Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: VAR on January 02, 2026, 07:20:49 AM
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Hello, first post here, so apologies if I have done anything wrong !
I'm hoping someone might have some helpful experience.
I've been on HRT for 9 months. I'm only 40, but have a family history of early menopause & osteoporosis so GP & I felt HRT was important.
Pre HRT was having hot flushes, increased migraine, severe mood issues & anxiety + insomnia.
I started on cyclical HRT and was on this for 7 months. It helped the insomnia a lot and the mood issues a bit.
However, the flushes and migraines got worse.
I started continuous utrogestan 2 months ago 200mg utrogestan daily + 100mg evorel patch (felt fine on cyclical utrogestan).
It has really helped my migraines and flushes, but my mood is just awful.
I feel very down, insecure, anxious and extreme rage. It's worse the closer I get to when my period is due. Basically just super-extreme PMS + anxiety.
Do mood symptoms settle on continuous HRT?
I'm wondering whether to try and SSRI since I'm glad the migraines have improved, but I really feel this is just a direct result of hormones so uk not sure it would work. Do SSRIs help for PMS type mood issues?
I was expecting to be concerned about breakthrough bleeding, but this has been OK. The mood symptoms took me by surprise as I didn't notice them to be an issue on sequential.
Many thanks for any replies !
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I wouldn't use an SSRI to treat the side effects of progesterone, I would change the progestogen, there are tons of other options.
If you are really keen on micronised progesterone and currently taking it orally, some people find it more tolerable vaginally. The dose is the same.
However at your age if you don't get aura with your migraines, you may be better with a combined oral contraceptive pill taken continuously.
This shuts down the hormonal rollercoaster instead of exacerbating it, adding back a stable daily dose of estrogen which is typically more generous and age appropriate than menopause hormone therapy, and keeps you bleed free throughout perimenopause which MHT doesn't.
I take Zoely and I love it!
Additionally have you considered androgen replacement as well - anecdotally testosterone helps support mood on progesterone and makes it easier to tolerate.
I take DHEA in addition to my combined pill.
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Has your oestrogen increased when you went on conti? Flushes are an oestrogen deficiency syndrome so unlikely to be affected by the change from sequi to conti. If sequi suited you it might be better to stay with this, I'd be tempted to try a couple of cycles and see if things are better. It's a little unlikely you're meno now rather than peri but even in meno you can continue with sequi if you prefer, they told me there's a slightly higher risk of endometrial cancer this way but for me it was better than the side effects from utro
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Thank you very much for the replies!
I haven't increased the estrogen since starting conti.
Physically I felt much worse on sequential utrogestan. I was having 15 migraines a month, terrible neck and shoulder pain. I'm down to 5 now (normal for me).
But emotionally... I feel terrible now. Massive rage, and I feel so insecure, paranoid, waking early with existential dread. This is all why I started HRT in the first place - similar set of symptoms. It's like I'm back at where I was before I started.
I didn't find utrogestan had a negative effect on my mood sequentially- I actually felt better on it. I've felt worse on every other kind of progesterone historically so i felt this might be best to try and make work.
I'm really interested in Zoley though, this was my alternative if I couldn't get utro to work.
Do you mind if I ask if it has stopped your cycles completely?
I was a bit concerned it might not have enough estrogen in to manage low estrogen symptoms.
My GP made me do blood tests, my estrogen was pretty low before starting HRT. No idea what it is now.
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Yes Zoely and every previous combined pill I have used plus the Nuvaring have completely stopped my cycles and I have been 100% bleed free and hormonally stable since 2009 apart from when I temporarily lost access to my pill during the pandemic which was miserable.
I am on combined hormonal contraception specifically for menstrual suppression no other purpose, and I take the active pills only no placebos or pill free interval, as withdrawal bleeding is not medically necessary and no medication works as well when it is only taken 75% of the time. The Nuvaring I just changed after 4 weeks without a break which also worked fine.
I have been on Zoely for about 5 years now and plan to continue it until my mid 50s then switch directly to MHT.
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VAR, what type of migraines do you have ie are they with or without aura? This would make a difference re the type of HRT regime/progesterone you need to be using.
I'm not surprised you had problems with Utrogestan because so many women do. I suffer with menopause induced silent migraines (aura but no headache) and Utrogestan was probably the worst form of progesterone for me with the exception of norethisterone.
Usually a continuous combined HRT regime is recommended and in the case of migraine with auras a progesterone that suppresses FSH and LH.
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Thank you for the reply.
I have migraine without aura - I've never had an aura.
They're almost purely menstral migraines, so I knew when I started getting them all over the place my hormones had gone out of wack - they're useful from that perspective- I know the second something has changed hormonally because I'm hit by constant unending migraines.
So far, they're much better on continuous HRT. I don't really blame the sequential utrogestan for them getting worse though - they got much worse before I started HRT.
I am surprised that continuous utrogestan has made my mood problems so much worse - If anything, I felt better in the utrogestan phase of sequi. It is in the phase when my period would be due anyway that my mood dips (understatement), along with cramps and other PMS symptoms. It all improved today, but I started spotting on the date my period is due. So I think my own cycle is causing me the issues, the HRT is pretty well stabilised.
It's basically just like standard PMS - but so, so bad.
It's like I'm OK on the utrogestan until either my own progesterone is added on too, or it's the dive in estrogen towards the end of the month maybe? But the estrogen component hasn't changed.
