Side effects after starting cyclical body-identical HRT and possible dose changes

[LogicAndLavender]

Looking for some advice or shared experiences!
I am on cyclical body-identical HRT 6 weeks ago:
Evorel 50 patches (continuous)
Utrogestan 200mg (oral, 2 weeks on / 2 weeks off)
Since starting HRT, I’m experiencing side effects I didn't have before

1. Unrested sleep (waking up unrefreshed on progesterone-free days)
2. Noticeable hair shedding
3. Breast tenderness & soreness
4. Involuntary muscle twitching

My guess is that because my ovaries are still working, adding Evorel 50 might be overshooting on estrogen, and the oral Utrogestan cycles might be messing with my sleep architecture. A few questions for anyone who has been here: Did you start on a lower dose (like Evorel 25) to avoid stacking on your natural estrogen? Did switching Utrogestan to vaginal administration help with sleep grogginess or side effects? Did initial sleep deprivation, hair shedding and breast soreness, muscle twitching settle down after 2–3 months? Would love to hear how you tweaked your regimen with your GP! Thank you!

I added the gel to my mirena coil.
I got breast tenderness but it went after a short time.
Are you taking magnesium glycinate for sleep? You might want to think about a coil as it’s continuous low dose.
Muscle twitching can be helped by magnesium.
I was losing hair before I started HRT so it’s no different for me.

@PersephoneParlormaid i am not taking Magnesium Glycinate, but my calcium tablet had magnesium in it. The calcium and magnesium combination taken at bed time was giving me stomach cramps and hence I stopped. Another symptom I started to feel now (since HRT starting) is jaw restlessness (inability to find a comfortable resting position for my jaw at night).

I second guessing if I should continue HRT.

Hi there @LogicAndLavender

I've been on gel and Utrogestan for years (around 18).

I think it's possibly too soon to link some of your side effects to HRT.
Many of the things you describe are menopause symptoms and your HRT won't be sorting those yet- too soon for some.

Hair shedding doesn't happen in 6 weeks. The hair cycle is many months and it's more likely that your hair was going to shed anyway due to low estrogen.
Reason I'm saying this is I've had a lot of hair shedding lately and it's coincided with reducing my estrogen for the past 6 months ( as an experiment) from what would be a 50mcg patch to a 25mcg patch (so I'm now going back up to 2 pumps =50mcg patch.)

The sleep- again, a typical menopause symptom.
Utrogestan is sedative so you will sleep better on it (usually) and notice a difference on the 2 weeks off.

Breasts- very common when starting HRT. It is usually linked to estrogen dose, so dropping to a 25mcg patch might help. Whichever, it often settles by 3 months.

Muscle twitching- no idea but it's not linked to HRT (no evidence of this) and more likely a peri symptom. Jaw- is this teeth grinding? It can be stress.

The medical guidance is to give HRT 3 months before changing doses.

@JinglingSpringbells thanks. 18 years on HRT gives you great perspective. The main reason I’ve been looking closely at the timing is I was feeling completely fine beforehand (before starting HRT). Particularly noticing these symptoms during the 14 days off Utrogestan.
Hair shedding could be initial hormonal shift/shock . It's really interesting that reducing your dose triggered shedding for you. thanks for the reminder about the 3-month guideline. I’m going to stick with it a bit longer, focus on bedtime magnesium for now (no calcium to avoid stomach cramps).

I personally don’ t think HRT is a cure all, I take steps and supplements to help some symptoms.

I've seen a private gynaecologist, one of the best in the UK, for all that time which adds up to a lot of hours picking their brains, with appts 2 or 3 times a year.

Hair loss doesn't happen in 6 weeks unless it's some terrible trauma when it can happen.

Look up 'hair cycle'. The cycle is around a year from growing to shedding.

TBH I'd not add magnesium yet. You won't be able to judge if it's the HRT or magnesium or even magnesium as a placebo.
There has been something in the media lately about magnesium and it's shown to be mainly placebo with no real evidence is works.

@PersephoneParlormaid thanks for your reply. what specific issues you found HRT caused, and what supplements or steps ended up making the biggest difference for you.
I only started HRT as a treatment to protect my spine after a DXA scan. I felt great before starting HRT no symptoms, my goal now is just to make sure the HRT regimen itself isn't introducing unnecessary side effects and long term issues.

Do you have low bone density and is the HRT a treatment (for osteoporosis) or severe osteopenia?

How old are you?

It changes the picture quite a bit to know you had no menopause symptoms but were recommended to use HRT.

Supplements will not address bone density by the way.

A DXA scan done as a measure of precaution showed low bone density in my early 40s.

How low is it?
Is there a reason / risk factors why you had the scan?
What's the bigger picture? Did you have an early menopause or are you still having periods?

I don't mean to bombard you with questions but am happy to help if possible.
I've had DEXA scans for 20 years - one every 2 years - and that is partly why I've stayed on HRT, as well as ongoing meno symptoms.

I have had advice and input from my gynaecologist and also a consultant rheumatologist(who he referred me to) who reviews the dexa scans.

Magnesium glycinate definitely helps me sleep, no matter what the ‘experts’ say. I gave up alcohol years ago as that gave me agitated sleep. I also go to bed at the same time every night, and read a book, as I think a good sleep routine helps too.
HRT did nothing for my joints, I found the biggest difference from taking a good omega 3.
I power walk a couple of times a week, plus use weights, for my muscles and bones, and take D3 with K2.