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[Emo10]

Hi,

After a recent very high oestrogen reading on only two pumps and horrific symptoms  (psychological and physical) I stopped oestrogen. I couldn't cope with the severity of the symptoms. I suspect I'm intolerant/extremely sensitive to oestrogen and have only discovered this now as I've only every used progesterone only birth control.

After about 3 horrific weeks off hrt my symptoms have levelled and the scary palpitations, blurry vision and adrenaline rushes have reduced significantly. However, they are still there in the background and some of my original symptoms have returned (flushes, aches and pains, exhaustion etc).

I saw my nurse today who advised I try 1 pump and test my levels again in 4 weeks but I'm not sure I can face an increase in symptoms again. I'm worried that reintroducing hrt again will become unmanageable but equally I can feel the original symptoms returning and these too could get back to unmanageable levels again.

Has anyone got any advice or has had a similar experience. I'm on a waiting list for a face to face local private menopause clinic having done online appointments in the past but until then I'm winging it.

Thanks for reading.

[vintagefiend]

no great advice, i'm afraid, but offering solidarity
i have been able to tolerate oestrogen hrt in the past- it was great! and now i'm in the same position as you- i was on the patch which became more difficult for me to tolerate, now i'm on the gel (which i have been on before) but decided today to try half a pump a day as yesterday's one pump was unbearable!! the day before that i'd omitted it and think i def need consistency of same amount every day, rather than missing days.
i'm just gritting teeth as really want the oestrogen.
i've been on the gel 2 weeks so far
women on here have said that it may take several weeks so i'm just going go with that.
good luck xx

[Marchlove]

Hi Emo

Sorry to hear you’ve been having an awful time.

I would try just taking 1/2 pump in the morning until you’re retested. When you take your next test try and do it at the same time of day, as levels do fluctuate throughout the day as well as the month.

Are you using the oestrogen on your inner thigh?
Are you still peri and are you taking Utrogestan?

X

[Emo10]

Thanks, Vintagefiend.

Hope the gel works for you. I was great after the first 3 months on the gel but then things got out of hand. I'm clearly absorbing too much or my own oestrogen is still unstable that adding extra is only making it worse.

[Emo10]

Thanks, Marchlove.

I'm peri and have been using the gel on my inner thigh. I also have a mirena because of very heavy and short cycles.

I'm back to work next week so I will try 1/2 a pump and a consistent approach from then. Hopefully 1/2 a pump won't have too much if an impact.

[joziel]

Before you add in the estrogen again, I'd suggest just adding in the progesterone side of things.

Get a copy of Lara Briden's Hormone Repair Manual for the over 40s. She advocates (as do many US doctors) using utrogestan by itself initially during peri and only adding in estrogen if that isn't enough. She quotes research showing that utrogestan can actually deal with hot flushes and night sweats and joint pain and that many of these things we think are a lack of estrogen, are actually a lack of progesterone.

Synthetic progestins are not the same as body identical progesterone. They all keep the lining of the uterus down, but they have very different actions on every other part of the body.

If you were on a sequential HRT regime before, try just adding the utrogestan back in - so, from day 14 of your cycle for 2 weeks. See what that is like for a couple of cycles. If you still have symptoms, then you can start with a very low dose of estrogen - the lowest dose you can introduce.

I am also very intolerant of estrogen and have recently had to stop it - things are much better but not 100% gone yet and I"m still having every night a night of palps. (Fine during the day.) This had never happened before starting HRT. I have kept taking the utrogestan though, and I have not had my pre-HRT symptoms return yet....

[Marchlove]

The thing is though Joziel, is Emo likely to be prescribed Utrogestan by anyone as she’s got the mirena?

I agree completely though with the lowest dose of estrogen possible going forward. X

[joziel]

Oh I missed that bit. You can for sure still take utrogestan even though you have a Mirena. The Mirena will deal with the bleeding and uterine lining but the utrogestan can help many other symptoms and might be especially useful if you can't take estrogen or want to reduce your use of it.

However you'd need an especially sympathetic or forward-thinking GP to listen to you on that one. I think a private menopause expert would for sure allow you to try it. Not sure about a regular GP.

[Hurdity]

Hi emo10

Sorry to hear about your menopause woes.

Without knowing your complete story I can't really comment eg need to know your age, and also what led you to try HRT in the first place - what symptoms were you wanting to relieve. If you've had a Mirena as BC then it's tricky to know where you are in menopause without a cycle and then you have to go by symptoms...

Personally I would never want to take additional progestogens on top of Mirena whatever they are, because bottom line is - some of the side effects (of Utrogestan and synthetic progestogens) are similar for women who don't tolerate progestogens well, notably the sedative effects, fatigue brain fog, tendency to migraines etc.

Not sure why your oestrogen levels are being measured - they are not especially useful in determining what to do and vary enormously, especially if you still have some sort of natural cycle going on that hasn't been suppressed by the Mirena.

Depending on your age you might be better off with one of the BC pills with bio-identical oestrogen in - these do eventually suppress the cycle but won't give you excess oestrogen when your body may not yet need it? The two types are Qlaira and Zoely.

