Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: joziel on May 31, 2022, 10:21:03 PM
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Can I ask for other people's experiences with palpitations and blood pressure on HRT? If you experienced any of this, how long before it settled down or went away when you settled on a HRT dose?
Palpitations were one of my symptoms before starting HRT. It was then (and still now on HRT is) specifically in the evenings and at night.
I'm with a doctor at the Newson Clinic. I started a 25 Estradot patch for 2 weeks, then increased to 50 for 7 weeks. As I still had a few symptoms remaining, and as my estrogen bloods were only 233nmol, as per advice I then increased to 75. That was just 4 days ago. I'm also on Testogel and my FAI on my bloods was 3%, so that's about right and within normal female range. I started the Testogel after 1 week at 50, so that's quite a while now. I'm also on utrogestan 100mg continuous and Cerazette POP to keep endo away. Which seems to be working.
I am feeling fantastic in all ways except this. I am now at approaching 10 weeks on (any kind of) HRT. But clearly I've gone up several doses in that time and also started testosterone. (I'm due my review next week and will talk about all this with the doctor.)
The palpitations have been there, off and on, throughout all this. Sometimes, on the 50 patch, they stopped for a week or two but then came back. I wasn't worried about the palpitations, because I'd read loads online about them being a menopause symptom and related to fluctuating estrogen levels.
What worries me is that, since starting HRT, I'm also getting higher blood pressure in the evenings - my blood pressure is usually around 120/80 and it goes up to 144/79 in the evenings. I feel like my heart is beating harder in my chest. And I can feel a pulsing sometimes when I'm lying in bed, it even feels like the bed is shaking slightly(!) under me. :o This can make it hard to sleep, as can feeling a bit anxious about it. I wasn't worried about all this until I realised the higher blood pressure thing. I hadn't read that on menopause forums, so it worried me more.
I actually only discovered this was happening because I registered at a new GP practice (hoping to find a menopause-friendly GP there) and the intake doctor took my blood pressure and found it was 144/something. She checked it twice. She thought it was just white-coat syndrome (I am slim and work out 4x a week!) but asked me to do a week of at-home testing twice a day. I'm on day 5 of this (thank god, only 2 more days) and I've discovered that my morning readings are usually good, around 120/80 or under and if I do the 'evening' reading at 5pm, it is still about the same. But if I wait till 7pm or later to do the evening reading, it is then around 135-145/82. (Which then totally freaks me out.) This makes sense because it is also in the evenings that I get all these other sensations - feeling jittery, throbbing/pulsing in my veins and sometimes palpitations. I also sometimes get the 'irregular pulse' icon coming on, on the blood pressure monitor. (I've checked this with my Kardia ECG device that works with my iPhone and it says I have a normal Sinus rhythm, but it fits with the palpitations. :-\ )
I get really anxious about doing the blood pressure test. Just the feeling of the cuff tightening around my arm is enough to make me panic(!) and I start to dread the upcoming blood pressure sesh about 2 hours before(!!!). The suspense over 'what will the result be?' and trying to breathe and relax whilst it is taking it is horrible. And if the result is high, I then panic even more. And obviously anxiety doesn't help with symptoms like these!!
Could some of this be caused by the testosterone? Should I try stopping testosterone for a couple weeks?
LAST QUESTION - does my machine even work properly? Look at these results:
7.45pm 141/78
7.50pm [v anxious about previous result!!] 159/77
8.10pm 133/89 [what?]
8.20pm 145/88
What is that 133 doing in there? Can blood pressure really change that much in 20 minutes or is my machine faulty?! I then have to choose which of these to put on the form for the doctor!?! ;D I went with the first one here, as it seemed most representative.
I've gone from really being blah and not bothered about these symptoms, to freaking out.
It would really help me to hear some stories of people whose similar symptoms have gone away again. And how long on a stable HRT regime it took, for that to happen....???
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I’m sorry, palpitations are scary so I understand why you are so anxious. I didn’t have them before HRT, but got them after reducing a dose. I also had general anxiety and bad GERD, and it seemed to all come together. I also had slightly raised thyroid levels at the same time, I’m hypothyroid, so it was confusing to work out what was causing the palpitations. You can get them with GERD, with falling estrogen as you say, with anxiety and with raised thyroid hormones. So I know my thyroid levels are now good because I retested, I’ve been on reduced estrogen almost 3 months and my GERD and burping haven’t happened this month, so no palpitations. I am on my period week so they may show up! But they are at least better because I haven’t had them yet. I think likely that I’m getting used to the lower estrogen as other symptoms have eased also. So like other symptoms, they should resolve as your estrogen optimises. I am also on testosterone but started that 7 months ago so didn’t think that was the issue. I’m at Newson also, I ran this symptom past my doctor there via email and she reassured me and told me to wait another few months from that point to see if I optimise otherwise she would give me a bit more estrogen around my period and just before. She didn’t mention testosterone. You can send your doctor there an email question if you like.
You need BP machines calibrated at your doctors before using.
Hope you feel better soon. Try not to worry, these are not nice symptoms but they should resolve soon.
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Hi, to be honest I think your anxiety about your BP can send it sky high! Mine can anyway. If you are feeling jittery in the evenings anyway and expecting a worrying result then your body anticipates that and BP goes up!
Are you taking BP three times? With a minute between each. And take the lowest reading. That might help a bit. BP is normally higher in the morning so sounds like you are fine but the anxiety around this is blowing your evening reading up a little. Could you have a week off monitoring it just to get out of the habit of getting stressed about it?
