Perimenpause - use of EstroGel

[Raddish]

Hello,

reaching out becuase I am having such a difficult time with insomnia due to perimenpause. 20 months ago (July 2021 at the age of 48) I just stopped sleeping. Up all night and very anxious about everything- enough small stuff, and I have never suffered with axiety all my adult life. Within in eight weeks (thanks to friend who is a GP but also specialise in women’s hormones) I got confirmed as being perimenopause with very high estrogen (2325 on blood test) and no progesterone. I was put on Ustrogestan and with in 12 weeks I was stating to feel like my normal self. Fast forward to October 2022 and my insomnia came back. Night after night of no sleep at all. Had my bloods done and on paper my estrogen levels looked more normal and within range at 326. However after no improvement and being told I had depression, My doctor friend (who works at a leading private menopause/perimenapause clinic in London) suggested some EstroGel. Started on 1/2 for a month - no difference. Then 1 pump for another month. Some improvement in mood, but not massive. Then I went up to 2 pumps. Didn’t have any reaction at first and had a week of solid sleep, but then my axiety went through the roof. Panic attacks like I have never experienced, crying out of control, cortisol through the roof, and heart rate racing.

I think that two is too much and I am just going to have to be patient with one pump and given my body time to balance out.

Any thoughts, advice or similar experiences I would love to hear from you. Not worked for five month now and just struggle to even be a mum to me two beautiful girls.

thank you in advance for responsing/reaching out

Rachel xxx

I'd never heard of using only Utrogestan in peri apart from one poster here recently. I don't understand why it's given on its own, because as part of HRT it's only used to prevent the womb lining over-growing. In post menopause, women never have any progesterone for the rest of their lives. It's only produced after ovulation.

Yes, it's a sedative, but a lot of women (me ) find it a nuisance with more side effects than benefits.

Was this a specialist who prescribed it? In peri your estrogen would be all over the place which is why blood tests aren't done on women over 45 anyway. Your friend who is a GP is unusual in prescribing it for you on its own.

How much Utrogestan are you taking each day?

I hadn't heard of the gel until a couple of days ago when it was mentioned on here. Having done a bit of research, I would be wary of using it because of the side effects and the link to various cancers.

Didn't you say in your other post that some years ago you had used HRT as tablets? If so, did you not have the risks explained to you then?

Many apologies if I'm confused and that wasn't what you said.

They come with all the same warnings, and gel which is body-identical is much safer in many ways.

The online information you will have read is the same leaflet for all HRT but transdermal types (gel and patches) don't cause blood clots.

You say “cortisol through the roof” - how high is high? You need to be investigated for cushings if that’s very high. Have a google. (I have Addisons which is the opposite - I don’t make cortisol at all). If you are having testing for anything cortisol related you will need to stop anything containing oestrogen for 6 weeks prior to any testing as it can give a falsely high cortisol result. (If your cortisol was high on the oestrogen this may have been why and isn’t anything to be concerned about unless it was literally over 1000).

Hi, my GP friend is also a hormone specialist who works in a private clinic in London. When I was on the utrogestan on its own for around 18 months I was fine (back to my normal self). It is unusual to prescribe it on its own, but it worked for me and it never made me feel sick.

The issue I have is the introduction of estrogel more recently. My insomnia came back so both my GP friend and gyn at west mid hospital suggested I introduce Estrogel. This is when the horrific anxiety attacks happened and sleep got even worse when I moved from one to two pumps a day. Just wondering if anyone else has had that

Thanks
rachel

I didn’t test my cortisol, I can just feel it. I use to be a competitive runner and the feel was a the same just before I use to race, but this is at night when I can’t sleep since being on estrogel. If you can test for cortisol maybe that is something I should look into

I understood what you said in your first post.
What I was asking is what dose of Utrogestan you are using now?
Is it 100mgs a day or 200mgs on a cycle (12 days a month?)

It may be that it's a complete coincidence that these symptoms have arisen with gel, and it isn't impossible that the amount of Utrogestan no longer suits you. The things you are describing are often what women find when using Utrogestan.

If you are being treated privately then why not ask the dr who's giving you the HRT? The tests etc they have carried out are not mainstream and many private consultants wouldn't feel the same about them. (Is this the Gluck Clinic or does your friend work at the Chelsea & Westminster Meno clinic?)

To be honest, I'd try using HRT in the normal way and see if that makes any difference.

