4 mins read

My HRT Journey

Author: Louise Balmforth

September 27, 2023

Female health

Louise holding a hrt patch

After taking Forth’s MyFORM® perimenopause home blood test, which helped confirm I was going through perimenopause, I began to consider my HRT options.

Although I was not having a huge number of symptoms, luckily, I was aware that HRT isn’t all about symptom management. I want to protect my long term health which is why I was considering HRT.

I’d carried out a lot of research as part of my role at Forth in order to create educational content for women just like me. So, I knew a fair amount of information on the types of HRT, as well as their risks and benefits.

I decided that the patches were the right choice for me because they were easy to use and carried a lower risk of blood clots compared to the tablets.

I made an appointment with my GP and said I wanted to go onto HRT patches. As I had my hormone results to hand from Forth, I was able to share this information with my doctor. I was asked questions to assess my suitability for taking HRT and was prescribed Evorel Sequi HRT patches which I started taking in January 2022.

What are Evorel Sequi Patches?

Evorel Sequi is a combined HRT treatment that includes oestrogen and progesterone hormones. It’s a sequential HRT treatment for women who are going through perimenopause and are still having periods.

Evorel Sequi contains x4 Evorel 50 patches and x4 Evorel Conti patches. The Evorel 50 patches contain oestrogen only and are taken in the first two weeks and the Evorel Conti patches contain oestradiol and progestin and are taken in the second two weeks of treatment.

Louise holding a hrt patch

What I experienced on HRT

One thing I hadn’t realised about these patches prior to taking them is the type of progesterone used. Evorel patches use progestin, which is a synthetic chemical that mimics the effects of progesterone on the body. The type of progestin used in Evorel patches is called norethisterone. 

The other type of progesterone used in HRT is body identical progesterone, also known as micronised progesterone – the only brand of micronised progesterone available in the UK is Utrogestan® and comes in tablet form.

Now, both forms of progesterone are regulated and prescribed by the NHS, but I began to notice some changes when I started on the Evorel patches which use synthetic progesterone.

When I started on the HRT patches, my periods became more regular, night sweats became less frequent and the symptom I was suffering from at the time of a drying out of my mouth and nose also went after starting on the HRT patches (yes ladies, things begin to dry up!).

So, that’s the plus side. However, what I also started to notice was a change in mood and an increase in tiredness when I switched to the Evorel Conti patches which contained the synthetic progesterone.

I felt like old PMS symptoms were coming back – lack of energy and irritability. I wasn’t feeling as awake first thing in the morning – just slow and sluggish.

I didn’t think much of it until my GP prescribed Evorel Conti a year later, when my hormone results from doing the Forth Female Hormones blood test showed FSH levels indicative of menopause (although I hadn’t yet reached the 12 month mark of no periods which is the day you officially hit menopause).

A few days after starting the Evorel Conti patches – that contained both oestradiol and synthetic progesterone – my period started, and just didn’t stop. I had a bleed for 11 days! It started very light, then gradually got heavier – this is a known side-effect.

But the biggest symptom I suffered was a change in mood. What I had experienced on Evorel Sequi became more exaggerated – I started to suffer from rage!

I was tired, irritable and had bouts of uncontrollable rage. I was snapping at people for no reason and just felt completely out of control of my own emotions. It was, quite honestly, terrifying.

Working for Forth, I’m lucky to work alongside one of our doctors. I was talking about my experience in the office one day and he asked me what type of HRT I was on. I told him and that’s when he mentioned the type of progesterone in the patches.

Why was I suffering from rage?

That night I went home and Googled ‘norethisterone and mood changes’ and came across a community of women who’d been prescribed this form of progesterone either for menopause symptoms or to stop their periods. What they described perfectly matched my experience of mood changes, irritability, and rage!

Norethisterone is a derivative of testosterone and its chemical structure is very similar.

Chemical structure of norethisterone, testosterone and progesterone

I asked Dr Thom Philips, one of Forth’s doctors, if this could be the reason for my mood changes:

Although many doctors concentrate on the impact of oestrogen for overall symptoms and view progesterone as something that’s there for endometrial protection only, this discounts the lived experience of thousands of women who have felt the mood altering effects of synthetic progesterone. Increasingly there is a body of research that is linking different forms of synthetic progesterone to different symptoms. The type of progesterone in HRT (or contraceptive product) can have profound effects on someone’s mental health. Of course, no two women are the same, so results do vary from person to person but there is clear evidence that the different types of synthetic progesterone have varying effects on mood.[1][2]

Dr Thom Phillips

So, I made the decision to stop the combined patches as it just wasn’t right for me.

What next?

I’ve been off HRT for 5 months and I’m experiencing hot flushes along with other symptoms. My periods have stopped altogether, and I haven’t had one in nearly 5 months.

I’m now looking to go back on HRT not just to manage my symptoms but to also support my long term health. 

I’m going to try oestrogen gel with Utrogestan® micronised progesterone and see how I get on.

It’s a personal journey

While I didn’t get on with the Evorel patches containing synthetic progesterone, many women do – so don’t be put off trying them. 

There are many health benefits from going on HRT – it helps with preventing osteoporosis and cardiovascular disease – so if one type doesn’t work for you, do discuss other options with your GP.

Article references

  1. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry 2016;73:1154-62. 10.1001/jamapsychiatry.2016.2387
  2. Civic D, Scholes D, Ichikawa L, LaCroix AZ, Yoshida CK, Ott SM, et al. Depressive symptoms in users and non-users of depot medroxyprogesterone acetate. Contraception 2000;61:385-90. 10.1016/S0010-7824(00)00122-0

This information has been medically reviewed by Dr Thom Phillips

Thom works in NHS general practice and has a decade of experience working in both male and female elite sport. He has a background in exercise physiology and has published research into fatigue biomarkers.

Dr Thom Phillips

Dr Thom Phillips

Head of clinical services