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And yes you have my sympathy, palpitations are horrible. I suffered terribly until I started HRT, they were the first things to go away thank God.
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Sorry just to add (again) that I had an ECG at drs just to check due to palpitations, rhythm etc fine but heart rate at 120! It’s never that high normally (I have a fitness watch thing). That was just lying there. Talk about white coat syndrome!!
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ATB - thanks. I've had some thyroid tests run but I'm not totally 'up' on thyroid stuff so my doctor just says they are fine. Although I think sometimes interpreting these things is a bit of an art form...!
Back in October 2021, my TSH was 1.16mU/l (normal range supposedly 0.5 - 5)
Then, a couple weeks ago, my TSH was 0.95 mU/l. And I also got Free thyroxine 15.5pmol/l (normal range 10-25)
I did ask for T3 and T4 and I think the 'free thyroxine' is another name for T4. I can't see any T3 result. But I just kept being told all that is normal.
Vanillalover, you are right that being anxious about the test can affect the result - but I am now equally anxious about my morning tests because I've got myself in a bit of a tizz with all this - and I don't seem to be getting the same results then. (The 'irregular pulse' icon is coming on but the result seems okay.) So there doesn't seem to be a direct correlation with anxiety.
I just feel like the higher blood pressure is related to everything else (palpitations, heart thudding, beating loudly, feeling trembly, throbbing). I don't know if I should go back down to a 50 patch. I have a review a week today and I'm going to try to stay on the 75 until I speak to the dr but I don't know if I'll be able to. (This was also happening on the 50 but less intensely or frequently.) I'm also reducing the testosterone slightly to every other day or maybe just less of it.
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I don’t think this is testosterone. I know how hard it is to stay on a dose when you feel unwell, wanting to change because it’s the only thing you can change. But it makes it harder to determine what’s going on if you don’t stay on one dose for at least 2 months but normally 3. If you want to reduce it before your review I do understand, it’s only a week away. It may not resolve symptoms in a week though.
Yes thyroid tests should include free T3. Yours don’t jump out at me as being something to be too concerned about though just from what I see there, your Thyroxine or T4 would be super high if it was causing palpitations.
Do you try things like meditation and breathing techniques for anxiety? That helps me.
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Thanks. Yes, I have various meditation and breathing apps and I try to do them just before my blood pressure and even whilst it's being taken. I haven't noticed that it makes any difference!!
I kinda feel like this high blood pressure evening reading issue is related to everything else going on with me in the evenings/night. I don't think I generally have high blood pressure (as these readings show), it is just getting high in the evenings. I'm going to try testing at 5pm and 8pm, to see if I can confirm this pattern. Then I'll pass that info onto my doctor when I submit these results and write a note about what's going on....
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joziel, my bp went bonkers one day - like 170/102 and I completely flipped out, after that, like you, the sight of the cuff sent me into an anxiety spiral. When I spoke to my doctor and said "these levels are like I'm going to have a stroke!" and she said no, really, you're just stressing.
We then discussed anxiety and palpitations (which I was also having) and that's when we put two and two together with my low oestradiol. She actually put me on mirtazapine which might not be right for you, as I wasn't sleeping either. bp went down straight away, palpitations decreased. It was all stress/anxiety related.
Have you looked at any of the Sanjay Gupta vids on youtube? He's really good on this topic. Totally reassured me.
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Thanks, that's so good to hear. I am now thinking that asking someone who has recently started HRT (and just increased their estrogen) to do a week of blood pressure readings probably wasn't a good idea, ;D but it was just the intake doctor at this GP practice!! Retrospectively I should probably have said 'hey, let's just wait until I've been on a stable HRT regime for 6 months and then we can retest, please'.
But anyway. Somehow I have stumbled through this hell of a week and tomorrow is the last day and miraculously I also have mostly good readings so I am really looking forwards to just parking all this now. I just have a couple of 135 and 144. And if you average it all out, like it says to, it is totally normal, 120/75. ::) And I think that's what matters most?!
It all did reach the point whereby I was almost hyperventilating before taking a reading. And talk about overthinking things.... I would tell myself to relax, but then that would make me NOT relax - because why tell yourself to relax if you don't need to?? If you need to tell yourself to relax, you must be.... anxious.... And then the thing is strangling your arm and then you can hear your own pulse throbbing and is it throbbing faster.... is your heart beating faster... are you getting stressed... are you going to get another high reading....1!??!?!
OMG, it is just the height of ridiculousness. Can they please invent an instantaneous blood pressure monitor which you can't feel every time it works....?!?
And I thought it would be a piece of cake to do this quick test twice a day..... ;D ;D
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I really feel your pain and I really feel for you. I get palpitations and a very fast heart rate sometimes up to 135/140 so I know exactly what you mean. It’s so scary hearing your heart pounding away. Like you I absolutely loathe taking my blood pressure and like you I get anxious which then of course kicks off the tachycardia :( . It’s such a minefield isn’t it. I’m struggling to get the right dose and type of HRT … I’m sure we will all get there in the end they’re sending love and empathy xxx
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Thanks. I had a really good evening and night, last night. No palpitations (well, maybe just a couple of little ones) and I slept soooooo well.
I hope I've turned a corner, although I'm not expecting a sudden transformation in case I don't get one!
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Clearly I spoke too soon ;D I just had another night from hell. I can’t do it anymore, I’m going back down to the 50 patch.
