HRT side effects: dry eyes and constipation

[Signalbox]

Since starting taking HRT I have had 2 side effects that are really making me feel quite stressed out.

One is my eyes have become bone dry during the night. Feels like I have grit in my eyes. My doctor says it is unlikely to be a side effect of HRT because HRT is supposed to make things more lubricated. But it has come on so suddenly since I started HRT that it feels like a side effect to me.

Has anyone else noticed this?

The other is that as soon as I start taking the Utrogestan I become kind of constipated. It's not that I can't go, but just that I feel like I need to go about 4 times per day. But then it's hard to empty my bowel. This has then caused me to have piles. I have tried using the Utrogestan vaginally which has helped slightly but I am still not comfortable for the 14 days that I have to take it. I spoke to my doctor about this and she didn't really have any advice (apart from I could get the mirena coil which I am really reluctant to get.

I wondered if I spaced out the Utrogestan it might be less likely to make me constipated. I thought I could take one at night and one first thing in the morning. Does anyone know if it is OK to space out the dose of Utrogestan? Does anyone else do this?

Progesterone relaxes muscles in the body, so that includes the bowel- it works more slowly.

To counteract this when you take Utrogestan, try to increase fruit and veg, drink more fluids ( 2 litres a day) but also make sure you exercise- at least 30 minsbrisk walking a day. All this should help get things moving.

Dry eyes- there is some evidence that HRT may cause this but you can treat it with eyedrops to add moisture- just buy off the shelf in Boots etc.

To counteract this when you take Utrogestan, try to increase fruit and veg, drink more fluids ( 2 litres a day) but also make sure you exercise- at least 30 minsbrisk walking a day. All this should help get things moving.

Thanks for your reply. I'm already on the FODMAP diet and I'm not sure I could fit in much more veg without starting to remove other food groups from my diet. And I already drink plenty. That's why I was wondering whether spacing out the 2 Utrogestan pills might help (or more importantly if it's acceptable to space them out or do they need to be taken together?)

Also I already take over the counter eye drops and these aren't helping. I've booked an eye health appointment for today though so perhaps they can suggest something more effective.

My optician noticed my eyes were dryer on my last contact lens check and gave me some drops that were much more 'moisturising' than the usual types. Available in Boots Opticians.

Oh thanks. Hopefully they’ll be able to prescribe me something better then.

@Signalbox If you are doing the FODMAP under a dietitian (which is how it's supposed to be done) could you ask them for advice on what you can increase? I know a lot about FODMAP, from a personal point (one of my family did it via a very good dietitian who was given an award for her work in that area). I appreciate it's fairly limited, but in time, it's sometimes possible to introduce more items. you could maybe eat more of the things that you are allowed.
Exercise is also really important for bowel health to get things moving!

It won't make any difference spreading out the Utrogestan. You will still have 200mgs in your system whether you take it at 10am and 10pm, or both at 9pm.

I'm not sure I could fit in much more veg without starting to remove other food groups from my diet.

I'm not sure what you mean by this.

You shouldn't need to take out the foods that don't affect you if you add others.
Fodmap is about triggering foods, (high in not the actual number of foods.

It's also supposed to be done for around 8-12 weeks, then trialling new foods gradually, under medical supervision, to see how you respond.

This is just one list I grabbed online and there are quite a lot of things that can be eaten.

-Proteins: beef, chicken, eggs, fish, lamb, pork, prawns, tempeh, and tofu
Whole grains and starches: white and brown rice, lentils, corn, oats, quinoa, cassava, and potatoes

-Fruit: blueberries, raspberries, pineapple, honeydew melon, cantaloupe, kiwi, limes, guava, starfruit, grapes, and strawberries

-Vegetables: bean sprouts, bell peppers, radishes, bok choy, carrots, celery, eggplant, kale, tomatoes, spinach, cucumber, pumpkin, and zucchini

-Nuts: almonds (no more than 10 per sitting), macadamia nuts, peanuts, pecans, pine nuts, and walnuts

Seeds: pumpkin, sesame, and sunflower seeds, as well as linseeds

Dairy: lactose-free milk, Greek yogurt, and Parmesan, Colby, cheddar, and mozzarella cheeses

Oils: coconut and olive oils

Beverages: peppermint tea and water

Condiments: cumin, saffron, cinnamon, paprika, coriander, cardamom, soy sauce, fish sauce, some chile-based products, ginger, mustard, pepper, salt, white rice vinegar, and wasabi powder

I was under a dietician when I started the diet and it's helped me a lot. I don't actually find it that restrictive and when I stray from it I immediately feel worse again so now I mostly stick with it and just occasionally treat myself to something not FODMAP or if I am away from home and I can't control what I am eating.

I understand that I am having the same amount of Utrogestan, but I just wondered if blasting myself with 200mg at bedtime (when my bowel movement is generally first thing in the morning) might be more likely to cause issues than spacing it out. All I really want to know is if it's OK to space it out? I suppose I need to ask a pharmacist.

HRT fixed my dry eyes so maybe give it a while for your estrogen levels to settle. Utrogestan knocks me out so I'd be worried about taking it in the morning. How about taking cod liver capsules in the morning instead?

