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[Furyan]

Good evening ladies

I’m a little confused about how to interpret my symptoms and what to do about them. Over the summer I switched from patch/cyclogest combo to Livial to try and simplify my regime for a while. Livial worked well for general energy and libido but, within weeks I had a return of hot flushes and the most insane night sweats that would drench me night after night. I eventually figured the oestrogen effect was too weak so I switched back to body identical HRT, this time increasing my Evorel patch to 75 with 100mg cyclogest.

I was relieved of the hot flushes better than ever before, but started to experience strong anxiety/tearful pangs and weakness through the day and restless legs/body at night. I am a lot more irritable and reactive as well. I increased progesterone to 200mg figuring it was the oestrogen that needed balancing. This has relieved about 60% of the symptoms. I trialled 250mg cyclogest just for two nights and it had an even better effect on anxiety and restless body (I reduced to 200 again because I felt nervous about taking such a high dose). What really bothers me as well is that, since the oestrogen increase, I’ve also noticed my blood pressure and heart rate are up quite a bit - uncomfortably so.

My question is what component do I adjust? Do I decrease the oestrogen even though it has eliminated hot flushes OR increase the progesterone to 300mg? Some forums advise ladies to try decreasing oestrogen before increasing anything else and I do feel nervous about increasing the progesterone to 300 - I don’t know which imbalance is more likely to be causing the high heart rate and blood pressure, which were fine before. I guess it would also be helpful to know what people have experienced when their oestrogen was too high in relation to progesterone especially around heart rate etc.

I am on Tostran 10mg twice weekly and apply it with each patch change.

Any ideas or experiences would be helpful. Thanks very much.

[joziel]

What E dose were you on before?

You can for sure increase P if you'd like to. I am on 300mg continuous orally (with a 5 day break to bleed) and I even increase to 400mg for the last week, because it helps sleep and I'm on a very high E dose. Which is all to say - no worries about taking more P if you want to.

With the E, it's funny because I also got this early on when I first started HRT. I would get high BP events (very fit and never had this before in my life) and a racing heart especially at night. I actually turned out to need a lot MORE E, not less. I spent ages cutting up patches and thinking I was very sensitive to E and needed less of it etc, but really I think I wasn't taking enough. (I tried stopping all HRT and this continued.) However, I do know it is hard to get yourself to increase when you feel things are getting worse every time you increase...

You could try splitting the difference - so if you were on 50 before and 75 now, try 62.5. If you have 75 patches, you will need to measure a few mm and cut it off the patch. As long as you are consistent with what you cut off with each one, you should be fine. You can also get your bloods done on day 3 of your cycle to see if you are absorbing the E. Your own E will be lowest then and it will give you a clue as to whether you are on too high a dose or not. Really you want to aim for about 450pmol from HRT, some women need higher. And you could also try switching to the gel, just because sometimes a different form of E is absorbed differently and helps.... 75 patch is 3 pumps of Oestrogel.

[Furyan]

What E dose were you on before?

You can for sure increase P if you'd like to. I am on 300mg continuous orally (with a 5 day break to bleed) and I even increase to 400mg for the last week, because it helps sleep and I'm on a very high E dose. Which is all to say - no worries about taking more P if you want to.

With the E, it's funny because I also got this early on when I first started HRT. I would get high BP events (very fit and never had this before in my life) and a racing heart especially at night. I actually turned out to need a lot MORE E, not less. I spent ages cutting up patches and thinking I was very sensitive to E and needed less of it etc, but really I think I wasn't taking enough. (I tried stopping all HRT and this continued.) However, I do know it is hard to get yourself to increase when you feel things are getting worse every time you increase...