I can’t do any more nights lying awake with a fluttery heart beating weirdly and feeling like I drank 8 Red Bulls.
At 4am I got up and did an ECG with my Kardia device. It said something about sinus rhythm with wide QRS which could be ok and due to benign stuff or high blood pressure or could be something serious. So I paid £9.99 and sent it off in the app for a review with a cardiologist. The ECG quality is rubbish in my Kardia though so I hope they can use it.
My feeling is that it was another high blood pressure episode. Why am I getting these on HRT?! My blood pressure is okay most of the day but in the evenings and at night I get high blood pressure. Accompanied by heart beating hard, fluttery heart or palpitations and it makes me anxious - which doesn’t help - but it doesn’t begin with anxiety. It begins as a physical thing I then get worried about.
I’m reducing back to 50 patch as of today. But it was still happening to a lesser degree at 50.
I don’t want to come off HRT because of its effect on my blood pressure…? If we’re just replacing our own natural lost hormones and if my bloods showed only 233nmol of estrogen at 50 why am I getting these symptoms? I wasn’t before HRT….
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I’m sorry you’ve had a bad night, it can be scary.
In your opening post you said palpitations was one of your symptoms before HRT?
In any case, new symptoms of the same things ie falling estrogen could occur only on HRT, although not necessarily because of it.
I’m sure you’ve looked but the NHS page on palpitations is useful:
https://www.nhs.uk/conditions/heart-palpitations/
In our case they are most likely associated with *falling* estrogen. I believe you dropped from 75 to 50? After quick increases? I think this may be why you’re getting worsening palpitations, lots of increases then a decrease. It’s fluctuations and low estrogen that are most likely causing this. It will settle down with a consistent dose most likely. Mine have. I’m not aware that palpitations are a sign of high blood pressure. Usually there are no symptoms of that. Completely understand your panic, but I would take lots of deep breaths and try and remember that palpitations are rarely serious, they’re not typically associated with blood pressure, the most likely cause is hormone fluctuations so you don’t want to make that worse.
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Thanks, yes palpitations were one of my peri symptoms before HRT - but only the 'heart dropping a beat' kind. No fluttery heart feelings. No heart beating hard/loud. No lying in bed and feeling my whole body throbbing or pulsing. (It actually feels as if the bed itself is moving sometimes, but it is me.) And when I went to sleep, it didn't wake me up (before HRT) - I didn't get the heart skipping a beat in sleep.
In fact the heart skipping a beat kind of palpitation is happening less, but all this other stuff is happening more.
No, I didn't drop from 75 to 50. I was:
25 - 2 weeks
50 - 7 weeks
75 - managed 1 week(!)
But it was happening even at 50 - part of the reason I tried the increase to 75 was in case it was all low estrogen and thinking that would make it better. But it got worse and happened pretty much every night instead of every few days. My blood estrogen was 233nmol on 50 which was on the low side so I thought that made sense to try an increase.
I don't know if I stayed at 50 for long enough? Perhaps I should have stayed there a whole 12 weeks.
This morning instead of going back to 50, I cut a patch in 4 instead of in half (very technical and a lot of measuring involved there!!) to make 12.5 - and added that to a 50 - and so I'm now at 62.5. ;D ;D ;D I will at least stay there until Weds when I have this video call with my doctor! If that dose works for me I guess she can prescribe me some 25 patches to cut in half, which would be easier! I look forwards to seeing her reaction when I tell her I'm on 62.5 ;D
The only reason I think high blood pressure is involved is because of the feeling of pulsing against things, it is very weird. And my blood pressure was raised at 144/something at the doctor's last week. I've done readings twice a day since and most of the time they are fine, but then there is the odd 144. And those readings were done at 8pm at the latest, and all this stuff really ramps up later in the evening and overnight. Truth be told, I'm a bit afraid to get my blood pressure thing out in the middle of the night and see what it is. I know no one can help me unless they know what is really going on though.
I suspect I'm having a kind of 'episode' overnight which involves high blood pressure and vasomotor stuff - and that is causing some of these weird heart palpitations. (The one I had last night, sinus rhythm with wide QRS, even said on the info for it that one possible cause is high blood pressure so that makes sense too.) Even now, this morning, I haven't relaxed and can feel my thighs pulsing on the chair for eg. I will call my doctor but of course it is now a holiday weekend ::)
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Gosh I’m so sorry you are really having a hard time and I totally understand the concerns you have and the feeling you need to change the dose. Although some improvements are expected initially staring HRT and new dosages, you really don’t know until you are on a dose for at least 8-12 weeks what it does for you. My doctor when I sent an email last month about my palpitations told me to go to my GP if I get actual chest pain or tightening. She said she was not concerned about palpitations as they are not usually a sign of anything bad but if they continued until our next appointment, 2 months away at that point, she would discuss adding more estrogen, not reducing, at the times I got the symptoms- when naturally my estrogen lowers. So the issue if it’s related to estrogen is usually falling, or low estrogen. Not the other way. I know that may not make sense to you based on your observations, but fluctuating hormones are also a reason and your own natural cycle is still going up and down underneath what you are adding in. Even though you were only on 75 a week, it’s the effect of going up up up and then down, contributing to this most likely, because although not long it’s still fluctuations. I fear you might be unfortunately getting high BP readings due to your anxiety, not to dismiss your concerns but to hopefully reassure you. Anxiety and panic can cause palpitations and high BP, even if initially caused by something else. You won’t know if the adjustment you’ve just made is helping for a while anyway and it can affect the assessment your clinician is going to make, although they are very used to this and I’m sure she won’t be surprised or bothered by it. She is there to work with you and help reduce these fears and uncertainty. Do tell us how the appointment goes.
