HRT - to persevere, or not? And any other solutions?

[Puffykins]

I started the patches on Saturday - and haven't really slept since, am dripping in sweat (worse than before) and am so low and teary. It's also been a shocking few days (DS suspended from school, huge amount of work, travelling for work, computer crashed and I've lost a lot of emails - I deleted them by mistake, which I think I could attribute to increased brain fog.) This is my second go at HRT - I abandoned the pills and gel after 6 months because it was making me suicidal. The anxiety when I'm not on anything is awful - but I think being on HRT is just as awful, but in a different way. I had such hopes for the patches - I've ripped it off and haven't put on another because I cannot cope with the insomnia, sweat and low low mood. I have to be able to function. And I wondered if anyone has had similar issues/ has any advice... ? Thank you.

You need to give it 3 months. The symptoms you're talking about are meno symptoms, not caused by HRT.

HRT doesn't work overnight- it takes weeks to build your estrogen levels back to where they were .

Keep going.

After 3 months you might need to assess the dose and go up a bit.

Which patch are you using?

I was told to get into contact with doctors if I had issues - so maybe those. Bit it can take some months for things to settle down. My periods were all over the place.
but it’s settled down a lot and I’m very happy.
Is It combined? Estrogen and progesterone?

Ask for oestrogel and start low then build up slowly if you're sensitive, so oestrogel one pump in a morning and increase after a few weeks to 2 pumps.
Take utrogestan vaginally to reduce side effects.

Lots of physical activity to promote sleep and improve mood. Avoid caffeine and alcohol.

How old are you, is this definitely peri/ meno? Have you tried cbt to help with wellbeing issues?

I felt very similar to what you’re describing when I first tried HRT with oestrogel at the standard dose - I had this wired insomnia and was emotionally very much not okay, I’ve never had anything like it and had to stop. I did eventually try again and was fine by easing into it slowly - by using 1/4 of a dose for a couple weeks (in my case that was 1/2 a pump so the equivalent of 12.5 mg patch) and then gradually increasing it. I’ve now swapped to Everol patches which work better for me but again I started at 25 mg patch and am now on 50. What dose are you on? If it’s Everol you could always cut the patch in half if you try again and see if that is less of a shock to the system. I could not have “given it three months” as the official guidance suggests as I was not okay, but the very slow increase was fine.

@abdnhiker
I've been given the 50 patches - that's a genius idea about cutting them in half, I'd never even considered that. Yup. There is literally no way that I could carry on for 3 months. I was terrifyingly low.

@Janiie I'm 45. Or 46. I can't actually remember and can't seem to work it out. I think it might be 45. I don't know if it's definitely peri - it appears to be impossible to tell, but, my periods are irregular, I get weird aching legs at night (I take plenty of exercise, and don't drink) and I get hideous anxiety. But actually I'd rather the anxiety than the aching sadness. I have had CBT and quite a lot of therapy for historic anxiety - but it's still an issue.

Maybe some people just aren't a fit for HRT? I just sat next to a woman at dinner who had the same issues as I do - I feel like we only hear the "HRT saved me!" Stories, and fewer of the less successful experiences.

I have dreadful anxiety on HRT and feel much better without it. And I was taking it for a lot longer than 3 months before I worked out what was causing it. It's disappointing because I worry about my bones.

I just take Setraline because the anxiety and insomnia went on for literally months and I was having suicide ideation which was scary. I know people say GPs just fob you off with anti-depressants instead of HRT but it works for me and I am reluctant to start trying to work out HRT now.
I also do lots of exercise including weights which really helps my mental health. I especially like the sauna for meditating in as well.

@TalulaHalulah so unfortunately every time I go on anti-depressants I put on 3 stone. I came off them 5 years ago and just don't think I can cope with having to go through coming off them and having to lose all the weight, again. Maybe I can manage them and not put on weight... (but I say that every time, and then eat all the chocolate and doughnuts and don't care about the repercussions because the anti-depressants have relaxed me etc. I have no will power on anti-depressants, it seems.) But I am somewhat reassured @Almostwelsh that there are others for whom HRT just doesn't work. I also take lots of exercise, incidentally. Anyway thank you all, I really appreciate your input.

You need to give it chance to work

I’ve come off mine as couldn’t stick it for three months. I found I got various new symptoms that could also be perimenopause symptoms, but which didn’t appear before I took HRT. I had no relief from the symptoms I took it for.

Yes, they do have the same effect on me (weight gain), which is my one reservation. I go to the gym and swimming alternately six days out of seven and walk where I can, and watch the carbs and sugar. I had to lose three stone after the pandemic and a full on management role where I had no time to exercise so I am wary of putting on weight as well. So I am keeping an eye on that. I would be worried about HRT having the same effect on me and it’s the trying to get one that works for several months that puts me off.
I don’t think I eat more when I am on them, but I do less because I sleep more and I am not wired (which must burn calories!)

I hope you find something that works for you.

Write a diary of your symptoms and commit to a 3 month trial. You really do have to give it time.

