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[ATB]

Gosh I’m so sorry you are really having a hard time and I totally understand the concerns you have and the feeling you need to change the dose. Although some improvements are expected initially staring HRT and new dosages, you really don’t know until you are on a dose for at least 8-12 weeks what it does for you. My doctor when I sent an email last month about my palpitations told me to go to my GP if I get actual chest pain or tightening. She said she was not concerned about palpitations as they are not usually a sign of anything bad but if they continued until our next appointment, 2 months away at that point, she would discuss adding more estrogen, not reducing, at the times I got the symptoms- when naturally my estrogen lowers. So the issue if it’s related to estrogen is usually falling, or low estrogen. Not the other way. I know that may not make sense to you based on your observations, but fluctuating hormones are also a reason and your own natural cycle is still going up and down underneath what you are adding in. Even though you were only on 75 a week, it’s the effect of going up up up and then down, contributing to this most likely, because although not long it’s still fluctuations. I fear you might be unfortunately getting high BP readings due to your anxiety, not to dismiss your concerns but to hopefully reassure you. Anxiety and panic can cause palpitations and high BP, even if initially caused by something else.  You won’t know if the adjustment you’ve just made is helping for a while anyway and it can affect the assessment your clinician is going to make, although they are very used to this and I’m sure she won’t be surprised or bothered by it. She is there to work with you and help reduce these fears and uncertainty. Do tell us how the appointment goes.

[joziel]

Thanks that's reassuring ATB. I ended up in A&E today  I got back a review of my crap ECG I took at home which said I should send it to my doctor within 24hrs and some stuff about what it had on it which sounded terrifying.

The A&E doctor was very laid back and reassuring and not at all terrified by it. He took my blood pressure and it was 158/89 or something but said I am incredibly stressed so that's understandable. They did an ECG and it was normal. I was glad I went because it calmed me down and helped. Although he did say 'well you might have to come off HRT' and didn't seem to get it as a necessity rather than a kind of vanity product. But... whatever.. Maybe men should lose all their testosterone suddenly at age 40 and then we'll see if their attitude to sex hormones changes....

But still, since I am getting these 'irregular pulse' warnings on my blood pressure monitor, they said next step is to go to my GP and ask for a cardiologist referral and I'll probably have to wear a holter for 48hrs and might have an echocardiogram. Just to see if there is any irregularity to my heart beat.

As I'm on the Cerazette mini pill at the moment, my own ovaries should be pretty dormant and not really contributing much by way of hormones so I shouldn't really have a cycle going on to speak of as it stops ovulation and suppresses estrogen to the early follicular stage (v low).

I think palpitations can just be caused by hormonal fluctuations and changes, whether up or down. Although I don't understand why that happens given that our usual cycles have estrogen going from 100-1000 sometimes without these symptoms pre-menopause.

For me there was a big difference between the low estrogen palps (just a skipped beat which was distracting but that's all) to on HRT palps - ongoing constant heart fluttering literally all evening and night like there is a bird stuck in me, so I can't sleep, whilst feeling blood pulsing around myself. It is just truly weird, especially happening so frequently. It's the blood pressure thing which worries me more than the palpitations TBH. Because I really wasn't anxious when I first noticed that. I just thought it was interesting that the bed appeared to be moving a bit under me and then dismissed it. 

[joziel]

Also I should not be watching the new series of Stranger Things at this time 

[Gnatty]

I just thought I would add that I had the bed moving sensation! It was quite a few weeks back and happened two or three times as I was on the verge of falling asleep. It was most strange, I thought it was maybe a mini earthquake but when I sat up it wasn't anything. I then found I couldn't get to sleep. It resolved once I started splitting my dose of oestrogel and putting some on in the evening. Quite why this sorted it I have no idea. But it does suggest something hormonal was going on!

[joziel]

Oh my goodness, I could hug you.  It is such a relief to find someone else who knows what I'm talking about. And yes, once it happened just after I fell asleep and it woke me up...! I have no idea why this tends to happen at night either. There is so much we don't know about women's health, there is a shed load of research they need to do. It makes some sense that pre-HRT palpitations due to low estrogen happen at night because you could just say it's due to the daily fluctuation of hormones and maybe estrogen is especially low then. But if you're on HRT with a constant supply of estrogen, that doesn't really explain it any longer... There are so many mechanisms at work here which I feel we don't understand yet.

I'm on patches, so theoretically they should be continuously releasing the same amount of estrogen so I shouldn't getting dips or spikes. I wondered if it relates to when I'm changing a patch, and the new patch getting warmed up and working - but I can't see that it happens just on those days or any relationship there. 