I'm just really scared of changing anything because I know it will instantly cause migraines, and I've already had so much time off work.
I've finally stabilised the migraine, but am also now just a total psychopath!
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Yes Zoely and every previous combined pill I have used plus the Nuvaring have completely stopped my cycles and I have been 100% bleed free and hormonally stable since 2009 apart from when I temporarily lost access to my pill during the pandemic which was miserable.
I am on combined hormonal contraception specifically for menstrual suppression no other purpose, and I take the active pills only no placebos or pill free interval, as withdrawal bleeding is not medically necessary and no medication works as well when it is only taken 75% of the time. The Nuvaring I just changed after 4 weeks without a break which also worked fine.
I have been on Zoely for about 5 years now and plan to continue it until my mid 50s then switch directly to MHT.
Thanks for this - it's really helpful. Have you found any other issues with it like mood etc?
My main concern is that the estrogen in it is quite low. I'm wondering if you can 'top up' with HRT on top of Zoley.
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I wouldn't use an SSRI to treat the side effects of progesterone, I would change the progestogen, there are tons of other options.
If you are really keen on micronised progesterone and currently taking it orally, some people find it more tolerable vaginally. The dose is the same.
However at your age if you don't get aura with your migraines, you may be better with a combined oral contraceptive pill taken continuously.
This shuts down the hormonal rollercoaster instead of exacerbating it, adding back a stable daily dose of estrogen which is typically more generous and age appropriate than menopause hormone therapy, and keeps you bleed free throughout perimenopause which MHT doesn't.
I take Zoely and I love it!
Additionally have you considered androgen replacement as well - anecdotally testosterone helps support mood on progesterone and makes it easier to tolerate.
I take DHEA in addition to my combined pill.
Sorry I just noticed you made 2 other points, I just got distracted by the Zoley suggestion First - testosterone - that's a great idea. I was actually going to ask for it anyway but purely in the hope it might help libido. I was just waiting to try and stabalise the rest before adding something else into the mix, but if it might help with the progesterone symptoms that would be great.
Also - your point on using utro vaginally, I've had a lot of gynae issues with local pain and I'd prefer to avoid using anything locally. I also won't use the merina coil partly for this reason.
Thanks for your great thoughts !
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Zoely is quite a low dose of estrogen, 1.5mg. I have high ovarian reserve and even on a combined pill there is a basal level of estradiol released from healthy ovaries, so I maintain an estradiol level of around 400pmol/L.
Obviously not all of this is from the Zoely, so if you were noticing perimenopausal symptoms to begin with, you may not achieve this level, and I also check yearly to ensure I remain therapeutic.
I personally wouldn't hesitate to add a patch to top up Zoely if needed - obviously this wouldn't be provided on the NHS but some private specialists would be happy to support this.
My mood is much better on Zoely than it is with exposure to endogenous progesterone. It contains a really kind progestin NOMAC that is favoured by those with PMDD and progestogen intolerance.
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Menstral migraines require a consistent and stable dose of oestrogen and progesterone. Avoiding spikes is key and very often a Mirena coil is recommended. Utrogestan is definitely not a stable form of progesterone and it's terrible for mood so I think you will need to find an alternative. Transdermal oestrogen is usually preferred for women who suffer with migraines and you also need to avoid a cycle because of the hormonal instability that goes with that.
I would go with bomb's suggestion and start with trying Zoely. It's oral but I think it's a good starting point and you can probably buy it in a pharmacy without a prescription. I agree topping up with an oestrogen patch is a good idea and of course it means you will have a constant flow of stable oestrogen.
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Zoely is quite a low dose of estrogen, 1.5mg. I have high ovarian reserve and even on a combined pill there is a basal level of estradiol released from healthy ovaries, so I maintain an estradiol level of around 400pmol/L.
Obviously not all of this is from the Zoely, so if you were noticing perimenopausal symptoms to begin with, you may not achieve this level, and I also check yearly to ensure I remain therapeutic.
I personally wouldn't hesitate to add a patch to top up Zoely if needed - obviously this wouldn't be provided on the NHS but some private specialists would be happy to support this.
My mood is much better on Zoely than it is with exposure to endogenous progesterone. It contains a really kind progestin NOMAC that is favoured by those with PMDD and progestogen intolerance.
Thanks, that's really helpful info!
I had a lot of symptoms for a couple of years before starting HRT. Particularly flushes and increased migraine.
Pre-HRT my estradiol level was 210pmo/L. I'm not really sure if that's low for age 40 pre-menopausal ? It was a Gynae who started me on HRT, she said it was 'a bit lower than we'd usually like'.
So you can test levels OK after starting HRT? I wasn't too sure. That might be worth doing.
Is there some sort of comparison between oral and transdermal estrogen? What would be the rough equivalent of 1.5mg in transdermal form?
100mg patch is the only level which stopped the flushes for me. I'm quite anxious about having a big drop as I know it will trigger migraine badly.
Mary G - you are completely right. It is fluctuating estrogen behind my migraines. Progesterone also has a role for me, which is why I am better on continuous, but it's predominantly estrogen dips.
I spent years thinking that couldn't be true because always get a migraine at the end of my period too, but it turns out there is also a dip in estrogen at this time before it rises sharply.
Thank you both for your kind advice, I really appreciate it.