Too much HRT?

[Buzzyfeeder]

Just wanting to sound out if this seems like a lot of HRT ? I still feel out of sorts and I’ve been on some kind of HRT for 5 years, I’m 50. Wonder if I feel like I do because it’s all too much and maybe I should stop it all? It feels like a lot.
patches 100
spray 2 x per day
progesterone tablets x2 daily
merina coil

Why so much oestrogen? Max patches and 2 sprays of Lenzetto is a lot.

Do you mean you're on all of those at the same time?

Yes I’m on them all at once. My estrogen is still around 300 when last measured.

Why are you on so much progesterone? Is your mirena coil still less than 5 years old? I'm switching to a mirena soon and have been told that will be all i need for endometrial protection.

I'm on a lot of oestrogen (200mcg). On 150mcg my oestrogen level was still only 300-330, and the increase in dose definitely made a difference to my symptoms which are now largely under control.

I'm also on a high dose of testogel because that level wasn't coming up. With some tweaking and change to applying it to my upper arms/ shoulder rather than my outer thighs my testosterone levels have now gone from very low to too high, so I'm now reducing the dose back down and retesting in a few months. So i do wonder whether i don't absorb very well in my thighs, which is also where i apply my oestrogen patches. Problem is i find my skin gets sore if i stick them on my buttocks and I'm not blessed with a flat tummy, and oestrogen isn't supposed to go above the waist so can't stick them on my shoulders.

Anyway, what I'm trying to say is it might be worth changing application site for your oestrogen and getting someone competent to review you progesterone requirements.

@Buzzyfeeder Are you getting this from your GP?
It's very odd, to be honest.

You shouldn't be on that amount of estrogen or doubling up on progesterone.

Blood tests aren't accurate for testing estrogen, so if your GP thinks they do, that's not correct.

The way to test doses is by looking at your symptoms.

What were they and how do you feel now?

Hi, yes all from my GP I have a review booked in a week . I feel like everytime I go with a symptom they add another form of HRT. The progesterone is a recent addition and my coil is due for renewal this year but no one has said it’s temporary measure just that it’s for more endometrial protection.

i did use the gel for a while before I had the spray but I didn’t absorb it well and my estrogen dropped bringing more symptoms. It seemed when my bloods once showed estrogen around 500 my symptoms were eased but I don’t think they know what to do to get me back to those levels and is that a good thing to keep the estrogen higher? Just so tired of it all. It feels so piecemeal in approach and I feel loaded with hormones.

Your GP sounds as if they don't know what they are doing, frankly.

Your GP needs to understand that blood tests are not accurate. I could link to many medical research papers on this but you can google and do it yourself.

I've never ever been tested (on HRT over 15 years), excellent consultant, who says blood tests are not necessary.

Dose is on symptoms.

What are your symptoms?

HRT is good but you can also do a lot with lifestyle - exercise, diet, etc.

For reference, the British Menopause Society (they write guidance on HRT for GPs) says that no woman should need more than the maximum amount of estrogen. That's a 100mcg patch or the equivalent (4 pumps of gel.)

They made this statement when some private clinics were prescribing huge amounts of estrogen.

Obviously, there may be very occasional needs above this but they should be consultant-led with careful monitoring.

Thank you @JinglingSpringbells. I will arm myself with some research for my review.

My symptoms are essentially broken sleep, fitful sleep, headaches, itchy dry skin and fatigue. Never had hot flushes or the alike. It’s the accumulative impact of never shaking them off.

I do keep myself in pretty good shape, exercise regularly but I could always improve my diet but I don’t carry lots of weight.

It does seem like an awful lot. I was also told that there's not much value in testing hormone levels via a blood test (in my case it was about cortisol) because they fluctuate constantly. Could you possibly see a different GP for a second opinion at the practice?

I take Evorel Conti combined patches so there is progesterone in them also for two weeks, it’s brilliant and only one item.

There is no way I could remember that amount of things to take daily. I just stick on a patch and don’t think about it again.

Besides the quantities of the actual medication, that’s a lot of different items to remember . Do you feel like you want to cut back?

I just want to feel better! If I stopped everything I don’t know if I would feel better or worse but I would stop it all if I had planned reviews and support from a trusted gp specialist. My gp is the meno specialist at my surgery. Not sure if they would refer me to a consultant for a proper HRT review?

None of it makes any sense OP.

The Mirena coil gives endometrial protection so there is no need for additional progesterone. (but at the same time, no one takes double high doses of estrogen.) Why has your GP said you need it? You should ask why.

If I were you I'd stop everything (apart from the Mirena which you can't stop unless it's removed.)

Give it 4 to 6 weeks with no estrogen if you can then start again gradually with either 1-2 sprays of Lenzetto or a 50mcg patch.

