Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Happeechic on June 10, 2025, 10:16:10 AM
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Hi,
I would be grateful for any help at all. I started on one pump of gel and 100mg and then out of nowhere I started experiencing continuous ectopic beats. They are absolutely awful, night and day. I increased the gel to 3 pumps and they got worse and worse. I stopped the gel one morning and they stopped. I was admitted to a hospital and cardiology wise. Everything was fine, but they stopped the HRT. after five days the ectopics came back and I restarted HRT but as I increased the oestrogen again, they got worse and worse to the point of being unbearable. I have taken the dose right down to half a pump of gel, but I am still getting them all the time, but my heart has stopped thudding.
The GP can’t shed any light. I went to see a consultant gynaecologist and she was no help and said she didn’t know what it was. I just don’t know who to see next? A cardiologist? An endocrinologist? A menopause specialist?
I have wondered whether it could be histamine intolerance and have started taking antihistamines although there has been no change. I have the gene mutation MTHFR.
I tried to get an appointment with Tina Peers but I don’t think she is taking on patients and I can’t find anyone else.
I really am desperate and would appreciate any advice. My mood has gone so low with this and because I am on such low HRT but increasing it is making me ill.
Thank you so much
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Here's what Chatgpt has to say:
Based on what you’ve described — ectopic beats worsening with oestrogen (HRT), some improvement when stopped, and ongoing issues despite dose reduction — here’s a breakdown of possible explanations and next steps.
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Key Issues in Your Case
1. Ectopic heartbeats linked to HRT use
2. Symptoms not clearly tied to any structural heart problem
3. Poor guidance from GP and gynaecologist
4. Known MTHFR mutation
5. Trial of antihistamines not helping
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Possible Mechanisms
1. Oestrogen and Cardiac Sensitivity
Oestrogen can affect cardiac ion channels, autonomic tone, and electrolyte balance, sometimes triggering palpitations or ectopic beats in susceptible individuals — especially during dose changes.
2. Histamine and Mast Cell Involvement
Histamine intolerance or mast cell activation syndrome (MCAS) could contribute to palpitations. However, antihistamines not helping suggests histamine may not be the main issue, or that you're not targeting the right pathways (e.g., you may need both H1 and H2 blockers or mast cell stabilisers).
3. MTHFR Mutation
MTHFR mutations may impair methylation, which affects detoxification and hormone metabolism — this could lead to heightened sensitivity to hormone shifts or increased oxidative stress, indirectly impacting your heart rhythm.
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Who You Might See Next
Menopause Specialist with HRT and Complex Case Experience
This should ideally be someone very familiar with nuanced, low-dose or bespoke HRT strategies and systemic effects.
Ask if they consider transdermal vs oral options, or compounded low-dose protocols.
Some specialists are better with sensitive patients and can consider bioidentical HRT, if appropriate.
Cardiologist (Preferably Electrophysiologist)
Since your ectopics are persistent, even though structural heart disease was ruled out:
Get a 24- to 72-hour Holter monitor if not already done.
They can assess if this is a benign arrhythmia or something needing rhythm control support.
Ask if electrolyte imbalance or autonomic dysfunction (POTS, etc.) might be playing a role.
Endocrinologist
They can:
Assess for thyroid dysfunction, adrenal involvement, or other hormone interplay.
Help you understand if MTHFR or other metabolic factors are compounding the response to oestrogen.
Optional:
Functional Medicine Doctor – especially if traditional routes keep failing.
Genomic medicine consultant for MTHFR, detox pathway insights, histamine/methylation interplay.
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What Might Be Worth Testing (If Not Already Done)
Full thyroid panel (TSH, fT4, fT3, antibodies)
Electrolytes (especially potassium, magnesium, calcium)
Vitamin B12, folate, methylmalonic acid (due to MTHFR)
Oestradiol and progesterone levels on HRT
24-hour Holter or event monitor
Plasma histamine / tryptase, DAO levels (if considering MCAS)
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Some Practical Suggestions
Consider switching from gel to patch, or non-oestrogen options if you still need HRT (e.g., low-dose vaginal oestrogen + non-hormonal systemic therapy like SSRIs or clonidine).
Work with a pharmacist trained in menopause/HRT to fine-tune dosing.
Start a symptom diary correlating ectopics, stress, food, HRT use — useful for spotting triggers.
Check if perimenopausal fluctuations (not just HRT) are creating ups and downs, complicating the response.
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Suggested Next Step
Find a menopause specialist who also understands complex cases and can work in a multidisciplinary way. If you're in the UK, consider private specialists like:
Newson Health
Balance Menopause (Dr Louise Newson’s team)
The Hormone Health clinic (Dr Nick Panay or colleagues)
Ask for a combined consult with a cardiologist if possible, or get a separate referral to one with arrhythmia expertise.
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Sounds like the MTHR issue which I believe I also have, where oestrogen isn’t breaking down properly.
Have your tried a whole 28 days break from the HRT? It can take that long to reset any cortisol dis-regulation.
I had it for weeks after dabbling with high dose Utrogestan (which can over stimulate oestrogen receptors) and was terrifying as the high cortisol symptoms and tachycardia seemed stuck on high. Once I gave it the full 4 weeks on nothing, it all stopped like a plug being pulled out on Day 28 (as also advised by ChatGPT!).
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That is so amazing Emma and Dangermouse. I am so grateful for your replies. I, too, have resorted to ChatGPT and I have to say I have had some of the most sensible medical advice!
Thank you Emma for such a thorough reply, I will take a look at all of that.
Dangermouse, I have been tested for MTHFR and definitely have the gene mutation. It was only through chat GPT that I learnt of possible contribution to this problem and the histamine intolerance. Did you go back on HRT after 28 days? I have decided today to stop all HRT – isn’t ideal because I get other symptoms but I can’t go on like this. if you went back on HRT, how did you do that? Slowly I assume and did it work?
Thank you both so much, you have made my day 😍
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What on Earth is ChatGP :-\ ........ Another thread mayB?
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ChatGPT is AI. It allows you to ask it anything and it remembers all of your history so great for complex medical questions.
I do not handle oestrogen at all, even tiny doses. I am now just using about 10mg of progesterone cream rubbed into fatty areas such as thighs, so it drips through and is giving me the best balance I’ve had in years.
I am now thinking that it’s about the low dose that cascades down to all of the sex hormones (where pregnanalone produces progesterone, which then produces oestrogen and testosterone). If I have higher prog, I end up with too much prog and oestrogen circulating.
I did try a thyroid stimulating diet, which is also meant to cascade down, but that didn’t suit me so back on the cream but at low dose it’s finally giving me balance.