Has anyone felt mentally worse on oestrogen patches during menopause?

[WyrdHag]

Have been on HRT four four years, now 50 (nearly 51). I have a Mirena for progesterone and use oestrogen patches (75) twice weekly.

I can be a bit hit and miss with the patches (thanks AdHD!) and have noticed that mentally I feel so much better without them. The only physical symptom I get without them is joint pain really, maybe hot flushes/night sweats but it's been difficult to tell in this weather.

After 2 or 3 weeks without I put half a patch on a few days ago as I was suspecting hot flushes weren't entirely weather related. My mental health almost instantly took a nose dive.

Obviously I'm going to speak to my GP about going down to a 25 patch or coming off completely but I just wondered if anyone else had experienced this?

Um, yes. Me too. I've read up a lot on peri and it's progesterone that's the hormone that declined first and typically, is the calming hormone. You may want to reduce your oestrogen . Personally I'm on the lowest oestrogen dose and that managed hot flushes without causing an increase in anxiety. We're all different ultimately, experiment and find what works for you! I naively listened to others and was told to keep on increasing the oestrogen but it made me feel terrible mentally.

This makes sense. I felt better initially but not the life changing 'wow factor' that you hear a lot of with HRT so I assumed upping the oestrogen would make me feel even better.

Mentally I feel great without it! I put half a patch on on Wednesday morning and since then have had two meltdowns (specific trigger for one and just a lot going on generally, but don't feel that they'd have been as quick to happen or as intense otherwise).

@WyrdHag Can I suggest you look at it the other way?

Your symptoms sound like estrogen-loss, after a few weeks of not using any.

Estrogen doesn't drop immediately when you stop HRT.
It can take weeks. (My consultant suggests women stop for 3 months to judge if they still need it.) I have stopped twice as an experiment and it took around 3 weeks for my symptoms to kick in again.

The experience you're having could be due to the fall in estrogen. Not putting the patch back on.

A 25mcg patch is a tiny amount. It will take some days or weeks to build up to anything like a 75mcgs dose.

The symptoms you're having may not be due to adding estrogen, but the level in your body falling to a level where it's now noticeable.

You also aren't conducting a 'true' experiment as forgetting to change your patch on time will give you a see-saw of side effects rather than a steady dose.

The only way to find out which is to carry on with the patch dose you were on, or at least a 50mcg patch, for a few weeks.

@JinglingSpringbells thats definitely food for thought.

Tbh my body chemistry is an absolute shitshow anyway - menopause, ADHD, underactive thyroid and I suspect high cortisol levels off the back off a very stressful few years in and out of work.

i need to get into a proper routine and make time for meaningful self-care (rather than doomscrolling while inhaling crisps and wine) but it's so bloody hard!

Have you considered estrogen gel or the spray? It might be easier for you to a) apply at the same time- every day, not changing a patch over the week and b) changing the dose to get the right fit.

I switched from the gel because having to apply it every day and wait for it to dry was a pain in the bum.

That said I now take regular meds when I get into bed at night so if I did it then rather than in the morning it might be worth trying. I don't love the patches tbh - the glue is revolting and impossible to get off.

It depends how you apply it and how much.

You can split 3 pumps morning and evening, so 1 pump per arm/leg and one at night.

You can even split 2 pumps over 2 arms and 2 legs- dries in no time.

I was on hrt due to a medical menopause when i was 40 and was on it 13years.
I’m now 54 and I stopped taking it (cold turkey ) after they changed me to patches and I felt awful and gained 10 lbs in 2 weeks,the progesterone made me feel like I was having a breakdown.
i feel so much happier,healthier and less achy now after nearly a year off it and my mental health is the best it’s been in years.
I suspect that I’m adhd and always suffered terrible with pmd which i now realise was pmdd but that wasn’t a thing in my time of having periods.
my daughter has pmdd and is treated for that and it’s like a miracle for her which I am so grateful for.

after they changed me to patches and I felt awful and gained 10 lbs in 2 weeks,the progesterone made me feel like I was having a breakdown.

No one should 'change you ' to anything- you have input and choice.
This sounds more like poor medical care rather than HRT not helping.

Progesterone makes me feel bad and causes weight gain. I was fine until my gp doubled progesterone dose due to new guidelines. I have gone back to the previous dose (without telling them) and feel so much better plus all the aches and pains have gone.

The guidelines are just that- a guide.

Many GPs seem to be taking them as mandatory. The guidance says 'consider' (more so for 4 pumps of gel, not 3.)

That is not 'must'.

It's there as an option if women bleed on the usual dose or if they have hyperplasia ( thickened uterine lining shown on a scan.)

