Not happy on gel - what is going on?

[HufflepuffRavenclaw]

Have been using HRT for about a year. I use oestrogen only as I have had a hysterectomy and don't need the progesterone component of it. Started on 50 mcg Estradot patches, gradually increased to 75mcg patches, due to supply issues they had to give me Evorel which I reacted badly to - the glue seems to cause an allergic reaction. GP switched me to gel which I started at the beginning of December, using 4 pumps a day (2 in the morning and 2 in the afternoon).

The gel is definitely controlling my symptoms somewhat in that I am not having the crushing anxiety and the night/hot sweats. But I still don't feel like me. I'm on edge, grumpy, feeling anxious, dry skin. I have a lot going on in life at the moment with ill and elderly parents and am currently completing a Master's dissertation. I also find this time of year awful with all the darkness an raid.

Is it possible though that I am only "well" on one particular brand of patch? Or has my anxiety got me convinced that only Estradot is the answer?

Can you discuss with your GP. I moved to the spray from the gel in the summer due to supply issues and all of my symptoms came back. I'm back on the gel now and things feel more under control. Could you do your 4 pumps at the same time? I do inner thighs and outer arms.

I have a lot going on in life at the moment with ill and elderly parents and am currently completing a Master's dissertation. I also find this time of year awful with all the darkness an raid.

Isn't it more likely that all of this is what's making you feel anxious?

Maybe you suffer from SAD?

HRT isn't the be all and end all, although it can help.

Sounds as if you might benefit from looking at other things that can help you switch off and relax. Do you do any of these - Yoga? Meditation? Walking in the countryside? Mindfulness?

How's your diet? There is increasing evidence that gut health has a huge impact on the brain, especially depression.

Your gel dose is higher than your patch dose, the equivalent to 75 patch is 3 pumps if gel.
I’ve seen on here that taking too much can bring it’s own side effects.
How about you try 3 pumps for 6 weeks and see what happens?

It may not be HRT related. A lot of autoimmune type issues tend to crop up around menopause- I would ask your Gp for some comprehensive blood tests including screenings for lupus, thyroid and anaemia and go from there.

I also agree that 4 pumps is right at the top end of the dosing so it’s unlikely to be that you’re not getting enough oestrogen.

My GP is hopeless. Even if you can get an appointment it's phone only and they really are not clued up on menopause AT ALL - they are happy to prescribe if you tell them exactly what you want and why you want it, but it's that they are reactive not proactive if you see what I mean. It's really up to me to decide what I think is best for me and ask them rather than them making suggestions. They are a 6 GP practice and none of them have any interest or specialist training in menopause.

@JinglingSpringbells you're probably right - the disentangling the general stresses of life from the menopause isn't easy. I do always feel better if I get out for an hour's walk each day and haven't been able to do this for about a fortnight as it has been raining constantly. It is dry this morning though and i'll get out in about an hour. Maybe I just have to accept I need to get out even if it's raining.

TBH I'd give the exercise a try and see if that helps as well as finding time for something you enjoy to escape the other stuff you have going on.

What do you enjoy that helps you switch off?

It sounds as if the balance in your life isn't great, and maybe it's worth trying to make a few changes there?

You need to look after you as well as all the other people in your life.

I am also on thyroid medication and have been for about 5 or 6 years - had my levels checked around 23rd December and nothing has changed there. Taking 125 mcg a day of thyroxine.

That’s interesting. I think it’s worth checking where you are in the range of “normal” - I had to really fight for my thyroxine to be increased from 125 to 150 because even though officially I was in the normal range I felt awful. I function better when my bloods are at the higher level of normal if that makes sense, whereas before they were at the lower end. Unfortunately doctors just tend to see “normal” and say that’s fine, but normal can be different for different people. It may not be that at all but just something to investigate.

I have wondered in the past whether I need more thyroxine but thinking back to the symptoms I had when my levels were too low, I was very different. I did speak to my GP a few years ago about that issue, whether I needed a bit more to push me into what's "normal for me" but they were having none of it.

Still feeling anxious and on edge today. Getting out for a walk was great yesterday though, bumped into a friend whose parent also has dementia so we had a good old moan to each other about how shite it all is and arranged to meet for a coffee next week.

I have also decided to put a patch on this morning - I have a 4 week supply to use - and see how I am feeling after that. I really don't think gel and I get on.

Are you sure you don’t need continuous progesterone like women who don’t have periods do?
there’s a lot of info on the newsons website or balance app

also read up about testosterone too. We lose all three hormones so they all need replacing. (Although I’m no dr and I don’t know how that works in your medical situation)

Here. Read this

www.newsonhealth.co.uk/wp-content/uploads/2021/07/Surgical-Menopause-updated-Feb-22-final-1.pdf

gps have no idea

It could be that the dose is too high as a PP suggested.

im on 4 pumps per day but I have got to that dose from 2 a day by adjusting things myself. 5 pumps makes me jittery, 3 pumps brings back night sweats and feeling lethargic and slightly depressed.
I didn’t consult my GP, and she is very clued up around menopause - I’m sure she would have just said, give it a go and see how it feels.

I didn't have my ovaries removed when I had my hysterectomy. I need to read up on the progesterone and whether I might benefit from some, and testosterone has been mentioned too. Although would either of those help with low mood?

If you don’t have a womb you don’t need progesterone. The progesterone part of HRT is to stop the lining of the womb thickening with the use of oestrogen. (Increased thickening of the womb has a link to womb cancer etc so that’s why it’s very important for women with a womb to take progesterone, either in the form of utrogestan, the mini pill and utrogestan or the mirena coil).

You may benefit from testosterone. It can definitely increase energy levels and improve mood in many women.

(Or obviously some patches etc have combined progesterone and oestrogen).

There does seem to be some thinking though @Xrays that even women who don't have a uterus might benefit from progesterone.

How old are you @HufflepuffRavenclaw ? When you are younger you need more hormones because naturally you would have more. I’m on 6 pumps of gel (at 40)

I'm 50. Had my hysterectomy when I was 44.

Try reducing you dose before trying anything else. I found too much oestrogen made me feel really really angry all the time. Lowering the amount I was using made me feel better almost immediately.

Added testosterone to the mix a bit later and that has been a real game changer.

I have had enough of the gel. I have managed to get Estradot 75 patches online and ordered 12 weeks supply in addition to the 4 weeks I had anyway. Put the first patch on yesterday morning and it might be psychological but I am feeling more settled this morning.

Also trying to take the advice on self-care. Have just renewed my annual Headspace subscription, and off to home bargains shortly (walking in the fresh air) to get some Vit D as looking back, my periods of anxiety/depression/low mood over this peri/menopause period have all been in December, January or February.

Oh and on the progesterone - I shall give it a good 6-8 weeks back on the patches and see how I'm doing. One thing at a time.

Hi I’ve just seen this as I’ve just joined. I am the same. I had sandrena gel and worked ok

the docs changed me to 3 x pumps estriodol gel and I feel anxious/jittery all day and sick.