u/LisaShiro

I'm 44 and started HRT/MHT 6 months ago for perimenopause. Vasomotor symptoms (hot flashes/night sweats) weren't part of my symptoms. About 2 weeks after starting, I began having horrendous hot flashes and night sweats. It was so bad that I almost passed out at a concert. I've seen 4 certified menopause specialists and none of them can figure out what's going on. And also, my estradiol is tanking, despite several increases in dosages. (I won't include my lab results here per community rules)

Jan 2026: .0375 estradiol patch + 100mg oral micronized progesterone
March 2026: .05 estradiol patch + 100mg oral micronized progesterone
May 2026: .075 estradiol patch + 200mg oral micronized progesterone
June 2026: .1 Femring + 200mg oral micronized progesterone

The hot flashes improved slightly when I moved from the .0375 to the .05 patch, but not resolved enough for a material quality of life improvement.

I have endometriosis and also only one ovary. I took norethindrone for 8 weeks several years ago to treat my endometriosis pain and it caused such terrible hot flashes that I had to stop it. I tried oral micronized progesterone shortly after that and tolerated it just fine, though it did nothing to help my endometriosis pain.

I'm open to any and all theories to take to my clinicians to try to figure out why MHT is causing hot flashes for me when it resolves hot flashes for everyone else and why my estradiol is tanking despite being on the highest dosage.

Am I not absorbing the estradiol? Do I have progesterone resistance and that's interfering with proper balance of my hormones? I'm at my wit's end with this!

I'm 44 and started HRT/MHT 6 months ago for perimenopause. Vasomotor symptoms (hot flashes/night sweats) weren't part of my symptoms. About 2 weeks after starting, I began having horrendous hot flashes and night sweats. It was so bad that I almost passed out at a concert. I've seen 4 certified menopause specialists and none of them can figure out what's going on. And also, my estradiol is tanking, despite several increases in dosages. (I won't include my lab results here per community rules)

Jan 2026: .0375 estradiol patch + 100mg oral micronized progesterone
March 2026: .05 estradiol patch + 100mg oral micronized progesterone
May 2026: .075 estradiol patch + 200mg oral micronized progesterone
June 2026: .1 Femring + 200mg oral micronized progesterone

The hot flashes improved slightly when I moved from the .0375 to the .05 patch, but not resolved enough for a material quality of life improvement.

I have endometriosis and also only one ovary. I took norethindrone for 8 weeks several years ago to treat my endometriosis pain and it caused such terrible hot flashes that I had to stop it. I tried oral micronized progesterone shortly after that and tolerated it just fine, though it did nothing to help my endometriosis pain.

I'm open to any and all theories to take to my clinicians to try to figure out why MHT is causing hot flashes for me when it resolves hot flashes for everyone else and why my estradiol is tanking despite being on the highest dosage.

Am I not absorbing the estradiol? Do I have progesterone resistance and that's interfering with proper balance of my hormones? I'm at my wit's end with this!

I'm 44 and started HRT/MHT 6 months ago for perimenopause. Vasomotor symptoms (hot flashes/night sweats) weren't part of my symptoms. About 2 weeks after starting, I began having horrendous hot flashes and night sweats. It was so bad that I almost passed out at a concert. I've seen 4 certified menopause specialists and none of them can figure out what's going on. And also, my estradiol is tanking, despite several increases in dosages. As of July 2025 it was 136pg/mL. I know that MHT is treated based on symptoms rather than labs, but we ran my labs to check if there were absorption issues with the delivery method.

Jan 2026: .0375 estradiol patch + 100mg oral micronized progesterone
March 2026: Estradiol labs 76pg/mL
March 2026: .05 estradiol patch + 100mg oral micronized progesterone
April 2026: Estradiol labs 37pg/mL
May 2026: .075 estradiol patch + 200mg oral micronized progesterone
May 2026: Estradiol labs 40pg/mL
June 2026: .1 Femring + 200mg oral micronized progesterone
June 2026: Estradiol labs 18pg/mL (post menopausal range)

The hot flashes improved slightly when I moved from the .0375 to the .05 patch, but not resolved enough for a material quality of life improvement.

I have endometriosis and also only one ovary. I took norethindrone for 8 weeks several years ago to treat my endometriosis pain and it caused such terrible hot flashes that I had to stop it. I tried oral micronized progesterone shortly after that and tolerated it just fine, though it did nothing to help my endometriosis pain.

I'm open to any and all theories to take to my clinicians to try to figure out why MHT is causing hot flashes for me when it resolves hot flashes for everyone else and why my estradiol is tanking despite being on the highest dosage.

Am I not absorbing the estradiol? Do I have progesterone resistance and that's interfering with proper balance of my hormones? I'm at my wit's end with this!