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[Obobal]

I’m 47 with reasonably regular cycles (sometimes every fortnight sometimes 40 days between - GP says this is regular). I’ve been on HRT for a year and it has given me back much of my life. I’m extremely grateful. I use evorel sequi patches

For the past few months ovulation and the few weeks after it have been hell for my moods. I literally fall out of love with my partner for the 2-3 weeks until my period arrives. My mood is low, I feel like shit and want to leave my whole family behind. As soon as the bleeding starts life is wonderful again. I love everyone again and I’m happy.

Now I don’t know if this is related to my HRT. I always had a bit of PMT pre peri but it was a couple of days feeling emotional and weepy at kittens and puppies, not hating all my loved ones for weeks. I know it’s hormonal and not just my feelings because I can time it to the phase of my body trying to ovulate.

Given the evorel sequi has worked so well until now, is it likely something has changed with HRT? Do I need to adjust dosage? Or do I have to ride this out feeling miserable and begrudging the existence of my family until it goes away itself?

It’s not depression because I can time it and it goes away as soon as I bleed. I will not take SSRIs.

[Hurdity]

Hi Obobal

Sorry to hear about your mood issues - you say your cycles vary from a fortnight to 40 days and that is even with HRT? This sounds like it is your natural cycle breaking through and irregular cycles are a feature of peri-menopause. A clue to where you are in menopause will be what your cycles were doing BEFORE you started HRT?

Feeling rough after ovulation ie second part of the cycle is  very common in many if not most women - due to a combination of oestrogen falling (overall) and the rise and then fall in progesterone. Added to this you have the progestogen of the HRT which is norethisterone in Evorel sequi - which also can cause problems with additional PMS in some women. If your previous pmt was just immediately before your period but now most of the time post ovulation, then it could be the progestogen in Evorel sequi so you could try a different patch eg Femseven sequi or alternatively go for a separate oestrogen ( patch gel or spray) with progestogen.

All the different preparations are listed on the menu here:

https://www.menopausematters.co.uk/treatafter.php

https://www.menopausematters.co.uk/to_progestogens.php

https://www.menopausematters.co.uk/perimeno.php

Hope this helps and you get it sorted soon

If we can help further please ask


Hurdity x

[VanillaLover]

Hiya,

Snap I am also 47 and my periods are very similar to yours even on HRT. Can vary between 16-38 day cycle in consecutive months! They have been like this around three years. I’ve been on HRT almost a year and it’s helped a lot. But it’s not doing anything at all to my cycle! I use Evorel patches and separate utrogestan.

I’ve had a few good months recently but this month has been dreadful. Mood is OK ish but awful hot flushes, nausea, dizziness, night sweats and tiredness breaking through. Also quite irritable! But it is hot and the school holidays and I am a creature of routine ….

I’ve just decided to ride it out for now and see what happens in the next few months. If no improvement may consider trying a higher patch. Because things have been manageable on the 50 patch I’m loathe to change anything really!

I do take an SNRI (have been on SSRI for 15 years but changed as it wasn’t working any more) - which I “chose” as I heard they are good for controlling hot flushes as well as anxiety/depression issues. It has been brilliant with the hot flushes to be fair. Until this month. I just think the fluctuations are too much sometimes.

[VanillaLover]

Jesus I am 46 not 47 ….that’s the old brain fog I can add to the list there!!

[joziel]

I agree that you might want to try changing your HRT to use utrogestan - body identical progesterone - instead of the synthetic progestin in the Sequi patch.

Utrogestan usually has a calming and stabilising effect for most women and it replaces the natural progesterone our bodies would produce each cycle, when ovulating. Synthetic progestins can't do that and can have adverse effects on mood instead...

[Perinowpost]

Obobal I could have written your post myself I was exactly the same at 47. 10 years down the line and those fluctuations have gone. Some good advice there from Hurdity et al. The only issues I have now are withdrawals when I stop progesterone. Synthetic prog like noresthisterone can cause horrible symptoms as mentioned but so too can utrogestan if unfortunately (like me) you’re sensitive to it. In the whole though I feel good for most of the time. Don’t give up your hrt may just need tweaking x

[CLKD]

Sounds like peri-menopause from where I'm sitting.

Keeping a mood/food/symptom diary is useful to take to the GP/Nurse Practitioner to discuss the possibility of HRT.  Let us know how you get on.  Don't be fobbed off with 'you are too young' etc.. 

I was advised by The National Association for Pre-menstrual Syndrome (NAPS) to eat every 3 hours, 24/7.  Stops that sudden burst when the body requires energy.  It is known that fluctuating hormones can cause some women to have intense rages.  It might be worth while thinking about your diet over all, food as well as liquid intake.

[laszla]

Agnus Castus can be highly effective in relieving PMS and PMDD and yes, you absolutely can take it even on HRT, I have it prescribed to me at the Chelsea & Westminster menopause clinic alongside my HRT. I'd recommend trying it to stabilise hormonal mood fluctuations.

[Obobal]

I meant to return to this but life got in the way. Apologies.

So I swapped to oestrogel (2pumps a day) and utrogestan for 14 days and it hasn’t helped my moods at all. My insomnia is worse during the first half of my cycle and my Mood is unbearable in the second half.

GP only offers antidepressants but I don’t want the happy fortnight to be turned into a blunt and flat four weeks which is what antidepressants did to me previously. I’d almost rather live with the meh so I can keep my two weeks of absolute happiness and contentment. I just wish it didn’t have to be like this. Men wouldn’t be left like this.

[VanillaLover]

Is it definitely after ovulation that you start to feel worse? If your cycles are so variable can you still tell when you ovulate?
Or do you mean it’s when you take the utrogestan in the second 14 of the 28 days that you feel worse? I’m just wondering if you are somehow finding yourself intolerant to the utrogestan nowadays? From what you said originally you were ok on the HRT for a bit and then it went wrong?

[sheila99]

I would try 3 pumps. Insomnia is a symptom of low oestrogen. Without the utro which for most people helps sleep it's possible you'd have it all the time. I found the utro phase very much better when my own body didn't add to it).

[Kathleen]

Hello Obobal

Thank you so much for the update. It is always good to hear how people are doing after posting on the forum.

I have mentioned many times that mood changes are ruling my life. They started when I became post meno and have been a factor ever since. I assume they are simply due to low oestrogen but efforts to correct that have led to other problems. If they are a result of fluctuations it can only be from the HRT.

I wanted to say that I support your reluctance to try Anti Depressants. I was given Venlafaxine (also known as Effexor) back in 2013. This was prescribed at the same time as HRT and I have never figured out how much the AD actually helps, if at all. I certainly haven't noticed a blunting of my moods generally but then perhaps I would be even more crackers without them lol. If you did decide to try ADs you have the advantage of experiencing HRT on its own so you could identify any benefits.

I hope things settle for you and I agree that men wouldn't be allowed to suffer like this. There is no justice in the world.

Wishing you well and take care.

K.