Feel so low after switching from HRT gel to patch. Any advice?

[pharmachameleon]

I was happily using 4 pumps of Oestrogel daily plus Utrogestan 100mcg at night for about 6 years and felt great on this combination. Loads of energy, optimistic, happy! However when my bottle changed to the cylindrical one a few months ago I felt rotten. I couldn't sleep and started having weird numb patches all over my legs.
I asked my GP to switch me to patches so she prescribed the equivalent dose of patch (Evorel 100) and upped my Utrogestan to 200mcg each night as she said patches are felt to be better absorbed than gel so I'd need a higher progesterone dose to cover me.
Ever since I switched I just feel I'm getting lower and lower in mood. I can't be bothered doing anything at all. I'm so pessimistic and feel bitter about everything. I don't think I feel suicidal but the thought has started crossing my mind. I don't really think I'm depressed as I can still function no problem, I'm sleeping okay, I'm not bursting into tears etc.
I hate feeling so low and wondering how I could tweak my HRT to try and help. I'm seeing my GP for a review in a couple of weeks so thought I'd ask for advice here.

I really struggled going up to 200mg utrogestan. Felt low, zombie like, slept well though. I now take one orally and one vaginally daily. Doctor not very happy and I do it at my own risk.

Oh that's a good idea. I could take one vaginally and see how I feel.
Do you feel better now @Cysco?

I can’t take progesterone orally as it makes me extremely low. I have a Mirena and use the 100 patch.

Thanks @Mamette. I suppose that's another option. I had the coil before though and didn't really get on with it.

Yes I feel better now, but you would need to speak to your GP before you did that. I don't think it's licenced in the UK for vaginal use but a few people on here seem to do that

It's the progesterone. Wrecks me.

You can take it vaginally and it's half the dose. 100 instead of 200. I take from days 12-26 only

Thanks @EauNeu. Oh do you half the dose? I'll need to read up on that. I felt great just taking 100mcg orally at night. I slept really well and my mood was great so I'd be really happy to continue it nightly but a lower dose I think. I just want to ensure it's a safe dose given I'm on the highest strength level oestrogen patch.

I was terrified getting the Mirena because of my previous reactions to progesterone. But I have had it now for nearly 3 years and no issues.

I have considered swapping from the utrogestan to mirena mainly because I now have a partner so it could double up as birth control too!
My concern is will it make me bleed! I am still having bleeds even on the 4 pumps of oestrogel and 100mg utrogestan nightly and don't want to bleed more than I absolutely have too...after years on the mini pill dealing with periods has come as a shock!

@2anddone I really hated the coil before as it made me bleed lots and I hated the fact I could feel it (plus my DH felt it when we did it. TMI I know!)
Maybe you need a higher dose of Utrogestan if you are bleeding? 4 pumps of the gel is the highest dose so I think the BMS now recommend higher doses of progesterone if women are on high doses of oestrogen.
You may be fine with the coil though-worth a try?

I would try the patch with your one vaginal and one oral for say a month, if that’s not improved I would try alternating days and then try going back to your old dose as an experiment.
Also can you check nice guidelines, does it actually say you need 2 or is that just your gp?

Evorel isn't the greatest and may not be the equivalent of your 4 pumps.

You could ask to change to Estradot.

@AnnaMagnani yes I would love to try Estradot as the Evorel patches are massive! I think the Estradot 100mcg patches are available again so I'm going to ask to switch to these too.

I'm sure some women do better on patches but I don't think it's a rule that they're more well absorbed than gel, I think it depends on the person. My doctor put me on gel because she said some women don't absorb with patches. A blood test showed that Sandrena gel was being absorbed better than the Estradot patches I'd been using.

I'm also progesterone intolerant so I now have a Mirena, which is so much better than the capsules, which made me feel very unhappy.

Agree @greeneggsandhamhocks I'm very happy with patches but my specialist told me her absorption went to pot and she's better on gel.

It seems very individual.

I think my GP was maybe trying to cover the fact I probably should have been on a higher progesterone dose with 4 pumps of Oestrogel. Maybe not. I wonder if she would consider a blood test to check my absorption of the patch. Are these easy enough to get on the NHS? This is all super helpful thanks. I can go and see my GP soon armed with lots of ideas.

I get my bloods and meds via GP, requested by gynae dept in local hospital. I have phone appointments with a GP trained in menopause issues and treatment (she also has a private menopause practice) who writes to my GP. Idk if a GP will do them independently, apparently my GP isn't obliged to test or prescribe.
I noticed a shirty lab note on my last results saying blood tests shouldn't be used to adjust HRT dose which leads me to believe that they won't do them indefinitely.

Update-I've been taking one Utrogestan orally and inserting one vaginally for a few weeks now and I feel so, so much better. However this morning I noticed some bleeding. Ugh! I've got a GP appt on Thursday. Any suggestions that I could discuss with her?
I'm a bit stuck now I think!