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[joziel]

Can I ask for other people's experiences with palpitations and blood pressure on HRT? If you experienced any of this, how long before it settled down or went away when you settled on a HRT dose?

Palpitations were one of my symptoms before starting HRT. It was then (and still now on HRT is) specifically in the evenings and at night.

I'm with a doctor at the Newson Clinic. I started a 25 Estradot patch for 2 weeks, then increased to 50 for 7 weeks. As I still had a few symptoms remaining, and as my estrogen bloods were only 233nmol, as per advice I then increased to 75. That was just 4 days ago. I'm also on Testogel and my FAI on my bloods was 3%, so that's about right and within normal female range. I started the Testogel after 1 week at 50, so that's quite a while now. I'm also on utrogestan 100mg continuous and Cerazette POP to keep endo away. Which seems to be working.

I am feeling fantastic in all ways except this. I am now at approaching 10 weeks on (any kind of) HRT. But clearly I've gone up several doses in that time and also started testosterone. (I'm due my review next week and will talk about all this with the doctor.)

The palpitations have been there, off and on, throughout all this. Sometimes, on the 50 patch, they stopped for a week or two but then came back. I wasn't worried about the palpitations, because I'd read loads online about them being a menopause symptom and related to fluctuating estrogen levels.

What worries me is that, since starting HRT, I'm also getting higher blood pressure in the evenings - my blood pressure is usually around 120/80 and it goes up to 144/79 in the evenings. I feel like my heart is beating harder in my chest. And I can feel a pulsing sometimes when I'm lying in bed, it even feels like the bed is shaking slightly(!) under me. This can make it hard to sleep, as can feeling a bit anxious about it. I wasn't worried about all this until I realised the higher blood pressure thing. I hadn't read that on menopause forums, so it worried me more.

I actually only discovered this was happening because I registered at a new GP practice (hoping to find a menopause-friendly GP there) and the intake doctor took my blood pressure and found it was 144/something. She checked it twice. She thought it was just white-coat syndrome (I am slim and work out 4x a week!) but asked me to do a week of at-home testing twice a day. I'm on day 5 of this (thank god, only 2 more days) and I've discovered that my morning readings are usually good, around 120/80 or under and if I do the 'evening' reading at 5pm, it is still about the same. But if I wait till 7pm or later to do the evening reading, it is then around 135-145/82. (Which then totally freaks me out.) This makes sense because it is also in the evenings that I get all these other sensations - feeling jittery, throbbing/pulsing in my veins and sometimes palpitations. I also sometimes get the 'irregular pulse' icon coming on, on the blood pressure monitor. (I've checked this with my Kardia ECG device that works with my iPhone and it says I have a normal Sinus rhythm, but it fits with the palpitations.    )

I get really anxious about doing the blood pressure test. Just the feeling of the cuff tightening around my arm is enough to make me panic(!) and I start to dread the upcoming blood pressure sesh about 2 hours before(!!!). The suspense over 'what will the result be?' and trying to breathe and relax whilst it is taking it is horrible. And if the result is high, I then panic even more. And obviously anxiety doesn't help with symptoms like these!!

Could some of this be caused by the testosterone? Should I try stopping testosterone for a couple weeks?

LAST QUESTION - does my machine even work properly? Look at these results:
7.45pm 141/78
7.50pm [v anxious about previous result!!] 159/77
8.10pm 133/89 [what?]
8.20pm 145/88

What is that 133 doing in there? Can blood pressure really change that much in 20 minutes or is my machine faulty?! I then have to choose which of these to put on the form for the doctor!?!  I went with the first one here, as it seemed most representative.

I've gone from really being blah and not bothered about these symptoms, to freaking out.

It would really help me to hear some stories of people whose similar symptoms have gone away again. And how long on a stable HRT regime it took, for that to happen....

[ATB]

I’m sorry, palpitations are scary so I understand why you are so anxious. I didn’t have them before HRT, but got them after reducing a dose. I also had general anxiety and bad GERD, and it seemed to all come together. I also had slightly raised thyroid levels at the same time, I’m hypothyroid, so it was confusing to work out what was causing the palpitations. You can get them with GERD, with falling estrogen as you say, with anxiety and with raised thyroid hormones. So I know my thyroid levels are now good because I retested, I’ve been on reduced estrogen almost 3 months and my GERD and burping haven’t happened this month, so no palpitations. I am on my period week so they may show up! But they are at least better because I haven’t had them yet. I think likely that I’m getting used to the lower estrogen as other symptoms have eased also. So like other symptoms, they should resolve as your estrogen optimises. I am also on testosterone but started that 7 months ago so didn’t think that was the issue. I’m at Newson also, I ran this symptom past my doctor there via email and she reassured me and told me to wait another few months from that point to see if I optimise otherwise she would give me a bit more estrogen around my period and just before. She didn’t mention testosterone. You can send your doctor there an email question if you like.
You need BP machines calibrated at your doctors before using.
Hope you feel better soon. Try not to worry, these are not nice symptoms but they should resolve soon.

