Just some technical help to arm myself to discuss Side effects of HRT/ hormones

[Piggywaspushed]

I have been trying to convince various health professionals that my nosebleeds are hormonal and am now pretty sure I have evidence but I wondered if anyone was expert enough to say what hormones are in which bits of HRT and how that interacts.

I was having loads of nosebleeds - several a week. These increased when I was taken off HRT at various points.

As soon as I was put back on HRT , they stopped almost entirely.

However, I still tend to have one or two while I am on the grey pills of Elleste Duet. This is the second bit with progestogen .Is there less oestrogen in these tablets than in the others? Is there any way the progestogen itself is too much for me/not enough? These are stronger Ellestes than the 'starter strength'.

During this time frame, I also tend to get quite itchy skin especially across the breasts - and the usual ragey stuff and nausea. I also get one or two night sweats (the main symptom before any HRT).

I am due to see HRT nurse and ENT consultant soon so want to arm myself with info.

I also still get terrible period pain and flooding :(

The other complicating factor is high BP. Can Elleste in itself push up BP or is high BP just contra indicative? I'm worried the surgery is going to attempt to take me off the tablets. I can't take anything else because I am allergic to the patches and the gel!

Any insights or 'science stuff' gratefully received!

I don't know Elleste in terms of colours, but if it's a sequential pack, there is only progestogen in the 2nd half of your pack. There is estrogen in every tablet.

It's a bit odd what you're experiencing.

In terms of overall health, estrogen is beneficial in so much as it opens up the arteries and prevents plaque building up.

My understanding is that high BP can cause nose bleeds. Are you not taking medication to bring it down?

If you could take Utrogestan, that actually reduces BP.

The periods- they will be withdrawal bleeds and not real periods.
The amount of blood loss is related to the estrogen dose.

Why not try an estrogen only tablet and maybe a Mirena coil - or a separate progesterone like Utrogestan or Norethisterone? (A nurse might not be up to speed with this kind of 'a la carte' prescribing- you may need referring to a specialist or refer yourself to a private meno specialist.)

Mirena Coil has been suggested but I'm averse to that.

The nosebleeds definitely aren't high BP - I have had them when BP has been normal. And not had them when it's been very elevated!

I was surprised the bleeding was so bad tbh as I thought they were just withdrawal bleeds but when I have had gaps off HRT , I was still bleeding (much to my GP's apparent horror!) That's sort of a side issue that I am really annoyed about, I guess. That was all better on patches but the allergy was awful.

The nurse is very nice and it's actually face to face so I'll see what she says about separate stuff.

In the past, frequent nose bleeds were treated with cauterisation by zapping the blood vessels in the nose.

Has this not been suggested?

Why are you averse to trying a Mirena if it could help? Many women are really happy with them.

HRT made my gums bleed when I first went on it and after my first dose increase. It settled down quite quickly though. Hormonal changes are known to affect gums though (eg during pregnancy).

This says that oestrogen and progesterone can cause changes in the nose which can cause nose bleeds. So seems like possibly a similar connection:

naitreetgrandir.com/en/pregnancy/first-trimester/pregnancy-nosebleeds/#:~:text=For%20example%2C%20estrogen%20can%20cause,lead%20to%20more%20frequent%20nosebleeds.

Also says similar here on Australian Government website:

www.pregnancybirthbaby.org.au/nosebleeds-during-pregnancy#:~:text=How%20do%20hormone%20changes%20cause,burst%2C%20resulting%20in%20a%20nosebleed.

Various reasons for the Mirena - mainly completely psychological.

I am under an ENT consultant for nosebleeds. He couldn't find anything to cauterise!

Oooh, thanks. That does make sense as both seem to suggest it's the progesterone.

I think you are going about this totally the wrong way, You have decided what the problem is, and have come here asking for evidence that proves it! That is not the way to get to the truth about anything

Ermm, OK. Cryptic.

What I wanted was the info about progesterone , its effects and so on. I feel , like many women, rather uninformed and faced with rather uninformed medical professionals at times.

I am curious to know whether, for example, itchy skin , can be caused by too much of something or a lack of something- so whether my HRT is too high, or too low.

Don't think that is controversial.

What do you suggest?

In terms of overall health, estrogen is beneficial in so much as it opens up the arteries and prevents plaque building up.

Not disputing this @JinglingSpringbells , but then why does the NHS say the following on their HRT page?

"Research has shown that taking HRT has little or no effect on the risk of getting coronary heart disease." (Copy/paste NHS)

Wouldn't preventing plaque build-up prevent prevent coronary artery disease?🤔

Generally, the progestogen phase is one that has most side effects.

Progestogens raise body temperature (this happens in normal cycle, without HRT- women get hotter in the 2nd half of their cycles.)

So your itching could be that.

I think you need to be open to trying other types of HRT.
It's unusual to be allergic to all transdermal - patches and gel (and there are 2 types of gel) and a spray called Lenzetto.

As you have high BP anyway, it's advised you use transdermal anyway if at all possible.

I have no idea about why you get nose bleeds when using progestogen. But the obvious solution is to try other sorts, such as tablet form Femoston, or estrogen only patches/ gel/spray - with micronised progesterone.

I've not read the links from Australia about hormones but all I'd say is that HRT doses are minute compared to pregnancy levels of hormones so they may not be comparable.

No idea why the NHS says that as it's contradicts everything out there by cardiologists and menopause specialists. How old is that NHS info?

Video is on the British Menopause Society website about the benefits.

It's well known and in all medical papers that using HRT within10 years post menopause is a 'window of opportunity' [that's what it's called] to prevent heart disease (and also why HRT is advised for women with premature menopause, to protect the heart.)

After 10 years, it's understood that the damage has been done (loss of estrogen on the arteries) and it's too late to reverse it.

https://thebms.org.uk/publications/consensus-statements/primary-prevention-of-coronary-heart-disease-in-women/

As you asked @CulturalNomad :) It may be because the NHS is not differentiating between tablet form and transdermal types. (because tablet form has a slight clot risk.)

There are also videos on the same site under BMS TV (under publications)

https://thebms.org.uk/publications/bms-tv/ Half way down Prof John Stevenson.

No idea why the NHS says that as it's contradicts everything out there by cardiologists and menopause specialists. How old is that NHS info?

February 2023

Thank you!

I genuinely am allergic to all the gels and patches. I didn't try Lenzetto because I was at that point frustrated with trying stuff, being allergic, starting something new after a gap. Rinse. Repeat. It felt like I never settled.

My BP isn't hugely high tbh. And it wasn't high when I started all this so will hopefully come down.

Maybe it's because the NHS is often out of date like the 'healthy plate' has to be mainly carbs.

@Piggywaspushed before I was on HRT, I always sneezed a lot in the second half of my menstrual cycle and no HCP could offer any explanation. I don’t mean sneezing to the extent that it interfered with my life or anything. These were big sneezes that would come from nowhere and weren’t triggered by anything obvious.

I’m on long cycle HRT so I only use progesterone for 2 weeks every 8-10 weeks. And guess what, the same sneezing happens during the progesterone phase now. I am intolerant to progesterone.

I get a lot of itchy skin (trunk and ears) if my oestrogen dose is too low.

That's really fascinating!