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Thanks that's reassuring ATB. I ended up in A&E today :o I got back a review of my crap ECG I took at home which said I should send it to my doctor within 24hrs and some stuff about what it had on it which sounded terrifying.
The A&E doctor was very laid back and reassuring and not at all terrified by it. He took my blood pressure and it was 158/89 or something but said I am incredibly stressed so that's understandable. They did an ECG and it was normal. I was glad I went because it calmed me down and helped. Although he did say 'well you might have to come off HRT' and didn't seem to get it as a necessity rather than a kind of vanity product. But... whatever.. Maybe men should lose all their testosterone suddenly at age 40 and then we'll see if their attitude to sex hormones changes....
But still, since I am getting these 'irregular pulse' warnings on my blood pressure monitor, they said next step is to go to my GP and ask for a cardiologist referral and I'll probably have to wear a holter for 48hrs and might have an echocardiogram. Just to see if there is any irregularity to my heart beat.
As I'm on the Cerazette mini pill at the moment, my own ovaries should be pretty dormant and not really contributing much by way of hormones so I shouldn't really have a cycle going on to speak of as it stops ovulation and suppresses estrogen to the early follicular stage (v low).
I think palpitations can just be caused by hormonal fluctuations and changes, whether up or down. Although I don't understand why that happens given that our usual cycles have estrogen going from 100-1000 sometimes without these symptoms pre-menopause.
For me there was a big difference between the low estrogen palps (just a skipped beat which was distracting but that's all) to on HRT palps - ongoing constant heart fluttering literally all evening and night like there is a bird stuck in me, so I can't sleep, whilst feeling blood pulsing around myself. It is just truly weird, especially happening so frequently. It's the blood pressure thing which worries me more than the palpitations TBH. Because I really wasn't anxious when I first noticed that. I just thought it was interesting that the bed appeared to be moving a bit under me and then dismissed it.
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Also I should not be watching the new series of Stranger Things at this time ;D
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I just thought I would add that I had the bed moving sensation! It was quite a few weeks back and happened two or three times as I was on the verge of falling asleep. It was most strange, I thought it was maybe a mini earthquake but when I sat up it wasn't anything. I then found I couldn't get to sleep. It resolved once I started splitting my dose of oestrogel and putting some on in the evening. Quite why this sorted it I have no idea. But it does suggest something hormonal was going on!
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Oh my goodness, I could hug you. ;D It is such a relief to find someone else who knows what I'm talking about. And yes, once it happened just after I fell asleep and it woke me up...! I have no idea why this tends to happen at night either. There is so much we don't know about women's health, there is a shed load of research they need to do. It makes some sense that pre-HRT palpitations due to low estrogen happen at night because you could just say it's due to the daily fluctuation of hormones and maybe estrogen is especially low then. But if you're on HRT with a constant supply of estrogen, that doesn't really explain it any longer... There are so many mechanisms at work here which I feel we don't understand yet.
I'm on patches, so theoretically they should be continuously releasing the same amount of estrogen so I shouldn't getting dips or spikes. I wondered if it relates to when I'm changing a patch, and the new patch getting warmed up and working - but I can't see that it happens just on those days or any relationship there. ???
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Did the bed shake thing happen when you increased your patch? I think mine occurred when I switched from green square to orange square oestrogel and I was applying it all in one go in the morning. So maybe it was a surge, I have no idea. Definitely feel more balanced splitting the dose. But yes for you it's harder to explain away with patches. However..... I didn't get on with patches, and did feel quite bad at nighttime on them. But most women seem to get on fine with them. It's so complicated as you say. And it's still early days for you so it could well all settle down.
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Just wanted to send you some good vibes Joziel as palpitations are awful. I went through a year of having them really badly, with the constant fluttering etc (I used to say it was like having a butterfly stuck in my chest, but bird is a good description too!). I was referred to a cardiologist and they did lots of tests which confirmed the irregular heartbeat but in the end was told it wasn't anything to worry about. With a few years hindsight and a bit more experience I suspect mine was caused by gradual adjustments I was making at the time to my Sertraline (I was on a slow taper) as I got them again later from doing it (and I also get it when I increase the dose however small).
The only other time I've suffered with it was for about 3 weeks this year with (or immediately after) Covid. It reminded me how awful it is.
Also just wanted to say your comment about "men should have all their testosterone removed".... never a truer word spoken!! We have a long way to go before the majority of doctors are educated about HRT. Hope you get to the bottom of it soon x
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Apparently the reason it happens at night is because of the compression of the chest cavity and stomach together. It also seems it happens more often lying on the left side because you activate the vagus nerve. This can happen to both men and women. I was just reading a Harvard article on this which I found interesting, all the different reasons. Even dehydration can cause it. Also low blood sugar, low potassium and low magnesium- also found out from too high magnesium too but that’s rare. Hyperthyroidism also- I have the opposite condition but my medication needs have lowered since HRT so I was over medicated for a short time, it may have contributed to my issue. I’ve watched some YouTube videos from a doctor at York, I think it’s Dr Gupta, which others here mention as well and he goes into this issue quite a lot if you think that may help.
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Wow, that's all really useful and interesting. Especially the bit about lying on your left. I think I figured that out myself before I started HRT but I had no idea why it happened lying like that.
