Can HRT stop working after a while?

[Iheartmysmart]

I’ve been on HRT for nearly 5 years. Just swapped back to gel after becoming allergic to the patches for some reason. I’m on 3 pumps of gel and Utrogestan for 12 days every second month due to side effects.

Just recently I’ve started to get really itchy skin all over, getting worse at night, I’m struggling to sleep despite being knackered, my hair is falling out, I’ve developed tinnitus, my fingers and toes are really painful and I’m so grumpy and lacking in any enthusiasm for anything. And the hot flushes are returning. I feel like I did before starting HRT.

On my last review a few weeks ago, the nurse did say if switching to the gel didn’t help then she could arrange blood tests to check hormone levels. I’m aware that I’m nearly at the top of the dosage level for oestrogel but don’t know where to go from here.

That sounds horrendous @Iheartmysmart. How old are you? I’m mid forties and on 5 pumps. Pharmacist would prefer me to drop to 4 pumps, but my doctor says it’s fine as everyone absorbs it differently. Four is the max before you go off licence so I would try four pumps, and if you still feel awful then maybe try the spray, or a different patch. Make sure whatever you’re taking is body identical. It really sounds like you’re not absorbing it for some reason. You don’t need blood tests - they’re unreliable as hormones fluctuate so much, and it’s obvious from your symptoms that your hormone levels aren’t right.

@BlueberryFlapjack Thanks for your response. I’m 58 this year. Tried Lenzetto but that didn’t help at all, the patches were okay until I became allergic to them which must have interfered with absorption as my symptoms started returning. There is definitely something not quite right but whether that’s the menopause or another issue I have no idea. I might ask for blood tests anyway even though they aren’t terribly accurate and get iron, thyroid and B12 as well. For some reason I thought I’d need less oestrogen as I got older, not more!

But it hasn’t stopped working you have changed medications. I’d keep trying until you get the balance right again.

You've not said how long you've been on gel @Iheartmysmart
Medical guidance is to allow 3 months with any change of type or dose.

It might be worth considering exactly how you're applying the gel. There is a wide variation in how we absorb it.

Are you following the instructions on the leaflet? The most important one is to apply to inner thighs, or upper outer arms. Or you can do both if you're on 3 pumps. Rub it in gently, but not too much. It should still be a bit tacky while you wait to dress.

It's also sometimes better to split a high dose into 2 applications - morning and evening - so use 2 pumps then 1 pump.

Make sure your skin is free from any products like body lotion or shower stuff- it needs clean, dry skin.

Allow to dry 100% before dressing and don't shower etc for an hour at least afterwards.

@JinglingSpringbells I’ve only been back on the gel for three weeks so appreciate that I’m being very impatient and need to give it longer to settle. The nurse said give it six weeks then let her know how I’m getting on and she’ll arrange blood tests if it’s not working.

I use the gel in the morning over my inner thighs and upper arms and it’s dry by the time I’ve washed my face and cleaned teeth. I shower and use body lotion in the evening so there isn’t any product on my skin.

At my last blood test - not HRT related - a few years ago, my ferritin, folate and B12 were very low in the range and I know there can be a cross over if symptoms so perhaps I need them tested again and start supplementing if they are still low.

It’s just such a struggle holding down a full time job and juggling elderly parents when feeling so awful.

The nurse shouldn't test you after 6 weeks- the guide is give it 3 months.

Also, it's not possible to get an accurate reading of estrogen from a single blood test on HRT. I've asked my consultant this (out of interest, as he's never tested mine) and he said only 24 hr constant testing shows the level (he's one of the top two meno gynaes in the UK) and I've used gel for 17 years.

Persevere but also get your blood tested for iron and ferritin, as well as B12 etc.