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

@brogueish sorry but I’m not taking any more gel. I was fine on the patches, didn’t have symptoms anything like that, so see no need to persevere with gel and respectfully, I disagree that my reaction was crashing estrogen levels. I am going to ask for Evorel 25 and see how I feel. 50 wasn’t working and again I was experiencing negative side effects (although nothing compared to the gel, which made me feel like I was being poisoned), particularly around ovulation when my own estrogen is peaking, and so it isn’t working.
I would be inclined to persevere with the gel if I hadn’t already had patches that didn’t result in those side effects, but I’m not willing to go through that again.

@Adifferentcorner unfortunately I was really looking after myself and was the healthiest I had ever been, until I just couldn’t any longer. I had no energy or drive and felt awful, so sadly I don’t think my situation was the same. I do totally agree with everything you’ve said though. I’m hoping to get back to a place where I can get really healthy again and if antidepressants are needed then so be it! I’m glad you’re in a much better place

Of course it’s up to you, and you know your body best. I didn’t mean any harm. I was just trying to highlight that HRT can take time to settle, and the oestrogen dose you’ve been used to was effectively halved by only using 1 pump. It’s important to find the best combo for you, and I wish you luck.

@wheretolivecannotdecide I'm currently thinking about switching to 1/2 pump, which sounds ridiculous, but I figure it will help to taper anyway so maybe it's worth trying before anything else. I find I am sensitive to medication - but I'm also an anxious person and have tended not to give things long enough (I'm surprised I've lasted on HRT this long, come to think of it). I have come across stories where women thought thought they needed to come off, were persuaded to up it instead and felt better. But when I tried that it was awful, for whatever reason. Maybe against all logic 1/2 pump will be just what I need for a microdosing positive effect without any downsides 😂 I hope you can get it figured out - the sudden onset migraine sounds so scary but a clear correlation at least?! Maybe we can keep in touch on this thread?

I've got a theory that maybe sometimes I need more estrogen than other times. If the issue is hormonal fluctuations and sudden drops and spikes rather than true low levels, if I think about it I'm not quite sure how taking estrogen really helps, because surely it means sometimes you have too much and other times still too little?

@Adifferentcorner That's the thing, I'm already prone to panic attacks and I seem to be at my worst right now. It feels like all my MH issues are largely flaring at once. Like so many I also think I'm undiagnosed autistic and it's now coming to a head. The more I think about it, the more SSRI feels like the best bet, because I probably should have been on one years ago. I did try prozac but was convinced it was making me worse after 2 weeks. I know you need to give it longer. Can I ask which one has worked for you? I know it depends on the person but it's good to hear experiences.

Please remember op that really stressful things in your life could be the cause, not coping, being sad and angry, being anxious etc are all normal human emotions and medication not working could be because the root cause is still there (and may not be solvable) definitely go to your gp, if someone in your practice has a specific interest in mental health do see them, but also consider the mirena which is constant low dose, I’ve had mine for 6 years and zero menopause symptoms, it’s magic!

@atgnat it seems we are very alike! I wanted to switch to the gel because I also believe l need less estrogen at some points than others. However, clearly that formulation isn’t for me and when I did research I found a raft of other women reporting the same and feeling much better on the patches. Yesterday I didn’t have any oestrogen and felt things lift and felt so much better, so I know it was a result of too much rather than too little as felt better once it was out of my system! Last night I cut a 50 patch in half and put it on. So far, so good. I actually feel a bit interested in things again. However, need to obviously see how I get on over a few months.

@hahabahbag totally agree certain things are human emotions and have always acknowledge that some of my symptoms could well be burnout. However, there were symptoms that were 100% hormonal and these were initially helped by the patch but other things were made worse. I was honest with my GP at the time over how I was feeling and he was in agreement that HRT should be trialled. I would rather rule these things out before taking antidepressants, but I am by no means against them.

I am on sertraline 50mg so not a high dose and apart from really random dreams, I don’t seem to have any other side effects apart from positive ones