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[GypsyRoseLee]

4 months on HRT and now, for the first time, I am struggling with tiredness and some nausea, especially in the mornings.

The last few nights I have had good sleep but wake up in the morning wanting another 3 hours in bed. I could doze in bed all morning if I let myself. Several times at work last week I could have slept in my chair.

But I am on the oestrogen only stage of my HRT, so can't even blame progesterone. Though it feels like I'm not getting any oestrogen either as my mood has been so low and flat for the last 8 days anyway.

I wonder if I'm having an anovulatory cycle this month (I suspect I've had them before) so aren't producing any of my own oestrogen really and the 50mg from my patch just isn't enough to lift me?

I felt fine during my withdrawal bleed and my mood was starting to improve and my libido was perking up then BOOM is was like someone had switched everything off. Then the tiredness and nausea started too.

Does anyone else get months like this, out of the blue?

[Dancinggirl]

Fluctuating hormones during the peri meno stage make things very difficult. There is nothing one can do about this really - just adjust your HRT as you get deeper into meno.  However, I would caution not to increase hormones too quickly as I found I got more side effects if I was on too high a dose of HRT. DG x

[GypsyRoseLee]

Thanks DG. I agree that all these constant fluctuations make things so much more difficult to control, or even attain any mind of consistency really.

I have been doing a lot of research and reading this weekend and I really feel that at this early stage HRT is just too 'soft' for what I need. Especially with my own hormones very much still in play and fluctuating so much.

I have gone back and read Pixiegirl and Briony's early posts and they were the same age as me with very similar symptoms. They were both told that HRT just isn't strong or sophisticated enough to effectively control such extreme mood swings etc.

I have decided to see my GP this week to discuss going on the Pill, whether that be Qlaria or a standard BCP. I think my own cycle is just out of control and needs shutting down for the time being.

I think HRT is wonderful if perhaps you're further into menopause and your hormonal fluctuations have subsided quite a bit. Also if you're suffering with hot flushes or VA, but neither of those have ever been a problem for me (yet).

For me it is just these extreme mood swings which are so exhausting and stressful.

[Briony]

Tiredness and nausea were my worst symptoms for a long time, pre HRT/pill and were the 'clues' that my problems were hormonal rather than neurological (as initially assumed).  There was no pattern to it and it scared me so much I remember avoiding driving at times in case I was sick in the car or else fell asleep at a red light! I also hated being fatigued at work as I do a job where you need your wits about you at all times - and all colleagues could suggest was an early night or more sugar/chocolate  . I just felt pathetic whenever it happened at work and embarrassed in case I was letting the team down.

I found the sickness sensation confusing as I had assumed higher estrogen would cause nausea rather than lower, but apparently that's not necessarily so.

I did initially still get  fatigue/nausea with Qlaira (sickness is a common side effect with pills) but it has massively reduced and is nothing like it was originally, pre any additional hormonal treatment.

No medication helped when I felt sick, but bread sticks, dry cereal  (especially Fruit and Nut Mini Weetabix!) and flat lemonade worked well (!)...

[BrightLight]

My sympathy - I have had this nausea a few times and also annovulatory cycles that did seem to increase symptoms, or at least the nausea and fatigue.  For me, I am not so sure it is low estrogen, but high.  It doesn't really matter in the end, you want to get rid of the symptoms or at least ride them out.

I am not on HRT and thankfully the symptoms are not lasting, they are moving and mostly daily, albeit subtle at times.  There is a pattern appearing and I guess my body is in a new cycle at the moment, about six months ago, things were swinging about much more wildly - I have to agree that considering the idea that HRT is creating wider swings as your own hormones are still fairly active seems logical.

I don't have any advise about that, except that you have good support from those that have been in exactly your situation and considering the Pill seems a good next step.

Personally I am convinced by anxiety/depressed mood is due to being stressed for the last few years and having a rather tired system.  The adrenal glands do a lot more work in producing hormones around this time and beyond and if they aren't functioning at optimum, it makes sense that mood would be a key symptom in this case.  I am trying so hard to calm my whole system with rest, positive thought, supplements and excercise and for now, things are OK ish.

Wishing you well at the GP's

[GypsyRoseLee]

Thanks Briony. I will follow your advice about snacking. I haven't felt this tired during the day in a very long time. It's just odd that it hasn't happened until now, 4 months into HRT?

[GypsyRoseLee]

Thanks Brightlight. What you say about adrenal glands makes sense. I have certainly been under a lot of stress for the past few years and my diet hasn't been good at all.