I can't remember if the jolting was relating to increasing patch. But I don't think I had any of this on 25 for 2 weeks, it was only when I increased to 50. Then it was happening occasionally, like one night in 3 or something. And when I went up to 75 it was every night and sometimes the mornings as well. I've now gone back down to 62.5 and it's been better the last 3 days.
I am not sure now if I should call my GP and go make an appointment ASAP about all this, or if I shouldn't just see how it goes on the HRT as I get used to it. I don't want to go down the path of lots of scary heart-related tests if it's all going to settle once my hormones stabilise.
But equally I don't want to be walking around with potential irregular pulses and something that needs to be spotted. I could at least make an appointment with the GP and tell her both those perspectives and see what she recommends....?? I guess, if I had the tests done and knew it was nothing that could harm me, I would not get anxious when it happens and then it probably wouldn't escalate into fear and a state which it's really hard to get out of. I just worry that they would get some result which could be nothing, but could also be something and further tests and etc etc.... and that it might be best just to wait a few months before doing the 48hr holter thing.
It has been much better the last few days (since I got reassured by going to A&E!) but I am living in fear of it coming back. It's like I don't trust my body/heart and any time I feel myself getting anxious, I'm like 'breathe... relax...' and 'oh no, is it happening again...?'.
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I think if it puts your mind at rest, see your GP and explain you know it’s likely hormonal fluctuations but need professional reassurance.
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Ok, thanks.... I just feel like I'm being a bit irresponsible if I don't even tell my GP I was in A&E. Although the nice A&E doctor said he would write to my GP to let her know what had happened. (At the time I was reassured by this but now I'm like - um - what if he was worried, but just didn't want to worry me, but wanted my doctor to know....!!)
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I found this a really helpful video by a psychologist, about how to stop over thinking. Might help you with this?
https://youtu.be/tK2LaefZcy8
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Thanks, the thing is I know all this (factually and in application to other people ;D ) it is just so hard to apply to yourself...
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Oh it absolutely is. That’s why I like seeing a therapist as she reminds me of all the things I forget for myself and advise to other people! I like the idea of writing down my worries and the resolutions, giving myself a time limit to do that and then moving on. They’re habits you forget for yourself but reminders can nudge us to keep practicing.
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I am a therapist ;D ;D ;D
Anyway(!) had another bad night last night. Woke at 4am with the blood pressure issue/throbbing and the fluttery palps :'(
My theory is that the high blood pressure episodes I’m having are causing these palps as I read they can be a cause. But why am I getting these episodes of high blood pressure on the estrogen?
I usually am perfect at 120/70, I work out 4x week and I’m slim at 5ft 10 and 9.5stone. I have no history of any blood pressure stuff before starting HRT.
Urgh.
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Do you think that can happen from physical stress like the fluctuations in hormones? They say it can be electrolyte imbalance also but I feel you would have ruled this out already. Is it because your estrogen was raised too quickly? I can’t see back as I write this to your original comment but from memory, there wasn’t 7-12 weeks before each increase was there? It’s horrible but I wonder if you don’t adjust anything, if this would pass in a few weeks.
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I definitely think the stress isn't helping but I don't think it's the cause. Because I was quite relaxed about all this to begin with and didn't even realise it was related to blood pressure. Like when I thought the bed was moving under me and realised it was actually me, I thought that was funny and some weird quirk involved in starting HRT.
So it has really been weeks and weeks before I've begun to be stressed about it. Definitely the stress then makes it worse and compounds it and makes it harder to get out of the state once I'm in it, but it's not what's causing it...
I haven't heard about electrolyte imbalances or looked into that. Should I get some electrolyte replacement powder stuff and see if that helps? We do filter our water at home with a distiller, which removes everything from it - including the 'good' minerals. (We tried to replace these afterwards but it made it taste gross so stopped!)
I was at:
25 - 2wks
50 - 7wks
75 - 1wk
62.5 - now
I was told to start at 25 for 2 weeks and then go to 50. After that, every 4-6wks, to increase if I felt I still had symptoms. So I actually waited a week longer at the 50 before increasing. But perhaps I am just super sensitive and needed to go very slowly.
Yes, my goal now is not to adjust anything and to see what happens if I give it a full 12 weeks at 62.5. I have a video review with my Newson dr this Weds - and in 2.5wks I have an in-person double appointment with this new menopause GP who is doing a training with the BMS.
Meanwhile, I've emailed my blood pressure results and an email explaining what's happening to the intake GP I saw and said I think it is due to the estrogen in the HRT....
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Well, I had a follow-up with my Newson doctor today via video.
She agreed that with the progesterone/endo situation, I should next try switching out the Cerazette for double the utrogestan (200mg continuously) and just see if that is enough to keep the endo away so I can stop the Cerazette. If it doesn't, return to 100mg continuous and re-start Cerazette and have a re-think. I could just stay on Cerazette until menopause when hopefully my ovaries will become inactive anyway - otherwise we'll need to think about a completely different regime. And she agreed with me that the current research suggests that transdermal estrogen is best so reluctant to come off that.
With the heart palps and estrogen, she thought it was overkill to start doing 48-hour holters and echocardiograms at this point and she was not at all freaked out hearing about my trip to A&E last week ;D ;D but I should just be aware that I'm very sensitive to changes in estrogen and we need to increase very gradually and remain at each dose for a good length of time before increasing again. I'm to stay at 62.5 (!) for many more weeks until all these symptoms stop (meanwhile I can be experimenting with the progesterone as above!) and then increase very gradually - she is sending me some 25 patches along with the 50s so I can cut the 25s in half - but I can also cut them into quarters if I want to increase even more gradually. So we just eke it up very gradually at least to 75.
