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[MadCatLady]

I started on HRT a month ago: Evorel 50 patches, and 100mg utrogestan for 25 days with a 3-day break. I am really struggling! I did suffer with depression when I was younger, but have been very well for about 15 years until now.

I am suddenly really troubled by fears of getting old and becoming isolated. This came on about 2 weeks ago. I'm not sure whether this is connected to my HRT. I am currently on day 3 of the 3-day progesterone break and this feeling hasn't lifted. I just keep bursting into tears and I have episodes of anxiety about it, and I can't sleep.

If it's the HRT, my body should adapt to it and this will eventually go away, right?

[CLKD]

Yep.
Morning.  Many are unable to tolerate the progesterone part of a regime.

hopefully some1 will be along with advice!   

[bombsh3ll]

Progesterone can have a negative affect on mood.

The only way to isolate this as the cause is to have a longer progesterone free interval with just the estrogen.

If it improves you'll know it was the progesterone.

If it is the progesterone, there's plenty can be done about this - simply switching to vaginal use helps some people.

Also anecdotally a higher dose of estrogen and the addition of testosterone can make the progesterone easier to tolerate.

There are also multiple other types of progestogen including the IUS, or alternatively tibolone.

[CLKD]

 

[MadCatLady]

So, I have taken a look at my spreadsheet (yes, I have a spreadsheet cos I am a big nerd) 

I started taking the progesterone orally as prescribed. I found that the side effects were surprisingly minimal, except my sleep was quite disturbed. I tried taking the progesterone a bit earlier at 6pm and this helped a bit. I tried taking it in the morning once and had a bad dizzy spell, which may or may not have been connected, and decided not to try that again! I then tried it vaginally and this resolved the sleep disturbance problem. However, I can now see that these feelings started two days later.

So all in all, I've messed about with it so much, it's impossible to tell. I'm going to re-start the progesterone tomorrow as planned, orally, at 6pm. And stick with it! (Unless it becomes unbearable.)

Despite getting hit by these feelings again this morning, I'm actually feeling OK currently. It could maybe just be Christmas which is a very busy and emotional time for me and my family.

[MadCatLady]

I'm still getting mild waves of this wierd dread, but nothing like it was last week. I'm back on the progesterone, orally, as of this evening, and will see whether it suddenly gets worse again. I am keeping my fingers crossed!

[CLKD]

Let us know how you get on?

[MadCatLady]

Thank you for your kindness in the midst of my existential crisis.

It has been over two weeks back on the daily progesterone, and I am pleased to say that these sudden waves of overwhelming fear are gone and haven't returned. I'm not completely 100% yet, but I'm also taking some steps to relieve isolation now. Apart from work and my parents, I have no other contact with people - and I'm not likely to have work or parents as I get older. So I'm trying out some local groups and will choose a couple to stick with and hopefully build up a little bit of a social network. I feel like it's been a bit of a wake up call, but I am starting to feel more hope than fear now for my future.

I have my HRT review booked for February and planning to ask for an increase in the oestrogen to 75mg patches. I am having only minimal improvement in dryness and hot flushes, so I think an increase is warranted. And this should hopefully also make the progesterone more tolerable for me.

[Hurdity]

Hi Madcatlady

Sorry to hear about your woes but glad things are improving.

I had a quick look at your history on other posts as you've only made a few (I don't normally do this except for members with hardly any posts otherwise takes too long!) and I see you are quite young to be peri-menopausal and very important to take the oestrogen!

So yes a good idea to try for an increase in oestrogen at your young age - you should be aiming for the average  oestrogen level across the menstrual cycle - which is 300-400 pmol/l if I recall correctly. Of course testing for oestrogen is not advised from age 45 + who are peri-menopausal and GPs are advised to go by symptoms alone. In addition they are inaccurate especially when peri and irregular ovulation is occurring. But the minimum benefit should be cessation of flushes and for more oomph especially with younger women, maybe a bit higher than this? Hopefully 75 mcg will see an improvement,

Re the progesterone - the metabolic by-products from oral intake - after digestion are different and in higher quantities from when it is used vaginally and do contain some compounds that may be more likely to lead to depressive feelings in those who are sensitive. However it is still absorbed systemically when used vaginally (considerably!) but often the main symptoms are fatigue and brain fog - which can also be depressive!

