HRT confusion - progesterone intolerance?

[Shcab]

I’m 47 so likely to be in perimenopause, but not really sure as I have a chronic illness which could be causing a lot of my symptoms. I’m going off my periods becoming lighter and my cycle getting shorter over the last few years. I have moderate endometriosis and mild PCOS. My GP prescribed me Evorel Sequi (the estrogen ones - 50, and the estrogen and progesterone ones - conti). I’m coming to the end of my first month on them now.

I seemed to start off ok - got some acne type spots and felt nauseous for the first few days on the estrogen patches but that settled and I felt ok - I even started to feel like I had slightly more energy. Then I started the progesterone patches and it’s not great. I’ve read about side effects and know that it can take a few months to settle but it’s making me wonder if I have progesterone intolerance:

I have had extremely sore breasts since a couple of days after starting the progesterone patches, and awful cramps, like very bad period pain from a day or so after that. Assuming this continues until my period starts, it’s going to have been 2 weeks of cramps and painful boobs plus a couple of days of cramps with my period. I used to get 10 days of sore breasts before my period anyway and was hoping that HRT might stop this.

Thats not the worst part though - I keep waking up covered in hives and an itchy rash, a bit like eczema. It’s made me remember that this kept happening 3 years ago and was a bit of a mystery. I’ve looked back through the photos I took of the rashes back then and every time it happened it was within the 10 days before my period started, usually in the 7 days before. Back then I was experiencing awful problems with breast pain and breast itching too. All of this was put down to my chronic illness, but now I’m thinking it’s progesterone.

If I’m right, where does that leave me with HRT? Do I even need it if my progesterone is naturally too high? The estrogen seemed to be helping so I’m confused.

It's really early days and it's normal to have some side effects....

HOWEVER...
Did you GP not give you some choice over what type of HRT you wanted?

Patches suit some women, but they progesterone in them is the 'old type'. It's synthetic, rather than body-identical (the sort that is exactly the same as out own.)

Don't assume you can't use HRT based on this experience.
There are many different ways of using it- patches, gel, spray, oral tablets, and 4 different types of progesterone.

You can even do what is called 'long cycle' HRT where you use progesterone once every 12 weeks, for 12 days.

There is also something called histamine intolerance, which may be what you're experiencing that can be exacerbated by the 'wrong type' of progesterone.

Maybe decide what you prefer first? With patches, you're stuck with the dose unless you change the patch dose.

With estrogen gel, you can start off very low (the amount can be 1 pump up to 4 pumps a day) and you can use micronised progesterone tablets with it, for 12 days a month.
This tends to be the most prescribed type at the moment, although not all women get on with it.

Without knowing what your chronic illness is it's hard to help as that might be affecting your response.

There is no such thing as high progesterone.
We only produce progesterone after ovulation, and as ovulation isn't regular each month in peri, you won't have 'too much'.

Thank you, this is really helpful. No, I wasn’t given a choice, everyone is given the patches around here unless they don’t get on with them. The gel seems like a more sensible option so I will ask about that.

It could easily be histamine intolerance as I looked into that when I was having the same symptoms 3 years ago, but my GP seemed to think it was not a thing 🙄 my chronic condition is hard to describe as I am diagnosed with fibromyalgia and chronic fatigue syndrome but I am 99% sure it is actually adrenal insufficiency but getting a diagnosis is proving very difficult. I was misdiagnosed with undifferentiated connective tissue disease a few years ago but it turned out that a lot of the pain was due to muscular skeletal issues and was not caused by autoimmune dysfunction.