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[Moomaid]

Hi all,

6 months ago I started on Evorel 50 for flushes, panic attacks and mood swings.

Things improved at first but then because some symptoms returned my dose was increased to 75.

Everything's been fine until the last few weeks, when I've noticed the mood swings returning, particularly at work where I've been getting irritated by the smallest thing.

I had my 3 month review with the GP yesterday who said it was entirely up to me as to whether I tried an increased dose.

However she added that mood swings aren't commonly helped by HRT and an increased dose of even oestrogen only HRT raises the risk of breast cancer, clots and stroke!

So, now I'm confused as not only have my mood swings improved compared to what they used to be before the HRT, everything I've read says that breast cancer, clot and stroke risk is lower with oestrogen only HRT.

I did challenge it when she said it but she was insistent!

I opted to give the 100 a go, at least for 3 months, as I thought 'nothing ventured, nothing gained' but I'm now reflecting and wondering whether I've done the right thing, and part of me does wonder whether maybe I'm just fed up at work and need a holiday???

Any thoughts out there??

Btw... I had a hysterectomy in 2011, including my cervix but leaving my ovaries in tact, and I'm 52 next month.

Thanks

[Mary G]

You definitely don't need to worry!  First of all, it might not feel like it at the moment but you are extremely lucky that you can take oestrogen only HRT and don't have to go anywhere near the dreaded synthetic or micronised progesterone. 

Oestrogen only HRT does not increase breast cancer risk and some experts even think it might reduce risk - have a Google on that one.  All HRT risk lies with the progesterone component and your doctor should know this.  If someone has an oestrogen dependent breast cancer then yes, extra oestrogen might speed things up but it doesn't just come out of thin air, it would have to be lurking there in the first place and said person would very probably get it eventually anyway.  I have never heard anyone say that oestrogen only HRT causes (and can be entirely responsible for) the entire process of oestrogen dependent breast cancer but I stand to be corrected.

I was in exactly the same situation as you when I used patches and I also went up to the 100mcg dose but I'm afraid I still couldn't get enough oestrogen out of them. 

I have since moved to Oestrogel which worked better immediately and I am able to get more oestrogen out of 2 pumps of gel than I ever could from the 100mcg patch.

So I would definitely try the higher patch but if it doesn't work, why not give the gel a go?

I do hope you feel reassured, I think you could really benefit for the right dose of oestrogen.

[Moomaid]

Thanks MaryG, that's really helpful.

With the exception of my mood swings my other symptoms generally seem under control.  It bothered me a bit that the GP said that HRT doesn't have any impact on mood swings but I guess only time will tell.

Mine have most definitely improved since starting so I'm hoping that the increased dose will sort them out once and for all and that I can stop being Mrs Angry at work!! 

[Hurdity]

I think what she means Moomaid is that HRT doesn't generally suppress your own cycle so your own hormones will still be coming into play and cycling up and down. However adding oestrogen will prevent the oestrogen dip during the second part of the cycle which is one part of the mood swings, although if you are still ovulating then your progesterone will still be cycling - so you may still get some pms symptoms due to the rise ( and subsequent fall) in this. However as you have found - your mood swings have lessened!

There is information about risks of HRT on this website: http://www.menopausematters.co.uk/risks.php and more importantly - balancing risks and benefits: http://www.menopausematters.co.uk/balance.php. You will see that age 50-60 the benefits outweigh the risks.

If your mood swings have returned but your flushes and sweats have not,  it may not be an increased dose that you need but could just be your own hormones in the background but it's up to you whether or not you increase.  Because you don't have a bleed then it is impossible to know! I agree with Mary G's point there about oestrogen only HRT not leading to an increase in risk of breast cancer - and in fact there was press publicity about this yesterday!

Hurdity x

[Moomaid]

Thanks Hurdity,

The more I read the more concerned I become about too much oestrogen and whether my irritability could be down to me getting too much rather than too little?

I am quite overweight and ever since my hysterectomy have carried most of my weight around my lower body/below my waistline which is apparently a symptom of high oestrogen levels!

[Michelle46]

Hi Hurdity
If my doctor is not good with Hrt do you suggest someone privately? I'm on 1 and a half pumps of estrogel and utrogestan for 10 days of the month. It's been my trial and error really. I still suffer a tight chest and no sleep !