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[CACEY]

Hi Dancinggirl, thank you so much for informative reply. I was put on this regime by a specialist, as all of my problems started when I came off the depo (over 6 years ago) I have tried numerous HRT, Had the mirena for over 18 months, but the specialist felt that I needed more progesterone, hence the Conti patch, I have been on this new regime for the past couple of weeks, but my body is very sensitive to any changes and whilst I know I need a settling in period, I definetly feel that my symptoms are creeping up again, hence not knowing which hormone is lacking. I have made another appointment with the specialist next week, and will ask him to check bloods, as my last appointment with him, he refused to do them. He did suggest going back on the depo, but I think at my age this would be the wrong thing, as my bone density scan has already come back as
low:(( So frustrating as I would just like some clear guidance, which seems lacking even from the specialist... I had to laugh as he said " I looked healthy and was obviously very good at making an effort to keep fit" I explained that all was not as it appears, as due to feeling so rough I am unable to attend the gym and struggle to walk my two dogs"  Most mornings I wake up feeling like I have the worse case of flu and struggle to push through and maintain a normal life!! Cacey x

[Dancinggirl]

You may need to give things longer to settle - it's probably early days to tell whether this patch is going to work for you or not. Is your specialist a gynae?  I'm not sure why he/she should think you need more progesterone???  It is usually the progesterone that gives the side effects and one usually feels good on the oestrogen only phase in a sequential HRT.  It tends to be Oestrogen that reduces meno symptoms and progesterone is mainly used to prevent the womb lining from building up. I know there are some that believe progesterone is important for symptoms but I'm personally not convinced??? There are many ladies who feel really good on the more bio identical progesterones  - I am using Utrogestan and do feel quite good on it but I'm not sure how I would feel if I used it continuously.
It does sound to me as though you are possibly progesterone intolerant so if you could try the Oestrogel with Utrogestan, if you haven't already tried it, this might be an option worth pursuing.  Try it sequentially first to see how you feel.  Have you considered an SRRI like Citalopram to see if that helps as well?
DG x

[dogdoc]

Hmmmm...if I look back to the original question of whether estrogen sits on top of our regular hormones I would have to say I don't think so. PS Sorry for the massive nerdishness.

Hormones are on a negative feedback loop with the hypothalamus and pituitary. The pituitary secretes pulses of GnRh to which stimulates FSH to be produced. FSH stimulates the production of estrogen from the ovary and the 'ripening' of an egg to be released. A surge in the LH causes ovulation. The 'ruptured egg sac...for lack of a better description' matures and produces progesterone in the second half of our cycle. If you don't ovulate..you don't make progesterone that month. So...if you think about thyroid hormone as a similar negative feedback loop for instance ..it should work the same way.

Thyroid stimulating hormone ( from the brain) stimulates production of thyroid hormone. If you have low thyroid hormone the negative feedback loop causes an increase in TSH because the brain is 'working harder' to produce more thyroid hormone. When you start a hypothyroid patient on thyroid hormone this 'down regulates' TSH...this is how doctors tell if their treatment for hypothyroidism is successful...a drop into the normal range of the TSH.

It should work the same way for gonadal hormones. FSH stimulates production of estrogen. The lower the estrogen the higher the FSH. If you 'add back' estrogen into the system the negative feedback loop will down regulate FSH, which will in turn down regulate our internal production of estrogen. So essentially I don't think we're 'topping up' I think we're taking over our ovaries a little bit. So in theory if you increase your dose of estrogen to a certain level...it should 'turn off' our production of FSH and completely shut down the function of our ovaries..the same as the birth control pill. Being on the pill stops your ovarian function due to this same negative feedback loop.  John Studd uses this same negative feedback loop to treat severe PMS...he puts women on 100ug of transdermal estrogen ....to shut down their cycles, as it's the cycling that causes so many of the symptoms of the peri portion of this trip.

There is a paper (not yet published, but I am awaiting eagerly) on whether 50ug of transdermal estrogen with a Mirena coil will completely shut down ovarian function in this way.

There is decent evidence that our levels of estrogen are ON AVERAGE higher in very early menopause ( meaning sometimes its low too) , followed by an overall absolute drop in our estrogen ( slow decline). Our symptoms are caused both by the changes in hormone levels ( think roller coaster) and the absolute lower level of estrogen. So adding estrogen should both help flatten the roller coaster ( avoiding both the highs and the lows) and also increase our absolute level of estrogen.

Nerd alert.
Tara

[peegeetip]

Very well put Tara (no nerds I can see) . The last paragraph makes a lot of sense in "flattening out" the roller coaster.