My testosterone levels are perfect so I'm to keep doing the same thing there, which is a pea-sized blob of Testogel so each sachet lasts 10 days.
The appointment was supposed to be 30mins but we spoke for at least 40mins and I didn't feel rushed. If anything, I was trying to end before her because I felt like I was keeping her too long! Compare this to the 10mins you get with a GP to discuss all this ::)
BUT... OMG the cost(!!!). The follow up plus prescription fee was £267 and then 6 months of meds was £450 :o :o :o :o I am trying to find a doctor locally but it is taking some time (I have an appointment in a couple of weeks) and I also don't know what will be in stock locally, HRT wise - whereas I feel like Newson have their hands on everything and make it a priority to source it all because it's all they do...But logistically it means that annually to do this will cost about £900 in meds + £267 in fees - that's with the minimum of one appointment a year. :o :o :o :o It shouldn't be this expensive to get your own hormones back :-\ Not when contraception is free. ???
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Oh that sounds like you had a great appointment and she seems to really understand what’s needed. I know it’s hard to stay on the same dose when you have symptoms, but hopefully soon things are much better for you. Newson is so expensive and it’s hard to not get frustrated we have to pay for that. It’s an unacceptable and unfair situation. Free health care my a**e. After being on HRT 6 months I went to my new GP and because it was working she agreed to write the prescriptions for Evorel & Utrogestan, so I just need the Androfemme from Newson which require just a yearly appointment. Thank goodness! So for me Androfemme will be £240 a year plus one consult and prescription charge- which is the biggest rip off ever! My doctor is lovely but doesn’t work out my needs properly and I end up needing an extra one every now and then and have to pay that charge again! They’re really raking it in at Newson now, a lot of doctors and a lot of video appointments.
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It's true, but when there is a lot of demand for something one way to reduce it, is to put prices up - although how that sits ethically with helping people, I'm not sure. It works for other businesses. Perhaps if they charge more, they attract more doctors who want to work for them, so they can then provide more help....
By the way, with the testosterone, Testogel is much cheaper than AndroFemme if you want to save a bit. It is something like £20 to AndroFemme's £80 for the same amount. Plus the ingredients are better - there are parabens and hydrobenzoates in the AndroFemme, which are pretty nasty things to put on yourself every day for the rest of your life(!). I checked them all out and the Testogel had the best non-active ingredients so I went with that. (I told my NEwson doctor that I got a rash with the AndroFemme and asked to switch to Testogel.)
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The reason I chose Androfemme is it’s designed for women, isn’t that right? And it’s the only one?
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It's designed for women but all that means is it's less concentrated. Instead of using a big measurement of cream (which you pay more for!) you use a tiny pea sized blob of Testogel. Which is cheaper. But you're getting the same amount of testosterone (active ingredient) either way. Testosterone is testosterone, whether it's for men or women, it's the same hormone. It's just about how strong/concentrated it is and so how much of it you need.
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(I said to my husband, they should just rebrand it TestoGAL and put in a pink sachet. Job done. ;D ;D )
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Oh that’s interesting. I might raise that with my doctor. I hate to change it if it’s working though even when I know it’s the same active ingredient. Different brands of thyroid replacement hormone, with same quantity of T3 & T4, affect me really differently. I use 0.5ml blob, pea sized?
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It's a bit rough and imprecise compared to the estrogen dosage ;D It takes you a couple of sachets to work out roughly what size blob gets you 10 days out of it. I squeeze a sachet into a little make up pot and then use a small syringe to suck up what I need.
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Jeeze, another shitty time with these palpitations :'(
Woke up at 4am (as often seems to happen now, no idea why, I used to sleep so well before HRT) to feel that my heart was beating fast and fingers throbbing again. I tried to sleep but I can't reason with myself about how I'm feeling if I'm not awake, I just get anxious - so I let myself wake up properly and tried to do some breathwork exercises. (Never seems to do much.)
It's early afternoon now and the heart palps seem to have stopped but I still feel like my pulse is fast and I probably have high blood pressure. Feel like I'm running on high octane fuel and have had multiple Red Bulls again. It's really hard to concentrate and work, I feel so jittery.
I have a kind of deja vu feeling about all this because when I was about 20 (long time ago!) I tried a combined pill, it was Microgynon, and I think I felt similar to this then. So I just went back to the doctor and went on a POP (Norgeston) and all was fine. It's not so easy to see a way out, now. You'd think that, this being body identical estrogen and transdermal instead of oral, my body would be better with it... I just can't figure out why it's causing this. I mean, my own natural estrogen levels during my adult life have easily been this high (only 233nmol!) and higher, without these symptoms. So why does taking exogenous estrogen cause this?!
I'm not so much worried that this is some heart issue as I am that, if it doesn't all go away and resolve, they're going to make me come off HRT. Or go on more meds like beta blockers. Which I really don't want. I am probably worrying again.
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I’m sorry to hear you’re getting continuous symptoms like this, it’s exhausting for you.
Regarding your sleep. What time do you take Utrogestan when you take it?
Are you on, have you tried, magnesium glycinate for sleep and anxiety? Helps a lot of women.
