When HRT Makes You Feel Worse: Understanding Oestrogen Surges in Perimenopause

Perimenopause can feel chaotic, especially when it comes to hormones. This phase involves more than just a gradual decline in oestrogen. Instead, it includes wild hormonal swings. Oestrogen levels can spike unexpectedly, while progesterone quietly exits stage left.

It's understandable that some women may feel worse after starting HRT. This is particularly true when they are prescribed oestrogen-only treatment without the necessary support of progesterone.

The Real Hormone Picture in Perimenopause

Perimenopause differs significantly from menopause. During menopause, hormone levels are low and relatively steady. In contrast, perimenopause is characterized by:

• Unpredictable surges in oestrogen: Levels can temporarily increase by 2–3 times higher than normal.

• Low or absent progesterone: This occurs due to fewer ovulations as we age.

• Disrupted hormone rhythm: This disruption can affect your mood, energy, sleep, and menstrual cycles.

  
  

These changes often lead to a condition called relative oestrogen dominance. This doesn't mean oestrogen is always too high; rather, progesterone is too low to create balance.

The Problem with "One-Size-Fits-All" HRT

Many women receive standard HRT prescriptions that fail to consider their unique hormone levels or stage in their cycle. It’s common to overlook vital aspects, such as:

• Progesterone: Often neglected unless you have a uterus, it is essential for regulating mood, promoting sleep, and calming the nervous system.

• Dosing strategy: Oestrogen doses are typically started too high or given alone, which can worsen the hormonal imbalance during a high-oestrogen phase.

• Timing: HRT designed for menopause is often administered during perimenopause without adjustments for its dynamic hormone patterns.

  
  

As a result, providing oestrogen without sufficient progesterone support can exacerbate anxiety, breast tenderness, insomnia, and heavy periods. These symptoms are frequently misattributed simply to perimenopause.

What Should HRT Look Like in Perimenopause?

In perimenopause, HRT should aim for more than just hormone replacement. It should work to create balance among hormones. A personalized approach may include:

• Micronised progesterone (body-identical): Taken cyclically to support sleep, reduce heavy bleeding, and alleviate anxiety.

• Low-dose transdermal oestradiol: Only if necessary, and introduced carefully to avoid worsening existing surges.

• Monitoring and adjusting: Tailored based on symptoms and stage, rather than just age or assumptions.

  
  

As the insightful Tanya Borowski expresses, “We’re not topping up a tank. We’re calming a storm.”

Natural Ways to Support Hormone Balance

HRT is undoubtedly a powerful tool, but it’s only part of the equation. Your body also thrives on:

• Magnesium and B6: These nutrients nourish the nervous system and support GABA, which is essential for calming brain chemistry.

• Stabilised blood sugar: Managing blood sugar levels is crucial, as spikes can increase cortisol, leading to worsened oestrogen dominance.

• Cruciferous vegetables and fiber: They aid your liver and gut in breaking down and eliminating excess oestrogen.

• Mindful movement and rest: These practices help regulate the HPA axis and reduce hormonal chaos.

  
  

Seeking Support for Worsening Symptoms?

If you're experiencing worsening symptoms while on HRT, you're not alone. It doesn’t necessarily mean HRT is unsuitable for you. It may indicate that the type, dose, or timing needs to be adjusted. Remember, navigating hormones is more of an art than a science!

📋 If you're struggling with your symptoms on HRT or are unsure whether it’s appropriate for your current stage, I can assist you.

Book your Wellness Review today.