take it easy on yourself and BTW your dose does sound super high. Good luck x

@Whattochoosenow

I’m coming to the conclusion for myself that dealing with the menopause needs to be a multi targeted approach rather than just relying onHRT. So diet, exercise, yoga , mindfulness, massage, vitamin supplements alongside the HRT and hopefully all things work together.

Such a palaver isn't it?! What vitamins are you on?

It made me feel worse too OP. I had a permanent headache and put on weight. I still had disturbed sleep which was the main reason I went on HRT. I also really suffered on the 12 utrogestan days. I've come off it now and the only symptom of perimenopause I have is insomnia (which sucks a little bit) but otherwise I feel great. I did some research and it is possible to have excess oestrogen/sensitivity to oestrogen which I think applied to me (i always felt awful if I ever was on the pill).

I will go back on HRT at some stage as I know it's beneficial, but will really need a tailored approach I think. And at the moment I feel ok as I'm still having regular periods and no other symptoms apart from the bastarding insomnia (which I still had when I took HRT).

@HoliHormonalTigerlilly wellwoman 50+ and extra vitamin D because even in the summer my levels were measuring low.

I now realise that I’m really unstable on the patches as well. Over the last four days I was burning up on days 1 of the patch change. Burning up half the day on days 2 and 3;and was much better on day 4 yesterday. Changed them last night and am absolutely burning up again today. I thought this was happening but I haven’t been able to find anyone else reacting like this. It’s like my body is sucking out all the estrogen at the start of the patch change. They keep increasing the dose because I was burning up but each increase has just made this worse. Might start a thread to ask about this issue in particular.

@Dawnpri

I now realise that I’m really unstable on the patches as well. Over the last four days I was burning up on days 1 of the patch change. Burning up half the day on days 2 and 3;and was much better on day 4 yesterday. Changed them last night and am absolutely burning up again today. I thought this was happening but I haven’t been able to find anyone else reacting like this. It’s like my body is sucking out all the estrogen at the start of the patch change. They keep increasing the dose because I was burning up but each increase has just made this worse. Might start a thread to ask about this issue in particular.

You didn't answer my query over the dose.

Are you really using 250mcgs patch?

That would be 2 patches of 100mcgs and 1 patch of 50mcgs all at the same time.

That is unheard of and if so, no wonder you feel odd.

I was,on HRT Gel for about 3 months, I felt as though I was being poisoned so quickly stopped using it.
I'm plodding my way through..the nightsweats/insomnia are horrendous but I've been taking HTP-5 Gummies and Clodinine (Clodipine?) and I'm noticing a little bit of a difference

what do you mean by 'burning up'- do you man you feel very hot?

Please say which patch it is (the name of it) and the actual dose of estrogen on each patch.

I’m using 100 patches and using 2.5 of them. The menopause clinic told me to do this because I wasn’t absorbing very well, according to the last check of my estrogen levels. Apparently they have women on 400 sometimes!
Yes, my insides feel like they’re burning up. Particularly in my chest and torso. I almost feel numb because I can’t feel the air temp at all. It was similar to this before I started on hrt but I think it’s even worse now. I def think I’m unstable on the patches and it’s causing massive fluctuations, which is then causing the symptoms; or making them worse. I’ve never had hot flushes, just burning up for hours at a time. Things did improve slightly at the beginning of hrt but it was brief. Aaaaaaargh!

@Piggy666

I was,on HRT Gel for about 3 months, I felt as though I was being poisoned so quickly stopped using it. I'm plodding my way through..the nightsweats/insomnia are horrendous but I've been taking HTP-5 Gummies and Clodinine (Clodipine?) and I'm noticing a little bit of a difference

Yes, starting to think I might have to give up hrt and use Clonidine instead. Will also investigate 5-htp. Thank you.

Sometimes I feel that I have little faith in menopause clinics. Many are 'staffed' by GPs doing an extra shift and they aren't always that up to speed.

Taking blood to test your levels is not that accurate, for a start. my consultant doesn't do that as he thinks it's a waste of time.

Just to put your dose into some context...

2 pumps of estrogen gel (a medium dose) is roughly the same as a 50mgs patch.

See this table here and scroll to the bottom to see the doses.

www.womens-health-concern.org/help-and-advice/factsheets/hrt-types-doses-and-regimens/

So, your 200mcg patches are the same as 8 pumps of gel. That would be ridiculous. No one could physically apply that amount to their skin and expect it to dry.

