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[Happeechic]

Hi, I have been in a desperate situation for the last 2 months. I started on HRT and was fine for 2.5 months. Then I woke up with continuous PVCs. I was told to increase the oestrogen over and over again and it made them much much worse. To cut a long story short, I stopped HRT4 weeks ago and the PVC is lessoned but haven’t gone. I have been investigating MCAS and histamine and intolerance and have started on an antihistamine and DAO enzyme and vitamin C. They were starting to lessen again but I have had three days where they are really bad. At their height, they were flooding in my back and I was getting them every third beat. I have a really low mood and I’m crying for no reason because I desperately need HRT but this seems to have made matters a lot worse. all of the cardiac tests have been normal.

I would really be grateful for any similar stories or suggestions.

Many thanks

[bombsh3ll]

From personal experience I have found that supplementing potassium citrate and magnesium citrate helpful for PVCs.

There is actually a combination product you can buy called heart calm.

I am not a fan of beta blockers but they can have a role in people really troubled by PVCs without contraindications - have you been offered or considered this?

I would however get back on the dose of hormone therapy that meets your needs irrespective of the PVCs - if you were a premenopausal patient nobody would be suggesting oophorectomy or zoladex as a treatment.

[Pippa52]

Happechic - so sorry you are suffering with PVC's they are not nice. I have had them for many years even before the menopause.  I have been checked out by a cardiologist but he was very happy for me to stay on HRT and even reckons it is good for hearts in some ways.  Every time I change my dose or type of HRT it really kicks mine off till they settle down to the new normal.  I was recommended to take magnesium glycinate and also make sure that your electrolytes are topped up especially in this hot weather.  I am also on a low dose beta blocker which helps a lot.  Hope so much you feel better soon

[joziel]

I had PVCs especially in the evenings before I started HRT. Getting onto HRT and taking enough of it really helped them to go away and now I very rarely get them.

You might also want to get a full thyroid panel run as well. It's likely that you need estrogen but also need to increase it very very gradually to allow your body to adjust to each increase. Too sudden hormonal changes can cause this, either way...

[Happeechic]

Thanks so much Pippa, Joziel and bombsh. Cardiologist is talking about an ablation which I’m scared about especially since I think it’s hormonal.

Pippa, which beta blocker did they put you on? I was on bisoprolol but it made things worse. Also, going to start magnesium glycinate and electrolytes. How long does it take yours to settle when you change? Mine were unbearable and I just couldn’t push through.

Low and slow as Joziel says this the way forward. Going to get all of my bloods redone to check everything.

What doesn’t make sense is I’m always showing as low oestrogen even though I was on three pumps in the end. I’m wondering if I’m just not clearing it.

Thank you so much for replying, it’s given me hope x

[bombsh3ll]

If you have been using gel, it could be the estradiol levels rapidly swinging up and down that is triggering your palpitations.

Blood tests for estradiol are not helpful on gel due to the pharmacokinetics - it peaks rapidly in the plasma then leaves the plasma equally rapidly.

You may fare better on a more stable mode of estradiol delivery such as patch or tablets.

[joziel]

Happee - if your bloods are always showing low estrogen, then you probably are not absorbing it well. It is important to separate the amount you are applying to your skin (whether gel or patches) from what you are actually getting into you (blood). Many people don't absorb well transdermally (myself included).

I was on gel only for a while and increased up to 12 pumps (!!!) trying to get my levels up, but on 12 pumps I was no higher than on 6 pumps - so I couldn't absorb more than that. I then added patches in as well. I am now on 300mcg of Estradot patches (3x 100mcg, where 100mcg is the max licensed dose) PLUS 4 pumps of gel. I was on 6 pumps, but I am gradually coming down on the gel and seeing what my levels are off it (and just on the 300mcg patches). I hate applying gel, waiting for it to dry and I worry about transfer to pets and partner, plus I am now bleeding too heavily during periods with flooding for 2 days. So I am reducing E. So far my symptoms are no worse and I've reduced by 2 pumps.

Anyways - that is all to say - you very likely need a lot MORE estrogen, especially if you have never tested with higher levels. You cannot rule out low estrogen as a cause of this, if you have never been able to trial higher levels in the blood. And taking a little bit of it but not enough, can upset homeostasis and cause more symptoms - which could be what happened when you started HRT.

If I were you, I would request a switch to Estradot patches (which are coming back into stock and IMO are the best patches) and then repeat tests privately if necessary to see if you can get levels up. If you reach 100mcg patches and still have low E, then you will need to go to a private menopause clinic to get prescribed higher off licence doses. As I do, with the Newson Clinic.

[Happeechic]

Thank you so much, Joziel. That’s so useful. what I don’t understand is that my oestrogen level didn’t register at all. It was always unquantified and less than 88 but no exact figure. That was even when I was on one pump and three pumps. Despite that though in the beginning, I had real resolution of a lot of symptoms so I wonder if my oestrogen levels in my blood talent with those in my cells because I don’t understand on such a small level why I had such a strong reaction to the gel and these awful palpitations

[Pippa52]

Happeechic I am on Atenolol beta blocker.  I know quite a lot of people struggle with bisoprolol it can really knock you out and make you feel very tired.  I had an ablation last year and it has been amazing.  Mine was for a different condition (same procedure they just target a different area),  Its a day case normally.  It is very successful apparently for PVC's if they become too frequent. When I had a flare up recently due to not being well the cardiologist told me if they persisted or get worse ablation has a really really high success rate. It may well be when you get your hormone levels back up to where they should be that they will calm down anyway.  If I change a dose or type of HRT mine always rear their head - stress also can bring them on.  I also was on Oestrogel and I didn't absorb it at all for some reason and I had hugely low levels but changed over to Estradot patches and they really worked for me to get the levels up.  There has been a shortage of them this year but I understand supplies are going to be available again soon and there are quite a lot of other patches as well.  Please try not to get too down I feel sure this is all sortable and as you rightly say it is more than likely because your hormone levels are low that you are getting PVC's.  xxx

[joziel]

Happeechic I think the best and quickest way to see improvement is to take things into your own hands slightly. Request to change to patches. Estradot 100s are available now and you can start on half of one of these (50) which is the same as 2 pumps of gel. You can then increase up to a full 100 patch if needed.

After a month or so on patches, get your bloods tested. I recommend using Randox and the 'premium' test device option for at-home testing, which is a thing that sticks on your shoulder to take a blood sample. It avoids any contamination that way (assuming you don't put gel on your shoulders).

Try to get your bloods over 300pmol at least and see how you feel when you achieve this. You should increase E until you achieve this.

By the way, I highly recommend the Newson Clinic and seeing a doctor there online. They will write to your GP and tell them what to continue with and you can get the meds on the NHS usually.