I found 2 pumps a days too low, and 3 pumps a day too much. My consultant suggested I alternate, and do 2 pumps one day, 3 pumps the day after. So it works out as 2.5 pumps a day. I also found that having 2 pumps before bed helps with the sleep and hot flushes. So maybe play around with when you apply the gel and see if that makes a difference? Good luck. x

You can’t feel you have too much cortisol. You can feel a surge of adrenaline- cortisol and adrenaline are not the same thing. Too much cortisol causes cushings symptoms- weight gain is usually the main thing people notice. Too little is fatal if untreated (Addisons) - if you had too little you would definitely know about it if it was at a dangerous level (losing weight, pigmentation patches in primary Addisons, nausea etc). If you have symptoms of cushings you should definitely get your cortisol levels checked properly, lots of people with cushings find they have tumours (non cancerous) on their adrenal glands, they then have these removed and it often results in adrenal insufficiency- the other way (ie Addisons but it would be secondary adrenal insufficiency not Addisons / primary). I have been diagnosed with Addisons since 2017 and am part of an Addisons / adrenal insufficiency support network. We often have people with cushings join.

https://www.nhs.uk/conditions/cushings-syndrome/#overview

Before I started HRT I was having multiple adrenaline 'flashes' a day and sleeping very badly. The symptoms were mostly physical. A horrible prickly feeling flashing through my body, ectopic beats, surges of anxiety etc. It was very distracting and I was unable to concentrate on my work or manage much at home.
I did the usual of more exercise, better nutrition etc, but started oestragel 2 pumps a day, utrogestan for a week each month and symptoms stopped immediately.
I never had blood tests.

Have you thought of trying magnesium for sleep rather than changing the oestrogen.
And perhaps constant progesterone in a coil might suit you better.

@Stripycatz Are you still on HRT now and using only 1 week of Utrogestan?
The dose is 12 - 14 days a month unless a specialist has prescribed something differently.
Sorry for asking but the BMS has made comments recently about under-dosing.

Hi, Thank you for coming back so quickly
i was on 1 utrogestan at night when my insomnia started again (after a year of being ok). After two
months of very poor sleep they moved me up to 1 for first half of cycle and 2 in second. Noticed some improvement.

friend is a gp in the nhs, but works for MG clinic as well. I addition gyn team at west mid hospital gave same advice.
Another month on with no improvement is when they suggested estrogel

I didn’t know utrogestan can cause simpler symptoms to be honest. Could you send me links to any information on this please

Thanks
rachel

Hiya, I have been have magnesium for six month now, as GP friend also a functional medicine doctor (so good a recommended natural alternatives as well). Waiting to have coil fitted (on waiting list). I have large fibroid so it has to be done under general aesthetic so hence the wait

Are you or were you still having periods?

I think your situation has become complicated because you had blood tests that weren't necessary and only showed what happens in peri- estrogen can be all over the place (high, low, high, low, varying daily) and progesterone is low (because of no ovulation some months.)

The usual way to treat this would have been estrogen daily, starting at a low dose, and Utrogestan for 12 days a month OR on a 3-month cycle of estrogen daily and Utrogestan for 14 days every 12 weeks.

That way, you'd have seen how much estrogen suited you .

At the moment you are doing it all back to front. You're having a lot of progesterone (which can actually cause night sweats, low mood, anxiety) and not much estrogen.

I know you may not want to do this, but (just my opinion) I'd revert to using HRT the traditional way of gel every day and progesterone for 12 days per cycle, or even 14 days per 3 months (this is acceptable for women in late peri.)

That way you can separate out which hormone is causing the side effects.

You see, many consultants would start you on estrogen only for 12 weeks to get the dose right, then add in progesterone to clear the womb lining.

Maybe think about it?

Fwiw it might be worth seeing a functional doc and getting your bloods done again at the right time of the month. Do you have very heavy periods? The symptoms you describe could also be a sign of anaemia. So get your iron and ferritin checked too.

Also glucose. Are you overweight? Struggle with sugar and carb intake? Could also be oestrogen dominant - a lot of us are ivr discovered and metabolic health is poor - which causes low progesterone levels at the time when we need them to rise in the luteal phase - which would make you feel terribly anxious. You may not need any oestrogen at all and a touch of progesterone. Obvs this is all guess work. Check out Mindy Peltz online she talks about all of this and it is so helpful. The NHS standard HRT dosing is not always what you need and may in fact exacerbate the oestrogen dominance that's causing the probs in first place.

I never knew magnesium was suggested for the peri-menopause. When I was about 46 I started taking Osteocare which is mainly calcium but contains Magnesium. I took it regularly despite not having any perimenopausal symptoms at that age because I wanted to shore up my bone density. A cousin of mine (not a blood relative but someone to whom I am close), had severe osteoporosis and I wanted to do my best to avoid that. I realise everyone gets a bit of osteoporosis, my mum did at base of spine but she was over 80 then and generally fit and well, but dear cousin was disabled by it. That scared me so I started taking it and still do take it in my seventies.

A few years ago I had a couple of accidents in which no bones were broken but I was severely bruised. A while after the second one I developed symptoms of peripheral neuropathy, at first not bad but at the end of 2021 and beginning of 2022 were dreadful. My nerves had been damaged. I started on Magnesium 1100ugm per day, plus other recommended supplements (B1thiamine, B12, folic acid, R-Alpha Lipoic Acid +), and the improvement was remarkable. I am OK now.

Sorry that little of what I have said above has anything to do with being perimenopausal but I do think having magnesium combined with a good, healthy diet, helps tremendously. The perimenopausal period does not last forever. If we are healthy our body adjusts to the lack of hormones.

If we are healthy our body adjusts to the lack of hormones.

