HRT depressive episode help

[wheretolivecannotdecide]

Hi all,

I posted not too long ago because I’m 41 and had recently been started on HRT after lots of mood / neurological symptoms that I felt were possibly linked due to early menopause running in my family.

initially I felt everything was worse due to the progesterone. Someone suggested taking it vaginally, and this did help.

however, the last 6 weeks or so I feel like im having a fairly severe depressive episode I just cannot seem to pull myself out of. My life isn’t great at the moment and I am dealing with a lot of quite tricky things with my children so I know that I’m under stress. But I feel so angry, upset, frustrated and spend most days crying or trying to keep away from everyone, I can honestly say I’ve never felt this down before and I’ve had challenges before now. i am currently on day 11 of my cycle and so not even taking the progesterone at the moment and yet everything feels completely awful. I am obviously progesterone intolerant but I’m not even on it right now. So I don’t think this can fully be blamed for my symptoms.

i am on sequential hrt so I have been given Evorel 50 as a patch and micronised progesterone 200mcgs days 15-26.

I have booked a hrt review but can only speak to the pharmacist as they said it didn’t need a doctor.

should I ask for an increase or just knock this on the head and stop? I felt like crap before and I feel like crap now and I’m so sad to think that no matter what I do, this is my life now 😢

any suggestions would be greatly appreciated

I started hrt two weeks ago and I think I feel worse too. Had a huge anxiety attack this morning. Think I’m going to give it 3 months as that’s how long they say it can take to work.

I’m already nearing that mark

Op, I’m sorry you’re feeling so low. I had to stop my HRT due to feeling despair on progesterone.
I’ve started taking vortioxetine, as sertraline wasn’t really helping. It has really helped with getting rid of my anxiety.
I think if HRT isn’t helping with psychological issues, which was my main problem, then something like escitalopram or vortioxetine can be more helpful.

@Lizzbearthank you. I was so convinced it was linked to my hormones, but maybe I am just really depressed 😞

It’s hard to know. I suspect I’m ADHD and am going for an assessment soon. Just waiting for appointment. Im actually hoping that my ADHD is the cause of all my emotional and psychological problems and hope the ADHD meds will help x

Hi op
How are you doing? Are you on the progesterone? I stopped mine as it gave me low mood, but am really missing the oestrogen part of HRT!

@Lizzbear. I’m not doing well. My mood was rock bottom before I started my progesterone cycle so I don’t think I can even blame that. I’ve no idea whether to try the gel in case im absorbing the patch badly or inconsistently or just coming off it altogether and accepting that this is my life now 😞 I’ve no interest in anything and feel permanently angry, fed up and tearful in equal measure

Hi op. Why is your oestrogen so low? My private gynae said younger woman need much higher oestrogen.

I was up at 100mcg patch within 4months of starting. I also switched to a cool because utrogestan made me depressed however I took it.

Btw I was 44 when I started. And I had been depressed for a couple of years.

High oestrogen sorted me out.

I switched to progesterone daily (just one) and my estrogel was upped and the depression vanished almost immediately. For me it was the two progesterone.

Sorry to hear that. It’s definitely trial and error. My mood was ok last week but awful today. Like, back to square one. I hope we can both find a solution x

I'd be doubling up on that patch tout de suite

Thanks for all the comments, this is really useful. I am thinking of switching to the gel from the patch so I can have a bit more control over my dose. I asked to see a doctor for my review but they’ve only given me the option to see a pharmacist so no idea if they’ll have any experience.

@Gardeningsideeffects this was the starting dose I was given and I haven’t had a review yet. I was worried perhaps my estrogen was too high? But looking at comments, maybe too low then? I’m only 41. I’m thinking of asking for gel so I can trial and error a bit more. I read that if I was increased to 100 that you then need 300 progesterone?

@wheretolivecannotdecide I went straight back to the GP once my first staring dose of 50 stopped keeping a lid on my hot flashes.