 

[Briony]

Hi Tara

Interesting what you say, as I am another one stuck in that roller coaster. Give me Alton Towers any day!

However, both the specialist and my GP said that at 43, the reason HRT was causing  'new' symptoms was because it was topping up my hormones, not controlling them. Therefore I was having, on occasions, excessive highs . As a result, I am now experimenting with Qlaira which is an HRT style low dose  contraceptive pill. It's too early to draw any conclusions yet but, in general, I have more energy and much less anxiety. (On the down side, the progesterone phase seems to be causing my hair to shred - annoying, as when I was on bio identical Utrogestan I always preferred the progesterone phase!).

x

[CLKD]

Casey: was the GP of the opinion that you take pain relief as required for 3 months or 3/4 times daily ………. I know that withdrawal from headache pain relief can mimic the symptoms for which the patient initially took the medication !

If you are getting crashing fatigue then thyroid function test etc. is the way to go perhaps?  No good fighting for hormone blood tests because they are reliably unreliable 

[Sunnydays]

Hi Tara, not at all nerdy - thank you for this information; really interesting to read. I'm reasonably intelligent(!) but when  it comes to science nothing seems to stick! You're saying about the absolute need for estrogen, can you tell me where progesterone comes into all this? Sorry, I need easier explanations  x

[Sunnydays]

Hi, I also wanted to add the following, particularly  to  Cacey's post but it may be relevant to what Tara has said.
I'm just 52 and 2 years no period, so a bit different from you Cacey in that sense. Looking back however, I realise that for the past 6 years or so my body has been showing reactions to changes in hormone levels (fortunately for me not at all as severe as many ladies out there) but I didn't know there were things that could help. I simply thought you carry on with periods, then bam one day they stop and you carry on but no burden of periods. How naive!
ANyway, I due to tiredness levels (not thyroid) I started on Fenseven conti patches. I tried it for 6 weeks and I know many of you ladies out there will, quite rightly, say I didn't give it long enough, but I just felt it was too strong. The nausea, irritability, headaches, strange feelings in my legs persisted. I initially felt an increase in energy levels but that abated. Anxiety increased then one night I had such a skull cracking headache and truly thought I might die, I removed the patch and did not put another one on. That was maybe 3/4 weeks ago. For a couple of weeks, I had all the symptoms that I experienced some while ago, night sweats etc and I wondered, is this because I had higher levels of estrogen in my body, and I'm 'coming down' from it? I felt dreadful and 2 weeks ago went to my GP, crying etc, and I asked to go on the ultra low dose Femaston. I have not taken it yet. Since last Thursday (it's Saturday today) I have felt on top of the world. Is it still the minute bits of estrogen still in my body maybe?
Over the past couple of weeks, I have

eaten small amounts of nuts/seeds in the day (no time to make an HRT cake)
Every other day take menopace (was taking daily)
Metatone tonic every day
A red flesh grapefruit everyday (in the evenings after tea, I love them!)
So, I thought I would give it 6 weeks post Femseven and see how I feel, and at that stage think about taking the Femaston. They are tablet form and I know the indication is that patches/ gel are best but there seems to be  nothing at this dose level out there.
I don't know if this helps anyone and for those with science backgrounds I'd appreciate your thoughts.
All the best.

[Dancinggirl]

Hi Sunnydays and welcome to MM.
Many women find the conti HRt gives problems because of the continuous progesterone.  Femseven patches unfortunately have the synthetic progesterone which many women also have problems with.  Femoston is popular because the progesterone is closer to our own so is kinder.
I think you are right to give yourself a break from HRT to see how you feel - your diet looks great. You have the Femoston to try if you wish but as and when you do try it you may find it takes a bit longer to show benefits because it is such a low dose so you would need to persevere for at least 3 months to see whether it's working. If you are then feeling well on Femoston but want greater relief from symptoms you could go up to the slightly higher dose of Femoston. 
Tablet HRT if absolutely fine at your age - it's when you get to 60 that transdermal is advised.
It is also worth considering  the sequential version - just because you are technically post meno doesn't mean you can't have a withdrawal bleed anymore - many of us choose to stay on a sequi HRT so the progesterone doesn't cause too many problems.  DG x

[dogdoc]

Well I'm a vet and not a human doc.. although I would like to have a good vet as my doctor...we look at the whole animal and try to give them just one diagnosis. Human docs are trained to look at people in packages: gastrointestinal tract, cardio, pulmonary, urogenital etc. I think this is half the reason it takes women so long to get to the 'perimenopause' diagnosis...we have to work our way through individual specialities.

