Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Happeechic on May 07, 2025, 11:00:12 PM
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I am new to the forum and I would be really grateful for some help. I started HRT in February – one pump oestrogel and 100mg progesterone. I was getting very low mood and also had been having arrhythmia’s – ventricular tachycardia. I had an MRI, CT scan and echocardiogram in December and everything was normal. The cardiologist didn’t acknowledge that the arrhythmias could be menopause related. I started HRT and everything got so much better.
Just recently – last two weeks – I have been getting horrible at topic beats which are really frequent in the evening and at night especially. Worse when I’m lying on either side, my back or sitting. The GP said these will definitely be menopausal but it feels like my chest is thudding. I am now getting them in the day as well. The GP told me to increase the oestrogel to at least 1.5 pumps - I am very sensitive to oestrogen and get swollen hands and water retention with any increase. I have done this slowly and so far so good. However, there has been only a mild improvement in the palpitations. I am working on going up to 2 pumps. I would really appreciate any advice and also anyone that can tell me that this will get better with increased oestrogen!
Many thanks.
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Hi and welcome to the forum :)
I can say I had a similar experience. Before HRT I also had palpitations as well as missed beats, and my heart rate would go really high on and off, especially at night but it would happen in the day too. My normal heart rate before was around 65/70bpm but it would go up to 120bpm at times. I started HRT (50 and conti patches) and it regulated almost immediately. After 3 months though it started happening again, I had other symptoms come back too so increased to 75 patch and 200mg progesterone (not sure what the equivalent would be with your gel). At first I think my body was reacting to higher oestrogen and I did have fast heart rate for a few days but it’s calmed again and doesn’t happen now. It does sound like you need more oestrogen and you do right increasing slowly if you are sensitive to it. It’s good that you were checked out though and they said all normal, at least you know it’s not a medical issue just this awful peri rollercoaster ::)
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Hi I had similar mine were ectopic or delayed beats and sometimes tachycardia, they improved after adjusting my oestrogen patches (I have a Mirena coil and use estrodot/ Evorelle patches 200mcg)
They did numerous ECGs and an ultrasound and found nothing was just told it was ectopic beats. Luckily there was a cardiologist at the GP surgery and when I asked him if it could be menopause related he said he was unsure but he did see a lot of ladies of that age. He said I could either try meditation or Beta blockers ! I was already doing guided meditation regularly I really made an effort to learn new breathing exercises etc. it helped sometimes but not always as it just sometimes feels like you have no control over them no matter how calm you might be feeling they just come out of the blue. This was maybe 4 years ago.
However I had a flare up of it after a prolonged period of stress after Xmas and because it was becoming more frequent I was fitted with a 24 hour monitor and saw a cardiologist who diagnosed ventricular ectopic beats. I also bought a Kardia ECG monitor on the recommendation of my GP and this managed to catch the ectopic beats happening because the ECG’s being only I think a minute long weren’t managing to record them. Because I’m on quite a high dosage now of oestrogen and my blood levels are I think about 470 I don’t really want to increase the amount of oestrogen I’m taking. I think that this period of stress has just triggered the ectopics again and I’m hoping they will settle down. I also had problems initially and had to very slowly increase my oestrogen patches which I could do in increments of 25 mcg, good luck hope it gets better
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I am so grateful for all of your replies, it really helps. I’m really struggling, they go on all day and night and I can’t sleep. I’ve had them nearly 10 days consistently. How long did it take to go away? Just wanted to know if it would be days or weeks or months!
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Hi Happeechic,
It was days for me before I felt better, not a long time at all. I do notice it occasionally now but I figured that is when my own hormones are fluctuating but it’s nowhere near like it was before HRT. If you manage to achieve that optimal balance of your hormones the symptoms will ease.
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Thank you so much LittleClaire. This forum has helped me so much. I’m just praying for some relief soon
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You’re welcome, fingers crossed your regime helps you soon and you get relief as it’s an unnerving and sometimes scary feeling I know x
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I too have suffered with palpitations, they’re just awful.
I had numerous ecg’s, CT scan, heart monitor etc all clear.
I have found that taking magnesium glycinate has helped to minimise them, I still get the odd one but I’ve seen a great improvement…
Hope this helps.
Ali x
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I had exactly the same before starting HRT, even down to it being more in the evenings and at night when lying on my side. It has completely stopped now and never happens.
1.5 pumps is very very low dose, you probably need to increase estrogen quite a bit. Make sure you are on progesterone as well, because it will help with the water retention....
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Thank you all so much. I have increased the two pumps of oestrogel. I have had two days on that. The pounding has eased off but still getting the ectopics and very regularly. How long do you think it will take to settle down? And do you think I should keep increasing? I’m not sure how many pumps is a reasonable amount to take? so grateful for your help.
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You need to give it a few weeks at each increase (each pump you increase by).
As for a reasonable amount, you need to test preferably around day 3 of your cycle to see how much you are getting from HRT. You want to get your estradiol to at least around 400pmol-ish.
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Thank you so much, Joziel. I feel like I’m going mad because I have palpitations all day and through the night and I’m just desperate for them to stop. I haven’t had a period for six months so no cycle but I’m thinking that I should maybe not split the second pump into two halves and spread because may be it’s not as effective.
