HRT symptoms returning on patches, would increasing oestrogen or Mirena help?

[Nervous81]

Wondered if anyone had advice for me.

I started 50mg patches every 3 days and progesterone for 12-14 days of my cycle last year, but found the effects wearing off quite quickly so upped to 75mg patches.
I'm finding the same thing is happening - symptoms returning (mainly mood related especially around ovulation and before period) I'm struggling with motivation to bother looking after myself properly even though I know I need to. It's not drastic but I'm missing my spark.

Has anyone else found this? Did upping the estrogen again help or would trying the mirena coil be an alternative?

What about testosterone?

I am planning a drs appointment but they can be hit and miss depending on who you get so I'd like to be prepared!

Any advice/similar stories would help 😊

Testosterone makes a huge difference to mood and motivation I’ve found

The mirena means no periods so more of an even keel (though I found the first month on it was hard until my body adjusted)

I’m on 100mg, mirena and testosterone now and feel pretty good, though slightly concerned I’m mostly held together by synthetic hormones….

I have a mirena and take oestrogel, and recently I was struggling with low mood/anxiety creeping back in. I’ve upped my dose from 2 to 3 pumps and it’s helped me but everyone is different.

No doctor has ever offered me testosterone though, that’s worth considering. I do feel that we should be getting some sort of review of our hrt now and then, I feel like we get this stuff thrown at us women and we are out the door/forgotten about for years!

That's interesting to hear the testosterone makes a big difference @Shuffletoesxtreme

@parachutegirl my Dr said I'd have to be referred to a specialist to discuss testosterone so maybe that's the way to get a review of things.

I would love to have no period in some way, but I also like the relief that it brings (not worrying about pregnancy, husband had the snip!)

I used the patches (75mg) for about 18 months with no issues, then suddenly last year they started to irritate my skin and my symptoms returned with a vengeance. I had a review with the nurse practitioner who recommended changing to gel which I did and felt better within a few weeks.

Annoyingly the symptoms are starting to come back again but I have my annual review today so will ask about increasing my dose. I am wondering if the recent hot weather has affected absorption in some way.

Legally, all meds have to be reviewed annually. Is this not happening?

My consultant (private) does reviews every 6 -8 months-ish but more if necessary.

GPs can offer testosterone and you're likely to wait months on the NHS for a specialist.

Patches did nothing for me. Am on oral progesterone and 3 pumps oestrogen and doing much better. Think you can titrate the oestrogen easier (and I think I absorb it better from gel).

I'm finding the same thing is happening - symptoms returning (mainly mood related especially around ovulation and before period)

Bit confused here as on sequential HRT you don't have your own periods, it's a withdrawal bleed.

Have you considered that it may be micronised progesterone that isn't suiting you if the symptoms happen when you start the course of them each month?

@JinglingSpringbells that's an interesting point about the bleed. I have the feeling of being on edge, similar to (but nowhere near as bad) as before I started hrt.

I have private health insurance through work so might see if I can book an appointment and talk through everything with a specialist. (My original GP was actually really good but it's a revolving door at our surgery and the last one I had didn't seem to have a clue)

@Iheartmysmart I tried the gel too but I found it really annoying waiting for it to dry, and it didn't seem to work like the patches. But then again it could have been a lower dose. Feels like so much trial and error doesn't it!

@Nervous81 I started on the gel and swapped to patches for the same reason. Waiting for it to dry was a nuisance, and it was inconvenient for travelling with work. The patches did work for quite a while but then stopped so it’s back to the gel. I’m currently on three pumps so do two in the morning straight after a shower and one in the evening before bed. It generally dries by the time I’ve cleaned my teeth.

@Nervous81 You need to check if your private health insurance covers menopause. Most don't. I've had private cover for over 40 years.You can get cover for symptoms that relate to gynaecology, but if it's long term treatment for menopause and HRT, they won't cover that.

But even if you have to pay for a consultation it may be worth it.

Re. Testosterone. Very annoyingly GPs tend to only prescribe for loss of libido so you just have to ask for it using that as your major symptom (whether it is or not as anecdotally I have heard good things about its benefits)

Hi op.

Yes increase to 100. My dose went up as soon as my symptoms came back, which was every 6 weeks after a rose change.

Mirena is great and no progesterone depression with it, but won't help hot flushes etc

Testosterone is also amazing, my GP prescribes it. But doesn't help with symptoms, for me it only hped with libido.

Thanks @DreadedInn I'll bear that in mind and ask for it at the GP.

@Carsexitthroughthecarpark is 100 the maximum dose? Have you found that wears off too or did things settle?

I don't have the solution, but I have had the exact same issue.

Started on 50mg patches and sequential utrogestan- initially felt much better, wore off, upped to 75mg - same thing. Went up to 100mg - same thing.

I was having bad migraines so moved to continuous utrogestan and actually have felt much better since then, especially the migraines, but still have symptoms clustered around ovulation and periods.

My GP suggested adding a pump of gel - which for some reason made me feel atrocious for 4 weeks, but then improved my sleep. Same cluster of symptoms around ovulation and period though.

I have never found utrogestan affected my period timings, not on sequential or continuous. I'm on 200mg a day and get a very regular period, just much lighter. I think the problem is sensitivity to large fluctuations of my own hormones which HRT isn't able to buffer, there's obviously still a very strong cycle going on.

I am better on HRT than off it because my background level is more grounded, but as the fluctuations get more erratic, I have less time spent in that more stable period.

I have vaguely thought about GNRH analogues to suppress my cycle, or adding Dygesterone (sp?) on top to try and do the same. I'm quite afraid of antagonising the migraines though <<shudder>>.

Ideally I would just like to reach menopause already, but suspect it's a while off.

Settled largely. I do have the odd period of night sweats but that's it.

Private gynae offered venlafaxine for them but I felt that was sledgehammer and nut territory.

Nope, I’ve had my mirena changed, but nobody has discussed anything else with me, I’ve been on the oestrogel for 5 years plus (doctor may have asked me about the oestrogel when I had the mirena change but that’s the only time)

OP I would recommend the mirena - my periods were horrendous (unpredictable/heavy) when I got to about 45, once I had it put in they stopped altogether. Some people continue to have light periods. It’s uncomfortable having it put in but it’s over with quickly!

Patches fine for a few years then all of a sudden not. Brands were being swapped about by pharmacy, which is understandable, but I was all over the shop. Private GP swapped me to Sandrena gel and much better and more predicable absorption. Have Mirena, which is at the tail end, so also 100 Progesterone and feel as stable as I could hope to I think.