Can you take HRT if you couldn’t tolerate the Pill?

[LostFrog]

Just that really. I tried several types of contraceptive pill through my late teens and early twenties, with terrible outcomes for my mental health, and coming off it was such a relief.

I strongly suspect I am perimenopausal now at 45 and struggling with very low mood for half the month, along with poor sleep and restless legs and occasional panic attacks. I think I need to explore HRT but I’m worried that it could make things worse and frankly, I’m afraid, because of my past experience. Has anyone else been in this situation?

Try it and see.

I was taken off the pill due to it giving me high blood pressure, HRT has reduced my blood pressure from a pre-hypertension 120/85 to 109/70, so for me it’s nothing like the pill.

I’m not sure but very interested to hear the answer to this too.

@DustyLee123 I’m sure the OP is aware she could try it and see.

Hi OP. I had exactly the same question as you. I'm 45 and have been on HRT since January this year.

I would steer well clear of taking oral progesterone. I did three months of oral utrogestan and spent those three months alternating between tears and thinking about walking into traffic/leaving my family. I wouldn't have don't any of it but the pill used to make me feel the same way.

I now use utrogestan vaginally and I am MUCH better though I still have fleeting negative thoughts on my 12 days using it, it is nowhere near as bad as it was.

I am going to try the coil next. I'm giving HRT a year.

When I'm on the oestrogen only it's fantastic. But the progesterone is like having awful PMT.

I was horrific on the pill in my late teens, tried again in 20s and ended up with severe panic attacks, depression with no energy, etc. It was actually triggering starting HRT for those reasons. Not oestrogen, I seem to be fine on that- gel and spray, but progesterone sent me over- which is the same as the pill. All mental health aspects were impacted and I had a physical panic attack one night which made me immediately stop taking progesterone orally. I’m trying some different paths as the oestrogen works and most importantly, helps me, but I may give it up if I can’t crack the safest-for my mental health-way to take progesterone.

Do be aware of the potential for risks to your mental health if you previously suffered from similar on the pill. Talk to your GP or private health clinic about your previous experiences on the pill (be it a combi or progesterone only). The benefits of being older are that you know what’s wrong and could be causing it, something we were left alone to figure out when younger.

I think the situation might be different because with HRT, you aren't producing as much (or any) of your own hormones. Whereas with the Pill, it was affecting your own production. Not sure if I'm explaining that right! So it may well affect you differently.

I couldn't tolerate the pill or Mirena coil. I struggled with cyclical progesterone HRT and was put on continuous utrogestan despite not being clearly post menopausal to avoid the awful mood swings. I've done a year of it and have just quit, I'm sick of the bloating and feeling groggy and ( albeit stable ) low mood. I realised on the odd day I forgot to take the progesterone that I woke up alert and happy! I'm going to see my GP. I wish I could just take the oestrogen but still have a womb so doubt that's an option.
I would try what's recommended but push for an alternative if it doesn't suit OP. Unfortunately anything progesterone isn't for me it seems.

I also reacted badly to the pill when younger - was told it was the progesterone.

Same as other pp, I have eostrogen patches - also has brought down my blood pressure and reduced my migraines to virtually zero.

After going a year without a migraine, I recently had a 'blip' and had two quite close together.

Pp was wondering if your own production of hormones affects the pill. I'm wondering similar with regards to peri menopause and menopause. When I started eostrogen replacement I was mid 50s and I'd had a hysterectomy 15 yrs previously.

So far, so good. 2 and a bit months in, utrogestan tablets and whatever the gel is (hasnt improved my memory, sadly).
No weight gain yet, mood has improved I think, less panics, all good (fingers crossed).
On the pill I was really unpleasant, huge, hungry, angry etc.

Yes, most women can take HRT if they were intolerant of the contraceptive pill, but it may take some trial and error to find a regime that works for you. Usually it's an intolerance to progesterone, or most commonly to the synthetic form, progestogen, used in the Pill and in some HRT. However, often women are OK with the bio-identical form of progesterone used in Utrogestan, especially if taken vaginally, OR with the synthetic hormones used in the Mirena IUD as the dose is so low & its effect is mostly local. You might be one of the few who draws the short straw re these too, but chances are you will be OK. The Louise Newson leaflet on progesterone intolerance has more info.

I'm interested in this too. I had a stroke when on the pill so wasn't allowed to take it any more after that. I'm wondering if I'll be able to take HRT - I'm not peri-menopausal yet but it's probably not too many years away. I realise it's a discussion I need to have with my doctor.

I am progesterone sensitive and used to get PMDD, which ruined much of my life, so I struggle to tolerate progesterone.
There is Tibolone which protects bones and stops hot flushes, and is a precursor to hormones or something, but isn't actually HRT .
I took that for a while but now am ok now on a continuous HRT but I take it for 3 days and have a day off, any more than 3 days and the progesterone starts getting to me. I haven't had medical approval to take it in that way, I just do it. Unfortunately all the time we hve a uterus we have to take progesterone if taking any oestrogen.

When I still had periods and had to take an HRT that had a similar cycle to the pill it was more problematic.

I was told that taking topical oestrogen and having a Mirena coil for the progesterone was helpful for some women with PMDD, but I didn't want to take the chance.

Thank you for all your replies. I don’t know anyone IRL who had the same experience with the Pill so don’t have anyone else to ask. My experience with doctors was not positive and I still get angry about having the Pill pushed at me at a young age, but that’s a whole other can of worms.

Really interesting thanks. I've always been slightly progesterone sensitive and am on my first month of evorel sequi and was fine for the first 2 weeks but have been teary and nauseous since starting the conti phase.

I did tolerate the mini pill ok previously although it killed my sex drive. So far I actually seem quite perky in that regard so I'm hopeful I will settle with the other symptoms.

I tolerated Microgynon well in my 20s but after I had kids I tried every Pill and was either bleeding or suicidal (or both).
I'm 44 and have been on Evorel Sequi for 10 months, adding Evorel 25 a month ago which has me pretty much back to myself.
I had the same anxiety over the hormones but as a PP and my GP said, HRT is more bio-identical than the Pill.
Good luck

Yes but you may have to try several different types.
I couldn't take the pill at all, so I just didn't have sex, too busy for all that anyway.
I ended up on patches which were fine and now I'm past the menopause I take oestrogen which hasn't given me any side effects at all.

I've not read every reply to you @LostFrog but there is no comparison between most types of HRT and the Pill.

1 The Pill is synthetic hormones and a large dose.
2 HRT is made from yams (most of it) and the molecular structure is identical to our own ( it's called body-identical.) it is also a lower dose than we'd have pre-menopause (even at a high dose of HRT.)

Most estrogen is body identical now but the only progesterone is Utrogestan.

I’ve been on hrt fir 6 months and It’s working well for me so far despite the hormone levels in the pill and minera coil not agreeing with me historically. I think the difference is that the levels of progesterone used are quite low -not high enough to be effective as a contraceptive for example and the hormones used in IVF are bio identical. I take a oestrogen gel daily and a progesterone pill from day 16 -day 28 of my cycle.
the progesterone actually chills me out and helps me go off to sleep. I have put on a lot of weight though but I think that might just be life style / peri.

OP, I never got on with the pill. Mental health/acne/terrible moods etc. I’m taking HRT and loving it.

I didn't get on with the pill despite it being prescribed for my periods continually. I hated the coil too. When I started HRT I was on the gel, but like a pp, was so, so low mood wise and in a very bad place and the GP told me to stop using it immediately. I'm really struggling though now with every symptom going, so yesterday was prescribed patches as the GP thinks I may respond better. I doubt I will but I'm feeling a bit desperate, so will try.