You could try splitting the difference - so if you were on 50 before and 75 now, try 62.5. If you have 75 patches, you will need to measure a few mm and cut it off the patch. As long as you are consistent with what you cut off with each one, you should be fine. You can also get your bloods done on day 3 of your cycle to see if you are absorbing the E. Your own E will be lowest then and it will give you a clue as to whether you are on too high a dose or not. Really you want to aim for about 450pmol from HRT, some women need higher. And you could also try switching to the gel, just because sometimes a different form of E is absorbed differently and helps.... 75 patch is 3 pumps of Oestrogel.

Hi Joziel, good to hear from you and thanks for your thoughts. Before trying Livial I would cut down a 75 patch to make approx .65ish which was helpful for most things but not libido. Reading your reply made me smile because I still have a ‘dummy’ patch that I marked into thirds (to mark the equivalent no of pumps of gel), then marks in between those in case I wanted the equivalent of 2.5 pumps etc. I’m post menopausal so no cycle.

Interesting that you had similar symptoms with low oestrogen and i have read that. Because the .75 seems to be ok in itself I wasn’t sure if I needed to increase it when taking more progesterone seems to help some of the symptoms (not the heart rate or blood pressure yet tho). Helpful to get reassurance that some women do take higher amounts of progesterone as I feel a little nervous about it. I’d be even more nervous to increase oestrogen atm as the high blood pressure etc seemed to follow the move back to body identical HRT when the oestrogen was increased. Toying with the idea of trying an increase in progesterone first to see what it’s like. If it’s worse, I could always go back to 200mg and drop the oestrogen back to where it was before all of this at .65. I didn’t get high blood pressure etc when I was on a lower strength patch.

[Furyan]

Guess a slight increase in oestrogen could be trialled depending how the other two options go. Just did a quick google search and most information so far seems to say that oestrogen is the protective factor against high blood pressure and increased heart rate so I am more confused now. I have some gel left so could use it to top up the patch as an experiment if increasing progesterone doesn’t do the trick. I just want my bp and heart rate to return to normal!

[Seasidegirl]

I'm having similar issues.   Aged nearly 55 but still had a cycle when I started HRT in May.

I do really well on the oestrogen only phase,  but as the months have gone on I've developed more issues on the P 14 days at 200.  Similar high blood pressure and elevated heart rate, jitteryness, irritability.

It doesn't seem to be a tolerance issue per se, it comes on when I'm c.4 - 7 days into the P phase.   It's like it builds up.   

It seems to improve if I take 100mg so I'm going to try a continuous regime and see if the lower level works as I feel good on the P until the issues kick in. 

I increased my oestrogen from 50 to 75 which helps with my joint pain and anxiety that were starting to reoccur.

The other option is that I've got a borderline hyperactive thyroid and the thyroid goitre I had previously has reappeared so I wonder if the P is  stimulating my thyroid in some way?   

Also the symptoms continued c.7 days after I stopped taking the P.

It's really tricky isn't it and so much trial and error which all takes try another month!

[Furyan]

I'm having similar issues.   Aged nearly 55 but still had a cycle when I started HRT in May.

I do really well on the oestrogen only phase,  but as the months have gone on I've developed more issues on the P 14 days at 200.  Similar high blood pressure and elevated heart rate, jitteryness, irritability.

It doesn't seem to be a tolerance issue per se, it comes on when I'm c.4 - 7 days into the P phase.   It's like it builds up.   

It seems to improve if I take 100mg so I'm going to try a continuous regime and see if the lower level works as I feel good on the P until the issues kick in. 

I increased my oestrogen from 50 to 75 which helps with my joint pain and anxiety that were starting to reoccur.

The other option is that I've got a borderline hyperactive thyroid and the thyroid goitre I had previously has reappeared so I wonder if the P is  stimulating my thyroid in some way?   

Also the symptoms continued c.7 days after I stopped taking the P.

It's really tricky isn't it and so much trial and error which all takes try another month!

