Really REALLY Struggling on HRT after five weeks, is this normal in menopause?

[Lifealittleboulder]

Hi all

Im so desperate for some help, I’m feeling completely and utterly rubbish on HRT. I started (1pump gel and 1 progesterone tablet) 5 weeks ago and it’s been crazy. At first I had really dark thoughts, scary and was SO low, the dr prescribed me a SSRI to add in to the mix. 2 weeks in I had
the most awful anxiety, I was shaking, having panic attacks and couldn’t function. A friend had to come and sit with me while my husband was at work. The dr told me to come off the SSRI immediately and said the combo was worsening my symptoms. Any way, since I came off and was on the 14 day break I started to feel some benefits and felt better, less brain fog, less body pain, more energy and less general unhappiness. Anyhoo.. back on it and
the migraines and morning ibs type symptoms are back and just feels like I can’t live like this. I feel like I never know what my body’s going to throw at me next. I have 2 kids one in primary one in secondary, a young doggo and my husband runs a farm. My parents are elderly and rely on me our in-laws are
also very elderly - all live close by and need our help. I just can’t trust my body, some days I’m not able to leave the loo for 2 hours the morning- others I’m in an and e with such bad migraines. is this normal? I keep hearing I need to push for 3
months…
(thanks for listening xxx)

I started HRT a year ago age 41; my psychological symptoms improved from week 1 but I had headaches/tiredness amongst other things on and off for few weeks, it definitely wasn’t plain sailing

I’m glad the doc took you off the SSRI

I recommend starting a diary for symptom watching - I use google calendar for this, on my phone. It’s very revealing when you start to see patterns.
Are you still having periods?

I should add that I bloody love HRT now, it might have saved my life, and was completely worth any struggles in the early days

I had a tiny bleed when I started the HRT 5 weeks ago previous to that I hadn’t had one for 7 months. I’m hoping it’s going to start helping soon these headaches are awful

The 13 day break I assume was a progesterone break, not a complete one? If so, and you felt better during that, it suggests the progesterone is the problem. Some women do respond differently to it.

I'd ask your GP about trying different formulations or routes of administration to see if that helps. There is a huge difference in how the body processes oral vs non-oral progesterone.

@Lifealittleboulder This^^

Many women don't get on with micronised progesterone.

I'm really confused by the dose you're on.
If it's a cycle of 12 or 14 days per month, you take 2 x 100 mgs capsules. (not one.)

If you're taking 100mgs daily you should be post menopausal. That's no periods for 12 months OR over 54.
Otherwise you should be using it 12 days a month.

You should also perhaps be on 2 pumps of gel, although starting low on 1 pump is fine - but not starting progesterone at the same time as you can't tell if that is the right dose of estrogen - progesterone 'reduces' its effects.

Does your GP actually know what they are doing?

As others have said, there are many more types of progesterone.
Patches, the Mirena coil, dydrogesterone (Elvee) and others.

Have a read about all the types of HRT and doses.
Something is not right with what you've been given.

Can you ask if you can take the progesterone vaginally as a pessary? Utrogestan is available but vagjnal use for HRT is off label. I do this as the oral progesterone makes me suicidal, vomit, gives me stomach cramps and also dizziness. The pessaries don’t give me any of those side effects.

On the subject of progesterone, I had a crummy time with it first two months, it made me feel tired to the point of sedation, … but when I upped my estrogen dose, the progesterone half of the month became (and still is) my favourite part!!!

HRT is complex and individual; time spent in research on forums and with the menopause doctor has been enormously helpful for me as I’ve figured things out progressively

I take the progesterone rectally to avoid the acid reflux that taking it orally gave me

oh also I didn’t get on with the generic progesterone, I prefer Utrogestan brand (the capsules are softer apart from anything else)

Hi I have been through this.

please try patches and a different form of progesterone.

im feeling so much better now,
i have estrodot patch and cyclogest progesterone Pessary…
It sounds like you are intolerant to progesterone like I am, the dark thoughts are a symptom of this.

@Nightmanagerfan Many women use the oral capsules vaginally. This method is still off-licence, but it means the same product can be used. The 200mgs capsules for vaginal use are licensed for fertility but not HRT so they do have to be prescribed off-licence.(They are also very expensive- more than twice the cost of a 100mgs tablet.)
I assume your GP was okay about prescribing the pessaries but some won't and using 100mgs x2 is an option.

Sorry to detract from the OP.., I started HRT in November. I’m on daily progesterone (100mg) for the full month. I’m 46 and don’t believe I’m post-menopausal yet, but have been on the mini pill for years which stopped my periods (I get a very short bleed every 6-9 months, and when I went on holiday recently and forgot to take my HRT with me, I had a full period after a couple of days having missed it). I also wasn’t told to start the oestrogen first then add the progesterone in so started them both together.

Is this wrong? I thought I found something online to say if on the progesterone only pill, the daily progesterone was correct.

The standard advice is that combined continuous HRT is for women of any age who have gone for 12 months with no natural period (having been on hormonal contraception disguises that so it doesn't count) OR who are over 54 (by which time 80% of women are post menopausal.)

The risk of using continuous combined too early is that a low daily dose of progesterone during peri often doesn't control the womb lining. This is because you have your own estrogen (often quite high) and also the added estrogen of HRT.

That can cause spotting or heavier bleeds which then need investigations - costly, stressful, etc.

Using the mini pill can be used as part of HRT if used in a higher dose ( 3 x the usual dose.)

I suggest you query all of this with your GP.
Obviously adding a small amount of progesterone daily (100mgs) with HRT might not be enough to control the womb lining.

So sorry you’re going through this. HRT can take a few months to settle for some people, but severe anxiety, migraines and struggling to function sounds like something worth discussing again with your doctor or a menopause specialist. Sometimes the type or dosage just isn’t the right fit. You’re dealing with so much already, so please don’t feel like you just have to “push through” if your body is reacting badly. Hope things improve for you soon.

Hi there everyone thank you so much for your messages. I saw the GP nurse our surgery today and she has advised me to take a different progesterone in a vagainal pessary. She thinks this will make a difference with the migraines. I’d really like to get to the three month Mark and see if it works for me she’s prescribed the off-licence variety as some of you suggested. She’s also suggested that I have some acupuncture for the migraines, which I’m going to do but that won’t be NHS.

Thanks for all the advice it’s a confusing time, isn’t it?