New to hrt and it's awful

[VixVox]

Hoping someone may pop along to give advice. I started hrt a week ago ( 2 pumps oestrogel and one 100mg ultrageston for 25 days), and honestly, it's been awful. I'm still in peri but my most troubling symptoms have been occasional hot flushes/ night sweats and insomnia/ anxiety. I'm already on an antidepressant but was hopeful that hrt would ease the remaining symptoms. However, if anything it's caused these to escalate. The ultrageston makes me incredibly anxious and I'm waking after a few hours broken sleep flooded with anxiety and feeling wired with surges of adrenaline. The next day I feel utterly depressed and hopeless. I'm ready to give up entirely. Has this happened to anyone else and does it get better, or should I just give up now?

I love the two weeks a month I take the tablets , makes me so sleepy.

it’s wild how something can make some of us feel so much better and some so much worse.

I tried a few before finding one that suited me. A couple just didn't suit me. Once I found the right one life was great again.

I am similar to you OP. I stopped HRT after a few months as although flushes stopped I felt I was getting slowly fatter and sadder with HRT!

I've been off HRT several months now, still gaining weight, sleep is not great (was good while on progesterone) but the black cloud I was living under has shifted... I'm not sure how much of the mood improvement is due to the longer days/ sunshine though! I still have a few months supply and I'm considering giving it another go over the summer as I could really do with the sleep!

It's crazy to see how hrt affects us all so differently. I would happily swap places with anyone who finds it great for sleep. It just seems to have a paradoxical effect on me! I'm wondering if I tried using the progesterone vaginally that might help? Is that even possible with the oral tablets, or do they have to be the specific pessary sort? Anyone know?

Again, you are trying to act like your own doctor, and unless you are a medical professional, yourself, skilled in this specific specialty and know these medications at a professional level . . . your experimenting carries the risk of making things worse. Just call your doctor.

I get in a rage if I stop taking it…

In my first month on progesterone tablets, I had the worst "pms" of my life, but it's much better now and HRT has definitely helped all the symptoms you describe.

Another thought! If you work, does your employer offer a menopause review clinic as part of occupational health? Mine did, and I was able to access a free 40 minute consultation with the nurse specialist and it honestly changed everything.
The poor GPs are so stretched, and you get a quick 5 mins at best it’s just not enough for most women and HRT seems to be the fix all answer for them - mine even prescribed without noting that I’d had a small brain bleed- I got to the neurologist and he told me under no circumstances to use it! The GP gave me HRT in under 5 mins over the phone and with no discussion of other alternatives or follow up.
Always check to see if your occ health offer this clinic, I was so glad I did.

Thank you, but work doesn't offer this support. My gp is lovely, but I've gone so often in the last few months that I really don't want to bother him again so quickly. I've done lots of reading today and it's looking like that I have progesterone intolerance. It all seems to fit my symptoms.

I get horrible anxiety on oestrogel and it's definitely the oestrogel and not the progesterone that's causing it, as I feel relief on dropping the oestrogel dose to the bare minimum.

So it's not necessarily the progesterone that is the issue. As far as I'm aware it's safe to take the progesterone alone, so you could try that for a day or two to test.

Oh well in that case if you’re missing periods it may not be oestrogen. Mine is the opposite, very heavy and regular. If I were you I’d ask about swapping the progesterone to pessaries (think you can use the tablets like that anyway) as that causes fewer side effects for many

You absolutely NEED to act like your own doctor though and understand which part is making you feel worse, esp as most GPs have very limited and outdated HRT training

If it’s the round Utrogestan ones, you can - Louise Newson says this

Thank you! I'll have another read later to double check. When I saw my gp initially he did mention taking it vaginally, but I thought it might be tricky so declined that option.

@VixVox I've been on HRT for over 15 years and this is my advice (my HRT is from a private consultant, renowned for their expertise.)

I'd suggest you reduce the gel. I was advised to use half a pump and work upwards over several weeks. I was also on only estrogen for 12 weeks, to get the dose right, before adding in progesterone.

One pump stopped day time flushes but not night sweats.

I also took Utrogestan on a cycle as I find daily didn't work for me (headaches.)

You could consider using 200mgs (2 capsules) for 12 days a month. That is an option. It's called sequential. You'd have a withdrawal bleed after that each month. If you are not post menopause (12 months with no period) you should be on sequential HRT anyway!

If Utrogestan doesn't suit you, there are several other options- Norethisterone as a tablet, or in a patch, or the Mirena coil.

Some women get on well with a tablet form called Femoston, which is a different type too.

I felt like shit for a couple of months now no side effects

OP - when are you using the oestrogel? It may be better to use that in the morning and the utrogestan at night.

On the tablets

It doesn't matter when gel is used as it's in your system for 24 hours after applying it.

Thanks for such detailed advice. I've had such useful info on here, so I think my next step is to sit back and reflect. Right now, I can't bear the thought of taking another tablet so I'm stopping that from today; it's not only anxiety/ lack of sleep, I also feel horribly nauseous. Too late to try only half a pump today as I've already applied it earlier. I can understand now why women resort to going private ( unfortunately, can't do this), the one size fits all approach clearly doesn't work for some of us.

Sorry you feel so bad.

In a nutshell, it's all too much too soon.
Too much gel to start with and in at the deep end with daily Utrogestan.

I really do suggest that if you restart HRT you try half a pump of gel- just don't press the plunger right down. And you might want to run it by your GP (but they seem to know very little as you should be in sequential anyway!) that you try a sequential way of using it.

You don't need to go privately for any of this but most GPs know very little.

We're here to help and share what we know, so keep coming back to ask and get support.

I felt awful on oestrogen gel but fine on that same dose of patches. I think I absorbed too much from the gel.

I take utrogestan 12 days a month and don't notice any difference on the days I take it. I did try it vaginally for a while and felt worse (I think more was absorbed using this route).

HRT is really tricky to get right as it is so personal so you need to work out what works for you. Plus whenever I change doses I need to discount the first few weeks of symptoms as it takes ages to adjust to a new dose.

I also find that now I am mid 40s I have to do everything else perfectly, diet, exercise, stress management etc for the hrt to work. It is ineffective if everything else is not supportive.

Yes, I'm veering towards this approach if I can summon up the courage to start again. For now, I'm stopping everything. I'm hoping it won't take too long for the hormones to wash out of my system. I think you're right, in that it was too much too soon and I'm also questioning whether I have a progesterone intolerance. The last few years of my cycle have been atrocious with 2 weeks of daily cramping and feeling like I was due to ' come on 'but with no bleed. This has progressed to no periods for the last few months, leading me to believe I'm heading to menopause. Thank you kindly for your very level headed replies. It DOES help to share, so thank you.

Yes, it seems so hit and miss. I've heard that about the gel, but then others who don't get on with the patches! It's an absolute minefield isn't it. Great you've found relief and a system that works for you. I was so hoping hrt was going to work for me but I can't continue with this regime, my body's screaming at me to stop.

I agree with JinglingSpringbells. You've been started on too high a dose. I'd suggest you drop oestrogel to half a pump or a single pump for now, then build it up.

You don't need to be on continuous utrogestan. You might find taking 2 tablets per day for 12-14 days a month suits you better.

I'd give that a try for a while, and if it doesn't suit you and you think it's the utrogestan causing you problems, my next suggestion would be to try Mirena instead of utrogestan. Utrogestan suits many women very well, but in other women it can cause anxiety and tiredness.

(Above advice is based on my own experience - I've tried various combinations of HRT for 5 years and my menopause consultant is an expert.)