Hi Seasidegirl, it’s VERY tricky and giving me a headache trying to fathom it all! I have an under active thyroid and wondered if that could be contributing too, as in the progesterone somehow helping the thyroid hormone to work a bit too much. I’m also on b12 injections and I’ve read somewhere that this can lessen the need for thyroid hormone. Like you, I might have a think about that if tweaking the progesterone doesn’t work. Last night I increased the progesterone to 300mg and woke up this morning feeling less weakness although the heart rate has gone down only a little.

Interesting that you got relief from decreasing progesterone and I’m getting some relief (with weakness) from increasing it!

I know it’s only one day and we have to give these things time but, if this doesn’t get much better, my next experiment is to reduce the oestrogen as this issue didn’t happen when I was on the lower patch - I’ll have to think carefully about that as I don’t want the hot flushes and zero libido back!

[discogirl]

Sorry to cut in but I take the utrogestan continously and I seem to be experiencing similar issues as seasidegirl with the utro building up. My issues seem to be at night affecting my sleep where I feel a bit wired.

Im using the utro vaginally and my gp said that I can insert it in the morning as it dissolves in minutes so this may help.

[Seasidegirl]

Sorry to cut in but I take the utrogestan continously and I seem to be experiencing similar issues as seasidegirl with the utro building up. My issues seem to be at night affecting my sleep where I feel a bit wired.

Im using the utro vaginally and my gp said that I can insert it in the morning as it dissolves in minutes so this may help.

Thanks discogirl, that's helpful.   Vaginally is my next trial of continuous orally doesn't work out.  I also felt wired at night.   Whilst it was working well I felt really good at night,  then it changed after a number of days. 

I don't really want the faff of vaginally but it might have to be that route. 

[Minicat]

I totally understand your confusion with HRT; it can feel like a juggling act. I switched my regimen a while back too, and I noticed that tweaking my progesterone helped with the anxiety and restless nights. It's definitely worth experimenting a bit, especially since the higher dose of cyclogest gave you some relief. I also had a spike in blood pressure when my estrogen was too high, so I’d recommend chatting with your doctor about that—it can be a tricky balance. Keeping a symptom journal really helped me pinpoint what was working and what wasn’t, so maybe give that a shot.

[Furyan]

I totally understand your confusion with HRT; it can feel like a juggling act. I switched my regimen a while back too, and I noticed that tweaking my progesterone helped with the anxiety and restless nights. It's definitely worth experimenting a bit, especially since the higher dose of cyclogest gave you some relief. I also had a spike in blood pressure when my estrogen was too high, so I’d recommend chatting with your doctor about that—it can be a tricky balance. Keeping a symptom journal really helped me pinpoint what was working and what wasn’t, so maybe give that a shot.

Thanks Minicat, that’s helpful to know, not least because I’m not the only one who’s experienced this. So last night I took a step of faith with 150mg cyclogest (totalling 300mg for day). This time, restless legs significantly better and this morning I had the presence of mind  and energy to clean the entire home which I haven't been able to do since I crashed with b12 and thyroid last year. Muscle weakness hasn’t gone but is better. Heart rate and blood pressure - well that needs to be monitored. But the difference seems enough for me to do it again tonight and see.

Incidentally I read today that there is a link between progesterone therapy and myelin sheath/nervous system repair in some ladies who experience muscle weakness and restless legs like I have. I thought it was just low b12 that caused mine but, after the difference the increased progesterone made today, I’m cautiously open to sticking with the increase. Great idea about the symptom diary, I started one a few days ago and aiming to include vitals to track bp and pulse.

[Furyan]

Sorry to cut in but I take the utrogestan continously and I seem to be experiencing similar issues as seasidegirl with the utro building up. My issues seem to be at night affecting my sleep where I feel a bit wired.

Im using the utro vaginally and my gp said that I can insert it in the morning as it dissolves in minutes so this may help.

I personally found Utrogestan vaginally felt stronger than Cyclogest for me. I took 100mg vaginally and really felt the effects but I feel that Cyclogest is ‘gentler’ on mood and how I feel generally, and that’s even with increasing to 300mg. I doubt I could take that dose of vaginal Utrogestan, which I don’t understand as they are both micronised and same strength.