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Sorry I meant to say, Joziel, do you regularly get blood levels done? My GP keeps saying it’s not necessary but when they did agree on one occasion they said my oestrogen was terribly low and then agreed to give me HRT (UK)
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Oh gosh Happeechic, you need better care than this.
So if you haven't had a period for 6 months (including on HRT) then you definitely need more estrogen! You are not making enough estrogen yourself to cause the lining of your uterus to build up each month, if you are not bleeding. And if you are only on 1.5 pumps, that is a miniscule dose. The normal *starting* dose is 2 pumps. And even that is too low for the vast majority of women.
The official guidelines from the NHS is that you need to increase first to the maximum licensed dose (4 pumps) if you still have symptoms. If you get to 4 pumps and still have symptoms, then they will (or should) offer you a blood test to check if you are absorbing it okay and what your levels are. Your GP may tell you to also increase your progesterone.
Just for reference point, I am on 6 pumps of gel a day PLUS 300mcg of patches. (3x 100mcg.) Each 100mcg is the equivalent of 4 pumps of gel. So I am on 4.5x the max licensed dose. This gets my serum level to around 850pmol, which is where I need it in order not to have neurological symptoms at night. (The palpitations stopped when I got to around 300, so you may not need as high as me, but I don't want you to be afraid of estrogen.)
If you want to do your own test, at home, you can any time - for about £50. Look up the Randox Health Tasso test. It has to be the Tasso option and not the finger prick because it attaches to your arm so it means you don't get contaminated results (if you use your fingers for a home finger prick test and you have gel, you can get falsely high results). This is assuming you don't apply the gel to your shoulders of course, but only your legs.
If I were you (and if your GP will allow and prescribe more gel) I would gradually increase up to the max licensed dose of 4 pumps without bothering about testing. You might find it a smoother ride to split it with 2 pumps in the morning and 2 at night, for eg.... so you get more regular levels.
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I am beyond grateful, Joziel. I have not been told any of that! Is there any guidance anywhere as to what your oestrogen level should be? I’m so relieved to know that you can take a test and I don’t have to beg my GP for it. I really think that the care around menopause and palpitations is still so poor. Even when I was saying over and over again that I had this adrenaline feeling inside me which precipitated the original palpitations, the cardiologist said it was very unlikely to be menopause. I was 54 (now 55) and still having periods.
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There is guidance for things like osteoporosis prevention, which is that it needs to be at least 270pmol + but benefits increase the higher the dose (ie the bone will be built back up again better and faster).
You have to realise the NHS is far far far too ill equipped to optimise HRT for all women, routinely. They just can't cope with that. They can't cope with the regular blood testing which would be required, with the referral for scans that higher estrogen doses might sometimes mean, or with millions of women needing personalised care because of varying absorption levels for all 3 hormones. So they give everyone a ridiculous generic dosage of low levels of estrogen and heavy handed high levels of progesterone and fight to refuse everyone testosterone so they don't need to deal with that at all. Only women who do their own research and learn what to advocate for, might get more what they need.
Most women need their estrogen to be between 400-650pmol for resolution of symptoms. That comes from Newson Health doctors, the several I've seen now. Some women need even higher and Newson say levels up to 1000 are fine. If you increase estrogen you need to be on a higher dose of progesterone as well. (Well, you might not need that - but you'd need to take it vaginally or rectally and test whilst taking it to see if you are absorbing enough. Otherwise it's just guesswork.)
Cardiologists know almost nothing about menopause, most of the time. Which is ridiculous because it affects the heart so much. This is all the effect of women's health being such a low priority... .
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That’s unbelievably helpful. Would you recommend the Newson clinic? I’m so so grateful to you for answering all of my questions – you have helped me so much.
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Yes, I see Dr Jane Robertson there and find her very good. She's one of their senior doctors and she seems to remember me and keep stuff in mind.
Previously I saw another doctor there who seemed to have no recollection of anything, which was hard to deal with when I'm a bit complicated - I had to re-explain everything from scratch each time.
You need to have one appointment a year to stay registered with them and they will write to your NHS GP and advise them what to prescribe. Most GPs follow this and then you get the meds free on the NHS. (That's what happens for me. Which is good because this high dose of estrogen is expensive!) The only one the NHS won't prescribe usually is testosterone, but that is actually very affordable (it's about £150/year).
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I've had horrible palpations and ectopic beats for about a year. Ecg and 24 hour monitor found nothing other than the ectopics. Adjusting my estrogen didn't help me. They've lessened quite a bit now but I still get them, they are unpleasant but I try not to worry about it. Palpitations is a common topic on here and I found reading old threads reassuring x
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Thank you so much Peach. I’m beside myself. I have had then continuously for nearly 10 days. Increasing my oestrogen does seem to be easing them but now I’ve developed gastric issues and a pain in my back. I have honestly never had so many health issues as I have since peri/ menopause!
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Peach, adjusting your estrogen if you're not absorbing it or if you don't go high enough, won't help. Just saying that in case you've increased one 'click' and found no improvement.