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[GypsyRoseLee]

Hello

Still very painful to type but wanted to ask a quick question (but sorry if I don't respond much because of painful typing).

But I have been applying 3mg of sandrena gel every morning between 8-9am. Mornings I feel okay mood wise but by lunchtime I feel the anxiety and agitation really riding and then peaking mid afternoon. Honestly I feel like I'm about to burst into a million pieces or need to scream.into a pillow.

Then they start to fade away around tea time and evenings I feel generally fine and calm again and cannot recognise the hysterical harpy I was just a couple of hours earlier.

Could it be that too much gel is hitting my system after 3-4 hours after applying and causing this rush of intensity?

Also a couple of days ago I started on 10mg of Citalopram on my GPs advice (Dr Annie was open to the idea too) to try and help even out these mood swings. But this afternoon black spot started well before starting the Citalopram.

Any input please? And I promise to reply much more when hand is healed.

[GypsyRoseLee]

Sorry. I apply 3 x sachets of sandrena gel each morning, but I think that is 3mg?

Dr Annie wobbled between suggesting 2 or 3 sachets but decided on 3 in the end. And I just wonder if it's just too much at once, or too much at all.

But physical ly I am not reacting to extra oestrogen, no headaches or breast tenderness or bloating.

[Dancinggirl]

Try splitting your doses - so do two at night and one in the morning?!! Maybe try one in the morning and one at night fro a week to see who you feel.  I do find too much oestrogen can make me feel agitated. Also do look at what you eat and when.  Sometimes blood sugar levels can have a big effect on mood and energy.  DG x

[Hurdity]

Hi GypsyRoseLee

Sorry to hear you are still feeling weird even on your new regime.

Just to confirm if you have the higher concentration of Sandrena ie the 1.0 mg gel then 3 sachets is 3 mg as you say, which is equivalent to 4 pumps estrogel.

Do you apply it to the same area of skin each time or different? You may well experience the peak serum concentration several hours after applying the gel? Have you thought of applying it at night - but of course you then have to be careful re transfer to partner?

Sorry I can't be any more helpful but hoping your finger gets better and also that you acclimatise to your new gel regime without feeling any agitation so that you feel better overall.

Hurdity x

[GypsyRoseLee]

Yes just checked and each sachet contains 1mg. I thinkaybe too much? She told me to apply to top of each thigh every morning. 1.5 sachets on each thigh.

Don't know anyone else on this much sandrena or 4 pumps of oestrogel?

[Hurdity]

According to the paper I have on absorption etc of different types of HRT, if you apply to the same area of skin you don't get so much fluctuation as the estradiol builds up in the skin to a certain extent and there is constant diffusion into the bloodstream through the skin layers. It's a paper by Kuhl 2005 in Climacteric - pharmacology of estrogens and progestogens..

I think Chi Chi was using 3 sachets Sandrena.

Hurdity x

[dangermouse]

In terms of daytime fluctuations, this is because when you have hormonal anxiety it is in the form of higher physical adrenaline that is more noticeable when our normal adrenaline is at its highest, in line with circadian rhythms. So 5am is when we tend to get first adrenaline surge (hence the early waking) and then this gradually climbs throughout the day, peaking at 5.15pm and coming down at around 8-9pm. So it's best to factor this into when you take your meds if short acting.

I've had to go on the pill (Loestrin 20) to lower the mid-peri oestrogen surges which were causing extreme nausea but I've still been getting the anxiety at these peak times so have been using natural progesterone at 5/6am and 2pm which is working. I find it works better with the pill than without as either too weak or it jumps onto oestrogen receptors when the levels fall as part of the surging (going by theory that hormones convert to where it appears to be most needed at the time). By keeping oestrogen more stable with the pill the progesterone appears to be going where it's meant to. Might just be me though!

Remember also that oestrogen is our uplifting hormone but can cause too much stimulation with oestrogen surges and progesterone is our relaxing hormone that can cause depression if too strong. I also wonder if synthetic progesterone causes anxiety because it is lowering our natural progesterone and may also explain why estradiol helps anxiety by lowering the synthetic progesterone as scientifically it should be making us hyper!

Btw, low dose beta blockers can be very effective for the adrenaline surges and you can just take as and when needed. They have no side effects and don't lower BP significantly if stick to about 10mg of Propanolol.

[GypsyRoseLee]

That's very interesting about adrenaline surges. I always wake now around 5am feeling panicky and anxious. Mid morning until lunch I'm usually alright but then feel the anxiety/adrenaline starting to surge and build during afternoon usually at its worst late afternoon. I tend to feel much better and calmer after about 8pm and just want to stay feeling like that and dread it all starting the next morning.

I'm a textbook example.

[dangermouse]

Yes we are not only a slave to our hormones but also to our circadian rhythms! This chart shows the most stressful/alert times of the day with highest collection of dots. They match me perfectly too.

http://super-memory.com/articles/sleep_files/images/c/c9/Circadian.gif

[Mary G]

GRL, I would definitely try splitting the dose, it might help to even out your levels. 

By the way, did Dr. Evans say why she favoured Sandrena over Oestrogel?

[GypsyRoseLee]

Must more concentrated apparently?

[Mary G]

That makes sense and perhaps Dr. Evans thinks that is the best route for you to take.  Early days yet so hopefully things will settle down. 

[Chi chi]

According to the paper I have on absorption etc of different types of HRT, if you apply to the same area of skin you don't get so much fluctuation as the estradiol builds up in the skin to a certain extent and there is constant diffusion into the bloodstream through the skin layers. It's a paper by Kuhl 2005 in Climacteric - pharmacology of estrogens and progestogens..

I think Chi Chi was using 3 sachets Sandrena.

Hurdity x

Yes I was on 4 pumps, then when I saw Annie she prescribed the sachets of Sandrena, can't remember if it was 3 or 4? Anyway at some point I went to 4 thinking it was the same as 4 pumps, it's not so in effect I was having more than 4 pumps. I started to get painful boobs and thought this was the culprit? But then I was running out of the sachets and had decided that I prefer the pump application so got a repeat script which was difficult as prof studd was out of the country. I had to spread out the sachets as best I could which meant that for 2 days I wasn't on the 3. That was 17 days ago and I've been bleeding ever since 

[GypsyRoseLee]

How do you feel on the 4 pumps Chichi? Or the 3 sachets?

[Chi chi]

I've been on 4 pumps pretty much ever since starting HRT, nearly 2 yrs now. If I'm honest I'm not even sure what has improved apart from my libido which I presume is down to the testim. I've tried lowering the amount of oestrogel to 2 and 3 pumps but there doesn't seem to be no real difference ( for me) so I just stick with the 4  still got pretty much all the same symptoms as when I first saw Studd, low moods with no real explanation, aches and pains which have got worse as they're now in my joints too, daily headaches, constantly needing to wee, and my sleep seems to go through stages of being ok to awful  at the moment I'm falling asleep pretty well but having weird vivid dreams and waking feeling like I've not slept 

Hope things are improving for you, hopefully Annie's regime will help x