[VanillaLover]

Hi, to be honest I think your anxiety about your BP can send it sky high! Mine can anyway. If you are feeling  jittery in the evenings anyway and expecting a worrying result then your body anticipates that and BP goes up!

Are you taking BP three times? With a minute between each. And take the lowest reading. That might help a bit. BP is normally higher in the morning so sounds like you are fine but the anxiety around this is blowing your evening reading up a little. Could you have a week off monitoring it just to get out of the habit of getting stressed about it?

[VanillaLover]

And yes you have my sympathy, palpitations are horrible. I suffered terribly until I started HRT, they were the first things to go away thank God.

[VanillaLover]

Sorry just to add (again) that I had an ECG at drs just to check due to palpitations, rhythm etc fine but heart rate at 120! It’s never that high normally (I have a fitness watch thing). That was just lying there. Talk about white coat syndrome!!

[joziel]

ATB - thanks. I've had some thyroid tests run but I'm not totally 'up' on thyroid stuff so my doctor just says they are fine. Although I think sometimes interpreting these things is a bit of an art form...!

Back in October 2021, my TSH was 1.16mU/l  (normal range supposedly 0.5 - 5)

Then, a couple weeks ago, my TSH was 0.95 mU/l. And I also got Free thyroxine 15.5pmol/l (normal range 10-25)

I did ask for T3 and T4 and I think the 'free thyroxine' is another name for T4. I can't see any T3 result. But I just kept being told all that is normal.

Vanillalover, you are right that being anxious about the test can affect the result - but I am now equally anxious about my morning tests because I've got myself in a bit of a tizz with all this - and I don't seem to be getting the same results then. (The 'irregular pulse' icon is coming on but the result seems okay.) So there doesn't seem to be a direct correlation with anxiety.

I just feel like the higher blood pressure is related to everything else (palpitations, heart thudding, beating loudly, feeling trembly, throbbing). I don't know if I should go back down to a 50 patch. I have a review a week today and I'm going to try to stay on the 75 until I speak to the dr but I don't know if I'll be able to. (This was also happening on the 50 but less intensely or frequently.) I'm also reducing the testosterone slightly to every other day or maybe just less of it.

[ATB]

I don’t think this is testosterone. I know how hard it is to stay on a dose when you feel unwell, wanting to change because it’s the only thing you can change. But it makes it harder to determine what’s going on if you don’t stay on one dose for at least 2 months but normally 3. If you want to reduce it before your review I do understand, it’s only a week away. It may not resolve symptoms in a week though.

Yes thyroid tests should include free T3. Yours don’t jump out at me as being something to be too concerned about though just from what I see there, your Thyroxine or T4 would be super high if it was causing palpitations.

Do you try things like meditation and breathing techniques for anxiety? That helps me.

[joziel]

Thanks. Yes, I have various meditation and breathing apps and I try to do them just before my blood pressure and even whilst it's being taken. I haven't noticed that it makes any difference!!

I kinda feel like this high blood pressure evening reading issue is related to everything else going on with me in the evenings/night. I don't think I generally have high blood pressure (as these readings show), it is just getting high in the evenings. I'm going to try testing at 5pm and 8pm, to see if I can confirm this pattern. Then I'll pass that info onto my doctor when I submit these results and write a note about what's going on....

[applejack]

joziel, my bp went bonkers one day - like 170/102 and I completely flipped out, after that, like you, the sight of the cuff sent me into an anxiety spiral. When I spoke to my doctor and said "these levels are like I'm going to have a stroke!" and she said no, really, you're just stressing.

We then discussed anxiety and palpitations (which I was also having) and that's when we put two and two together with my low oestradiol. She actually put me on mirtazapine which might not be right for you, as I wasn't sleeping either.  bp went down straight away, palpitations decreased. It was all stress/anxiety related.

Have you looked at any of the Sanjay Gupta vids on youtube?  He's really good on this topic. Totally reassured me.

[joziel]

Thanks, that's so good to hear. I am now thinking that asking someone who has recently started HRT (and just increased their estrogen) to do a week of blood pressure readings probably wasn't a good idea,    but it was just the intake doctor at this GP practice!! Retrospectively I should probably have said 'hey, let's just wait until I've been on a stable HRT regime for 6 months and then we can retest, please'.

But anyway. Somehow I have stumbled through this hell of a week and tomorrow is the last day and miraculously I also have mostly good readings so I am really looking forwards to just parking all this now. I just have a couple of 135 and 144. And if you average it all out, like it says to, it is totally normal, 120/75.    And I think that's what matters most?!

It all did reach the point whereby I was almost hyperventilating before taking a reading. And talk about overthinking things.... I would tell myself to relax, but then that would make me NOT relax - because why tell yourself to relax if you don't need to?? If you need to tell yourself to relax, you must be.... anxious.... And then the thing is strangling your arm and then you can hear your own pulse throbbing and is it throbbing faster.... is your heart beating faster... are you getting stressed... are you going to get another high reading....1!??!?! 

OMG, it is just the height of ridiculousness. Can they please invent an instantaneous blood pressure monitor which you can't feel every time it works....?!?

And I thought it would be a piece of cake to do this quick test twice a day.....   