I'm not sure what you mean by this.

What I mean is that there is only so much food I can eat within a within a day. If I add more veg I won't have the appetite to eat other food groups. I already have plenty of vegetables and some fruit daily in my diet.

Thanks, you're right that maybe I'm still getting used to the hormones. I've only been on HRT for approx 3 months and my dry eyes (at night) have coincided with that. But I know they were already on the dry side (I just not enough for me to notice). It'll be interesting what the optician says this afternoon.

Does cod liver help with constipation?

I have extremely dry eyes which have got steadily worse since menopause. One of the reasons I am trying HRT is to see if it improves. So far I may have seen a slight improvement but definitely not worse. Not sure if that is any help to you.

Hycosan eye drops are good but ££££. Artelac eyedrops also good. Look for drops with similar ingredients. I take omega 3 supplements top for dry eyes and I eat a lot of fish...

I can recommend Ortisan Fruits & Fibre cubes.

I also eat a lot of fish. I will try the omega supplements as well thank you.

Thanks I will give them a go :)

If you feel it's not possible to increase your fibre intake with fruit and veg, maybe try drinking more water? It won't do any harm and may help. But maybe just adding one more piece of fruit or another vegetable may help.

Do you get out every day for a walk?

It won't harm you to divide the dose of Utrogestan but there are 2 issues:

1 You might get some spotting because as the levels fall that's when bleeding each month starts. Leaving a 12 hr gap between doses might mean you get spotting.

2 If you use it orally during the day, you may get side effects like dizziness.

3 Dividing the dose won't make any difference. It's not like a painkiller where the effects where off within a few hours. It's circulating in your blood and that's what causes the relaxation of muscles (it happens a lot worse sometimes to pregnant women who have very high progesterone.)

I can recommend Ortisan Fruits & Fibre cubes.

It depends what's in them. wheat fibre? High fructose?

IBS and doing the fodmap excludes a lot of products with high fructose. Read the labels as you may as well eat 6 lovely fresh strawberries than eating something processed.

Thanks for your input. I will defo try to drink more water. I think I might measure it out so I know how much I am actually drinking. It's easy to forget sometimes.

I do walk daily usually for about an hour. But that is the extent of the exercise I do. I could perhaps do slightly more vigorous exercise.

I am using Utrogestan vaginally (my doctor said this was fine) which did help to reduce the constipating effects but it would be nice to reduce it further if possible. My diet is really about as green and fibrous as it's possible to be. Before I started with the Utrogestan I felt I had finally (after years of struggling) learned to manage my IBS by being extremely careful with what I eat.

Good point.

Oh yes - definitely check beforehand that you would be OK with the Ortis Fruits & Fibres cubes. I think they are mainly rhubarb, figs and taramind.

signalbox
I under your post completely having suffered with similar issues myself

I had settled my IBS and then took utrogestan and it all started up again!

Gave up tbh as the oestrogel made me feel great but the progesterone did not and I really could not eat more fruit/veg or drink more water I was eating very well

I hope you find a resolution

Hyabac eye drops are what the optician recommended for me.

Can I suggest that you see an optician about your dry eyes? I say this because as I have aged, my eyes got drier and dryer and dryer. I knew that I had a low blink rate because I had always struggled with contact lenses, but over the years I put the dry eyes down to one thing after another after another. Finally towards the end of last year they were unbearable – put that down to cataract surgery! But I had a proper optical consult (and by that I mean more than testing your eyesight!) and ended up referred to a specialist who agreed that I did have a low blink rate, but yes, there was more, and I also had something called meibomian gland dysfunction. I was utterly gobsmacked to discover it is really common, especially as one ages, and also in women. It is thought that up to 50% of all people have it to some degree although they may not realise it, and it gets worse over time. And yes – HRT can in fact make it worse. It isn’t dry eyes as such, which is something different, although you can have it in combination with other conditions.

It isn’t serious in that it won’t make you go blind but it can cause a lot of discomfort – and I had to really fight and fight to get a referral to a specialist because the NHS apparently doesn’t think that such things are important. In milder cases there are lots of things you can do to help yourself, and not just drops. In fact drops are of limited help because it’s actually blockages in the oil glands. An optician can advise and guide you, and there’s loads of stuff on the internet if you google.

Thanks cantheydothisreally I'm glad it's not just me. It's very frustrating isn't it when you feel like you've overcome something you've struggled with for a long time and then it just takes a medication that's supposed to be helping you to make you feel like rubbish again.

Thanks jalisco that's interesting. I've just gone to specsavers and they've done an NHS health check on my eyes. I have "very dry eyes" according to the optician.

She told me that HRT can cause the dryness to become worse.

I also have blephitis (which I'd never heard of) and also she said my oil glands should be stimulated (with a hot flannel and massage) and to make sure I am blinking especially when looking at the computer a lot.

So that was an education. I've been armed with various drops and lotions and information so feeling a bit better about it all.

I am hoping I start to get some positive effects from the HRT soon or I might just knock it on the head.