As most women of your age would be having periods you could take it on a normal cycle of 16 days oestrogen and 12 days utrogestan. You would get more of a withdrawal bleed though and some upheavals and potential breakthrough when ovulating.

The other thing is if you are still getting vaginal symptoms, do ask for vaginal oestrogen too - so important. Many women need this in addition to systemic HRT - I'm in my 70's and have been taking both for most of the time I've been on HRT which is getting on for 17 or 18 years. There are plenty of options.

Finally if you want to suppress the cycle completely then there are combined contraceptive pills which contain the bio-identcial estradiol, same as HRT and you would avoid the hormonal fluctuations of the peri cycles.

Hope this helps

Hurdity x

[CLKD]

Tnx for the update.  It can take a huge leap of faith to being mingling.  Our village has several 'go to' weekly places to join in hobbies with a cup of tea, two others are run by the Church and Chapel on different days.   We have book club; running club, swimming locally ......... I think those that had kids in school or walk a dog regularly will meet people to.

Those people that you meet socially don't have to visit your home if U don't want: none of our friends in the various groups come back, although we are in contact via WhatsApp groups! 

[MadCatLady]

Re the progesterone - the metabolic by-products from oral intake - after digestion are different and in higher quantities from when it is used vaginally and do contain some compounds that may be more likely to lead to depressive feelings in those who are sensitive. However it is still absorbed systemically when used vaginally (considerably!) but often the main symptoms are fatigue and brain fog - which can also be depressive!

As most women of your age would be having periods you could take it on a normal cycle of 16 days oestrogen and 12 days utrogestan. You would get more of a withdrawal bleed though and some upheavals and potential breakthrough when ovulating.

Thank you!

The weird thing is, this deep depression began just two days after I switched to taking it vaginally for the last week of my first cycle. I really messed about with timing and things a lot that first cycle, so I can't be sure whether that was the cause, but I'm reluctant to risk it again. It's lifted significantly even though I'm taking it orally, which I've been doing for over two weeks now. I often have weird reactions to medications, so I think I might just be a slightly strange person who tolerates it better orally.

I'm also concerned about doubling the dose, which I'd need to do it I halve the amount of time I take it for. However I've also heard on a Louise Newson video that some women actually have reduced progesterone intolerance on a higher dose. It seems counterintuitive, but perhaps it would be worth a try.

[MadCatLady]

Tnx for the update.  It can take a huge leap of faith to being mingling.  Our village has several 'go to' weekly places to join in hobbies with a cup of tea, two others are run by the Church and Chapel on different days.   We have book club; running club, swimming locally ......... I think those that had kids in school or walk a dog regularly will meet people to.

Those people that you meet socially don't have to visit your home if U don't want: none of our friends in the various groups come back, although we are in contact via WhatsApp groups!

I've been looking up some local activities and I've written myself a list of things to do if I'm struggling. I've set a reminder to look at it every 4 months - so I can keep it updated, but mostly to keep it fresh in my mind if I have another crisis. One of my goals is that I actually should start allowing people into my home. It would be lovely to know someone well enough that I could treat them to a home-cooked dinner once in a while.

I'm lucky, I live in a small town which does have a few things going on. I am looking forward to trying out a walking group on Saturday.

I'm not going to become a social butterfly, but I'm making a start.

[CLKD]

Good Luck!  Blogging might help. 

R there any supper clubs in your area where people swap recepies, 1 has to be careful about inviting people into our homes.  There is so much litigation that if some1 thinks that they get food poisoning  . 

[MadCatLady]

I'm thinking more that I will eventually make a friend or two, and invite them round only once I know them fairly well. But it's definitely a good friendship tip to avoid poisoning them 

[CLKD]

I don't cook: I can but as regular Members here know, I have a Chef that does  [he's a chemist, apparently it's like cooking  ]. 

I do the laundry, crocks, we share gardening .......... my main hobby which could take me miles if I didn't suffer anxiety. 

Clubs, visiting gardens: Alnwick is on the cards for this year  .  I do garden centres really, really well