Briony I'm 42 so 'young' as well. Although I think it started in my late thirties the crap really hit the fan when I hit forty. About 6-8 months prior to the onset of the bad stuff I lost about 45lbs rather quickly, and purposefully by giving up grains and sugar. BUT little did I realize at the time, I removed a boat ton of estrogen from my system by doing this ( estrogen was coming from fat tissue- estrone). I think I would have ended up in the same place, but think I drop kicked myself into this by the weight loss. Bummer.
Your doc and GP are right in one sense ...you're 'topping up' your absolute low levels of estrogen..but you're also reducing your own bodies production of estrogen by taking estrogen. It's a weird and complex system.

So some of us have symptoms of roller coaster hormones: headaches, tinnitus, PVC's, etc. These symptoms are often due to hormone fluctuations ( be they high OR low). We also have an absolute deficit of estrogen : think vaginal dryness, low libido, depression, hair loss, collagen breakdown, dry eyes etc.
Most of us have symptoms of both roller coaster hormones, PLUS absolute low levels.

By taking estrogen you are 'topping up' your absolute low levels of estrogen ( meaning your lows should never get too low I think they say most women feel 'optimal' when their lowest estrogen is above 200 or so...different studies, different findings). But because of the negative feedback loop..you are also lowering your bodies own production of estrogen ( if you supply it from outside your body, your body will stop producing as much). So taking estrogen should theoretically both 'flatten' the highs and lows, as well as increasing the overall basal level of estrogen.

Depending on the route you take your estrogen...the daily fluctuations in and of themselves can cause symtpoms. So say you take an oral estrogen...this causes a quick spike in your blood levels of estrogen, followed by a steady decline in your estrogen over the 24 hours until your next pill. In some women this is enough to cause them to get headaches ( or other distressing symptoms) because of the rapid shifts from high to low within the 24 hours. Thats why patches work better for a lot of women...more steady state delivery.

As far as progesterone goes, I think it's very much an individual reaction to all chemicals. Governed by our health, our hormone sensitivity, our body fat composition, our mental health ( although I don't think this plays nearly the role that most docs would have you believe), and our genetics. Some women feel great during their pregnancy when their progesterone levels are through the roof high. Some women feel like garbage all pregnancy long. And yet other women feel like the bottoms fallen out right after delivery when your hormone levels drop through the floor. Some women get baby blues, some women get post partum psychosis. Individual.

[CLKD]

Oh - as an aside we now have a MenoMatters Vet  to add to the MM Choir, MM Cooking group etc..

Thanks dogdoc ………. obvious now 

[Sunnydays]

Yes, just realised dogdoc - vet! Thank you Tara.
Re the spikes in estrogen levels with a pill form, is there any value in breaking it in half and taking half in the morning and half at night - keeps it more even maybe? The problem is Tara, there doesn't seem to be a way of getting a low dose in a non tablet form.

[BrightLight]

Intelligent knowledgable women - I started this post to understand better, I have definately gained insight, although no closer to really seeing how we can 'treat' this up and down in a way that is 100% easeful and positive - so I guess that is an insight in itself

We can do what we can to lessen the ups and downs and trial and error is unavoidable I think - whatever means you use to try and balance things.  So individual and complex .

[dogdoc]

Technically it's supposed to get easier post menopause, because there are no ups and downs. Only a steady low. Then you really are just topping up your hormones. It's the perimenopause that's the roller coaster. I am hoping and praying that at menopause it will become a smoother ride...but I don't really think life is ever that easy.

Sunnydays...there may be some benefit to splitting the dose ( but I'd ask my doctor or Dr. Currie on here before I changed any medications)   If any of you are interested in a very nerdy book there's one called " Screaming to be Heard" by Dr. Vliet. The first chapter I sobbed uncontrollably reading it because she hits the nail on the head so well...millions of women, trying to explain to their doctors what is going on, and NOT being listened to. Most of the book I will concede is pretty dry and there's a lot of pathophysiology in there that I think most people would need a pretty good background in biology to get through.
She has an interesting anecdote about a woman in there who got migraines whenever she went on estrogen. In the end they needed to break her tablet into 4 doses a day ( pain in the butt!!)...but this kept her estrogen dose steady enough.

Not sure what the doses in the UK are for estrogen patches. Here the lowest dose I believe is 14ug, but 25ug are easily obtained...I have been using Estradot. It sticks well and is about the size of my thumbnail.

[Sunnydays]

That's estrogen only isn't it Tara? What do you use for the progesterone bit if you don't mind me asking?