Interestingly when I am feeling 'bad' I get constant tingling sensations running from the small of my back down the backs of my thighs. I think your adrenal glands are located just above your kidneys so I wonder if this unpleasant sensation is connected?

I feel that all HRT is doing is just intensifying the good couple of weeks I am getting but isn't really cutting down the length of my bad weeks or lessening how bad I feel. I think my own cycle is just causing too much chaos at the moment?

[Briony]

GRL - I think you are probably still suffering from low estrogen. At our age our bodies need a lot more estrogen than they do at a more 'normal' meno age. It helped me appreciate this when the doctor described it as a 'deficiency'. The fatigue I had, pre and during HRT was horrid - no logic to it and it really 'stopped everything' . The  only way I can describe it is like I had bricks on my eyelids. In fact, initially I thought I was going to collapse -  it took a while to realise it was just crushing fatigue(!)

Recently I have had my first month in a year totally fatigue free , but it has taken nearly six months of the pill to reach this point. In my case, I think it was linked to my progesterone levels combined with low estrogen (progesterone can cause fatigue) .

I suffered from the weird tingling/crawling sensation loads, though for me it was in my upper body/shoulders. Lots of others have mentioned similar things on here. Still get it but it doesn't really bother me any more.  It's a recognised meno symptom, but not knowing this, my former GP insisted on MRIs to look for MS. What a waste ofNHS money! My adrenal function was also tested (cortisol) as I had fatigue and nausea - symptoms of Addisons - but much to my surprise, my cortisol was really high .

Try to hang in there and don't beat yourself for not being able to make logical sense of your various symptoms. Remember - as my 40 something, female doc recently said - with hormones, anything is possible and with peri menopause, the unpredictable becomes quite normal! 

[GypsyRoseLee]

I think you're right Briony I think it's low oestrogen. I am now 10 days into patch only but I still feel very flat and unable to take any pleasure in anything at all. It's really horrible. Bizarrely though my boobs are tender? Yet 2 weeks ago I was on top of the world and feeling great.

[BrightLight]

Really sounds like swings in levels to me, I get the flat feeling and fatigue just after my period and the nausea and 'bloating' just before it. Things are not extreme for me right now but getting to be a little bit annoying that some weeks I feel so different than others.

Good luck with your GP

[Briony]

One of the hardest things in all this is our natural desire to 'make sense' of it - I am the sort of person who likes to find a pattern or trend so that then I can rationalise how I am feeling. Trouble is, with the fluctuations/low levels/whatever, regularity and pattern-finding seems impossible! It's so frustrating as when you're most vulnerable is when your mind starts playing silly games - which makes the yucky emotional symptoms even worse!

When on a low to mid dose of HRT, I used to get symptoms of what I thought were fluctuations - headaches, tiredness, nausea, anxiety  etc -  yet now I am on the pill, taking a higher dose of hormone (which includes four different levels of dosage) - these symptoms have all but gone. I can only assume that I needed my 'baseline' to be boosted. What I had assumed were fluctuations or sudden high levels were in fact still relatively low for what my body wanted.

Interesting what you say about tender boobs, GRL. I think it's a reminder that are situation isnt just about our low/high/fluctuating estrogen levels - the progesterone levels and their relationship with the estrogen are another factor contributing to our delightful hormonal chaos! 

[GypsyRoseLee]

Both my GP and consultant assured me that a patch would raise my 'base line' so that my mood dips wouldn't be as extreme. But I think it must need to be raised much higher still and the extremes are still, well, extreme.

This horrible flatness and total lack of pleasure in anything is just how I used to feel prior to my period starting back before HRT. And this feeling would last right through my period until about day 6 of my cycle.

But now, I am only on day 10 patch only so SHOULD be feeling good.

Seeing GP tomorrow. Fingers crossed.

How much stronger is standard BCPs compared to the 50mg patch I currently use. Does anyone know?

[Briony]

There's lots of debate re the actual difference in strength between a BCP and patch (and a proper comparison is impossible because of the different routes of entry and the fact that not all pills - HRT or BCP - are natural, with conjugated estrogens being more potent, I believe?).

However, this is a post which helped me:

http://www.menopausematters.co.uk/forum/index.php/topic,25243.msg386811.html#msg386811

Most BCPs are around 2-4 mgs;  Qlaira is mainly 2, with two days of 3. To me, it 'feels' more than the 50mcg patch I had - and stops ovulation, which the patch didnt. I could have opted for a higher patch instead, but if I am honest, I thought one pill a day was easier to do than the combined patch and tablets regime I was on previously. I considered Femeston, but liked the fact Qlaira had more combined days whilst still having the b/i estrogen in it.

Blinking mine field, isnt it?!