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  • HRT for depression and insomnia, side effects, possible alternatives?

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    Old 09-11-2017, 12:55 PM   #1
    sw403
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    HRT for depression and insomnia, side effects, possible alternatives?

    Hello everyone: This is my first time posting and i'll try to keep it brief. I am a 55-yo woman taking Estradiol and Progesterone to treat severe depression and insomnia. They have worked liked magic for me after years, starting with perimenopause, of trying dozens of other treatments.

    However, this year I had a scare when one of my breasts swelled like a giant balloon (yes, only one). I was freaked out but after seeing many doctors I was told that it was not cancer, but likely a side effect of HRT. So, I have reduced my Estradiol by half. Now I am taking .5 estradiol, and 100 mg. Prometrium. However, my depression is back, and my sleep is worse. My breast has gone down in size but not completely back to normal.

    Is anyone aware of anything else that might address hormone-related depression and insomnia? Or anything that would address the breast swelling? Prometrium alone does not help me, I need estrogen. I literally feel like I cannot survive without it and am terrified of having to choose between mental sanity and a continually growing breast. (LOL). Is it possible that another form of estrogen would not create such a reaction? I tried several patches and got no benefit at all, it was like my body did not absorb anything from the patches. My doctor said that happens with some people. Or is it possible that someday my body will adapt and I will no longer have depression?

    Any ideas are extremely welcome and appreciated. I am feeling desperate.
    Thank you!

     
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    Old 09-27-2017, 06:56 AM   #2
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    I'm sorry no one had any suggestions. I can relate to the awful depression! I had an unwarranted hysterectomy and it threw me into a severe depression along with a long list of other problems. Getting enough estrogen in my body lifted the depression.

    If you don't want to take an anti-depressant there are some over-the-counter supplements that are supposed to help depression but of course you'd want to read up on their safety and effectiveness. SAM-e is one and 5-HTP another. I know you aren't supposed to take 5-HTP if you're taking an anti-depressant but not sure about SAM-e.

    You said the estrogen made your breasts bigger. Did it make them denser? It sounds like you're on estradiol tablets. It's possible that the first pass through the liver that you get with oral estrogen is causing the swelling. You could try taking them transbuccally (dissolve between cheek and gum). That may address the swelling as well as give you more estrogen since you aren't losing some of it to liver processing.

    Progesterone dampens the effects of estrogen. To make this lower dose more effective, you could cycle the progesterone and take it for 10 days but then you'd have a bleed from the progesterone withdrawal. You will want to check with your doctor to make sure the 100mg dose would still be adequate to protect your uterus if you want to go this route.

    Best of luck in getting this addressed. I know how awful it is!

     
    Old 09-27-2017, 07:19 AM   #3
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Dear STLouisgal:

    Thank you SO MUCH for this reply! I was getting a little dejected, but this was worth the wait. Anti-depressants don't work for me, and I have too many side effects with those anyway. I am very sensitive to meds. One doctor told me years ago that I am a slow metabolizer. I don't know if that has anything to do with my liver or not. I have tried 5-HTP and L-Tryptophan. Those work wonders for me, but only last about 2 hours. It's too expensive and inefficient. I tried SAME in the past with no luck, but it might be worth a try again since it's been years.

    I already had very dense breasts before the HRT. I don't think they are any more dense, although I do have a lot of fibrocystic tissue.

    I have never heard of "transbuccally" before! I am going to try it. If that doesn't do it, I will ask my MD about cycling. I would be very willing to bleed to have mental sanity.

    Thank you so much! It is wonderful to have options to try.

     
    Old 09-27-2017, 03:32 PM   #4
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    You're welcome. One thing I forgot to mention - It's my understanding that transbuccal delivery is about twice as effective as oral so your current dose of .5mg could give you as much as the old 1mg oral dose once you get the hang of not swallowing too much. But that should tell you if it's the estrogen itself or the metabolites from the oral delivery causing the breast swelling.

    Please post back and let us know what you end up trying and if / how well it works. Hope you can get this settled!

     
    Old 09-27-2017, 08:43 PM   #5
    sw403
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    Talking Re: HRT for depression and insomnia, side effects, possible alternatives?

    That is very good to know! Because I was so eager to get some sleep tonight, that I put an entire pill in between my teeth and gum

    It's like a sugar pill and dissolves really fast. I wonder how long before my one breast will match the other. Time will tell.

    I'll take a half tomorrow night, and I will definitely post the results.

    Thanks again!!! I am so appreciative.

     
    Old 10-01-2017, 08:15 PM   #6
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    If patches were not effective, Iíd consider a gel like Divigel. But have your estradiol levels checked after about a month to see how youíre absorbing. Transdermal is the only way to be sure you bypass any digestion of the estradiol, and some do better with gel than patches and vice versa.

    Iíve never heard of unilateral breast swelling on HRT. Have you had this checked by a breast surgeon/specialist? There are so many different types of antidepressants to try, that itís hard to rule them out unless youíve tried different classes of them. Good luck with all this!