[Seasidegirl]

Just to update my ongoing "how do I deal with this" saga in case it helps others.

Thursday night I ought to have started P again,  this time on my new continuous regime to see if the lower level is helpful. 

But.. being a bit of a tinkerer, my intention was to delay two weeks and start the whole new cycle on continuous.  Now clearly that's dodgy in terms of womb protection,  I get that but I really wanted to see how my natural cycle behaved and what happened to my thyroid symptoms, heart rate etc. without the P.

Well that didn't go well!   My natural cycle is clearly still going strong (nearly 55 🙄) and Friday morning all my mid cycle gynae pain returned with a bang - this had vanished with HRT.   I ended up having to step away from WFH to lay down which I never usually do as I tend to keep going.  My heart rate was also back up to where it hasn't been since HRT.

This was after 1 days delay!  I knew that many of my symptoms were worse mid cycle onwards and I guess this absolutely proves that I need P, I just need to find the right P and the right way of taking it.

I took 1 x 100 last night,  got twice a much deep sleep as I've been getting and feel good this morning.   Now just need to see whether I get this cumulative issue I seen to have been getting on 200.

I guess it's helpful to know that P can be really helpful as there is a tendency to think it's something bad that we have to take but clearly as with Furyan we do benefit from our at the right level and the right way. 

[Aubrey]

It seems crazy to me that some of us can't tolerate the prog' part, but some really respond well. I'm in the can't tolerate category, like a couple of people on this thread it builds up during the prog' phase, makes me agitated, sleepless and gives me migraines that sap my energy to 0. Working on those days hurts like hell. I take 100mg vaginally and it's still rough in the last 7 days. When I started I took 200 mg orally and turned into a psyho' picking fights with small children and lying awake all night having panic attacks, not about the small kids I'd wasted, they deserved it!

[Seasidegirl]

It seems crazy to me that some of us can't tolerate the prog' part, but some really respond well. I'm in the can't tolerate category, like a couple of people on this thread it builds up during the prog' phase, makes me agitated, sleepless and gives me migraines that sap my energy to 0. Working on those days hurts like hell. I take 100mg vaginally and it's still rough in the last 7 days. When I started I took 200 mg orally and turned into a psyho' picking fights with small children and lying awake all night having panic attacks, not about the small kids I'd wasted, they deserved it!

🤣  you did make me laugh out loud 🤣   (clearly not at your symptoms!)

It is bizarre, I feel so much better on P but only for a bit.   

[Furyan]

I took 1 x 200 last night,  got twice a much deep sleep as I've been getting and feel good this morning.   Now just need to see whether I get this cumulative issue I seen to have been getting on 200.

I guess it's helpful to know that P can be really helpful as there is a tendency to think it's something bad that we have to take but clearly as with Furyan we do benefit from our at the right level and the right way.

That’s great you went for it and increased the progesterone. I know you have to see how it settles over time but I really hope this trial works! Well done for trying because, as you said, it can feel scary to try something that others may have experienced as a disaster but at least you have the option of adjusting it if need be. This is what I thought last couple of nights when I increased to 300mg progesterone. Sleep has been generally better and restless legs are very minimal. Last night though, I found I had to decrease my 75 patch after all - alas, the anxiety pangs and high heart rate was too much to bear and, as I had suspected that the symptoms I described felt more like too high oestrogen, I got up at 2.30am and snipped a patch down to about the equivalent of around 2.75 pumps of oestrogel - today, my blood pressure is markedly down. Far less weakness and anxiety than I’ve had since I went to a 75 patch. Heart rate needs to reduce a bit further though.

 I’m not celebrating just yet, I’m going to see how all these symptoms are on slightly reduced oestrogen and increased progesterone and take it from there… would be interesting to see if oestrogen needs reducing even more…