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I take the utrogestan before going to sleep, so probably about 11pm. I have no problems falling asleep in the first place and seem to sleep well until about 4 or 4.30am each day. I don't know if I've become really sensitive to dawn(!) as it also seems to be when it's getting light and I can hear the birds etc - although this has never been a problem for me earlier in life.
Even if I don't have the heart palps etc, I still wake around 4am but I can then usually go back to sleep again if I don't have them. Just not sure what's so 'magic' about 4.30am!? Seems lots of women experience this!!?
Yes, I'm on a pretty high dose of magnesium glycinate. I take it throughout the day in 3 doses, maybe I should try taking a double dose later in the day instead.
On the plus side, constipation is a thing of the past and I'm pooping very well consistently, with more estrogen ;D (Wish I was a bit less windy, but that's less of a concern than not being able to poop!)
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Try taking the Utrogestan earlier- we are discussing it on the other thread!
I was liking magnesium but then I wasn’t sure where my palpitations were coming from, a new symptom for me at the time, and I was going through a process of elimination. I took out magnesium and lowered my thyroid meds which tests indicated. Then I didn’t feel as bad and no palps the next month. Either my estrogen is optimising, my thyroid was causing it, the magnesium was, or some combination of those. Most likely I think it was related to estrogen & thyroid as it accompanied burping which was a long standing problem well before adding magnesium. Both the burping and palps eased at same time. Thyroid and low oestrogen can cause low stomach acid and that can cause GERD- which is often accompanied by heart palps.
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Hmm, that's very interesting!
How would taking the utrogestan earlier help? Would it not just wear off even sooner and wake me up even earlier?! ;D
And if I should try this, how much earlier should I take it? 8pm??
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It made no difference to when I wake up, just that I wake up easier with more alertness. I don’t know why I thought you had trouble getting to sleep as you say you don’t!! Sorry. But you might like to try going to bed earlier. I see a lot of women saying they wake up at 5/5.30 now, I don’t know why that is? But I also really don’t seem to be able to sleep past 6am but often it’s 5. So now I take Utrogestan earlier and go to sleep early enough to get at least 7 good hours sleep, or 8 if I’m really lucky. Good sleep overall has helped my anxiety too. I switched from 10/11pm at night to by 6pm every night, exactly when depends when I eat, as ut needs to be 1 hour before food or 2 hours after.
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Going to bed earlier helped me initially as getting proper sleep helped the anxiety/palps/heart thudding etc. I blocked all light from my bedroom and I don’t wake before 8am now.
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It’s an interesting idea, if I go to bed earlier and still wake at 4am I’ll get more sleep for sure.
I don’t think I can take the utrogestan any earlier as it has to be 2 hours after food…
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Or an hour before your evening meal ( at least 2 hours after lunch )
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Do you think I should try taking the utrogestan vaginally??
I don't think I want to do that long-term (due to endo deposits being away from the vagina) but if I just did it for a couple of nights and immediately slept much better, it would be useful information and I might need to try a different progesterone.
I was just doing some Facebooking and found a few other people in FB groups who think their palpitations and anxiety during the night are caused by the utrogestan, not estrogen. Which gave me the idea...
Now would be a good time to try it as I'm also on Cerazette, which is suppressing the endo too. (Supposed to switch that for 200mg of utrogestan in 2 weeks time.)
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An update on the palps...
Things have generally been going better although not perfect. Better meaning, it is happening much less often. But not 'never' yet.
Last night was bad again. Woke at 1.30am. My hands felt like rubber gloves someone had blown up and a bit 'pulse-y'. Dozed for a bit, couldn't fall into a deep sleep because I felt like I had the fluttery palps and was pulsing again - presumably with high blood pressure. It really sucks when it happens because I start to get anxious about it in a semi-awake state - which means I can't reason properly and tell myself it's all okay - and just get more anxious. I try not to wake fully because then I will never get back to sleep again.
I'm now at 4wks since the increase to 62.5. But as this still seemed to be happening occasionally even after 7wks at 50, I am not sure it's realistic to wait for it to completely stop before increasing again or I may never increase.
Going to see a new menopause friendly doctor this Friday so will see what she says. Slightly daunted that I have only 20mins to explain about 5hrs worth of things.
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I just thought I'd update this in case it helps anyone who does a search on it later....
Menopause 'friendly' GP turned out to be menopause 'ignorant' GP, so won't be my GP ;D
She wasn't concerned about the heart palpitations unless I also fainted, collapsed, felt breathless or had chest pain. :o
No mention of referral to cardiology. She did get a letter from the A&E doctor, who had advised a referral to cardiology - but she couldn't understand why he was advising that, given my ECG was normal and I didn't have any other worrying symptoms. So she just ignored it. She looked at my 7-day blood pressure record and said it looked totally fine.
I am going to see how things go. In a couple of weeks I will increase estrogen again, but only by moving from 62.5 to 68.75 ;D ;D (which is a 50 patch and three quarters of a 25 patch - I will get the ruler out and measure it in mm !)
Meanwhile things are pretty minimal at the moment. At night, lying in bed to go to sleep, I can hear my heart beating a LITTLE louder/harder than usual but nothing like it used to. I don't feel the pulsing/ throbbing hands very much at all. And I haven't had any palps for about 4-5 nights although I'm not kidding myself they've gone for good, especially if I increase estrogen.
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Update: I am sooooo over waking at 5am on the dot for no apparent reason and feeling jittery and a bit throbb-y/pulse-y.
I am wondering if I should try some gel instead of patches, with the thinking that there would be a reducing of estrogen levels at night if I put gel on in the morning.
