Insomnia after stopping HRT or Acid reflux on it?

[SixDinnerSally]

Hi all, I have been on a low dose of HRT for ten months. After 5 months I developed signs of a hiatus hernia (horrific acid reflux and chest pain ) that resulted in two trips to A&E to rule out cardiac issues as the chest pain was so marked.

I was put on lanzoprazole which seemed to sort it out (most of the time). I have recently been referred for further tests, including endoscopy. These required me to come off lanzoprazole for a fortnight. I was terrified of doing as I knew is feel so unwell as even a short delay in taking each dose resulted in terrible stomach issues.

Last Friday I was Googling the reflux/ hernia issue and suddenly woke up to the link between HRT and stomach acid (I was very slow to realise as I had no side effects for five months). I stopped the HRT and the lansoprazole and my tummy troubles have virtually gone overnight! I told my GP about this on day three and they say it’s fine.

The trouble is that on night two and three since stopping HRT, I’ve slept really poorly. In general I feel okay about stopping HRT as my peri symptoms weren’t that bad to start with but this sleep issue is another matter altogether.

Any advice or experiences to share? Is this likely to be a short term cold turkey sleep issue? I’m worried I will eventually need to go back on some form of HRT to get my sleep back.

Feel like I m stuck between a rock and hard place: insomnia or chronic acid reflux. Yay, what a choice 🙄

Hiatus hernia isn't nice- my mum has it but it's kept under control with the meds.

I've never ever heard of HRT and stomach acid (side effects) . (Been on HRT for over 12 years but always transdermal- no oral.)
What did you read and where?

if you use transdermal so it doesn't go into your stomach, that should help.

what are you using now?

Here
There are plenty of other articles/ blogs too.
Yes, I thought it might be worth trying something that’s not taken orally if I absolutely need to go back on it. Had been taking oestrogel and progesterone tablets.

I'd be a bit sceptical of that link as it's only 1 study from 2008 AND in the US they have used (and still do) different types of HRT compared ot the UK. They tend to use CEE and synthetic progestins.

Were you advised on lifestyle measures for your HH?

It's a mechanical issue where the valve at the top of the stomach is a bit loose and floppy, so food comes up rather than staying down.

My mum was given advice to not eat late and use a high pillow or a raised bed head if necessary.

You might get on much better with patches or using utrogestan vaginally. There has to be a way to make it work for you!

Thank you so much, you sound very knowledgeable, @JinglingXmasbells . There were other links … I will have another look.
I think my preferred course of action would be to manage without hrt altogether. My GP and I are now not sure that I have a HH after all as my symptoms have disappeared since stopping HRT ( there is not a single doubt that HRT is the thing causing the stomach acid to reach unmanageable levels). Of course I could still have a (now symptom free) HH.

I suppose what I’m saying is that I don’t want to leap into alternative HRT solutions if the only issue is insomnia (which may resolve over time- I didn’t have it pre HRT)

UK study Think this is relevant but I’m not knowledgeable in interpreting such studies!

Also lots of anecdotal stuff on menopause matters forum.

Yeah, I had terrible acid reflux after starting HRT. Luckily it settled down after a few months. Perhaps you could try a different type of oestrogen?

@RestingMurderousFace It feels more logical that it would be the oral utrogestan tablets causing it (rather than the gel) but that’s probably not how it works!

Hmm maybe, I was taking the Utrogestan vaginally and I still got the acid. Who the hell knows, it’s all trial and error.

If you didn’t have the insomnia pre HRT, first of all lucky you! Seriously though, it’s likely that you’ll get your sleep back again when your body gets used to being HRT free. Insomnia is the worst, I feel for you.

Just a couple of ideas....@SixDinnerSally

I did google what you had first found and there was a more detailed reference to this effects, which said that only estrogen-alone, or progesterone-alone caused acid reflux. So it's a bit unclear.

If you have had an endoscopy the HH would be clearly visible. (They can fix it with an operation if it's really bad.) Acid reflux is a symptom of a HH, but it can also exist on its own. It is caused often by stress and hormonal changes in peri.

Types of indigestion can occur with any oral meds and that applies to Utrogestan. Are you using 2 capsules or one?

I guess you have options

1 stop hrt and see if your insomnia comes back (mine has never gone and if I reduce my estrogen dose, or come off it - tried for a few weeks- it's back with a vengeance!)

2 Try transdemal patches

3 Try Utrogestan vaginally.

HOpe that something helps!

@SixDinnerSally Had a little look at your UK link - don't know if this helps.

This is the gist of it.

1 It's an observational study (so, anecdotal) where women report their symptoms, so it's not a proper research trial with placebo v drugs. This means that the results are very subjective as they are - simply- women's opinions on what was happening.

( It could be that women who chose to use HRT also had a predisposition to gastro issues, caused perhaps by anxiety/stress / lifestyle which made them seek out HRT in the first place. Or that concerns about HRT made them anxious and they developed acid reflux.)

The conclusion is that there may be some link with estrogen (only) and GORD, but not with combined HRT.

This first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance.

It may be that women using PPIs have some other health/ gut issues that are all linked together with estrogen.

Thank you so much for your detailed replies @JinglingXmasbells
I realise I wasn’t clear on a couple of things in my OP:
I have been referred for endoscopy and H pylori testing but not had either of these yet. The HH was suspected but not diagnosed.

It was the terrifying prospect of two weeks without PPI that led me to Google.

I then stopped all meds three days ago. Stomach issues have virtually disappeared but I now have had three sleepless nights.

I understand that the study is anecdotal but I suppose all reporting of side effects is, too but it still interested me. I take your point about it being oestrogen only in that study. I did find many forum posts about utrogestan too, though.

I think I will try to manage for a week and then rethink as required! Thanks again:)

Hi @SixDinnerSally how have you been getting on? I’m suffering with terrible acid reflux (probably hiatus hernia) and I do suspect Utrogestan has played a part. I could stop Utrogestan (because I now have a Mirena coil providing local progesterone to my uterus) but I find that my sleep gets much worse. Did you find your sleep improved after a while?

The chap doing my ultrasound, said HRT could be linked to my having gallstones. I too, suffer from indigestion, just take lanzoprazole now & again