@PersephoneParlormaid @GhostLivesHere having ripped off the patch yesterday, and seen a vast mood improvement just by lunchtime, there is no way that I can stick at it for 3 months. They've caused suicidal ideation in me in the past, and it was heading that way again. Truly I cannot tell you just how low I was, it was horrific, everything felt hopeless, I couldn't actually function at all. I can't do that for 3 months. I think maybe HRT isn't for me and I'll have to find an alternative means of coping with the menopause.

@Puffykins I don't understand why you think it's 4 days of estrogen giving your hot flushes and insomnia when these are two of the main symptoms of perimenopause. It's quite likely you'd be experiencing these anyway and they are nothing to do with HRT. They can come and go in peri so it's a coincidence they are happening at the same time as using hrt.

You can't judge hrt on using it for 3 or 4 days.

I'm a bit concerned that when a poster asked how old you are, you said 45 OR 46 - you can't remember. Is that right or were you mistaking what she asked?

HRT didn't agree with me either. I was on the patches but they caused bleeding. Switched to gel and progesterone tablets which made me feel dreadful mentally. Really scared me. Stopped taking them over 6 months ago and been fine since. OP have you tried sage for the hot flushes?

@JinglingSpringbells it was longer than 2 days, and the symptoms were way, way worse than anything I'd had before.

My main peri symptoms are occasional hot flushes, and anxiety. And of those, it's the anxiety that is the worst.

And if it was just those symptoms/ side affects - the hot flushes and the insomnia - then maybe I could stick at it for 3 months. It's the very very low mood that is unliveable with.

@IsItAllMenopause yes - it's the mental change that is the hardest. I have not tried sage - thank you!

I think, and I'm not an expert but as you've asked for opinions, if you have existing mh issues then they may well been exacerbated by peri related fluctuating hormones. So while anxiety meds aren't indicated purely for meno related anxiety, in someone with preexisting anxiety issues then meds may well be worth considering too.

However, as I said previously some people are just very sensitive to new medication. HRT can make some feel a bit wired and hyper initially. So ask for gel instead of patches as it's easier to control dosing, start very low and go very slow to increase.

@Janiie I don't think I have existing mental health issues - I had postnatal depression after both children, which is where my experience of anti-depressants comes from.

The gel and pills were the HRT I tried the first time - and I was on that for 5 months (so I really did give it a chance.) The extreme low moods - and I reallly do mean extreme - coincided with when I took the pills. But I don't think one is allowed the gel without the pills.

I think maybe HRT isn't for me, as it isn't for other people on this thread - who I am really glad to have found, because HRT generally gets such rave reviews that one can wonder if one is somehow getting it wrong. Though I realise it is obviously brilliant for some (most?) Thank you though.

Ok sorry I misinterpreted what you said about the anxiety when you aren't on anything is terrible but worse on hrtand assumed that was pre existing but it's all new peri issues?

You would need progesterone as well as gel yes but that can be administered vaginally which reduces symptoms in many women.

Is your gp any good, can they signpost any mh support as well as hrt?

There are a lot of women who feel HRT isn't for them but usually it's because they have not been treated correctly (usually by a GP who knows very little.) Yes, some GPs are good but the majority are not HRT trained.

When they are asked what they have tried with HRT it's usually a very short list.
There are lots and lots of different types , doses, etc.
Most women who say it doesn't work for them have only tried a couple of types and not all the doses available.

For low mood, you can try St John's Wort although it can't be mixed with some other drugs.

The charity MIND has a lot of advice on low mood on their website. It's been proven that exercise is as effective as ADs for mild to moderate low mood. Also it's worth looking at CBT as Janiie said.

You said you stuck with HRT previously for 5 months. But did you increase the estrogen? Did you try different types of progesterone with it?

The extreme low moods - and I reallly do mean extreme - coincided with when I took the pills. But I don't think one is allowed the gel without the pills.

That would be micronised progesterone - low mood can be a side effect.

You have many different options, including the Mirena coil, Norethisterone (which is probably what's in your new patches) or Femoston tablet form.

There is also the option of longer cycles (every 2 to 3 months) with medical supervision where progesterone is used for 12 days per 2 months or even 3 months.

Ask your GP to refer you to a menopause specialist?

I still say you can't judge this on 5 days of any new HRT.
I appreciate you're feeling low but it isn't a quick fix.

I remembered this morning that the other thing was anaemia - so I was losing hair as well and my GP ran blood tests which diagnosed anaemia. I am now on prescription grade iron. It may be that this would have helped without the anti-depressants, I don’t know, but if your GP has not run a panel of blood tests, ask for these. They also tested my thyroid.
I am also taking a menopause supplement with sage and various other things but I would need to check what is in it.

In my case I got anxiety when taking the combined pill also, although I didn't realise at the time the cause. I think i can't use artificial oestrogen (I had no problems in pregnancy or when using the POP). The progesterone element is OK. I was on the gel and progesterone pills for 5 years and after a few months in was getting horrific anxiety and didn't know why until I had to drop my gel dose because of some bleeding. The anxiety improved and noticing this I dropped my dose more - more improvement. Stopped it and I feel so much better. I can live a normal life.

I was using HRT for bone protection and joint pain, plus sexual dysfunction, I don't have hot flushes or insomnia. I will put up with sore joints and no sex drive rather than being too anxious to leave the house. I do still take the vaginal oestrogen, but I am worried about my bones due to family history of osteoporosis.