Just reading along as I've recently started HRT in peri. I've been given progesterone 100mg capsules to take twice a day and 1 pump of eostrogel 750 micrograms to do with each pill. I feel similarly that it is a bit much and got very emotional and had a panic attack for the first time in several years in the 2nd week of taking it. Is the dose too high here too? I am not complaining about the libido or the lack of hot flashes, so it is doing something right!

I get jittery and slightly anxious if my oestrogen is too high.

Honestly, I don't know why a GP has prescribed a regime that needs two pills and two applications of gel every day. Could you swap to a Mirena coil and patches, or the combined patches?

I can't do the coil due to my womb being tilted so far back when I have one in it actually hurts and needs putting in/out in the hospital.

I was given the option of gel or patches but didn't really know what the difference was - I do wish now I just had patches to put on. Not eating for 2 hrs before a progesterone pill is often an issue (the bloating if I ignore is terrible!). I might go back and see if I can switch to the patches.

This sounds like yet another GP mis-prescribing.
If you are in peri you take Utrogestan for 12 days a month.
2 x 100mgs capsules for 12 days.

1 pump of gel is a low dose- it's 0.75mgs. The usual dose is two pumps.

I am going to think about stopping all of it and not replacing the coil. Take a break from it all and start again as you suggest @JinglingSpringbells Even if I felt the same as I do now i wouldn’t be loaded with HRT to boot! Will discuss at the review but I don’t really have much faith in the GP advice now !

Could you afford an appointment with a private menopause clinic, you're in a good position in that you have a GP who is keen to prescribe plenty of HRT even if they aren't quite getting it right, so a good 45 minute chat with a speciailist will give you better understanding going forwards and empower you to ask for what you need.

I use the Newson clinic, most of their doctors are GPs who have completed additional menopause training, but there are also a couple of obs and gynae consultants on their books if you know what you're looking for in the letters after their names. Charlene Villa is the only Gynae consultant on the list at the moment and is who i saw (video consultation) last time and is really nice and knowledgable.

@Periperi2025 hi yes I could go private I think. Thanks for the recommendation I will take a look. I don’t feel like my symptoms are complex just the remedies a)are not working and b) seem such a mix and high doses. It’s all complex I guess which is why you need an expert !

Ask you GP to refer you to a menopause clinic they would know more than a GP. I'm on Elleste solo 1mg. having had hormone implants after I had a hysterectomy when I was 27.
At 60 my GP wanted to stop prescribing hormone implants he sent me to the wellwoman clinic at the hospital the clinic put me on these. I'm 80 and still take one daily. I'm no doctor but the medley you are taking seems too much

Are you taking magnesium for sleep? If not you should be! How are your other vitamins? B vitamins great for itchy skin.
doctors often have very little to no training on menopause so if you can afford any private appointments it is worth it!

I would remove all hormones and work on your diet. Then work out what your symptoms actually are?

good luck!

I found that I stopped being able to tolerate HRT after 5 years and I have heard this can happen. I removed the coil and came off everything and do feel better physically but feel a little bit flat mentally. I make sure that I am in bed between 10pm and 11pm, weight train, jog and eat a fairly healthy diet. I do not feel bloated anymore and have lost a stone in weight.

The spray is quite a low dose so you certainly aren’t doubling up on your oestrogen so try not to worry.

If you can go afford to go private there are a number of providers. I have been using TMC, the menopause consortium, and they are really good and are now all over the country. You could book a consultation and see what they say? Always nice to have a second opinion.

I wouldn’t come off it cold turkey as HRT takes so long to settle it could make you feel awful trying to build your levels up again, and it isn’t good for you.

good luck!

I honestly feel your pain and sympathise. I spent 5 years trying to get to the dose that suits me. I now have a 100 patch and vagirux pessary twice weekly, and 200 progesterone nightly. I was told that if you take high levels of estrogen you need to balance it with a higher dose of progesterone so I would say your progesterone is fine but the estrogen you take seems very high, even though your blood tests don’t reflect this. You can get to the point where symptoms come back if estrogen levels are too high. I would say don’t rely too much on the blood tests because I was told that’s not a reliable indicator as it can fluctuate from day to day or even hour to hour, so I was always told to gauge it by symptoms rather than blood test levels. I also had problems absorbing and tried sprays gels patches and different strengths. I was put on testrogel at one point but grew a goatee any teenage boy would be proud of! Because the testosterone was outweighing my absorption of estrogen. It’s all trial and error, but after a complete re-evaluation and honest chat with the doctor I realised that my lifestyle was having an impact on absorption ie alcohol, caffeine, stress and lack of sleep can affect absorption. They all have a knock on effect with each other and since I addressed these I’ve been so much better. Our GP practice has access to a specialist menopause doctors hub so maybe there’s something like that? My advice would be to look at any factors possibly affecting absorption as I did, and then trying for example just a 100 patch and pessary for example, still with the 200 prog. I’d recommend the pessary to anyone with any issues down there! Good luck xx