But at that appt she asked me how I was and I burst into tears and said I couldn't stop crying on utrogestan and it was making me think terrible thoughts. So I went to 75 patch and tried vaginal utro. Then went back 6 weeks later and she upped me to 100 and booked me in for a coil fitting.

The difference for me on mirena coil and 100 oestrogen was night and day compared to Utro/low oestrogen.

I then added testosterone at 6 months in.

How are you doing OP?

I am also ultra sensitive to progesterone ansmd it sends me into a deep depression. It is really interesting to hear others have found a way to make it work.

I've tried different doses, taken it vaginally, tried 6 weeks ot estrogen alone before introducing it. From reading this thread, I may speak to my gp about upping the estrogen dose?

I used to have really bad night sweats but at 51 these now seemed to have reduced, but my anxiety is through the roof.

@Monr0e mine doesn’t seem to be particularly linked to progesterone now I’m taking it vaginally. In fact some of my worst symptoms seem to be days 7-15 of my cycle (so before I start my progesterone). I haven’t had night sweats or bad : regular flushes, so it’s harder to pinpoint whether estrogen is too high or low. Most of my symptoms were cognitive so low mood, overwhelm, brain fog and then crushing fatigue, muscle aches and zero drive and stamina. based off comments Ill try to up my estrogen and move to the gel to have a bit more control

After 3 years of trial and error I finally found an HRT regime that works for me. The main reason for my perseverance was due to my M.S and estrogen helps by damping down inflammation and associated pain.

The micronised progesterone was the absolute worst for me, I would rock and cry and feel completely out of control of my body and mind, horrific!

After many trials of HRT my menopause specialist decided to try out a regimen called Tridestra, unfortunately it is no longer manufactured, probably down to not being so popular. I now have the estrogen and progesterone prescribed separately and follow the regimen for Tridestra. This involves 70 days of purely just estrogen, 2mg tablet followed by 14 days of medroxyprogesterone, then 7 days of nothing and a withdrawal bleed, then start all over again. This has by far been the best thing for me, taking progesterone daily is FAR to much for my intolerance, this also explains why I didn’t get on with the pill many years ago.

My body thrives on estrogen, it’s my happy hormone. I also found the tablets more suitable for myself, I would get loads of breakthrough bleeding with the patches and my skin became irritated by the gel.

If I get any form of low mood now I know it’s caused by the usual trials and tribulations of life in general and not my HRT. I’d be in a right old pickle without it. I also use Testosterone in the mix, this was for lack of libido, which is now back, thank gawd.

I'm struggling too. Almost 40 and been on HRT since Feb this year. At first I was convinced I felt better, but since then I've been struggling. I was only on 1 pump of estrogel, so last month (or the one before - it's a blur) I upped it to 2 in case I needed more. It made me feel like I was going insane, along with other symptoms like breakouts. I've now been back on 1 pump for a bit and while not as bad as on 2 pumps (and skin clear), I just don't feel good. I think it is perimenopause for me because I have felt similar to this whenever I've had hormonal fluctuations in the past, including puberty, which this feels a lot like. But I seem to be bad with or without the HRT. I truly don't know what to do for the best. It feels like I've been 'coping' for 20 years and perimenopause is now making it all fall away and I'm having a breakdown.

I switched to mirena as I got too down on pregesterone, the slower steady dose of the mirena was better for me.

Sorry you’re going through this too. It’s really hard to know whether to add hormones or stop them.
I came off all my HRT a good few weeks ago. Having terrible hot flashes in this heat!!
But I think removing the progesterone has maybe evened out my anxiety.
Im post-menopausal so a different stage. I think anti-depressants can help. It’s finding one that suits and not everyone wants to take medication.

@Lizzbear It must be so hard when you have the very obvious menopause issues like hot flushes, joint aches, where you know coming off the HRT will bring them back. I'm fortunate that I never really had those (yet), but I have had some symptoms that HRT improved (libido to an extent, itching, fatigue to an extent) so I expect these will resume. I also felt so bad mentally before HRT that I was begging to go on it, so as much as I want to blame my mood issues on HRT, I know I can't. However, I feel the worst now on it than I've felt in years (MH issues since a teenager) so I can't ignore that, even though it may be a coincidence.

