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[Dorothy]

I am on Ovranette for early meno & suffer from crashing fatigue during my break (I can sleep for a solid 24 hours and have even fallen asleep standing up!) as well as increase in other symptoms.  My GP is reluctant to provide a lower continuous dose as I am experiencing a lot of symptoms even when I am taking the pill. 

The last time I saw her, she suggested I think about running 3 packs together, so I only have a break every 9 weeks instead of every 3.  She explained that it is not licenced to be used like this, but as it is often used this way for other issues, she can't see a problem with doing it in my case, as I obviously need a high dose of hormone.  So it is up to me if I want to try this.

Has anyone any experience of this and if so, any positive/negative comments.

[Briony]

I think GypsyRoseLee does this - with her GP's support too. Alternatively, have you considered a BCP with fewer blank days like Seasonale, Yasmine or Qlaira?

Are you sure it's the lack of hormones per se causing the fatigue? I know with me, the fatigue is at its worst when my progesterone is highest. Isnt Ovranette one of those pills which has is very progesterone-dominant in relation to the  estrogen it has? If so, you may need to try switching to a more estrogen dominant pill.

This will explain what I am trying to say more clearly than I have done here! :

 http://www.avongpeducation.co.uk/handouts/2012/youngpersons/The%20pill%20ladder.pdf

Hope it helps, B

[Dancinggirl]

Dorothy - If you have had a premature meno I'm a bit confused as to why you are on a BCP??  Surely you should be on HRT which could contain more natural hormones and might be given at a dose that would probably help more. Have you been under the guidance of a gynae or Menopause clinic?
What symptoms are you struggling with apart from fatigue?   DG x

[Briony]

Dorothy - If you have had a premature meno I'm a bit confused as to why you are on a BCP??  Surely you should be on HRT which could contain more natural hormones and might be given at a dose that would probably help more. Have you been under the guidance of a gynae or Menopause clinic?
What symptoms are you struggling with apart from fatigue?   DG x

DG, I tried HRT but it wasn't strong enough for what my body needed. (highest HRT pill tends to be 2mg estogen whereas that's a low dose for BCP). I  still got symptoms when I took Evorel and Utrogestan. Doctor said this was because I was younger. There are a number of other ladies in a similar boat eg GypsyRoseLee, PoppyFlower, possibly Estelle. The reason I take the BCP Qlaira rather than one of the others is that it is bio identical.  Unfortunately it's an expensive one (though free to patients) so some GPs dont suggest it. I was lucky as both the consultant and the GP recommended it for me.

[CLKD]

Crashing fatigue should be investigated, have you considered a Sleep Clinic?

[Dorothy]

CLKD, I haven't tried a sleep clinic but have had various tests through the GP to rule out other things.  It does seem to be hormone related as I am fine until I come off the pill and am then totally exhausted until I go back on it.

DG, I'm on BCP instead of HRT due to the higher level of hormones needed.  Worst symptoms are hot flushes, joint ache and tiredness.  They are mostly manageable while I am taking the pill but crippling when on my break.  Hot flushes go from being occasional to more or less continuous and it really hurts to move.  I also have an intolerance to caffeine and sugar - again, this goes from zero tolerance through to nearly normal, depending on what my hormones are up to!

Briony, how does Qlaira compare level-wise to other BCPs?  I'm a bit foggy about how the various pills compare, I just know that my symptoms are always much worse when I'm on my break.  My new GP is great and I am sure would be open to me suggesting a new pill as she tends to present me with options and discuss what is best, rather than just telling me.  Downside is she is so good it's a 4-6 week wait to see her!!!

[Dancinggirl]

Dorothy - when using the BCP I believe one doesn't necessarily need to have the break to have the withdrawal bleed as this is artificial anyway. My daughter is on a BCP and was told she could simply take it continually most of the time if she wanted. 

I still don't understand why the BCP is better than proper HRT, if you are so oestrogen deficient, but I assume you have tried all the HRTs - even the higher dose ones? I feel you should be getting some advice from a specialist gynae to really get to grips with what is going on. I assume you have been tested for thyroid function and things like Iron and vitamin D deficiency?

Are you actually post menopausal or are you still peri meno?  Have you tried Oestrogel with a separate progesterone on a sequential basis?  Oestrogel allows you to use quite a high dose of oestrogen daily as it is absorbed better through the skin and you simply use between one and 4 pumps per day.
If your flushes and aches are not under control then might indicate you need more oestrogen and maybe the BCP is simply not giving your body what it needs.  My understanding is that the hormones are very different in BCP to those in HRT.
Do tell us what HRts you have tried.  DG x

[Briony]

DG, The estrogen in BCPs is much stronger/higher than hrt, especially the synthetic forms (Qlaira and Zoely are the two exceptions - they have bio identical estrogen). Therefore on hrt your own hormones are topped up whereas on the bcp, your  own hormones are totally suppressed. GRL's pill diary thread maps out the comparisons really well. In it she explains why she has switched from hrt to a conventional pill.

Have to admit that for years I assumed hrt was stronger and only recently found out I was wrong. Only way you'd get a stringer hrt is if you took something like 2x 100 mcg patches, which the MPs recommends for severe pms.

 Agree with you about taking them back to back. I'm sure I've read it is fine to do this?