(I usually use between 1 and 1.5 pumps per day.)

Can i ask why you were referred to a clinic anyway and why your GP did that? Did you have a history of menopause issues or special requirements?

My personal advice would be stop the patches and change to gel. Use 1 pump a day for a few weeks then build up to 2.

You also need to consider the Utrogestan. Are you using 1 capsule each night? Utrogestan can and does increase body temperature. If you are using it nightly, it might be wroth trying it on a cycle (12 days per month.)

You don't say how old you are and how far into peri or post menopause you are.

Gp and gynae weren’t getting my severe symptoms under control so I went to the menopause clinic. She did seem to know her stuff much more. I did start on a 50 patch but things didn’t improve so was increased over eight months. I was still getting no stability even on lower doses of patches. So I think it’s a patch absorption problem, as well as not having enough estrogen overall. I did try the gel briefly but it appeared to do nothing. Might retry if I get desperate but think I need tablets for more stability. Although they will only give the equivalent of 100 patch maximum on licence.
Taking Utrogestan vaginally every other night, as instructed by clinic because you don’t need as much vaginally. However this is causing anxiety on the days I use it so that needs changing as well. Can’t tolerate synthetic progesterone either. Am losing hope.

I’m post menopause by the way.

Taking Utrogestan vaginally every other night, as instructed by clinic because you don’t need as much vaginally.

This guidance has been changed by the British Menopause Society, at the start of this year. They advise keeping to the normal dose of 1 capsule every day to avoid hyperplasia. Certainly if you are using a very high dose of estrogen, you should be on the licensed dose of Utrogestan, not half of it.

You say you want tablets for 'stability'.
Do you mean tablets for the estrogen?
They won't give you stability. Tablets are worse than transdermal. That is because a lot of the dose is lost in digestion.

Also, have you considered other ways to tackle your anxiety?
HRT is part of a whole range of ways of treating menopause.

You might want to try exercise ( at least 30 minutes a day), yoga, mindfulness, meditation, CBT, and of course a really healthy diet with lots of good oils, found in oily fish, nuts and avocado. These oils are 'brain food' and can help mood. Likewise, it helps to cut out all processed food and cook from scratch.

The estrogen dose you are on is unheard of! Even women with an early or premature menopause rarely use more than 3 mgs of estrogen a day, which would be 4 pumps of gel, or a 100mgs patch.

I do appreciate that but I have spoken to another meno specialist who also said he had some women on much higher doses because they weren’t absorbing it. My symptoms were so severe that I was initially sent to a neurologist because they didn’t know what was wrong with me! In fact, it was the neurologist that diagnosed menopause because he’d had another woman like me who had been sent to him. I went through months of tests and scans to check there was nothing else wrong with me too.
My case is unusual and I think that is the main problem.
The only reason I want tablets to try to get more stability is because on day one of my patches my symptoms are severe; slightly less on days 2 and 3 and then better on day 4. Then I change patches again and I’m back to intolerable symptoms on day 1. It never stabilises and it’s been like that for eight months, pretty much regardless of the dosage. I think I had a short period on a slightly lower dose where it was the other way around and I was a bit better on day one but then rubbish days two and three.

But if you feel worse when the patch is at full strength (Day 1) and better when it's ready to be changed, surely that means you are on a dose that is too high?

Not menopausal yet (at least not officially but there was fifty days between my last two periods, I turn 40 this year).
But I am hugely sensitive to estrogen, my body just reacts really badly to it, I can tell when I am ovulating because the cystic acne appears. I am diagnosed with PCOS so that might have something to do with it I guess.

I have thought about that but it was still happening at lower doses. I definitely agree that this high dose is worse though.

@ArabellaStrange

Not menopausal yet (at least not officially but there was fifty days between my last two periods, I turn 40 this year). But I am hugely sensitive to estrogen, my body just reacts really badly to it, I can tell when I am ovulating because the cystic acne appears. I am diagnosed with PCOS so that might have something to do with it I guess.

Yes, although I don’t have PCOS, I am starting to wonder about my tolerance to estrogen.

If your main symptom is anxiety, I suggest you look at specific treatments for that, such as CBT , yoga, and mindfulness.

You can't expect HRT to do it all, although hormones have a role.

Depending on your anxiety symptoms, you might need to use CBT to get control of your anxiety and also yoga focusing on your breathing and calming your nervous system may help.