Is my HRT unbalanced?

[menopauseadventurer]

Hi everyone

I wonder if I could ask some advice and get your experiences. I've been on HRT a while and I'm in perimenopause. I'm on oestrogen patch and Utrogestan.

Recently things have started to go a bit haywire. I have on and off lowlevel bleeding every few days. This has now been checked out and nothing looks ominous to be causing it (touch wood). But it continues and is making my life difficult.

Added to this I feel really strange and am changing from state to state day to day. Sometimes cripplingly exhausted all day, sometimes overly-energetic and like I could climb Everest! I have had bad sleeping problems for a couple of months now which is very unlike me. I have had a flush recently which I haven't had for a long time, and also migraine which I started to get a lot of before HRT but not since, until now.

I took a blood test which seemed to show everything in normal range, but only because the normal ranges are vastly wide. The oestrogen was right at the top and the progesterone lowish but not totally low. I realise that hormones can spike so any blood test is only a snapshot of a moment. So I'm wondering if I'm spiking up and down underneath the hrt or it could be that the oestrogen and progesterone has become unbalanced?

My question is if they are unbalanced and the HRT were to be tweaked, what would be the usual recommendation? Would the progesterone increased and oestrogen left the same? Would both oestrogen and progesterone be put up together? Or would the oestrogen be reduced and progesterone kept the same?

I've read that some people need to increase the progesterone, but noone ever suggests reducing the oestrogen. Is this because the oestrogen is likely swinging around so this won't help?

It's quite a long time until I can see anyone unfortunately so I want to research options beforehand. Thanks for any insights on this or if anyone has had anything similar.

All I can say is that I react badly to too much oestrogen. I take one or two pumps of oestrogel and I take progesterone every day.

Can I ask how? I’m on the gel and not sure if I’m having too much

Similar for me OP - hopefully some one will come along and tell us 🙈

I get weepy and miserable and lack energy

I have difficulty with artificial oestrogens too. It gives me terrible anxiety if I have more than 2 pumps of the gel. In fact I'm wondering if I should cut it back further. I don't have a problem with progesterone. I have recently started with testosterone and that is a game changer so far. My mood is so much better.

Personally I felt much better as soon as my oestrogen was very high and my progesterone was the minimum I could get away with - mirena coil.

Even then once the coil was fitted, I felt like I was walking through treacle, the tiredness was next level.

I still get over tired when my own cycle kicks in and I have essentially PMT underneath it all.

I'm on 100mcg patch, mirena and testosterone.

I suppose our natural cycles still continue in the background, I still have a cycle with the Mirena, bleeding, cramps and PMT and so your cycle will be there.

HRT doesn't make everything completely stable day in, day out like men are - sadly!

I discovered my oestrogen was too high (causing acid reflux as oestrogen makes the lower oesophigial splincter relax and also histamine issues). I have now lowered it and am feeling better. I think the progesterone dosage seems to be set at 200mg for 12 days (100mg continious) whatever oestrogen dose you are on. In peri your natural oestrogen swings all over the place so the hrt may be making the peaks too high for you. I would suggest trialling a slightly lower dose and see how you feel.

Balance is a word that gets very much overused in the menopause media. We need enough progesterone to counteract the effects of estrogen on the uterus but otherwise it's about getting the individual levels right. I would just change one thing at a time so you have a better chance of spotting what is changing. Tracking your symptoms should also help - is there a pattern e.g. of symptoms worsening the longer you are wearing a patch which might be due to varying doses being released over the use of a patch.

Thank you those who responded. What a range of experiences. It makes it so hard to work things out.

I'm trying to work out if I tweak the HRT with my doc, what direction to try. I do know that making any changes must be super gradual. I'll talk at my next appt about it.

There is very little info on what progesterone does apart from help protect the endemetriol lining. The only thing all the forums and also websites tend to talk about is oestrogen. They say it's that that helps sleep and that that helps mood etc. But on a sequential regime at the oestrogen-only times I was cheerful yes, but also extremely wired and jittery and buzzing and didn't sleep well at all.

During the progesterone plus oestrogen weeks I was the total opposite.

Neither state was livable with as both were quite extreme for me. We finally worked out a regime that worked for me, but recently I seem to have gone somewhat off-kilter again so I'm wondering if my underlying system/stage has changed.

It's hard to say what's going on but what dose are you on?
Usually it would be 2/3 pumps of gel or a 50mgs patch and 200mgs Utrogestan 12 days a month.

You may simply be on too much estrogen and at least with gel you can start low (1 pump) and increase it slowly.

To be honest if you feel rotten when you're taking Utrogestan, there are many other options.

BTW taking blood to assess hormone levels is not recommended. They are completely inaccurate and of no use. Some GPs do them but they aren't specialists and don't understand the complexity of hormones and tests.

It may be better to swap completely maybe to Femoston tablets (the progesterone in them is almost as body identical as Utrogestan) or even a combined patch where the progesterone is Norethisterone.