@wheretolivecannotdecide I forgot to say we seem similar in that it feels like it's estrogen/not just progesterone for me too. I'm definitely worse during the very end of the luteal phase (and always have been, pre-HRT too) but that often goes into the full length of my period. And if I'm honest with myself, I just feel bad more so than not through the whole month.

I'm thinking I just need to come off the estrogen to get back to a baseline. I was going through a difficult time life-situation-wise, peaking right before I started the HRT and it had been building the year prior, so maybe that factors in too.

I think my next step will then either be Mirena or SSRI. Both scare me for different and overlapping reasons, so part of my difficulty at the moment is not knowing which to go with first. At the moment I think it will probably be Mirena, just because if my periods can stop that's a huge win, and I've read some people felt more levelled out on it. It's the stories where it made people feel like they were losing it that scare me, because I feel I'm already there, and rather than feeling like I have nothing to lose it feels like it's going to make me twice as bad. There's also potentially a lot of pressure as if I beg to have it taken out "too soon", where if I'd given it time it may have worked out fine, they probably won't want to give me the chance again.

@atgnat that does sound very similar to my situation. I’ve been through an extremely stressful and emotional year and whilst my hormones certainly weren’t helping, maybe there was an element of my MH issues being situational prior to HRT.
I asked to change from Evorel 50 to the gel last week as I thought it might give me more control over dosage. I used it for the first time on Friday and only used half the prescribed dose, so 1 pump (which should be equivalent to Evorel 25 patch) what ensued after one dose of gel was awful! Migraine with aura, racing heart, first full blown panic attack for years, facial flushing, nausea and overwhelm. So in short, the gel really really does not agree with me! So I’m going to ask for a 25 patch which although low, may just keep my hormones in check. If that doesn’t work then I too shall be considering both mirena or mini pill. I don’t like the idea of mirena as I can’t take it out if I feel awful.
I don’t want to knock it all on the head too soon as initially it did help my crushing fatigue and I having had a headache since the patches but I’m convinced 50 was still too much despite other women needing or recommending far more. And actually, needing less of something is nothing new. I’m on far less than the recommended therapeutic dose if levothyroxine for my weight despite no thyroid function and am extremely sensitive to painkillers to the extent I often refuse them! So it does track. Let’s see how 25 goes…wish you the best sorting yours too

Sorry, I haven’t read all the posts, but I had this exact same thing. I think I’m highly sensitive to any hormone therapy as I had the mirena coil fitted and ended up having panic attacks and crying all the time. I had to have it taken out after 2 months. When I was on hrt I went through a bout of feeling terrible. Crying all the time, constantly ill and I actually started feeling suicidal, though only had thoughts about it, never acted on it. It was a combination of the hrt, menopause and depression. I ended up getting signed off work, came off the hrt and realised I needed to make a change. I started looking after myself a lot better, running and trying to eat more healthily and also recognised I needed a bit more support so I started anti depressants. I’ve been on them for 2 years now and I feel so much better, I feel like myself again. I had 3 children quite close together and I think you just lose yourself and stop looking after yourself and then when the menopause hits, your body just can’t take it any more. Your body is telling you to pause and take some deep breaths. We have such a high mental and physical overload sometimes that we just hit rock bottom. Please make an appt with your gp and tell them honestly how you are feeling. I really do think talking about it is one of the best things you can do, don’t keep it all inside. I hope you feel better soon x

@wheretolivecannotdecide before switching again, I would honestly try the recommended 2 pumps of oestrogel. One pump for me is not good either, but that’s because the dose is too low. Try the prescribed dose for at least a few weeks. Everything you describe is much more likely to be down to crashing oestrogen levels than intolerance to the gel. Good luck.