@JinglingSpringbellsive never understood this / I have never bled / is that too high oestrogen or progesterone? I’ve never had a scan so could I be causing problems by reducing progesterone?

Are you using progesterone daily or on a cycle?

There is a difference. Daily progesterone= no bleed type of hrt.

Progesterone works by changing the womb lining so it doesn't continue to grow.

Once you stop taking it (after the 12 or 14 days on a cycle) the decline in its level causes the lining to shed.

If the dose of progesterone is high compared to the dose of estrogen, the lining won't build up and on a cycle there won't be any lining to shed.

If you're not using enough progesterone you may at some point get breakthrough bleeding where the lining sheds as it's thick.

This is the point where on a higher dose of estrogen (3 or 4 pumps) the guidance is increase it to 200mgs daily or 300mgs x 14 days a month.

Watching this thread with interest. I was prescribed HRT whilst suffering terribly with my MH and whilst my dose of a new AD was repeatedly increased. On reflection I don’t feel that was in my best interests and I’m not on a fairly decent dose of an SNRI.

I was prescribed 100 oestrogen patches and 1 Utrogestan (progesterone) continuously via Newson Health clinic. A couple of months ago my GP recommended I stop the progesterone as I have a coil and to be honest I haven’t really noticed a difference. She’s now suggested I drop my oestrogen dose to see if I need to be on such a high dose. Im intrigued what impact I’ll notice of that.

I felt worse but was on too little plus was on progesterone only half the month and that was the half my anxiety was awful - when I changed to a patch and then went contiguous progesterone and gradually titrated the dose I felt better but I felt worse before I felt better

For me it was the swing between the two cycles that caused the worst mental health and anxiety. I have now been taken off the cyclical patches and put on daily oestrogen gel and progesterone, and even in 3 weeks I have noticed I am so much less up and down. I don’t think the patches were absorbed consistently and my cycle was absolutely deranged.

After 4 years aren’t they supposed to offer you a continuous method? I only found this out when I went in to ask about my cycle which was down to 17 days sometimes, I was constantly premenstrual or bleeding. If you are sporadically changing your patch then patches possibly aren’t the best method for you.

There is no thing as '4 years' then onto continuous.
I've used HRT with an eminent consultant for over 15 years and it's my choice, and with their support, to use sequential. I don't like daily progesterone.

It's a choice for women to try continuous when they are 54 + or have had no natural period for 12 months.

Why were you using progesterone when you have the Mirena coil? You don't need both.

@JinglingSpringbells it’s not as simple as that (IMO). Progesterone does more than just protect the womb lining. At the time of starting HRT I was 3 months into a pretty horrific breakdown and was a mess.

progesterone was prescribed for the impact on mental health (there are strong links).

I no longer take it and haven’t noticed much difference however I’m very stable. The thing I do miss is easy sleep though.

There is some misinformation about progesterone, much of it from the US where the 'doctors' are naturopaths and not recognised here as doctors.

. Post menopause women have none but they continue to have very low levels of estrogen. Women on estrogen only hrt don't take it.

There are more women who have side effects with progesterone- either their own or supplemented- than without it.

It can have a sedative effect in some women but equally it can cause all kinds of other issues and many women hate it.

I was told I'd love or hate it. I do hate it a bit , but I'd rather use it than synthetic types with higher BC risks. Used it for around 12 years now after using a synthetic type for years.

@JinglingSpringbells I was told that after 18 months of cyclical they are supposed to offer continuous, particularly if like me you are having absolutely crazy cycles. My periods were regular when I went on patches but after 3 years of heavy periods, flooding, iron deficiency etc I saw a new gp and she said I should have been offered continuous after 18 months. I appreciate it’s your choice to accept or not, but they are supposed to actually review your medication and whether it is still working same as any other medication you might be on. I’m 43 so it’s nothing to do with my age, and I was still having “periods” although the cycle lengths were becoming increasingly erratic.

There is no 'offer continuous after 18 months'.
That guidance does not exist.
The guidance (in the British Menopause guide) is offer continuous to women over 54 or as a trial to women of any age with no periods for 12 months.

Many GPs are not correct on HRT.

The standard advice is as my previous post. (I can post a link to Menopause Matters if you like where the consultant has explained this.)

In fact combined continuous is considered the worst if you have irregular periods. This is because the 'half dose' of daily progesterone (combined to sequential) won't control the bleeding.

Sequential hrt in the right dose is supposed to create an hrt cycle that will be predictable.

Yes, reviews are necessary but offering the incorrect regime isn't !

If it works for you, fine, but the guidance is not what your GP says.