Whereas with the patches, perhaps I am just getting a constant high amount all the time and, for some reason, my body doesn't like that at night?? (Maybe naturally our estrogen levels are lower at night and the gel would help mimic that??)
I'm not going to rush to try this yet but am thinking about it. :-\
I had an idea that I could do an experiment - I change my patch on a Friday morning, so I could take the old patch off the night before and have a night with no patch on, and see if I sleep better before putting the new one on in the morning. If that works, then it might suggest that the gel in the morning would help...
ALSO: I don't understand why I am this sensitive to estrogen. I mean, natural levels during the month are all over the place in peaks and troughs and I haven't had any issues with symptoms like this earlier in life when not taking any hormones. Is this estrogen is body identical, why is it affecting me like this?!
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HELP!! I slept so badly 2 nights ago, I was exhausted all day and had to go have a nap late afternoon yesterday (was a rubbish nap as the house was too loud to sleep properly). Couldn't work or keep my eyes open, after months like this.
I then had some good sleep last night from 11.30pm but again woke up at 6am. Feeling throbby and pulse-y and jittery. ARRRRRGGGGGGGG :-\ :-\ :-\ :-\
I seem to get rubbish sleep for a few nights and then am so exhausted that overwhelms me and I finally get some decent sleep - but still wake early between 4.30-6am. Sometimes (if I'm not too throbby or heart isn't beating hard) I can sleep lightly again a bit longer after that.
I just don't really know what to do with this or where to go with it. ??? I am stuck. I need HRT/estrogen. All my peri-symptoms have pretty much gone on it. (This sleep stuff was NOT a peri symptom!!) But on estrogen, this is what I'm dealing with after about 14-16wks. (I really hoped it would settle and go away.)
Doctors don't seem to care, once they have established I'm not having a heart attack and I don't have permanent high blood pressure (leaving aside these episodes of it in the mornings). I don't know if they realise quite how much this is affecting me.
I experienced similar when I was 21 and taking the combined pill for a few months, so I reckon it is my reaction to estrogen. (I don't know why, considering my own body produces this stuff and seems fine with what I produce!!)
I am supposed to be increasing to a 75 patch in 2 weeks time - there's no way I'm doing that, if I'm still having episodes of this right now because it's just going to get worse. So I now think I'm going to stay at 62.5 for the foreseeable. I might even need to come down to 50. But I'll try to do a fingerprick blood test as I am at the moment before making a decision on that.
I spent an hour at 5am this morning trying to google research papers about the rate of absorption from the patch versus the gel, because one idea I had is to try the gel and to use it in the morning - with the hope that it is really wearing low by the time we get to 4-6am and therefore less likely to trigger this. But all the research papers I can find suggest that using the gel provides quite a constant steady supply of estrogen in the blood over 24hrs - so maybe that's not going to help either??? Does anyone know?? . :-\ I know that some women split their gel morning and evening, for stability, so presumably it does wear off some?!
This Thursday night, I'm going to take off my 50 patch (leaving on my little 12.5 bit) and sleep without the 50 on. Because I'm due to change patch Friday morning. If I then have a good night on Thursday night, and sleep past 6am, it suggests lower estrogen levels at night might help and I could try the gel...
But if the gel doesn't reduce the amount of estrogen enough overnight, I can't be taking patches off every night and sticking them on again the next morning, can I?!
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Update: I tried my little experiment last night - I removed the 50 patch around 9pm and kept on the little 12.5 half patch. I spent the night like that.
Well, it wasn't a normal pre-HRT totally perfect sleep night. :( Still a little pulse-y and tingly in hands and feet and still waking at 6am - but some good sleep before that and able to doze after that and no awful palps.
So I'd say that in terms of how I am on HRT, it was a 'good' night - but it wasn't like sleep used to be before HRT either :(
I will repeat the experiment on Monday and Fridays, which are patch change days, a couple more times.
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Oh dear, this is such a hard journey for you. I had a similar thing as I’ve said where I was waking up at around 4, quite panicked. I lowered both estrogen ( had other symptoms of too high ) and my thyroid meds and stopped magnesium ( just to eliminate ) and about a month or so later it stopped. But it’s not scientific so I have no idea what stopped it. Why are hormones so darn difficult! It doesn’t seem right the female body is this complicated. Poor design if you ask me! It seems we are destined to try things out ourselves until we figure it out while trying to manage a normal life at the same time. You have my sympathies Joziel.
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Thanks, yeah it sucks ??? I am investigating a low histamine diet at the moment, but also not sure it really applies to me. I don't have any itchy skin or hives or allergies in terms of skin reactions to things. And in terms of blood pressure, it mentions low blood pressure for histamine intolerance - and I have the opposite problem when I'm having an episode. I do have the palps of course, plus a drippy nose and watery eye and over-production of mucous especially after eating.
I guess it can't hurt to try the diet for a couple of weeks and see if it all stops though. It's just a pain because I like eating so many of the things that are supposed to be high histamine ;D I eat a lot of yoghurt and kefir and it seems I'd have to drop all that! I'm going to need to finish up some of the food I've got here before I can start it, as well as order in a few things.
I might also reduce my estrogen back to 50. The main reason I increased was that my blood estrogen was only 233nmol and I wanted to get a bit higher for bone protection. But I've been googling research and it seems quite mixed about how much you need for that, with some doctors saying a low dose is enough to protect you. Others want higher. Do we know?! Might start a new post.