@LBFseBrom Not for everyone. A few women (maybe 10% or more) have symptoms for life. My consultant has women in their 90s on HRT.

I thought you might find it helpful to see the latest guidance on taking calcium, especially for women your age.

Calcium alone will not prevent osteoporosis.

It also has risks of heart disease and it's not recommended that anyone takes these supplements unless they are unable to eat 'real food'.

[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910980/

We found that calcium supplements were significantly associated with an increased risk of CVD and CHD in a meta-analysis of 28,935 participants from 13 double-blind, placebo-controlled RCTs, specifically in healthy postmenopausal women. In the subgroup meta-analysis, dietary calcium intake of 700–1000 mg per day or supplementary calcium intake of 1000 mg per day significantly increased the risk of CVD and CHD. There was no significant association between the use of calcium supplements and the risk of cerebrovascular disease.

The current meta-analysis of double-blind, placebo-controlled RCT showed that the use of calcium supplements was significantly associated with the increased risk of CVD and CHD by 15%, specifically in postmenopausal women. Our findings should be explicitly confirmed by conducting further RDBCTs with CVD outcome measures as well as the incidence of osteoporosis or fractures as the primary endpoints.

It's now known that taking calcium supplements increases the risk of cardiovascular disease as the excess calcium is laid down in the arteries and causing furring-up.

You might want to ditch the supplements and get enough calcium from your diet- that's the expert advice now.

@LBFseBrom If we are healthy our body adjusts to the lack of hormones.
Unless they don't. Which happens. Or the adjustment takes decades and in the meantime women end up suicidal and desperately unwell. Countless women were institutionalised with severe mental illness and psychosis before HRT.

Thank you so much for your reply
I am grateful for insights

so I was oestrogen dominant (2325 on blood test and progesterone was 0) 20 months ago and was just put on progesterone (utrogestan). It took my body 3-4 months and then I was back in balance. I had a good 10-12 months of feeling great and then again my horrific insomnia came back.

Had another blood test done in November last year when insomnia started again on day 21 of cycle (use same date to help with consistency). Oestrogen was down to 325 and progesterone at 20. Estrogen was now within range but a massive decrease from previous year and more recent test had it at 123. Whilst tests are only a moment in time it does give some guidance. This was why I started on Estrogel. First 1/2 pump, then up to 1 and finally 2. What I am trying to find out if anyone has had horrible panic attacks from estrogel. I know it is so hard to pin point things, but my panic attacks happened in the evening after second pump was applied (within 1-2 hours of application)

any insights welcome as just struggling to work my body out.

@Raddish

It sounds as if having blood tests is actually being counter-productive. No one has them on the NHS and not even privately unless there is a very good reason. My consultant doesn't do them and says they are a waste of time.
What you need to aim for is using the right amount of gel to relieve your symptoms.

Please don't take this the wrong way....but the whole estrogen-dominace thing doesn't exist. It's something often referred to by alternative practitioners but there is no science behind it.

NICE meno guidance says that women over 45 don't need blood tests. The reason for this is that estrogen levels can be sky high one day and very low the next- that's 'peri'! It doesnt need to be balanced by adding progesterone.

Women who have had a hysterectomy and use HRT , only use estrogen- because progesterone is not needed to 'balance' it. If it was, it would be prescribed.

I don't think anyone can answer your question to be honest. You ought not to be having panic attacks on 2 pumps of gel. You may be having panic attacks etc because you need more estrogen and it's going to take a few weeks to increase your levels.

I did suggest that you reduce your Utrogestan and try using it only for 12 days in a month. This will allow you to judge how estrogen is working, because at the moment using both hormones daily isn't allowing you to do that.

Completely agree with all of this.

On what basis do you say oestrogen dominance doesn't exist? That's such an odd thing to say. GPs are only beginning to catch up with the whole gut brain thing and as such they do not work on the basis of prevention. For a lot of people HRT becomes a sticking plaster that doesn't address the underlying imbalances due to decades of lifestyle. These drugs and dosing are developed for the average person - we are not all the same. If you have adhd and dopamine issues or sugar addiction, obesity you are likely to be oestrogen dominant. Endo and adenomysos are all fed by oestrogen. Even with a hysterectomy the thinking is now that you still need progesterone- it's not black and white as you say. I'm sure you are very experienced in relaying the NHS dosing information but this is not necessarily the right thing for all.

@worriedgasper Going back many years, estrogen dominance was first theorised in the US by the late Dr John Lee who was selling progesterone cream (which can't be absorbed enough by the skin to be useful.)

I agree with what you say about diet and gut health, but nothing can replace estrogen except estrogen.

Endo and adenomysos are all fed by oestrogen. Even with a hysterectomy the thinking is now that you still need progesterone

Whose thinking? Happy to read reputable research.

I do have adenomyosis as it happens. Been on HRT for almost 15 years, very experienced meno consultant, who trains others.

I don't 'relay NHS dosing'. It's the dose on licensed product. I often suggest other options that women can try with medical agreement. I am not on an 'NHS' dose myself and never have been. It's tailored to my individual needs by a private consultant.