    Last edited by weathergirls; 10-01-2017 at 08:19 PM.

     
    Old 10-01-2017, 10:02 PM   #7
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Dear weathergirls: thanks for the reply! How is it possible that I have never come across Divigel? I have never heard of it, but am happy to know about it. Yes, I have tried many different types of anti-depressants, thanks.

    Yes, the breast swelling was actually very scary. It looked freaky. I went to my PCP, then a radiologist for U/S and mammogram. When a radiologist tells you that she has no idea what is going on with your breast, it is a bit scary, since she is the only one who can see inside it. Then i went to the GYN, who sent me to a breast specialist. No one had any idea what it was, but they ruled out cancer, and said the only thing they could think of was the HRT. Since I halved the dose, the swelling did go way down, but not entirely. So I will try the transbuccal and if I still have it, will ask about the gel.

    Thanks so much! This is very helpful.

     
    Old 10-22-2017, 01:21 PM   #8
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Hello STLouisgal and weathergirls. I have been trying the transbuccal at half-dose for about 3 weeks now. My breast swelling has not reduced any further since I switched to transbuccal - one breast is still larger. Also, my insomnia and depression have just gotten worse.

    Is it possible that something happens in my liver that is required for me to metabolize the estradiol? Could it somehow be related to why I could not get any benefit from the patch?

    On the one hand, I am getting no benefits with the transbuccal delivery. On the other hand, I still have the negative side effect. It seems very confusing.

    I think I need to go back to full dose , transbucally or orally, for a week, and see how I feel. I am having a hard time with daily living and functioning right now. I wonder if there is something here with the progesterone? I heard that progesterone can cause breast enlargement also. I will ask my doctor about cycling the progesterone as STLouisgal had mentioned.

    Thanks for any additional insight!

    Last edited by Administrator; 11-04-2017 at 09:11 AM.

     
    Old 10-25-2017, 09:15 AM   #9
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    I have known a number of women who simply did not do well on HRT. Whether their bodies do not process the hormones well or what it is, I don't know. Many like yourself, say some symptoms are better, some are worse or not improved. If it was me, I would want to try completely without it to see if the breast swelling resolves completely. But I am cautious by nature. That would give you your answer. I hope you figure out what works best for you. I know it's frustrating!

     
    Old 10-25-2017, 01:32 PM   #10
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Thanks you weathergirls! I literally can't live without it. I can't sleep at all, and I can't function due to severe depression. I have an appt with a Reproductive Endocrinology doc tomorrow. I think he mostly does fertility, but I am hoping he has some expertise with this. Thanks again for responding. It means a lot to me.

     
    Old 10-27-2017, 10:24 AM   #11
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Just FYI, I experienced breast swelling on HRT, and very noticeably one breast swelled more than the other. One breast is a D cup, the other an E. It's horrible.

     
    Old 10-27-2017, 10:56 AM   #12
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Sadtosay: I am sorry to hear this, but thank you for sharing. I went to the doctor yesterday. He told me that as long as cancer has been ruled out, that there is no health risk to continue taking the estrogen at my higher dose (1 mg). He gave me a few options to try, so I will pass on to you in case they are helpful: (1) since switching to transbuccal estrogen did not reduce all swelling, try using the prometrium vaginally instead of orally. Vaginal application does not become systemic. So, this will help identify if some of the breast swelling is due to progesterone. (2) switch to a SERM instead of HRT. (3) Breast reduction surgery. The latter sounded ridiculous to me, but he did say that he could argue that insurance should cover it as medically necessary.

    I tried the progesterone vaginally last night and my sleep was crap and I felt sick to my stomach. Not sure if those were related or not. I am going to try again for a few nights and see what happens. He said that hormones applied to the skin will still become systemic and could affect breasts.

    Sorry you are enduring this. I'll let you know if I learn anything else.

     
    Old 10-27-2017, 10:58 AM   #13
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    Sadtosay:

    Are you still taking HRT? If not, did your breasts remain swollen after stopping?

     
    Old 10-27-2017, 11:25 AM   #14
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    I made the decision this morning to stop taking it.

    Originally the progesterone helped me sleep, but that stopped after a year or so. Now I feel there is no point to it at all, and nothing but a constant struggle with my weight, so I am going off it. Getting older is hard enough without hating the way you look.

    Last edited by Administrator; 11-04-2017 at 09:06 AM.

     
    Old 10-27-2017, 11:28 AM   #15
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    Re: HRT for depression and insomnia, side effects, possible alternatives?

    I feel lik HRT is a very mixed bag. Iím planning to stop entirely by end of year. Currently down to the lowest dose patch at 0.025. The risk and worry are not worth it, at least for me personally they arenít. I hope you are able to sort everything out.

    Last edited by weathergirls; 10-27-2017 at 12:53 PM.

     
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