How long do I stick out the side effects of HRT to see if it works?

[Menopoly]

I’ve been on patches for a few months now (Estrei). How soon should I see any positive impacts, rather than just negative ones?

~ Sore and really achy knees, shoulder, loss of strength in hands, feels like hands have gone to sleep for quite a while when I wake up (I had this with my hands intermittently through pregnancy), joints/ligaments will sometimes go so suddenly unable to weightbear on ankle for a bit (had a bit of this in pregnancy too)

~ had a regular cycle, but now get additional periods and no idea what actual cycle is anymore

~ sometimes very bloaty, sometimes sore breasts

~ exaggerated emotions - but not good ones! I’m having disproportionate emotions of sadness and anger

~ keep finding myself clenching my jaw

Has anyone else had any of these after starting HRT? Shouldn’t I see some positive effects by now?

I was actually hoping for relief from brain fog, memory, fatigue, nausea.

All these- bar the sore breasts- are menopause symptoms so it could be that your symptoms have increased. I kept increasing my dose and my symptoms weren't alleviated until I was on 100 patch.

My symptoms changed and we're added to whilst taking HRT, eg vaginal atrophy and vertigo only started when I'd already been on HRT for 6 months.

Thank you. I’m on 100 at the moment which seems quite high. It just seems strange that these other things only started after taking HRT. I hope HRT is helping your additional issues.

I’m also on the gel for dryness and that seemed to help that issue, so I’m able to wear a tampon for a bit again on some days for example.

For the sore breasts Starflower oil is helpful.

I think starting on the highest dose is unusual. I think most people start on 50 and increase from what I've read.

I’ve not heard of that - is it something you rub in or something you take as a capsule? I’m wondering whether it’s to do with periods changing. I should prob keep a symptom diary and track.

I went on HRT a couple of years ago - a 25 patch with progesterone (ugesterone I think). I was moved onto the gel and went up to about three daily pumps. I just stopped it in the end as finally twigged that it was the progesterone giving me the rage. That died down when I stopped. That was about 15-18 months ago.

@Menopoly Could you clarify a few things?
It's not clear which patch you're on - maybe there is a typo? Estrei

Never seen it before. Are you in the UK?

What is the progestogen it it- or is it an estrogen only patch and if so, what are you using alongside it? Is it a sequential patch or continuous combined?

You say you're on gel for vaginal dryness.
What is the name of it?
There is one gel for vaginal use called Blissel but it's a very low dose and there are other options (cream or a small tablet you insert) that are more usual to use.

The medical advice for sore breasts is to take evening primrose oil (in a large enough dose) but usually reducing the estrogen helps too.

Ps

If you are on a sequential type of HRT you should have a regular withdrawal bleed each cycle/month when you complete the progestogen part of the HRT cycle.

Your other symptoms like loss of strength etc don't sound connected to menopause- have you had a blood test for anaemia etc?

Starflower Oil is a supplement.

Thanks. The patches are Evorel Sequei, so 2xevorel 50 two times a week for first two weeks and then Evorel conti with the same dosage pattern for next two weeks.

My ferritin isn’t great, but I take iron tablets to keep it in the teens.

i can’t remember the name of the vaginal cream and don’t have it with me, but it’s a tube of white cream with an applicator that you insert vaginally. It comes in a purple and white box.

Possibly the type of progesterone in the patches doesnt suit you? It’s norethisterone which can cause side effects you’ve reported - mood changes, sore breasts etc.
Plus your oestrogen might need to be higher.
The joint pain etc seems to indicate your levels are not high enough.
Or you might not absorb that brand very well. Eg. I get good symptom control on Estradot & FemSeven, but I don’t absorb Evorel.
Some people absorb the gel or spray better. Some people don’t absorb transdermal preparations well at all, and need a dose that is higher than nhs prescribing guidelines to get symptom control.

To answer your question, it can take a fair amount of time to find the regime that works for you. There are many variables.
I’ve gone through several changes to find the one that works for me. Plus, if you are in peri-meno your symptoms can change over time as you progress towards meno/post-meno.

My Dr likes me to trial each change of dose/type of HRT for 3 months, to see if it’s settling/working. But if things are intolerable then I’d change sooner. In my personal experience, if it doesn’t suit me, it never settles. I had a Mirena for 2 years and it never improved for me. But I know for others, it can settle down.

Estriol?

I lasted two weeks on daily HRT. I now take a tiny dose a couple of times a week, I was an emotional wreck on it.

It might be estriol!

The first sort of HRT I tried didn't suit me so my GP tried me on another one which was much better. Maybe you could speak to your doctor and ask their advice?

Thanks all. I think I’ll stick it out til the end of this period (came on today) and then come off and contact doctor for a review. Tummy is so bloated today. I’m just not seeing any benefits, with a lot of drawbacks that only started after taking the patches. I’ll keep on the vaginal cream.

Did anyone have overwhelming fatigue and brain fog?

*fatigue and brain fog that helped by increasing oestrogen over 100, but no impact at all on less than that?

Oestrogen makes me clench my jaw, I’m like it at the moment. I’ve tried for nearly two years to use gel and patches but within a few days of applying either my teeth are itching which makes me want to gnash my teeth. My ears ring, I can also get TMJ when it gets really bad.

I stop oestrogen for a while and just take progesterone only daily and I’m great on that but then start having really long and nasty periods (still cycling at 52).

it’s definitely oestrogen that makes me feel awful. Tense, jittery and tired but wired

I had some drinks last night and the worst shoulder is agony today. I suspect I forced movement as it didn’t hurt so much under alcohol. I can barely move my arm today. I can’t drive. I can’t even sit with a hand on my lap. Taken the patches off. I’m not waiting for the latest stupid heavy extra period to finish. I can move my arm, with some force about 45 degrees from my side if elbow bent and about 25 degrees if straight. How long does it take for this HRT stuff to get out of your system? Typing left handed so apols if typos.

That sounds like frozen shoulder rather than a side effect?

Maybe, but the shoulder started after starting the HRT.

Frozen shoulder can be caused by lack of oestrogen. HRT provides only a fraction of what we made naturally. There are lots of oestrogen receptors in the shoulder, the shoulder perceives the lack of oestrogen as an injury so the shoulder shuts down to protect itself. Once the process starts there's no going back- the shoulder grows a protective thick skin which stops the joint working.

I had it for nearly 18 months and it was awful. I had a cortisone injection 4 months in that stopped the pain but I still couldn't move my arm.

I have pains in my stomach when I apply patches or gel to my thighs and when I apply gel to my arms I get headaches or TMJ / bad ears.

Im convinced that the local oestrogen affects these areas. I feel awful after a few days of it. Takes about 2 days to wear off