[Gnatty]

Did the bed shake thing happen when you increased your patch? I think mine occurred when I switched from green square to orange square oestrogel and I was applying it all in one go in the morning. So maybe it was a surge, I have no idea. Definitely feel more balanced splitting the dose. But yes for you it's harder to explain away with patches. However..... I didn't get on with patches, and did feel quite bad at nighttime on them. But most women seem to get on fine with them. It's so complicated as you say. And it's still early days for you so it could well all settle down.

[Gilla999]

Just wanted to send you some good vibes Joziel as palpitations are awful. I went through a year of having them really badly, with the constant fluttering etc (I used to say it was like having a butterfly stuck in my chest, but bird is a good description too!). I was referred to a cardiologist and they did lots of tests which confirmed the irregular heartbeat but in the end was told it wasn't anything to worry about. With a few years hindsight and a bit more experience I suspect mine was caused by gradual adjustments I was making at the time to my Sertraline (I was on a slow taper) as I got them again later from doing it (and I also get it when I increase the dose however small).

The only other time I've suffered with it was for about 3 weeks this year with (or immediately after) Covid. It reminded me how awful it is.

Also just wanted to say your comment about "men should have all their testosterone removed".... never a truer word spoken!! We have a long way to go before the majority of doctors are educated about HRT. Hope you get to the bottom of it soon x

[ATB]

Apparently the reason it happens at night is because of the compression of the chest cavity and stomach together. It also seems it happens more often lying on the left side because you activate the vagus nerve. This can happen to both men and women. I was just reading a Harvard article on this which I found interesting, all the different reasons. Even dehydration can cause it. Also low blood sugar, low potassium and low magnesium- also found out from too high magnesium too but that’s rare. Hyperthyroidism also- I have the opposite condition but my medication needs have lowered since HRT so I was over medicated for a short time, it may have contributed to my issue.  I’ve watched some YouTube videos from a doctor at York, I think it’s Dr Gupta, which others here mention as well and he goes into this issue quite a lot if you think that may help.

[joziel]

Wow, that's all really useful and interesting. Especially the bit about lying on your left. I think I figured that out myself before I started HRT but I had no idea why it happened lying like that.

I can't remember if the jolting was relating to increasing patch. But I don't think I had any of this on 25 for 2 weeks, it was only when I increased to 50. Then it was happening occasionally, like one night in 3 or something. And when I went up to 75 it was every night and sometimes the mornings as well. I've now gone back down to 62.5 and it's been better the last 3 days.

I am not sure now if I should call my GP and go make an appointment ASAP about all this, or if I shouldn't just see how it goes on the HRT as I get used to it. I don't want to go down the path of lots of scary heart-related tests if it's all going to settle once my hormones stabilise.

But equally I don't want to be walking around with potential irregular pulses and something that needs to be spotted. I could at least make an appointment with the GP and tell her both those perspectives and see what she recommends....?? I guess, if I had the tests done and knew it was nothing that could harm me, I would not get anxious when it happens and then it probably wouldn't escalate into fear and a state which it's really hard to get out of. I just worry that they would get some result which could be nothing, but could also be something and further tests and etc etc.... and that it might be best just to wait a few months before doing the 48hr holter thing.

It has been much better the last few days (since I got reassured by going to A&E!) but I am living in fear of it coming back. It's like I don't trust my body/heart and any time I feel myself getting anxious, I'm like 'breathe... relax...' and 'oh no, is it happening again...?'.

[ATB]

I think if it puts your mind at rest, see your GP and explain you know it’s likely hormonal fluctuations but need professional reassurance.

[joziel]

Ok, thanks.... I just feel like I'm being a bit irresponsible if I don't even tell my GP I was in A&E. Although the nice A&E doctor said he would write to my GP to let her know what had happened. (At the time I was reassured by this but now I'm like - um - what if he was worried, but just didn't want to worry me, but wanted my doctor to know....!!)

[ATB]

I found this a really helpful video by a psychologist, about how to stop over thinking. Might help you with this?

https://youtu.be/tK2LaefZcy8

[joziel]

Thanks, the thing is I know all this (factually and in application to other people  ) it is just so hard to apply to yourself...

[ATB]

Oh it absolutely is. That’s why I like seeing a therapist as she reminds me of all the things I forget for myself and advise to other people! I like the idea of writing down my worries and the resolutions, giving myself a time limit to do that and then moving on. They’re habits you forget for yourself but reminders can nudge us to keep practicing.

[joziel]

I am a therapist 

Anyway(!) had another bad night last night. Woke at 4am with the blood pressure issue/throbbing and the fluttery palps 

My theory is that the high blood pressure episodes I’m having are causing these palps as I read they can be a cause. But why am I getting these episodes of high blood pressure on the estrogen?

I usually am perfect at 120/70, I work out 4x week and I’m slim at 5ft 10 and 9.5stone. I have no history of any blood pressure stuff before starting HRT.

Urgh.