Dorothy, Qlaira is at the lower end of the bcp scale. It was designed very much as a bridge from the bcp to hrt and has less potent estrogen as it is bio identical. You take 3mg for 2 days, 22 days with prog and 2 mg estrogen, 2 days 1mg and 2 days of none. This is designed to mimic your own cycle and also reduce MPs type symptoms as it only has two blank days.

Hope this post makes sense. Feeling a bit off today and my head's not with it! X

[Dorothy]

DG, I'm not very knowledgeable on these things myself, but apparently, it is usual to put younger women on BCP instead of HRT - I haven't tried any HRT because my GP said any of the HRT available would be too low dose for someone my age.  So I just use the BCP plus Ovestin cream to deal with vaginal issues. 

I assume I am still peri but have no way of knowing unless I come off the pill.  I started getting my first symptoms at 35 though didn't realise what it was till last year (I am now 40).

My current GP ran all sorts of tests including thyroid, iron etc to rule out anything else - as she said, especially with younger women, she likes to rule out anything else before assuming it is menopause.  She said that blood tests wouldn't be accurate for me regarding that, but based on my symptoms and having ruled out other options, she was ok to diagnose early perimeno. 

Briony, thanks for the info on Qlaira.  If it's lower dose, it sounds like it might not work for me.  I think I will keep going with Ovranette back to back for now and see how I get on.  I manage ok while I'm taking it - ok, so I don't feel the way I used to pre-peri, but I think it's as good as it gets now!  And if I only have to have a break every 3 months, it will make it more manageable.  I'm a bit nervous of swapping pills in case a lower dose makes me feel worse all the time - as I said, my GP is booked up weeks in advance, so if a change of pill goes badly wrong, I've a long time to wait before I can see her again.  (Oh, yes, I could see the other GP instead...the one who ALWAYS has same day appointments available...which tells you all you need to know about that GPs abilities!)     

[Briony]

Dorothy, do look at GypsyRoseLee's thread. I think it could be useful. She takes the same philladypu but it has a different name. I think we're all in the same boat, needing something stronger to control our crazy hormones. When I am older/nearer menopause I hope to  switch to HRT as I feel it is better to be bio identical, but for now my body seems to need something stronger.

[Dorothy]

Briony, thanks for the advice - GypsyRoseLee's topic was really helpful and has decided me to try the BCP back to back for 3 months.  Like you, I will hope to switch to HRT when I am older, but right now I think I definitely need the higher dose.

Also, I must admit I feel more comfortable on BCP as it doesn't make me feel so different - I'm surrounded by friends who are having babies and who view meno as something that happens to 'old women'.  I often feel like I've suddenly been 'moved up' a generation as it is, and I think HRT would make me feel even worse - at least many of my friends are on BCP even if it is for a different reason, so I don't feel quite so much the odd one out!

[peegeetip]

Mentioned the different types of bcp on earlier post.

Yasmin - you need a 7 day tablet free window which is not for everyone and sometime easy to forget
Qlaira - back to back packets so no gaps or forgets also only 2 days of "empty" tablets in the pack.

[GypsyRoseLee]

Hi Dorothy

Really pleased my Pill Diary has helped you.

It's very interesting what you say about your GP saying that younger women need far stronger doses of hormones than women going into their 50s and 60s. A GP I know, on a social basis, confirmed this for me a few days ago. She said that not all women need the same level of hormones, some need far more than 'average' and HRT just isn't anywhere near strong enough for women like that. The GP described taking HRT as 'just a little bit of drip feeding' for a woman like me, in her early to mid 40s who presents with hormonal, extreme mood swings/anxiety/depression etc.

I definitely feel that overall the BCP has been a positive step forward for me. But, as you know having read my diary I do have issues with constant spotting. And that despite taking the packs back to back I had a brief, period type bleed during my 2nd pack and a return of my anxiety/depression/insomnia for 2-3 days.

And now, half way through my 3rd pack the same is happening again. Period like cramps, enough of a bleed to need a panty liner (rather than just when I wipe) and a return of my symptoms. It's been going on since Monday and I've had enough of it now, especially having been feeling so good for the 2.5 - 3 weeks beforehand. Really hoping I improve by the weekend. I can deal with this if it's just going to be for a few days per month, but I'm concerned it's going to spill over into lasting a week or 10 days or even longer. Which would have me back at square one.

But, as you say the BCP lessens the symptoms. Yes, I do feel flat and pretty miserable inside (though putting a brave face on it, or at least trying to) and I feel a nasty ****le of anxiety BUT I have felt much worse in the past.

I'm just so surprised that even on the BCP my body is still able to force out a period/withdrawal bleed, my hormones must be pretty determined and strong?

[Limpy]

When I was using COCP (for contraception) I was advised by issuing pharmacist not to run more than 2 packs together at any one time. I seem to remember the logic for this was running more than 2 packs together would increase the risk of breakthrough bleeding.

[GypsyRoseLee]

Yes, I remember hearing something similar Limpy?

My GP suggested I take the BCP continuously so that I have a constant level of hormones, and he explained there is no physiological need to ever bother with having a withdrawal bleed at all. The only reason the manufacturers of the BCP included the option for a withdrawal bleed was as a reassurance to women that they weren't pregnant each month. But of course it's not actually a period you get at all, it's just a reaction to stopping progesterone.

I can understand that I would perhaps get a breakthrough bleed when running packs together. But I don't understand why I would also get a return of my symptoms at the same time? Or is it just a coincidence?