HRT, Anxiety and Epilepsy

[wizbit93]

So after a two month wait for the GP to hear from my neurologist as to if I could take HRT, I started about six weeks ago (Everol sequi - I’m on the second patch of box 2). I’m 50.
My anxiety (the main reason for taking it) has slightly improved in the progesterone weeks but seems to have increased in the oestrogen only weeks. Has anyone, particularly with epilepsy, experienced this? I can only take patches due to the epilepsy. I have a blood test next week to see how it is affecting my lamotrigine levels (epilepsy meds) and I am hoping it is just that causing me to be more anxious in that I am hoping it hasn’t affected it!
I take clobazam when I feel panicky (as my neurologist helpfully told me that feeling panicky could be a seizure, even though most of my friends all have peri anxiety 🙄) but really don’t want to become too reliant on it.
Any thoughts/help would be gratefully appreciated!

It's too soon to say really as you must be only half way through the 2nd cycle (?)
Usually for most women it's the progestogen that gives side effects. On a patch you will be using Norethisterone for half the month.
Some women find that can cause PMS type symptoms.

You can always consider other options like estrogen gel ( where it's easy to reduce the dose because 50cg patch is considered medium.) You could, on gel, reduce the half that by using 1 pump only.

Or you could halve the estrogen only patch (cut it in half) but you can't do that with the ones containing Norethisterone.)

If you used gel, would have to use a separate progestogen for 12 days per month and these would be tablets but as far as I know are not an issue with epilepsy but you'd need to check that out.

I literally only started on 23rd Dec after a wait until neurology gave me the okay / I had blood levels taken. I haven’t actually got to the oestrogen only bit yet but do feel like my anxiety has reduced very slightly.

Did you have blood tests before you started to check your medication levels? You could possibly ask for that and then repeat bloods in 4 weeks / knowing that you’re being monitored might make you feel less anxious.

Sorry completely missed that you’re having blood tests next week.

I'm not sure I understand this @kirinm

How have you started HRT but not used estrogen yet?

It's the first thing you start with.

I’m taking progesterone pessaries now and will do for the next 8 days in addition to the oestrogen patch. So I don’t know if I will feel differently when I stop taking the progesterone.

Is that unusual?!

It's more usual to start with estrogen and add the progesterone after 14 days.

Are you seeing a specialist for HRt?

A women’s health doctor. I was told to start the progesterone as I was mid-cycle (almost to the day) when I was prescribed the medication.

It makes sense to start progesterone mid cycle if you can for your first HRT cycle, but you won't be able to do this forever because your cycles will become longer or shorter (and you will miss some for months in peri.)

The medical advice on this is to start progesterone on the same DATE each month.

However, you're supposed to use estrogen every day , so at the same time as starting progesterone (not wait until you've stopped it.)

I put on the oestrogen patch on the same day as I started the progesterone and my instructions are to take the progesterone for 14 days starting on the same date every month. My cycle happens to be ‘regular’ at the moment but I was told to take it on the same date each month not try and guess 14 days before my period.

Hopefully my post was just confusing rather than you think I’ve been misadvised?

Yes, just confusing. :)
When you said you'd not got to the estrogen only bit of hrt it seemed you were starting only on progesterone, (but you're on a patch with both in.)

Hope it goes well.

Thanks @kirinm. Am I right that you have epilepsy too? Funnily enough I had my lamotrigine levels checked in October and they were 9. My neurologist has said if they go below that at my next test next week he will up my lamotrigine, although I am already on a little bit more than the recommended dose for epilepsy (525mg a day).
I keep telling myself that he wouldn’t agree to letting me start HRT if he thought it was too much of a risk, but I’m due to get my licence back at the end of Jan and I’m so scared of a seizure related to the HRT!
I started the HRT on the 26th Nov, so I’m only a few weeks in I guess. Hopefully the anxiety will ease soon.

Thanks @JinglingSpringbells. I think you’re right and I do need to give my body time to get used to it. I’m on the 10th patch now. I’ve been told that I must take transdermal HRT as it is absorbed differently and bypasses the epilepsy meds better, but if I use the gel then I have to have progesterone tablets, so therefore I’m not allowed the gel.
I had heard about cutting the patch in half, so that’s something I could consider if my blood tests show that the HRT is affecting my meds too much.

Yes I’m epileptic and on lamotrigine and keppra. My blood level for L was 8 as of last week and I wasn’t given any indication of that being too low. I’m due to be tested again in about 3 weeks time,

When I was pregnant they monitored my levels every 2 weeks and increased my medication slightly so I’m assuming it’ll be something similar with this.

Fingers crossed for you. I know the fear of losing your license.

Solidarity then @kirinm! Luckily I didn’t develop epilepsy until I was in my 40s so I didn’t have the worry of it during pregnancy.
Fingers crossed for you too

One thing worth thinking about is that if you were to use gel and micronised progesterone, you can use the progesterone off-licence, vaginally. This means it's absorbed without going through the liver first and gets more where it's needed. Obviously you would need to check with your specialist.