Could by oestrogen dose be too high?

[Impossiblepossibilities]

Started HRT 5 months ago. Evorel 25 plus 12 days Utrogestan. It went great at first. My migraines have stopped completely and I gradually felt and slept better than I had in a very long time, but then the effect seemed to taper off. My joint pain in particular got much worse, especially when it was the day to change my patch and I had a few hot flushes coming back. The worst was my feet, I could barely walk when I first got up in the morning on the day my patch was due to be changed.

At my 3 month review, I explained the above and the GP put me on Evorel 50. Apart from the fact the patches are a pain in the rear, because if you get hot they just crinkle and start peeling off, I am now back to having major hot flushes again, both in the daytime and at night. They are much worse than even before I started HRT and are at their worst during my progesterone phase.

Also, before my 3 month review I was still having a bleed regularly (within a few days/to a week here and there) although this was tending to start mid-progesterone phase. Since I changed to the 50 patch I have not had a bleed at all, despite following the same protocol. (Patch change twice a week, progesterone days 1-12 of every month.)

I would prefer to be on the gel, so I could manage my dose better, but there is still a big problem with stock levels around where I live and Evorel patches are the only thing I have been able to actually get dispensed.

I am struggling to work out why. Could it be that the oestrogen levels are too high now? I’ve tried Googling, but couldn’t find a sensible explanation.

From your symptoms they sound like not enough estrogen!
a 25mcg patch is a tiny tiny dose.

50mcgs is medium.

It's usual to need more sometimes as you go further into post-menopause.

Im getting my estrogel without delay via Boots online prescription service.

@JinglingHellsBells that’s what I thought at first, then I wondered if it might be inconsistent dosage, due to the patches drying up and peeling in the heat, but it’s cooler now and the flushing is worse. (I did try putting tattoo barrier over the top of the patch to stop the drying and crinkling/peeling, but that restricted the slight movement of the patches and caused my skin to rip.)

After over an hour in a phone queue, I have just managed to get a very rare appointment with my GP for the end of this month to review things, so I’ll have to see what she says. We had a bit of an argument last time, as my periods were still regular - within a day or two -, but she wanted me on the daily dose of progesterone and I wanted to stick with 12 days a month. Her argument was that I must need the daily dose because I am 52.

Up until I started HRT 5 months ago my periods were pretty regular, just a couple of days out here and there, but I was having lots of symptoms, which initially the 25 mcgs patch really helped at first. Since moving onto the 50 mcg patch I haven’t had a bleed at all. Currently in the middle of my 12 days of progesterone and the hot flashes have been really debilitating, day and night, when I have never had them this bad before.

I told dh last night that, at this rate, he will be able to save on energy this winter as I will be producing enough heat to keep the house warm!

Sounds a lot like Estrogen Dominance to me.
www.hrt.org/estrogen-dominance-signs-symptoms-tests-and-treatment/

Your GP was probably correct that you needed the progesterone daily. Estrogen has to be countered with progesterone otherwise you risk estrogen dominance symptoms and risks.

@Discovereads that’s what I was reading about this morning, but I have very few of the symptoms listed, just the hot flashes, brain fog and fatigue (the latter two of which I suffer from anyway due to having autonomic dysfunction). My hands and feet constantly feel hot too, so that’s the opposite of what oestrogen dominance causes and I am not at all depressed or anxious. (My anxiety has improved massively since I started HRT despite going through a particularly stressful time recently.) I don’t get any breast tenderness/sensitivity either or mood swings/PMT.

I am already a higher risk than many for stroke (lifelong complex migraine with associated WM brain lesions - although the migraines stopped dead when I started HRT, haven’t had even one in 5 months now, when I used to lose several days a week to them) so that’s a real concern for me. As I mentioned previously, I also have autonomic dysfunction, which can result in all sorts of weird symptoms, including poor temperature control, but previously I have only ever become hot with prolonged standing. For most of my adult life I have been unable to sweat, other than my scalp and face - and then only when I was pre-syncopal, now I’m getting full body sweats with the hot flushes.

I suppose I will have to wait and see what the GP suggests, which I reckon will either be sticking with 50 mcgs and trialling daily progesterone or dropping back down to 25 mcgs. I really can’t face the painful joints though, especially barely being able to walk with my feet being so painful, it honestly makes me feel like such an infirm old lady hobbling around.

Estrogen dominance

There is no science behind this and you won't find any UK menopause experts using the term. It was started in the US by mostly 'alterantive' drs. The link that's above is not a medical site, it's a commercial site.

Menopause symptoms begin with the decline of ovarian function and loss of estrogen.

@Impossiblepossibilities The fact you are not having a bleed means you are probably not absorbing much estrogen. Bleeds happen when the uterine lining is thickened by the dose of estrogen and progesterone is withdrawn. (sorry if that sounds a bit 'formal'!)

Maybe patches don't suit you, but estrogen gel might?

The other important point is that your GP is wrong about daily progesterone.
This is from a medical website, written by consultant gynae Dr Heather Currie. www.menopausematters.co.uk/postmeno.php

Daily progesterone is for women who are

1 over age 54 (so most ovarian function has stopped.)
2 have not had a natural period for at least 12 months (as above)
3 prefer to have a no-bleed option for HRT

It is not mandatory to have continuous progesterone. Some women do not get on well with progestins every day owing to side effects and prefer the sequential sort. (I have a friend in her late 60s still on sequential.)

One important point that many GPs seem unaware of is that continuous progestins have a slightly higher risk of breast cancer, compared to sequential regime. This might be relevant if you want to use HRT for many years.

So, it's up to you how you deal with your GP but she's in the wrong to try to force continuous on you, and medically you are not ready for it.

Thank you @JinglingHellsBells that’s what I understood about progesterone and I gave her the exact three points you listed, plus pointed out that 12 days is what is actually advised on the manufacturer’s info leaflet in the packet! She then agreed to me sticking with 12 days a month. I would prefer to stay on the 12 days if I can for now.

I would like to trial gel, but had such a lot of trouble trying to get hold of it when I was first prescribed HRT that I gave up in the end and accepted patches.