Omg! I actually came here to ask whether anyone thought my HRT dose is too high, but I've been having awful stomach issues for ages which seem to be getting worse lately, and now I'm wondering if the oestrogen is causing/worsening it?

Fwiw I take the mini pill continuously (so 75mg progesterone) plus 100mg progesterone capsule with 1.5mg Sandrena (oestrogen) gel daily - does that sound too high?

@iknowimcoming I would trial a lower dose to see if it helps. I was on a 75mg patch when I had symptoms (which I think is equivalent to 1.5mg gel). Symptoms went away when I dropped to 50mg (so 1mg gel).

Look into the natural supplement DIM - it helps you metabolise and get rid of excess oestrogen and eliminates the hrt migraines. It's worked really well for me as I was having similar struggles on 4 pumps of gel and daily progesterone until a specialist suggested this.

Some info on DIM here but do research properly for yourself and maybe discuss with a hormone/hrt specialist. Your gp is unlikely to have any understanding or knowledge of Dim unfortunately.

www.buoyhealth.com/health/dim-supplements-hormonal-imbalance-management

Why didn't you just stop taking four pumps of gel? Two is fine!

@Brananan 2 might be fine for you but I still had all my symptoms on 2 plus there has been an issue with the quality of the gel which means some batches had less active ingredient in them. Also I was taking advice from an hrt specialist rather than just deciding for myself so that is what I was prescribed and it works for me!

OK seems a bit mad to take 4 pumps then have to take a supplement to remove excess oestrogen. If that was genuinely recommended then your doctor sounds like a quack.

OP, what dose are you actually on? Bleeding can be too much oestrogen/not enough progesterone. Is/was your cycle fairly regular and do your progesterone weeks line up with the second half of your cycle?

Jittery also sounds like too much oestrogen.

When you say you were the opposite on the progesterone weeks do you mean you slept well but had low mood?

It’s not as simple as removing excess oestrogen - if you read the link it explains the different types of estrogen in your body. The DIM helps metabolise estrogen more effectively and removes the cause of the migraines. Anyway it worked for me so just a suggestion if something to look into as the op had estrogen related headaches.

That is interesting about the DIM. I see it is found in cruciferous vegetables and I have been feeling a bit better since upping my green veg intake.

@Apileofballyhoo "When you say you were the opposite on the progesterone weeks do you mean you slept well but had low mood?"

Thanks for replying. When I say the opposite I mean on that part of the regime I was no energy, foggy, really tired, slept and slept and also extremely hungry all the time. So I was swinging from one extreme to the other between the two parts of the regime, if you see what I mean.

We adjusted things and I've been good for ages, but recently it's not working so well. But then I'm getting older. I have gone from very regular cycles to all over the place recently. I'm guessing my underlying system has changed and perhaps I need to tweak the HRT with my doc. But it's not clear how to tweak it. Hence my post.

I have gone from very regular cycles to all over the place recently. I'm guessing my underlying system has changed and perhaps

Your cycles should follow an HRT pattern of 4 weeks, with a withdrawal bleed every 4th week (usually 3 days after the last progesterone dose.)

Are you not starting the Utrogestan on the same day every month?

You aren' t supposed to try to sync it with your cycle.

@JinglingSpringbells "To be honest if you feel rotten when you're taking Utrogestan, there are many other options.
BTW taking blood to assess hormone levels is not recommended. They are completely inaccurate and of no use. Some GPs do them but they aren't specialists and don't understand the complexity of hormones and tests.
It may be better to swap completely maybe to Femoston tablets (the progesterone in them is almost as body identical as Utrogestan) or even a combined patch where the progesterone is Norethisterone."

i'm reluctant to start over with a whole new set of stuff as Utrogestan has worked very well for me up until recently. In fact I'd say I feel better on it. Changing things up too much makes me feel rotten like my body just overreacts. But it is the recent thing of low-level bleeding and some cramping that's been an issue I need to solve. I have had scans to check etc so hoping that it is ok. At the moment it's stopped again and I feel enormously better. But I don't know if this will last.

Would you like to say what dose you're on and how you're using it (see my post above)? What dose is your patch?

It's a bit odd that your cycles are all over the place on HRT.

Are you doing the usual dose of 12 or 14 day of 200mgs Utrogestan, starting on the same day every month?
eg 1st Jan, 1st Feb etc.

Hi there are you the same person as JinglingHellsBells? Different names but so similar I thought I'd ask?

I didn't want to go into tonloads of personal details on the forum. I do know the prescription guidelines obviously but it's good to underline for others. That wasn't really the question. I'm on a mid-dose of Oestrogen and take Utrogestan in the suggested amount.

My questions were the questions in the opening post.

A few posters have asked what dose you're on.

My question is if they are unbalanced and the HRT were to be tweaked, what would be the usual recommendation? Would the progesterone increased and oestrogen left the same? Would both oestrogen and progesterone be put up together? Or would the oestrogen be reduced and progesterone kept the same?

Tweaked from what to what?

Can't offer much insight without knowing the dose and timings of it.