[Pippa52]

I really feel your pain and I really feel for you. I get palpitations and a very fast heart rate sometimes up to 135/140 so I know exactly what you mean. It’s so scary hearing your heart pounding away. Like you I absolutely loathe  taking my blood pressure and like you I get anxious which then of course kicks off the tachycardia . It’s such a minefield isn’t it. I’m struggling to get the right dose and type of HRT … I’m sure we will all get there in the end they’re sending love and empathy xxx

[joziel]

Thanks. I had a really good evening and night, last night. No palpitations (well, maybe just a couple of little ones) and I slept soooooo well.

I hope I've turned a corner, although I'm not expecting a sudden transformation in case I don't get one!

[joziel]

Clearly I spoke too soon  I just had another night from hell. I can’t do it anymore, I’m going back down to the 50 patch.

I can’t do any more nights lying awake with a fluttery heart beating weirdly and feeling like I drank 8 Red Bulls.

At 4am I got up and did an ECG with my Kardia device. It said something about sinus rhythm with wide QRS which could be ok and due to benign stuff or high blood pressure or could be something serious. So I paid £9.99 and sent it off in the app for a review with a cardiologist. The ECG quality is rubbish in my Kardia though so I hope they can use it.

My feeling is that it was another high blood pressure episode. Why am I getting these on HRT?! My blood pressure is okay most of the day but in the evenings and at night I get high blood pressure. Accompanied by heart beating hard, fluttery heart or palpitations and it makes me anxious - which doesn’t help - but it doesn’t begin with anxiety. It begins as a physical thing I then get worried about.

I’m reducing back to 50 patch as of today. But it was still happening to a lesser degree at 50.

I don’t want to come off HRT because of its effect on my blood pressure…? If we’re just replacing our own natural lost hormones and if my bloods showed only 233nmol of estrogen at 50 why am I getting these symptoms? I wasn’t before HRT….

[ATB]

I’m sorry you’ve had a bad night, it can be scary.

In your opening post you said palpitations was one of your symptoms before HRT?
In any case, new symptoms of the same things ie falling estrogen could occur only on HRT, although not necessarily because of it.
I’m sure you’ve looked but the NHS page on palpitations is useful:
https://www.nhs.uk/conditions/heart-palpitations/

In our case they are most likely associated with *falling* estrogen. I believe you dropped from 75 to 50? After quick increases? I think this may be why you’re getting worsening palpitations, lots of increases then a decrease. It’s fluctuations and low estrogen that are most likely causing this. It will settle down with a consistent dose most likely. Mine have. I’m not aware that palpitations are a sign of high blood pressure. Usually there are no symptoms of that. Completely understand your panic, but I would take lots of deep breaths and try and remember that palpitations are rarely serious, they’re not typically associated with blood pressure, the most likely cause is hormone fluctuations so you don’t want to make that worse.

[joziel]

Thanks, yes palpitations were one of my peri symptoms before HRT - but only the 'heart dropping a beat' kind. No fluttery heart feelings. No heart beating hard/loud. No lying in bed and feeling my whole body throbbing or pulsing. (It actually feels as if the bed itself is moving sometimes, but it is me.) And when I went to sleep, it didn't wake me up (before HRT) - I didn't get the heart skipping a beat in sleep.

In fact the heart skipping a beat kind of palpitation is happening less, but all this other stuff is happening more.

No, I didn't drop from 75 to 50. I was:

25 - 2 weeks
50 - 7 weeks
75 - managed 1 week(!)

But it was happening even at 50 - part of the reason I tried the increase to 75 was in case it was all low estrogen and thinking that would make it better. But it got worse and happened pretty much every night instead of every few days. My blood estrogen was 233nmol on 50 which was on the low side so I thought that made sense to try an increase.

I don't know if I stayed at 50 for long enough? Perhaps I should have stayed there a whole 12 weeks.

This morning instead of going back to 50, I cut a patch in 4 instead of in half (very technical and a lot of measuring involved there!!) to make 12.5 - and added that to a 50 - and so I'm now at 62.5.   I will at least stay there until Weds when I have this video call with my doctor! If that dose works for me I guess she can prescribe me some 25 patches to cut in half, which would be easier! I look forwards to seeing her reaction when I tell her I'm on 62.5 

The only reason I think high blood pressure is involved is because of the feeling of pulsing against things, it is very weird. And my blood pressure was raised at 144/something at the doctor's last week. I've done readings twice a day since and most of the time they are fine, but then there is the odd 144. And those readings were done at 8pm at the latest, and all this stuff really ramps up later in the evening and overnight. Truth be told, I'm a bit afraid to get my blood pressure thing out in the middle of the night and see what it is. I know no one can help me unless they know what is really going on though.

I suspect I'm having a kind of 'episode' overnight which involves high blood pressure and vasomotor stuff - and that is causing some of these weird heart palpitations. (The one I had last night, sinus rhythm with wide QRS, even said on the info for it that one possible cause is high blood pressure so that makes sense too.) Even now, this morning, I haven't relaxed and can feel my thighs pulsing on the chair for eg. I will call my doctor but of course it is now a holiday weekend