HRT 5 months on. Is this the best I can expect to feel?

[fortyfifty]

I started HRT in March. I'm on Estradot 50 and utrogestal taken half the month.

The good thing is HRT immediately took away the panic/anxiety I was feeling. I have felt better, had plenty of energy, felt I have some control over my weight, sleep well, no joint or musecle aches.

But... I still feel a complete lack of motivation. I go out and do things but I still have an over all 'flat' feeling and feel a sense of being lost in the world without a plan but I don't have the motivation to think of things to do or set any goals or aims for the rest of my life. Which is completely unlike me as I am a planner, I always have things on the calendar, I always have things I want to do and places I want to see. But for the past few years, and still now on HRT, I'm still really 'meh' about everything.

It's so difficult to know how much of it to put down to peri-menopause, how much of it is a spill over from covid lockdowns, how much of it is my current stage in life. One dc is at university and one is about to start 6th form and you could say that Covid got in the way of that transition for me. I'm not needed in the same way but don't know what I want to do with myself in absence of the busy mum-role. Work I am completely meh about but I don't have any sense of wanting to do anything else. It is easier to go through the motions and keep doing what I know.

Would more estrogen help? Is testosterone the answer? I quite honestly have zero libido. On first taking the utrogestan, I thought it was coming back but that hasn't stuck.

Oh and I am bleeding heavily again when I have periods and having completely erratic short cycles - which is annoying, as before I started HRT, my periods had become shorter and lighter, and more frequently I skipped a month. Now I am having flooding type periods on day 1 and 2 which is not great when i can't pinpoint when I will get it. I thought the progesterone would have at least made them predicatable but I bleed before I have stopped the utrogestan for that month.

Any words of wisdom or shared experience, thoughts, advice how I get out of the flat unmotivated brain funk would be most welcome.

It might be that you need more HRT or something extra like testosterone or it might be you are in a phase if adjusting to your new reality with the children transitioning to independence, post Covid etc. I felt a lot like you but realised being busy all the time no longer suits my needs and a lot of things I would have enjoyed previously like concerts, theatre, just don’t float my boat in the same way. It’s so hard to say what’s going on as there’s lots to unpick but if it helps I can relate to how you feel and feel similar at times.

From what my private consultation said yesterday sounds like you need to add testosterone for the 'flat' feelings. Hard to get hold of though, I believe, and some doctors don't like to prescribe it. It comes as a cream.

Ooooh lots of stuff there @fortyfifty

First, bleeding a lot usually means you are not using enough progesterone or it's not being absorbed very well. You could try inserting the capsules vaginally which gives better absorption often. You could go to 14 days a month on it not just 12. (This is all medical advice, by the way, from the British Menopause Society who published a paper on this Jan 22.)

Secondly, it may be that Utrogestan is just not for you. My consultant describes it as a 'love/hate' drug.

It's become popular as it's body identical, but a similar (almost natural) type is in Femoston (tablets) and you could try swapping to those.

Thirdly, don't assume your feelings are to do with HRT or menopause.
A lot of people have made emotional adjustments as a response to lockdown. It had its downside, but at the same time it has made a lot of us realise who we want to spend time with and where we put our energies. Maybe you need to look ahead and find new hobbies, interests etc? Just a thought.

Do you work? Do you enjoy it? How do you want to spend your next 40 years? Have you a burning goal or a list of what is important to you? What's the unspoken/ unachieved ambition you have?

I really do agree with the PP that keeping busy and looking forward and outwards is important, as is daily exercise which is a proven mood -lifter. getting to the gym, doing yoga, Zumba, HIIT, etc might well help, or even just volunteering to take you out of yourself and into something else.

TESTOSTERONE is only licensed (well, it's not actually!) but given for libido and muscle strength. You need to tweak the HRT first with trying other types before adding testo and you won't get it anyway for the reasons you mention.

I'm not on HRT. But I had that flat miserable feeling on progesterone only contraception which is why I had to quit it.