I've been on .075 climara for about six months now and it has worked very well for my menopausal symptoms, mainly insomnia and panic attacks. IN the last three months, and after an emotional stress, I've found it to be working less well, mainly just not the sex drive and feeling of well being that I had initially. Now after more stress, the 9/11 events, I find that even the panic attacks are threatening at least in the days before my minimal period, and my estradiol was only 23, the lowest yet. I tried adding an extra patch and it really didn't do much, although it did get rid of the terrible itchy skin preperiod thing. Can one become resistant to the estrogen, like insulin resistance? I also have longstanding thyroid problems so it's always difficult to sort out which malfunctioning organ is causing the problem. My endocrinologist doesn't want me to take more estrogen, but isn't 23 toolow? I really, really dread having the panic attacks come back.Does anyone else have difficulty stabilizing on an HRT regimen?Amanda

Typically, what we experience as "not working any more" means that needs have changed and the previous dose is no longer adequate. Stress is a BIG factor in this, since it affects the adrenal glands' inter-conversion of ovarian hormones by using the raw materials to create cortisol, the stress hormone, rather than ovarian hormones.

Are you taking any progesterone? This is the step in the steroid pathway where the two sets of hormones (ovarian and stress) intersect. Many women (especially those in surgical menopause, but it can happen with natural as well) find that if they increase progesterone a bit during stress, that keeps them on an even keel. For me, another 5 mg of progesterone cream makes all the difference.

Since progesterone also tends to counteract the neurostimulation of estrogen and spares estrogen for more estrogen actions as opposed to trying to fulfill progesterone needs as well, looking into whether you might benefit from some/more might be a fruitful avenue of investigation for you right now.

And yes, many women find that their hormone situation is very fluid, some for quite a long time. It all depends on whether your ovaries give up quickly or slowly.  I'm speaking relatively, of course--they don't quit entirely. In fact, ovarian hormone production rarely declines in a smooth curve. Also, every time you change your hrt (and thyroid), things take at least a month and more likely three to fully accomodate.  

I say all the above assuming that you have experienced no adhesion problems with the climara recently. If a patch is not 100% stuck down 100% of the time, you're not receiving a full or consistent dose. It seems that every fall, when women start using more potent (oilier) body lotions, bath products and all, a certain number find they suddenly have trouble with their hormone doses and it turns out their patches are not adhering properly. It's always the first thing to eliminate when having sudden problems.

Good luck in finding the particular solution that's right for your body, and know that you certainly aren't alone in having to tweak things from time to time.