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[Dorothy]

Hi, can anyone advise?

I'm 39, been on the combined pill since 30 to deal with period problems.  On the pill, my periods were like clockwork until I was about 35 - always starting the morning of the 3rd day after my final pill, about the same flow and finishing after 5-6 days.  Since then, they've started fluctuating a bit more - starting between 3th and 6th day, lasting 4-12 days and varying hugely in flow, though gradually lessening over time.  Also been less painful (this has been an issue since I was 13)  Recently, I've been getting a few hot flushes and night sweats, mood swings, broken sleep patterns, itching, dry skin, achy joints, difficulty concentrating...

So I'm wondering if I'm starting early - my Mum did and had to go on HRT at 41 because her symptoms had become so bad.  I've read you can't tell if you've started while you are on the pill, but also that if you start before 40 you may need some HRT to prevent problems.  If I'm on the pill, does this mean I'm ok?  My doctor isn't very helpful and I usually come away from the surgery feeling a bit upset, so I really don't want to go there unless I have to, but I don't want to cause myself health concerns in later life either.

[Dancinggirl]

Hi Dorothy
This sounds like something that needs Dr. Curry's help and advice.  Can you afford to do an email consultation with her - I think it's £25.
The other alternative is to ask for a referral to a menopause clinic or gynaecologist.  I also had a premature meno and so did my mother and grandmother and had HRT from the age of 37 - but I wasn't on the Pill at the time. You need to be more assertive with your GP about your concerns, especially knowing your family history regarding this - perhaps write out everything you want to say and ask and hand it to him/her - I do this and I find it very effective in encouraging them to really address the issue.
Somebody may be along who is more knowledgable about this but I believe even the pill can give some protection should you be experiencing early ovarian failure.
DG x

[Dorothy]

Thanks for your advice - that's a really good idea to write things down, especially as my brain isn't functioning too well!  Also maybe it will help me stay calm - hate going there at the best of times so not a good place to be when my hormones are making me feel upset already 

[dahliagirl]

Hi

I stayed on the pill until 49 and experienced changes in the last 5 years:

Stronger tendancy to oestrogen withdrawal headaches during the week's break, then a feeling of relief when I started taking them again.
More night sweats (I had them for over 10 years though - should have gone to the doctor I suppose  )
Lessening of breast changes - they were sort of flattening out
Dryness and Itching around vulva
periods came later and only lasted 3 days (only one proper day)

I had to change to a progestogen only pill which I took for 12 weeks and had no period.  I then had a period 9 weeks later.  I had hoped it had already stopped.  After that, I had bleeds at least every 3 weeks along with urogenital symptoms and attacks of joint ache for over 18 months and have gone on hrt now, which sort of helps most of the time.

The contraceptive pill is a higher dose of hormones which activates your own feedback systems and stops you producing your own hormones (although I suppose you must begin producing your own oestrogen during the week off when not near menopause).  The only way to know for sure if you are menopausal is to stop taking it and wait and see, but you lose the contraception.

As far as I can work out, staying on the pill should have helped at least with bone density etc like hrt would, even though it is different forms of the hormones.  I have read that you can have extra oestrogen during the week off, or use a pill like qlaira which has similar hormones to hrt.  However, most doctors seem to want to get you off the pill.

For me, the advantages of staying on the pill have been that I presume that I have missed a lot of the 'flooding' that my mother and sister experienced during their 40s, I did not have the mood problems and painful periods I had before I took it, and for those last 4 years I had nice skin for the first and only time in my life!

[Dorothy]

Thanks dahliagirl, that is really helpful.  I'll keep doing some reading around the various options so I am more informed when I see the doctor.  I'm just really worried if I come off the pill I will go back to being like I was before - I had to use nighttime towels and change every hour and was in constant pain.

[dahliagirl]

The option I was given after I had to come off was Mirena with the possibility of using oestrogen if I had menopausal problems. 

If you are happy with it, it does seem a good option as it is the lowest dose of progestogen in the right place.

Like POP, it does not prevent ovulation so may not give the control over periods you may need. It is used for control of heavy periods during perimenopause. My GP said I would not have any periods, but that is worth researching as I think this is only the case in some women.  I gave pop Norgeston a go, because it is the same (levonorgestrel)

http://cks.nice.org.uk/menopause#!prescribinginfosub

http://www.fpa.org.uk/contraception-help/ius-intrauterine-system

[dahliagirl]

Sorry - norgeston uses the same progestogen as in mirena, but it is not the same thing!