Joziel - if there are recent references demonstrating the efficacy of progesterone alone in alleviating menopausal symptoms for a significant number of women then I would be very interested to read them? I haven't looked up stuff recently but my understanding is that studies have not shown this and only a very small minority of women may benefit in this way (though studdies I think have shown that very large = pharmaceutical doses of articificial progestogens can reduce hot flushes apparently though this is when used as a drug rather than as hormone replacement - if I recall correctly).

Hope this helps emo

Hurdity x

[joziel]

Emo did say that she has been on POPs for a long while, so it sounds to me like she tolerates synthetic progestins just fine and her problems are with the estrogen (as are my own).

Plenty research exists on progesterone only hormone therapy during peri-menopause:

https://pubmed.ncbi.nlm.nih.gov/26512775/

"OMP effectively treats vasomotor symptoms and sleep disturbances, and could safely be used alone for symptomatic menopause."

https://pubmed.ncbi.nlm.nih.gov/29962247/

"In conclusion, progesterone effectively treats VMS, improves sleep and may be the only therapy that symptomatic women, who are menopausal at a normal age and without osteoporosis, need."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/

https://www.nature.com/articles/nrdp201531.pdf?origin=ppub

https://www.larabriden.com/why-progesterone-is-just-as-important-as-estrogen/

And lots more...

[Emo10]

Thanks, Joziel.

I read lots of your posts and see a lot of my own experience in yours. The most significant difference being my experience of extreme palpitations prior to hrt. With hrt they settled for a while but then became extreme when my levels hit too high. I too have a low resting heart rate (high 40s to low 50s) and see an increase with palpitations. I've been to A&E twice with extreme palpitations (once in front of 30 15/16 year olds 😐).

Will definitely get Lara's book as I feel like I'm in this for the long haul. Will also definitely look in progesterone in preparation for my appointment.

[joziel]

Emo, wow, we sound v similar. I'm always on the lookout for similar people so I can try to make some sense of all this.

I did have palpitations before HRT but they were a different kind: They were your classic 'skipped beat' in the evenings, a low estrogen symptom. Those stopped when I started estrogen. And then I got this stupid fluttering thing instead.

Did you also get episodes of higher than usual blood pressure? My blood pressure is usually perfect but on estrogen, there were high measurements - 145/85 at the GP once, then 158/90 at A&E, then 163/90 at the GP again... all very atypical for me. As soon as I stopped the estrogen, the blood pressure was back to normal within 24-48hours (105/65).

I am sure there is a connection between the blood pressure and the palps - I assume the blood pressure caused the palps. But now the blood pressure is normal, it is taking my body a while to get out of the pattern of palps, especially at night which is when the blood pressure and palps were always at their worst. (I am now fine during the day - which is an improvement since on HRT it was 24/7 by the end.)

Have you ever taken a combined pill earlier in your life and did you have similar side effects then? I did...

[Emo10]

Thank you gor the reply, Hurdity.

I'm 42 and lost an ovary when I was 35 and started with peri symptoms at 38. I experience very heavy periods on a very short cycle (sometimes less that 2 weeks between bleeds), palpitations, night sweats  adrenaline rushes, total inability to sleep and eventually very low mood which prompted me seeing a doctor. I suspect I'm very much at the start of my peri journey.

My bloods were done as a 3 month check of my new hrt and to check I was absorbing it. I certainly am; my estrogen was 1839 pmol! I was experiencing some terrible symptoms at this high level so reduced and eventually stopped.

I will look into the BC options too.

Thanks for your advice!

[Emo10]

Yeah, my palpitations prior to hrt were different. Mine felt bubbly! Also mainly happened at night but eventually crept into daytime too.

I never really measured my blood pressure on hrt (I couldn't face another thing to trigger my health anxiety which suddenly started with my hrt) but I did experience some classic high blood pressure symptoms inc headaches, pulsating in legs and fingers etc. My palps have reduced in severity and frequency and I seem to manage them better without hrt.

Never taken a combined pill as I have experienced migraine with aura since childhood. Was always mini pill or coil. So extra oestrogen is very new to my body.

[joziel]

Goodness Emo, it's not surprising you had such symptoms if your levels were that high. You might not be estrogen intolerant at all, you might just have been on a very high dose of it. If that was on only 2 pumps, you may not need estrogen yet(!) - it would be extremely unusual for 2 pumps of estrogen to give you that much estrogen, so it would seem that your own ovaries are contributing a lot..... I'd suggest again just trying the progesterone for now. Your symptoms sound like that's what you need...

The Lara Briden book explains all this in detail but basically, when our bodies are functioning how they are supposed to, we ovulate and the progesterone is then produced by the corpus luteum in the last half of the cycle. As we get older, our ovaries often don't ovulate every month and we have anovulatory cycles instead. If we don't ovulate, we don't produce any progesterone. So our cycles can be very short because we don't have the progesterone there to sustain the uterine lining for 2 weeks.

Equally, without the progesterone there, the uterine lining builds up too much and that can lead to a very heavy flow when you do get the bleed.

Do check out the book for more info on using progesterone only during peri. It is very common to do this in the US and there are a lot of US Facebook groups with women using progesterone only - CrispyChick told me about the Estrogen Dominant group, which is very interesting. Anyway - it would not be unusual to use progesterone only, in the US. You would use it in the second part of your cycle, so from day 14 to the end. This link explains how to do that and how to deal with bleeding and timing of taking the utrogestan: https://www.cemcor.ubc.ca/resources/cyclic-progesterone-therapy