[Dorothy]

Thanks for your help - seeing the practice nurse tomorrow so will see how I get on, but at least I feel a bit more informed now!

[Dorothy]

Waste of time going to the surgery - she was only interested in whether I still had bleeds, and as I do, I can keep taking the pill until the menopause and apparently, on the pill, I 'can't' be having any of my symptoms.  Don't you hate it when people say you can't be feeling what you ARE feeling?  Made to feel like a batty hypochondriac who was wasting their time.  Absolutely zero sympathy and understanding.

Think I will start a new career as a best-selling novelist, as obviously I must have an amazing imagination to be 'inventing' all these symptoms!

Moving in a few months, so will leave it until then and hope my new doctor is more helpful.  Meanwhile, will try to eat as healthily as possible and hope for the best. 

[dahliagirl]

Hi - sorry the nurse was not much help.  You probably need a doctor with an interest in this area.

I had to come off because the rules had changed and you couldn't stay on the pill if you have ever had migraine with aura. I had learned to manage my symptoms - drinking plenty of water to prevent the headaches and coping with the night sweats.  Since stopping it, I have had much bigger problems with joints and urogenital symptoms than I ever had whilst on the pill, even with hrt.  So it might be just as well to stay on it.

Take a look at your diet and exercise and lifestyle - it is a good time to give it an overhaul  (see menu to the left).  I have been taking vit D3 and omega 3 and it has helped me.  I also took up dance in my 40s and love it - it has given me so much more than exercise 

[Cassie]

The pill will cover you for now.... I went through early around 37/8 took the pill until I turned 40 then went over onto the gel and Utrogestan for the progesterone side....never looked back, much friendlier option as well. Perhaps hang in there and if your symptoms persist, try to get a script for the gel, it helps a lot.

[Hurdity]

Hi Dorothy

In your position, and as you are so young, if you want to stay on the pill, I would definitely try Qlara as dahliagirl has already suggested because the oestrogen is as good as bio-identical (oestradiol valerate) and is converted to oestrogen in the body, and it only has two pill free days so you will not experience the same drop in your hormone levels as with other combined pills which have a pill free week. Also you will have the health benefits from maintaining your oestrogen levels without having to worry about contraception or whether you have actually reached menopause.

I would have the thought the high dose of oestrogen in Qlara would eliminate your flushes and sweats as it is approx the same dose as high dose tablet HRT (apart from the pill free 2 days).

Otherwise as dahliagirl suggests the Mirena coil will give sufficient progestogen both for contraception and protection of the uterus lining during HRT and you can then use an oestrogen preparation of your choice - eg gel as Cassie suggests - again without worrying about whether or not you are at menopause or not.

Hurdity x

[Briony]

I had to come off because the rules had changed and you couldn't stay on the pill if you have ever had migraine with aura.

Thought you might be interested to know that my GP has suggested I try Qlaira, even though I have migraines with aura (and a family history of strokes). She said that, although she wouldn't prescribe another COP, she would allow this one 'if other possibilities have not worked' (HRT patches with Utrogestan are really helping, but my own hormones are still rearing their crazy heads occasionally  and causing havoc, so I may need something more controlling). 

I am still a bit reticent to swap, mainly because there is so little information on Qlaira (it's expensive, so it's often not suggested). This is all such a gamble, isn't it?    x

[Dorothy]

Thanks for all your advice and help - and support - I felt awful when I came out of the Doctor's, so it is great to be reminded I'm not the only one.

Don't think I can face going back there, but once I move and have a new GP I will ask about Qlaira, though I am worried about making any changes at all in case I go back to how I was before I went onto my current pill.  Problem I am finding is that there is very little information available for women who take the pill for non-contraception reasons.  For example, this morning, she suggested POP, but kept on about how you must take it at the same time each day for reliable contraception.  Every time I pointed out that I am single, contraception is not an issue, but how would it affect my problems, she just went back to talking about contraception.  Surely I can't be the ONLY single female in Britain who is on the pill for medical reasons?  Sometimes, I feel like I am the only one on the planet

[Briony]

If it makes you feel any better, I don't think any of my friends are on the pill for contraceptive reasons - all are taking it for health reasons. I think this is because many doctors don't recognise HRT is still useful for younger women - they automatically prescribe the pill for peri menopausal women.